{"ID":78184,"post_author":"9208550","post_date":"2018-12-17 16:46:25","post_date_gmt":"0000-00-00 00:00:00","post_content":"","post_title":"Introduction to Medical Devices: Volume 1","post_excerpt":"","post_status":"draft","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"","to_ping":"","pinged":"","post_modified":"2018-12-17 16:46:25","post_modified_gmt":"2018-12-17 21:46:25","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.limsforum.com\/?post_type=ebook&p=78184","menu_order":0,"post_type":"ebook","post_mime_type":"","comment_count":"0","filter":"","_ebook_metadata":{"enabled":"on","private":"0","guid":"FD633C54-E350-42B2-AE99-5B1FF5DDCDBA","title":"Introduction to Medical Devices: Volume 1","subtitle":"","cover_theme":"nico_13","cover_image":"https:\/\/www.limsforum.com\/wp-content\/plugins\/rdp-ebook-builder\/pl\/cover.php?cover_style=nico_13&subtitle=&editor=Shawn+Douglas&title=Introduction+to+Medical+Devices%3A+Volume+1&title_image=https%3A%2F%2Fs3.limsforum.com%2Fwww.limsforum.com%2Fwp-content%2Fuploads%2FStetoskop.jpg&publisher=LabLynx+Press","editor":"Shawn Douglas","publisher":"LabLynx Press","author_id":"26","image_url":"","items":{"509a78b4fc5d0046b2bae625b2c376a6_type":"article","509a78b4fc5d0046b2bae625b2c376a6_title":"Staphylococcus epidermidis","509a78b4fc5d0046b2bae625b2c376a6_url":"https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis","509a78b4fc5d0046b2bae625b2c376a6_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tStaphylococcus epidermidis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\n\n\n\nStaphylococcus epidermidis\n\n\n\n\n\nScanning electron image of S. epidermidis.\n\n\n\n\n\n\n\nScientific classification\n\n\n\n\n\n\n\nDomain:\n\nBacteria\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPhylum:\n\nFirmicutes\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nClass:\n\nBacilli\n\n\n\n\n\n\n\n\n\n\n\nOrder:\n\nBacillales\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFamily:\n\nStaphylococcaceae\n\n\n\n\n\n\n\n\n\n\n\n\n\nGenus:\n\nStaphylococcus\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSpecies:\n\nS. epidermidis\n\n\n\n\n\n\n\n\n\nBinomial name\n\n\nStaphylococcus epidermidis \r\n(Winslow & Winslow 1908)\r\nEvans 1916\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSynonyms\n\n\n\nStaphylococcus albus Rosenbach 1884\n\n\n\n\nStaphylococcus epidermidis is a Gram-positive bacterium, and one of over 40 species belonging to the genus Staphylococcus.[1] It is part of the normal human flora, typically the skin flora, and less commonly the mucosal flora.[2] It is a facultative anaerobic bacteria. Although S. epidermidis is not usually pathogenic, patients with compromised immune systems are at risk of developing infection. These infections are generally hospital-acquired.[3] S. epidermidis is a particular concern for people with catheters or other surgical implants because it is known to form biofilms that grow on these devices.[4] Being part of the normal skin flora, S. epidermidis is a frequent contaminant of specimens sent to the diagnostic laboratory.[5]\n\n Staphylococcus epidermidis biofilm on titanium substrate\nContents \n\n1 Etymology \n2 Discovery \n3 Cellular morphology and biochemistry \n4 Virulence and antibiotic resistance \n5 Disease \n6 Identification \n7 See also \n8 Notes and references \n9 External links \n\n\nEtymology \n'Staphylococcus' - bunch of grape-like berries, 'epidermidis' - of the epidermis [6]\n\nDiscovery \nFriedrich Julius Rosenbach distinguished S. epidermidis from S. aureus in 1884, initially naming S. epidermidis as S. albus.[7] He chose aureus and albus since the bacteria formed yellow and white colonies, respectively.\n\nCellular morphology and biochemistry \n Staphylococcus epidermidis, 1000 magnification under bright field microscopy\nS. epidermidis is a very hardy microorganism, consisting of nonmotile, Gram-positive cocci, arranged in grape-like clusters. It forms white, raised, cohesive colonies about 1\u20132 mm in diameter after overnight incubation, and is not hemolytic on blood agar.[4] It is a catalase-positive,[8] coagulase-negative, facultative anaerobe that can grow by aerobic respiration or by fermentation. Some strains may not ferment.[9]\nBiochemical tests indicate this microorganism also carries out a weakly positive reaction to the nitrate reductase test. It is positive for urease production, is oxidase negative, and can use glucose, sucrose, and lactose to form acid products. In the presence of lactose, it will also produce gas. S. epidermidis does not possess the gelatinase enzyme, so it cannot hydrolyze gelatin.[citation needed ] It is sensitive to novobiocin, providing an important test to distinguish it from Staphylococcus saprophyticus, which is coagulase-negative, as well, but novobiocin-resistant.[3]\nSimilar to those of S. aureus, the cell walls of S. epidermidis have a transferrin-binding protein that helps the organism obtain iron from transferrin. The tetramers of a surface exposed protein, glyceraldehyde-3-phosphate dehydrogenase, are believed to bind to transferrin and remove its iron. Subsequent steps include iron being transferred to surface lipoproteins, then to transport proteins which carry the iron into the cell.[4]\n\nVirulence and antibiotic resistance \nThe ability to form biofilms on plastic devices is a major virulence factor for S. epidermidis. One probable cause is surface proteins that bind blood and extracellular matrix proteins.\nIt produces an extracellular material known as polysaccharide intercellular adhesin (PIA), which is made up of sulfated polysaccharides. It allows other bacteria to bind to the already existing biofilm, creating a multilayer biofilm.\nSuch biofilms decrease the metabolic activity of bacteria within them. This decreased metabolism, in combination with impaired diffusion of antibiotics, makes it difficult for antibiotics to effectively clear this type of infection.[4]\nS. epidermidis strains are often resistant to antibiotics, including rifamycin, fluoroquinolones, gentamicin, tetracycline, clindamycin, and sulfonamides.[10] Methicillin resistance is particularly widespread, with 75-90% of hospital isolates resistance to methicilin.[10] Resistant organisms are most commonly found in the intestine, but organisms living freely on the skin can also become resistant due to routine exposure to antibiotics secreted in sweat.\n\nDisease \n Staphylococcus epidermidis stained by safranin.(x1000)\nAs mentioned above, S. epidermidis causes biofilms to grow on plastic devices placed within the body.[11] This occurs most commonly on intravenous catheters and on medical prostheses.[12]\nInfection can also occur in dialysis patients or anyone with an implanted plastic device that may have been contaminated.\nIt also causes endocarditis, most often in patients with defective heart valves. In some other cases, sepsis can occur in hospital patients.[citation needed ]\nAntibiotics are largely ineffective in clearing biofilms. The most common treatment for these infections is to remove or replace the infected implant, though in all cases, prevention is ideal. The drug of choice is often vancomycin, to which rifampin or an aminoglycoside can be added.[citation needed ] Hand washing has been shown to reduce the spread of infection.\nPreliminary research also indicates S. epidermidis is universally found inside affected acne vulgaris pores, where Propionibacterium acnes is normally the sole resident.[13]\n\nIdentification \nThe normal practice of detecting S. epidermidis is by using appearance of colonies on selective media, bacterial morphology by light microscopy, catalase and slide coagulase testing. On the Baird-Parker agar with egg yolk supplement, colonies appear small and black. Increasingly, techniques such as quantitative PCR are being employed for the rapid detection and identification of Staphylococcus strains.[14][15] Normally, sensitivity to desferrioxamine can also be used to distinguish it from most other staphylococci, except in the case of Staphylococcus hominis, which is also sensitive.[16] In this case, the production of acid from trehalose by S. hominis can be used to tell the two species apart.\n\nSee also \nBiofilms\nMicrobiology\nStaphylococcus\nNotes and references \n\n\n^ Schleifer, K. H.; Kloos, W. E. (1975). \"Isolation and Characterization of Staphylococci from Human Skin I. Amended Descriptions of Staphylococcus epidermidis and Staphylococcus saprophyticus and Descriptions of Three New Species Staphylococcus cohnii, Staphylococcus haemolyticus, and Staphylococcus xylosus\". International Journal of Systematic Bacteriology. 25 (1): 50\u201361. doi:10.1099\/00207713-25-1-50. ISSN 0020-7713. \n\n^ Fey, P. D.; Olson, M. E. (2010). \"Current concepts in biofilm formation of Staphylococcus epidermidis\". Future Microbiology. 5 (6): 917\u2013933. doi:10.2217\/fmb.10.56. PMC 2903046 . \n\n^ a b Levinson, W. (2010). Review of Medical Microbiology and Immunology (11th ed.). pp. 94\u201399. \n\n^ a b c d Salyers, Abigail A. & Whitt, Dixie D. (2002). Bacterial Pathogenesis: A Molecular Approach, 2nd ed. Washington, D.C.: ASM Press. ISBN 1-55581-171-X. \n\n^ Queck SY & Otto M (2008). \"Staphylococcus epidermidis and other Coagulase-Negative Staphylococci\". Staphylococcus: Molecular Genetics. Caister Academic Press. ISBN 978-1-904455-29-5. \n\n^ http:\/\/www.vetbact.org\/vetbact\/?artid=205 \n\n^ Friedrich Julius Rosenbach at Who Named It? \n\n^ \"Todar's Online Textbook of Bacteriology: Staphylococcus aureus and Staphylococcal Disease\". Kenneth Todar, PhD. Retrieved Dec 7, 2013 . \n\n^ \"Bacteria Genomes - STAPHYLOCOCCUS EPIDERMIDIS\". Karyn's Genomes. EMBL-EBI. Retrieved December 23, 2011 . \n\n^ a b Otto M (August 2010). \"Staphylococcus epidermidis - the \"accidental\" pathogen\". Nature Reviews Microbiology. 7 (8): 555\u2013567. doi:10.1038\/nrmicro2182. PMC 2807625 . \n\n^ Otto M (2009), \"Staphylococcus epidermidis \u2014 the 'accidental' pathogen\", Nature Reviews Microbiology, 7 (8): 555\u2013567, doi:10.1038\/nrmicro2182, PMC 2807625 , PMID 19609257 \n\n^ Hedin G (1993), \"Staphylococcus epidermidis \u2014 hospital epidemiology and the detection of methicillin resistance\", Scandinavian Journal of Infectious Diseases Supplementum, Oslo Norway: Scandinavian University Press, 90: 1\u201359, PMID 8303217 \n\n^ Bek-Thomson, M.; et al. (2008). \"Acne is Not Associated with Yet-Uncultured Bacteria\". Journal of Clinical Microbiology. 46 (10): 3355\u20133360. doi:10.1128\/JCM.00799-08. PMC 2566126 . PMID 18716234. \n\n^ Francois P & Schrenzel J (2008). \"Rapid Diagnosis and Typing of Staphylococcus aureus\". Staphylococcus: Molecular Genetics. Caister Academic Press. ISBN 978-1-904455-29-5. \n\n^ Mackay IM (editor). (2007). Real-Time PCR in Microbiology: From Diagnosis to Characterization. Caister Academic Press. ISBN 978-1-904455-18-9. \n\n^ Antunes, Ana L\u00facia Souza; Secchi, Carina; Reiter, Keli Cristine; Perez, Leandro Reus Rodrigues; Freitas, Ana L\u00facia Peixoto De; D'azevedo, Pedro Alves (2008-01-01). \"Feasible identification of Staphylococcus epidermidis using desferrioxamine and fosfomycin disks\". APMIS. 116 (1): 16\u201320. doi:10.1111\/j.1600-0463.2008.00796.x. ISSN 1600-0463. \n\n\nExternal links \nType strain of Staphylococcus epidermidis at BacDive - the Bacterial Diversity Metadatabase\nTeruaki Nakatsuji et al.: A commensal strain of Staphylococcus epidermidis protects against skin neoplasia, in: Science Advances; 28th of Feb., 2018; Vol. 4, No. 2, DOI:10.1126\/sciadv.aao4502\nvte\nFirmicutes (low-G+C) Infectious diseases\nBacterial diseases: G+\nprimarily A00\u2013A79, 001\u2013041, 080\u2013109\nBacilliLactobacillales\r\n(Cat-)Streptococcus\u03b1optochin susceptible\nS. pneumoniae\nPneumococcal infection\noptochin resistant\nViridans streptococci: S. mitis\nS. mutans\nS. oralis\nS. sanguinis\nS. sobrinus\nmilleri group\n\u03b2A\nbacitracin susceptible: S. pyogenes\nGroup A streptococcal infection\nStreptococcal pharyngitis\nScarlet fever\nErysipelas\nRheumatic fever\nB\nbacitracin resistant, CAMP test+: S. agalactiae\nGroup B streptococcal infection\nungrouped\nStreptococcus iniae\nCutaneous Streptococcus iniae infection\n\u03b3\nD\nBEA+: Streptococcus bovis\nEnterococcus\nBEA+: Enterococcus faecalis\nUrinary tract infection\nEnterococcus faecium\nBacillales\r\n(Cat+)StaphylococcusCg+\nS. aureus\nStaphylococcal scalded skin syndrome\nToxic shock syndrome\nMRSA\nCg-\nnovobiocin susceptible\nS. epidermidis\nnovobiocin resistant\nS. saprophyticus\nBacillus\nBacillus anthracis\nAnthrax\nBacillus cereus\nFood poisoning\nListeria\nListeria monocytogenes\nListeriosis\nClostridiaClostridium (spore-forming)motile:\nClostridium difficile\nPseudomembranous colitis\nClostridium botulinum\nBotulism\nClostridium tetani\nTetanus\nnonmotile:\nClostridium perfringens\nGas gangrene\nClostridial necrotizing enteritis\nPeptostreptococcus (non-spore forming)\nPeptostreptococcus magnus\nMollicutesMycoplasmataceae\nUreaplasma urealyticum\nUreaplasma infection\nMycoplasma genitalium\nMycoplasma pneumoniae\nMycoplasma pneumonia\nAnaeroplasmatales\nErysipelothrix rhusiopathiae\nErysipeloid\n\n Biology portal \nTaxon identifiers\nWikidata: Q131915 \nWikispecies: Staphylococcus epidermidis \nBacDive: 14529 \nEoL: 975953 \nEPPO: STAPEP \nGBIF: 3227655 \niNaturalist: 356566 \nIRMNG: 10540350 \nITIS: 377 \nNCBI: 1282 \nNZOR: a3dfb255-a960-44df-bbef-6642126dd86a \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis\">https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis<\/a>\n\t\t\t\t\tCategory: Science termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal 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id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\"><i>Staphylococcus epidermidis<\/i><\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n\n<p><i><b>Staphylococcus epidermidis<\/b><\/i> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gram-positive\" class=\"mw-redirect\" title=\"Gram-positive\" rel=\"external_link\" target=\"_blank\">Gram-positive<\/a> bacterium, and one of over 40 species belonging to the genus <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus\" title=\"Staphylococcus\" rel=\"external_link\" target=\"_blank\">Staphylococcus<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-SchleiferKloos1975_1-0\" class=\"reference\"><a href=\"#cite_note-SchleiferKloos1975-1\" rel=\"external_link\">[1]<\/a><\/sup> It is part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_flora\" class=\"mw-redirect\" title=\"Human flora\" rel=\"external_link\" target=\"_blank\">normal human flora<\/a>, typically the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin_flora\" title=\"Skin flora\" rel=\"external_link\" target=\"_blank\">skin flora<\/a>, and less commonly the mucosal flora.<sup id=\"rdp-ebb-cite_ref-FeyOlson2010_2-0\" class=\"reference\"><a href=\"#cite_note-FeyOlson2010-2\" rel=\"external_link\">[2]<\/a><\/sup> It is a facultative anaerobic bacteria. Although <i>S. epidermidis<\/i> is not usually pathogenic, patients with compromised <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_system\" title=\"Immune system\" rel=\"external_link\" target=\"_blank\">immune systems<\/a> are at risk of developing infection. These infections are generally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital-acquired_infection\" title=\"Hospital-acquired infection\" rel=\"external_link\" target=\"_blank\">hospital-acquired<\/a>.<sup id=\"rdp-ebb-cite_ref-Levinson,_W._2010_94\u201399_3-0\" class=\"reference\"><a href=\"#cite_note-Levinson,_W._2010_94\u201399-3\" rel=\"external_link\">[3]<\/a><\/sup> <i>S. epidermidis<\/i> is a particular concern for people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheters\" class=\"mw-redirect\" title=\"Catheters\" rel=\"external_link\" target=\"_blank\">catheters<\/a> or other surgical implants because it is known to form <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilms\" class=\"mw-redirect\" title=\"Biofilms\" rel=\"external_link\" target=\"_blank\">biofilms<\/a> that grow on these devices.<sup id=\"rdp-ebb-cite_ref-Salyers_4-0\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup> Being part of the normal skin flora, <i>S. epidermidis<\/i> is a frequent contaminant of specimens sent to the diagnostic laboratory.<sup id=\"rdp-ebb-cite_ref-Queck_5-0\" class=\"reference\"><a href=\"#cite_note-Queck-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\/lossy-page1-220px-Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Staphylococcus epidermidis biofilm on titanium substrate<\/div><\/div><\/div>\n\n<h2><span class=\"mw-headline\" id=\"Etymology\">Etymology<\/span><\/h2>\n<p>'Staphylococcus' - bunch of grape-like berries, 'epidermidis' - of the epidermis <sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Discovery\">Discovery<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Friedrich_Julius_Rosenbach\" title=\"Friedrich Julius Rosenbach\" rel=\"external_link\" target=\"_blank\">Friedrich Julius Rosenbach<\/a> distinguished <i>S. epidermidis<\/i> from <i>S. aureus<\/i> in 1884, initially naming <i>S. epidermidis<\/i> as <i>S. albus<\/i>.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> He chose <i>aureus<\/i> and <i>albus<\/i> since the bacteria formed yellow and white colonies, respectively.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cellular_morphology_and_biochemistry\">Cellular morphology and biochemistry<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermids.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Staphylococcus_epidermids.jpg\/220px-Staphylococcus_epidermids.jpg\" width=\"220\" height=\"162\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermids.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><i>Staphylococcus epidermidis<\/i>, 1000 magnification under bright field microscopy<\/div><\/div><\/div>\n<p><i>S. epidermidis<\/i> is a very hardy microorganism, consisting of nonmotile, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gram-positive\" class=\"mw-redirect\" title=\"Gram-positive\" rel=\"external_link\" target=\"_blank\">Gram-positive<\/a> cocci, arranged in grape-like clusters. It forms white, raised, cohesive colonies about 1\u20132 mm in diameter after overnight incubation, and is not <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemolytic\" class=\"mw-redirect\" title=\"Hemolytic\" rel=\"external_link\" target=\"_blank\">hemolytic<\/a> on blood agar.<sup id=\"rdp-ebb-cite_ref-Salyers_4-1\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup> It is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalase\" title=\"Catalase\" rel=\"external_link\" target=\"_blank\">catalase<\/a>-positive,<sup id=\"rdp-ebb-cite_ref-Todar_8-0\" class=\"reference\"><a href=\"#cite_note-Todar-8\" rel=\"external_link\">[8]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulase\" title=\"Coagulase\" rel=\"external_link\" target=\"_blank\">coagulase<\/a>-negative, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Facultative_anaerobe\" class=\"mw-redirect\" title=\"Facultative anaerobe\" rel=\"external_link\" target=\"_blank\">facultative anaerobe<\/a> that can grow by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerobic_respiration\" class=\"mw-redirect\" title=\"Aerobic respiration\" rel=\"external_link\" target=\"_blank\">aerobic respiration<\/a> or by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fermentation_(biochemistry)\" class=\"mw-redirect\" title=\"Fermentation (biochemistry)\" rel=\"external_link\" target=\"_blank\">fermentation<\/a>. Some strains may not ferment.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Biochemical tests indicate this microorganism also carries out a weakly positive reaction to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrate_reductase_test\" title=\"Nitrate reductase test\" rel=\"external_link\" target=\"_blank\">nitrate reductase test<\/a>. It is positive for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urease\" title=\"Urease\" rel=\"external_link\" target=\"_blank\">urease<\/a> production, is oxidase negative, and can use glucose, sucrose, and lactose to form acid products. In the presence of lactose, it will also produce gas. <i>S. epidermidis<\/i> does not possess the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gelatinase\" title=\"Gelatinase\" rel=\"external_link\" target=\"_blank\">gelatinase<\/a> enzyme, so it cannot hydrolyze gelatin.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> It is sensitive to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Novobiocin\" title=\"Novobiocin\" rel=\"external_link\" target=\"_blank\">novobiocin<\/a>, providing an important test to distinguish it from <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_saprophyticus\" title=\"Staphylococcus saprophyticus\" rel=\"external_link\" target=\"_blank\">Staphylococcus saprophyticus<\/a><\/i>, which is coagulase-negative, as well, but novobiocin-resistant.<sup id=\"rdp-ebb-cite_ref-Levinson,_W._2010_94\u201399_3-1\" class=\"reference\"><a href=\"#cite_note-Levinson,_W._2010_94\u201399-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Similar to those of <i>S. aureus<\/i>, the cell walls of <i>S. epidermidis<\/i> have a transferrin-binding protein that helps the organism obtain iron from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transferrin\" title=\"Transferrin\" rel=\"external_link\" target=\"_blank\">transferrin<\/a>. The tetramers of a surface exposed protein, glyceraldehyde-3-phosphate dehydrogenase, are believed to bind to transferrin and remove its iron. Subsequent steps include iron being transferred to surface lipoproteins, then to transport proteins which carry the iron into the cell.<sup id=\"rdp-ebb-cite_ref-Salyers_4-2\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Virulence_and_antibiotic_resistance\">Virulence and antibiotic resistance<\/span><\/h2>\n<p>The ability to form <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilm\" title=\"Biofilm\" rel=\"external_link\" target=\"_blank\">biofilms<\/a> on plastic devices is a major virulence factor for <i>S. epidermidis<\/i>. One probable cause is surface proteins that bind blood and extracellular matrix proteins.\nIt produces an extracellular material known as polysaccharide intercellular adhesin (PIA), which is made up of sulfated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polysaccharide\" title=\"Polysaccharide\" rel=\"external_link\" target=\"_blank\">polysaccharides<\/a>. It allows other bacteria to bind to the already existing biofilm, creating a multilayer biofilm.\nSuch biofilms decrease the metabolic activity of bacteria within them. This decreased metabolism, in combination with impaired diffusion of antibiotics, makes it difficult for antibiotics to effectively clear this type of infection.<sup id=\"rdp-ebb-cite_ref-Salyers_4-3\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<i>S. epidermidis<\/i> strains are often resistant to antibiotics, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rifamycin\" title=\"Rifamycin\" rel=\"external_link\" target=\"_blank\">rifamycin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroquinolones\" class=\"mw-redirect\" title=\"Fluoroquinolones\" rel=\"external_link\" target=\"_blank\">fluoroquinolones<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gentamicin\" title=\"Gentamicin\" rel=\"external_link\" target=\"_blank\">gentamicin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetracycline\" title=\"Tetracycline\" rel=\"external_link\" target=\"_blank\">tetracycline<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clindamycin\" title=\"Clindamycin\" rel=\"external_link\" target=\"_blank\">clindamycin<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfonamide\" title=\"Sulfonamide\" rel=\"external_link\" target=\"_blank\">sulfonamides<\/a>.<sup id=\"rdp-ebb-cite_ref-Otto_10-0\" class=\"reference\"><a href=\"#cite_note-Otto-10\" rel=\"external_link\">[10]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methicillin\" title=\"Methicillin\" rel=\"external_link\" target=\"_blank\">Methicillin<\/a> resistance is particularly widespread, with 75-90% of hospital isolates resistance to methicilin.<sup id=\"rdp-ebb-cite_ref-Otto_10-1\" class=\"reference\"><a href=\"#cite_note-Otto-10\" rel=\"external_link\">[10]<\/a><\/sup> Resistant organisms are most commonly found in the intestine, but organisms living freely on the skin can also become resistant due to routine exposure to antibiotics secreted in sweat.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Disease\">Disease<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stained_Staphylococcus_epidermidis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Stained_Staphylococcus_epidermidis.jpg\/220px-Stained_Staphylococcus_epidermidis.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stained_Staphylococcus_epidermidis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><i>Staphylococcus epidermidis<\/i> stained by safranin.(x1000)<\/div><\/div><\/div>\n<p>As mentioned above, <i>S. epidermidis<\/i> causes biofilms to grow on plastic devices placed within the body.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> This occurs most commonly on intravenous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheters<\/a> and on medical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">prostheses<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\nInfection can also occur in dialysis patients or anyone with an implanted plastic device that may have been contaminated.\nIt also causes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocarditis\" title=\"Endocarditis\" rel=\"external_link\" target=\"_blank\">endocarditis<\/a>, most often in patients with defective heart valves. In some other cases, sepsis can occur in hospital patients.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Antibiotics are largely ineffective in clearing biofilms. The most common treatment for these infections is to remove or replace the infected implant, though in all cases, prevention is ideal. The drug of choice is often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vancomycin\" title=\"Vancomycin\" rel=\"external_link\" target=\"_blank\">vancomycin<\/a>, to which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rifampin\" class=\"mw-redirect\" title=\"Rifampin\" rel=\"external_link\" target=\"_blank\">rifampin<\/a> or an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aminoglycoside\" title=\"Aminoglycoside\" rel=\"external_link\" target=\"_blank\">aminoglycoside<\/a> can be added.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> Hand washing has been shown to reduce the spread of infection.\n<\/p><p>Preliminary research also indicates <i>S. epidermidis<\/i> is universally found inside affected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acne_vulgaris\" class=\"mw-redirect\" title=\"Acne vulgaris\" rel=\"external_link\" target=\"_blank\">acne vulgaris<\/a> pores, where <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Propionibacterium_acnes\" class=\"mw-redirect\" title=\"Propionibacterium acnes\" rel=\"external_link\" target=\"_blank\">Propionibacterium acnes<\/a><\/i> is normally the sole resident.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Identification\">Identification<\/span><\/h2>\n<p>The normal practice of detecting <i>S. epidermidis<\/i> is by using appearance of colonies on selective media, bacterial morphology by light microscopy, catalase and slide coagulase testing. On the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baird-Parker_agar\" title=\"Baird-Parker agar\" rel=\"external_link\" target=\"_blank\">Baird-Parker agar<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egg_yolk\" class=\"mw-redirect\" title=\"Egg yolk\" rel=\"external_link\" target=\"_blank\">egg yolk<\/a> supplement, colonies appear small and black. Increasingly, techniques such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quantitative_PCR\" class=\"mw-redirect\" title=\"Quantitative PCR\" rel=\"external_link\" target=\"_blank\">quantitative PCR<\/a> are being employed for the rapid detection and identification of <i>Staphylococcus<\/i> strains.<sup id=\"rdp-ebb-cite_ref-FrancoisP_14-0\" class=\"reference\"><a href=\"#cite_note-FrancoisP-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Mackay_15-0\" class=\"reference\"><a href=\"#cite_note-Mackay-15\" rel=\"external_link\">[15]<\/a><\/sup> Normally, sensitivity to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Desferrioxamine\" class=\"mw-redirect\" title=\"Desferrioxamine\" rel=\"external_link\" target=\"_blank\">desferrioxamine<\/a> can also be used to distinguish it from most other staphylococci, except in the case of <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_hominis\" title=\"Staphylococcus hominis\" rel=\"external_link\" target=\"_blank\">Staphylococcus hominis<\/a><\/i>, which is also sensitive.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> In this case, the production of acid from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trehalose\" title=\"Trehalose\" rel=\"external_link\" target=\"_blank\">trehalose<\/a> by <i>S. hominis<\/i> can be used to tell the two species apart.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilms\" class=\"mw-redirect\" title=\"Biofilms\" rel=\"external_link\" target=\"_blank\">Biofilms<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microbiology\" title=\"Microbiology\" rel=\"external_link\" target=\"_blank\">Microbiology<\/a><\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus\" title=\"Staphylococcus\" rel=\"external_link\" target=\"_blank\">Staphylococcus<\/a><\/i><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Notes_and_references\">Notes and references<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-SchleiferKloos1975-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SchleiferKloos1975_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schleifer, K. H.; Kloos, W. E. (1975). \"Isolation and Characterization of Staphylococci from Human Skin I. Amended Descriptions of Staphylococcus epidermidis and Staphylococcus saprophyticus and Descriptions of Three New Species Staphylococcus cohnii, Staphylococcus haemolyticus, and Staphylococcus xylosus\". <i>International Journal of Systematic Bacteriology<\/i>. <b>25<\/b> (1): 50\u201361. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1099%2F00207713-25-1-50\" target=\"_blank\">10.1099\/00207713-25-1-50<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0020-7713\" target=\"_blank\">0020-7713<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Systematic+Bacteriology&rft.atitle=Isolation+and+Characterization+of+Staphylococci+from+Human+Skin+I.+Amended+Descriptions+of+Staphylococcus+epidermidis+and+Staphylococcus+saprophyticus+and+Descriptions+of+Three+New+Species+Staphylococcus+cohnii%2C+Staphylococcus+haemolyticus%2C+and+Staphylococcus+xylosus&rft.volume=25&rft.issue=1&rft.pages=50-61&rft.date=1975&rft_id=info%3Adoi%2F10.1099%2F00207713-25-1-50&rft.issn=0020-7713&rft.aulast=Schleifer&rft.aufirst=K.+H.&rft.au=Kloos%2C+W.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FeyOlson2010-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FeyOlson2010_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fey, P. D.; Olson, M. E. (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2903046\" target=\"_blank\">\"Current concepts in biofilm formation of Staphylococcus epidermidis\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Future_Microbiology\" title=\"Future Microbiology\" rel=\"external_link\" target=\"_blank\">Future Microbiology<\/a><\/i>. <b>5<\/b> (6): 917\u2013933. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2217%2Ffmb.10.56\" target=\"_blank\">10.2217\/fmb.10.56<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2903046\" target=\"_blank\">2903046<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Future+Microbiology&rft.atitle=Current+concepts+in+biofilm+formation+of+Staphylococcus+epidermidis&rft.volume=5&rft.issue=6&rft.pages=917-933&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2903046&rft_id=info%3Adoi%2F10.2217%2Ffmb.10.56&rft.aulast=Fey&rft.aufirst=P.+D.&rft.au=Olson%2C+M.+E.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2903046&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Levinson,_W._2010_94\u201399-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Levinson,_W._2010_94\u201399_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Levinson,_W._2010_94\u201399_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Levinson, W. (2010). <i>Review of Medical Microbiology and Immunology<\/i> (11th ed.). pp. 94\u201399.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Review+of+Medical+Microbiology+and+Immunology&rft.pages=94-99&rft.edition=11th&rft.date=2010&rft.au=Levinson%2C+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Salyers-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Salyers_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Salyers_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Salyers_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Salyers_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Salyers, Abigail A. & Whitt, Dixie D. (2002). <i>Bacterial Pathogenesis: A Molecular Approach, 2nd ed<\/i>. Washington, D.C.: ASM Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-55581-171-X.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Bacterial+Pathogenesis%3A+A+Molecular+Approach%2C+2nd+ed.&rft.place=Washington%2C+D.C.&rft.pub=ASM+Press&rft.date=2002&rft.isbn=1-55581-171-X&rft.au=Salyers%2C+Abigail+A.&rft.au=Whitt%2C+Dixie+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Queck-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Queck_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Queck SY & Otto M (2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.horizonpress.com\/staph\" target=\"_blank\">\"Staphylococcus epidermidis and other Coagulase-Negative Staphylococci\"<\/a>. <i>Staphylococcus: Molecular Genetics<\/i>. Caister Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-904455-29-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Staphylococcus+epidermidis+and+other+Coagulase-Negative+Staphylococci&rft.btitle=Staphylococcus%3A+Molecular+Genetics&rft.pub=Caister+Academic+Press&rft.date=2008&rft.isbn=978-1-904455-29-5&rft.aulast=Queck&rft.aufirst=SY&rft.au=Otto%2C+M&rft_id=http%3A%2F%2Fwww.horizonpress.com%2Fstaph&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.vetbact.org\/vetbact\/?artid=205\" target=\"_blank\">http:\/\/www.vetbact.org\/vetbact\/?artid=205<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.whonamedit.com\/doctor.cfm\/1203.html\" target=\"_blank\">Friedrich Julius Rosenbach<\/a><\/i> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Who_Named_It%3F\" class=\"mw-redirect\" title=\"Who Named It?\" rel=\"external_link\" target=\"_blank\">Who Named It?<\/a><\/span>\n<\/li>\n<li id=\"cite_note-Todar-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Todar_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/textbookofbacteriology.net\/staph.html\" target=\"_blank\">\"Todar's Online Textbook of Bacteriology: Staphylococcus aureus and Staphylococcal Disease\"<\/a>. Kenneth Todar, PhD<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">Dec 7,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Todar%27s+Online+Textbook+of+Bacteriology%3A+Staphylococcus+aureus+and+Staphylococcal+Disease&rft.pub=Kenneth+Todar%2C+PhD&rft_id=http%3A%2F%2Ftextbookofbacteriology.net%2Fstaph.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ebi.ac.uk\/2can\/genomes\/bacteria\/Staphylococcus_epidermidis.html\" target=\"_blank\">\"Bacteria Genomes - STAPHYLOCOCCUS EPIDERMIDIS\"<\/a>. <i>Karyn's Genomes<\/i>. EMBL-EBI<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 23,<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Karyn%27s+Genomes.&rft.atitle=Bacteria+Genomes+-+STAPHYLOCOCCUS+EPIDERMIDIS&rft_id=http%3A%2F%2Fwww.ebi.ac.uk%2F2can%2Fgenomes%2Fbacteria%2FStaphylococcus_epidermidis.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Otto-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Otto_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Otto_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Otto M (August 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2807625\" target=\"_blank\">\"<i>Staphylococcus epidermidis<\/i> - the \"accidental\" pathogen\"<\/a>. <i>Nature Reviews Microbiology<\/i>. <b>7<\/b> (8): 555\u2013567. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrmicro2182\" target=\"_blank\">10.1038\/nrmicro2182<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2807625\" target=\"_blank\">2807625<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews+Microbiology&rft.atitle=Staphylococcus+epidermidis+-+the+%22accidental%22+pathogen&rft.volume=7&rft.issue=8&rft.pages=555-567&rft.date=2010-08&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2807625&rft_id=info%3Adoi%2F10.1038%2Fnrmicro2182&rft.au=Otto+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2807625&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFOtto_M2009\" class=\"citation\">Otto M (2009), \"Staphylococcus epidermidis \u2014 the 'accidental' pathogen\", <i>Nature Reviews Microbiology<\/i>, <b>7<\/b> (8): 555\u2013567, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrmicro2182\" target=\"_blank\">10.1038\/nrmicro2182<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2807625\" target=\"_blank\">2807625<\/a><\/span>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19609257\" target=\"_blank\">19609257<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews+Microbiology&rft.atitle=Staphylococcus+epidermidis+%E2%80%94+the+%27accidental%27+pathogen&rft.volume=7&rft.issue=8&rft.pages=555-567&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2807625&rft_id=info%3Apmid%2F19609257&rft_id=info%3Adoi%2F10.1038%2Fnrmicro2182&rft.au=Otto+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFHedin_G1993\" class=\"citation\">Hedin G (1993), \"Staphylococcus epidermidis \u2014 hospital epidemiology and the detection of methicillin resistance\", <i>Scandinavian Journal of Infectious Diseases Supplementum<\/i>, Oslo Norway: Scandinavian University Press, <b>90<\/b>: 1\u201359, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8303217\" target=\"_blank\">8303217<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scandinavian+Journal+of+Infectious+Diseases+Supplementum&rft.atitle=Staphylococcus+epidermidis+%E2%80%94+hospital+epidemiology+and+the+detection+of+methicillin+resistance&rft.volume=90&rft.pages=1-59&rft.date=1993&rft_id=info%3Apmid%2F8303217&rft.au=Hedin+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bek-Thomson, M.; et al. (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2566126\" target=\"_blank\">\"Acne is Not Associated with Yet-Uncultured Bacteria\"<\/a>. <i>Journal of Clinical Microbiology<\/i>. <b>46<\/b> (10): 3355\u20133360. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1128%2FJCM.00799-08\" target=\"_blank\">10.1128\/JCM.00799-08<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2566126\" target=\"_blank\">2566126<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18716234\" target=\"_blank\">18716234<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Microbiology&rft.atitle=Acne+is+Not+Associated+with+Yet-Uncultured+Bacteria&rft.volume=46&rft.issue=10&rft.pages=3355-3360&rft.date=2008&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2566126&rft_id=info%3Apmid%2F18716234&rft_id=info%3Adoi%2F10.1128%2FJCM.00799-08&rft.au=Bek-Thomson%2C+M.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2566126&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FrancoisP-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FrancoisP_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Francois P & Schrenzel J (2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.horizonpress.com\/staph\" target=\"_blank\">\"Rapid Diagnosis and Typing of Staphylococcus aureus\"<\/a>. <i>Staphylococcus: Molecular Genetics<\/i>. Caister Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-904455-29-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Rapid+Diagnosis+and+Typing+of+Staphylococcus+aureus&rft.btitle=Staphylococcus%3A+Molecular+Genetics&rft.pub=Caister+Academic+Press&rft.date=2008&rft.isbn=978-1-904455-29-5&rft.aulast=Francois&rft.aufirst=P&rft.au=Schrenzel%2C+J&rft_id=http%3A%2F%2Fwww.horizonpress.com%2Fstaph&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mackay-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mackay_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mackay IM (editor). (2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.horizonpress.com\/rtmic\" target=\"_blank\"><i>Real-Time PCR in Microbiology: From Diagnosis to Characterization<\/i><\/a>. Caister Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-904455-18-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Real-Time+PCR+in+Microbiology%3A+From+Diagnosis+to+Characterization&rft.pub=Caister+Academic+Press&rft.date=2007&rft.isbn=978-1-904455-18-9&rft.au=Mackay+IM+%28editor%29.&rft_id=http%3A%2F%2Fwww.horizonpress.com%2Frtmic&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Antunes, Ana L\u00facia Souza; Secchi, Carina; Reiter, Keli Cristine; Perez, Leandro Reus Rodrigues; Freitas, Ana L\u00facia Peixoto De; D'azevedo, Pedro Alves (2008-01-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1600-0463.2008.00796.x\/abstract\" target=\"_blank\">\"Feasible identification of Staphylococcus epidermidis using desferrioxamine and fosfomycin disks\"<\/a>. <i>APMIS<\/i>. <b>116<\/b> (1): 16\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0463.2008.00796.x\" target=\"_blank\">10.1111\/j.1600-0463.2008.00796.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1600-0463\" target=\"_blank\">1600-0463<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=APMIS&rft.atitle=Feasible+identification+of+Staphylococcus+epidermidis+using+desferrioxamine+and+fosfomycin+disks&rft.volume=116&rft.issue=1&rft.pages=16-20&rft.date=2008-01-01&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0463.2008.00796.x&rft.issn=1600-0463&rft.aulast=Antunes&rft.aufirst=Ana+L%C3%BAcia+Souza&rft.au=Secchi%2C+Carina&rft.au=Reiter%2C+Keli+Cristine&rft.au=Perez%2C+Leandro+Reus+Rodrigues&rft.au=Freitas%2C+Ana+L%C3%BAcia+Peixoto+De&rft.au=D%27azevedo%2C+Pedro+Alves&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1111%2Fj.1600-0463.2008.00796.x%2Fabstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bacdive.dsmz.de\/index.php?search=14529&submit=Search\" target=\"_blank\">Type strain of <i>Staphylococcus epidermidis<\/i> at Bac<i>Dive<\/i> - the Bacterial Diversity Metadatabase<\/a><\/li>\n<li>Teruaki Nakatsuji et al.: <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/advances.sciencemag.org\/content\/4\/2\/eaao4502\" target=\"_blank\">A commensal strain of Staphylococcus epidermidis protects against skin neoplasia<\/a>, in: Science Advances; 28th of Feb., 2018; Vol. 4, No. 2, <a href=\"https:\/\/doi.org\/10.1126\/sciadv.aao4502\" class=\"extiw\" title=\"doi:10.1126\/sciadv.aao4502\" rel=\"external_link\" target=\"_blank\">DOI:10.1126\/sciadv.aao4502<\/a><\/li><\/ul>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181216234105\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.556 seconds\nReal time usage: 0.684 seconds\nPreprocessor visited node count: 4512\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 131979\/2097152 bytes\nTemplate argument size: 4268\/2097152 bytes\nHighest expansion depth: 24\/40\nExpensive parser function count: 14\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 41981\/5000000 bytes\nNumber of Wikibase entities loaded: 13\/400\nLua time usage: 0.297\/10.000 seconds\nLua memory usage: 5.64 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 570.947 1 -total\n<\/p>\n<pre>35.03% 199.981 1 Template:Reflist\n27.33% 156.051 1 Template:Taxobox\n25.24% 144.119 1 Template:Taxobox\/core\n20.88% 119.232 5 Template:Cite_journal\n20.16% 115.115 11 Template:Navbox\n12.89% 73.620 1 Template:Taxonbar\n12.61% 71.976 14 Template:Delink\n11.46% 65.443 11 Template:Taxobox_colour\n 9.75% 55.648 1 Template:Gram-positive_bacterial_diseases\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2648919-1!canonical and timestamp 20181216234104 and revision id 873445757\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_epidermidis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214715\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.043 seconds\nReal time usage: 0.243 seconds\nPreprocessor visited node count: 25\/1000000\nPreprocessor generated node count: 139\/1000000\nPost\u2010expand include size: 127\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 5\/40\nExpensive parser function count: 0\/100\nLua time usage: 0.020\/7.000 seconds\nLua virtual size: 8.2 MB\/50 MB\nLua estimated memory usage: 0 bytes\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 230.591 1 - -total\n 64.63% 149.024 1 - wikipedia:Staphylococcus_epidermidis\n 34.98% 80.668 1 - Template:Italic_title\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8433-0!*!*!*!*!*!* and timestamp 20181217214715 and revision id 24675\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis\">https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","509a78b4fc5d0046b2bae625b2c376a6_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Staphylococcus_epidermidis_01.png\/440px-Staphylococcus_epidermidis_01.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\/lossy-page1-440px-Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Staphylococcus_epidermids.jpg\/440px-Staphylococcus_epidermids.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Stained_Staphylococcus_epidermidis.jpg\/440px-Stained_Staphylococcus_epidermidis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/Issoria_lathonia.jpg\/48px-Issoria_lathonia.jpg"],"509a78b4fc5d0046b2bae625b2c376a6_timestamp":1545083235,"c9e7e589abaded1dc205bee7420521de_type":"article","c9e7e589abaded1dc205bee7420521de_title":"Single-use medical device reprocessing","c9e7e589abaded1dc205bee7420521de_url":"https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing","c9e7e589abaded1dc205bee7420521de_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSingle-use medical device reprocessing\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (July 2014)\nSingle-use medical device reprocessing is the disinfection, cleaning, remanufacturing, testing, packaging and labeling, and sterilization among other steps, of a used, (or, in some cases, a device opened from its original packaging but unused), medical device to be put in service again. All reprocessed medical devices originally labeled for single use in the United States are subject to U.S. Food and Drug Administration (FDA) manufacturing requirements and must meet strict cleaning, functionality, and sterility specifications prior to use.[1] Although first regulated in the U.S., the reprocessing of medical devices, particularly those that are labeled \u201cSingle Use Device\u201d (SUDs), is a global practice with countries in Europe, Asia, Africa, and North America actively engaged in reprocessing.[2] Currently, approximately 2% of all SUDs on the U.S. market are eligible for reprocessing by a qualified third-party vendor.[3] The U.S. revenue for reprocessed devices (not SUDs) is estimated to be around $400 million annually.[4]\n\nContents \n\n1 History of reprocessing in the United States \n\n1.1 The Single Use Label \n\n\n2 Commonly reprocessed SUDs \n3 U.S. regulations for reprocessed SUDs \n4 Safety and efficacy of reprocessed SUDs \n5 Benefits of reprocessing \n\n5.1 Economic \n5.2 Environmental \n\n\n6 Physician and Clinical Statements in Support \n7 List of Known Regulated Third-Party SUD Reprocessing Vendors \n8 International Regulation of \u201cSingle-Use\u201d Medical Device Reprocessing \n\n8.1 European Union \n8.2 Africa and the Middle East \n\n8.2.1 Israel \n\n\n8.3 Asia\/Japan \n8.4 Australia \n8.5 Canada \n\n8.5.1 British Columbia \n8.5.2 Manitoba \n8.5.3 Alberta \n8.5.4 Northwest Territories \n8.5.5 Ontario \n8.5.6 Saskatchewan \n\n\n\n\n9 References \n\n\nHistory of reprocessing in the United States \nThe practice of reusing medical devices labeled for only one use began in hospitals in the late 1970s.[5] After a thorough review by the U.S. FDA in 1999 and 2000,[5] the agency released a guidance document for reprocessed SUDs that began regulating the sale of these reprocessed devices on the market,[6] under the condition that third-party reprocessors would be treated as the manufacturer and would meet the same criteria as the original equipment manufacturers (OEMs) of the medical device.[6] Following the implementation of FDA regulation, the U.S. Congress codified these standards and other requirements in the Medical Device User Fee Act of 2002.[7]\n\nThe Single Use Label \nOriginal equipment manufacturers undergo a thorough analysis to determine whether a device should be single-use or reusable. Factors in determining to label a device single-use include but are not limited to possible infection\/sterility concerns and the risk of reduced efficacy. Depending on the device and its design, failure to completely clean a single-use device could lead to cross patient infection or there is the risk that the chemicals used to clean the device will themselves pose a risk to patients by being absorbed, for example, by the plastic from which the device is made and then subsequently leaching out into a patient's body. There can also be the risk of deterioration of the device when exposed to cleaning or sterilization processes which could lead to device malfunction. When a manufacturer designs and develops a product, it determines the materials used and how the device is labeled.[8] In the U.S., to market a device as \u201creusable\u201d, a manufacturer must provide increased data requirements and invest the resources necessary to demonstrate to FDA that the product can be safely reprocessed at the hospital level.[9] Unlike reusable devices, single-use devices are not sold with instructions on how they can be properly cleaned and sterilized nor have they been validated or tested for exposure to cleaning or sterilization processes, including chemical exposure and heat.\n\nCommonly reprocessed SUDs \nCommonly reprocessed medical devices include lower-risk, U.S. FDA Class I non-invasive devices such as sequential compression sleeves, tourniquet cuffs, and pulse oximeter sensors, to medium-risk, FDA Class II minimally invasive surgical devices including Ear, Nose and Throat microdebriders and cautery electrodes, laparoscopic graspers, scissors, forceps, scalpels, orthopedic blades, bits, burs, external fixation clamps, bolts and components, and electrophysiological cardiac catheters.[10] To date, the FDA has not approved for reprocessing any Class III, or higher risk, SUDs.\n\nU.S. regulations for reprocessed SUDs \nThe Medical Device User Fee and Modernization Act of 2002 (MDUFMA), and Medical Device User Fee Stabilization Act of 2005 were signed into law on October 26, 2002, and August 1, 2005, respectively. All medical devices including reprocessed devices are subject to premarket review by the U.S. FDA, unless the agency has, by regulation, declared the device to be exempt from premarket requirements.[1] Unless exempt, the lower risk \u201cClass I\u201d and \u201cClass II\u201d devices, whether \u201coriginal\u201d or reprocessed, are required to have cleared premarket notification submissions (\u201c510(k)s\u201d).[11] With regard to premarket review, reprocessors are subject to more stringent regulation by FDA than are OEMs[12] because MDUFMA, require FDA to withdraw premarket notification exemptions for a significant number of previously exempt reprocessed devices, although \u201coriginal\u201d devices remain exempt from premarket review.[13]\nReprocessors must also validate the cleaning and sterilization methods they seek to use in the reprocessing of a SUD, and include in their 510(k) submissions \u201cvalidation data [...] regarding cleaning, sterilization, and functional performance\u201d to show that the reprocessed device \u201cwill remain substantially equivalent [...] after the maximum number of times the device is reprocessed as intended\u201d.[14] Both OEMs and reprocessors are subject to establishment registration and medical device listing; medical device reporting; medical device tracking; reports of corrections and removals, the quality system regulation (\u201cQSR\u201d); and labeling requirements.[6]\n\nSafety and efficacy of reprocessed SUDs \nFDA and the independent U.S. Government Accountability Office (GAO) have concluded that there is no evidence of harm to patients from FDA-regulated reprocessed SUDs. A 2008 GAO report found that of the over 320,000 adverse events filed with FDA between 2000 and 2006, only 65 adverse events \u201cactually involved or were suspected to involve a reprocessed SUD and that the reprocessed SUD was one of several possible causal factors in the adverse event. In reviewing these 65 reports, FDA found that the types of adverse events reported to be associated with the use of reprocessed SUDs were the same types of events that were reported for new devices\u201d.[15] The 2008 GAO report concluded: \u201cAfter reviewing the available evidence \u2013 including FDA\u2019s process for identifying and investigating device-related adverse events reported to involve reprocessed SUDs, peer-reviewed studies published since 2000, and the results of our and FDA\u2019s consultations with hospital representatives \u2013 we found no reason to question FDA\u2019s analysis indicating that no causative link has been established between reported injuries or deaths and reprocessed SUDs\".[15] In a separate letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006, FDA indicated that a total of 65,325 reports have been filed between 2003 and 2006 for the malfunction or injury associated with the first use of devices labeled for \u201csingle use.\u201d The same search produced 176 cases of apparent malfunction or injury associated with reprocessed devices. Upon analysis of the latter reports, FDA determined that these adverse events were not related to the reprocessing of the \u201csingle use\u201d device.[16]\n\nBenefits of reprocessing \nEconomic \nFDA-regulated reprocessed devices cost between 40%-60% of an original device.[17] Currently, reprocessors estimate that a typical 200-bed hospital, if taking advantage of a reprocessor\u2019s full product line, can save between $600,000 and $1 million a year and divert between 5,000 and 15,000 pounds of waste from landfills.[18] According to a study by The Commonwealth Fund with funding from the Robert Wood Johnson Foundation and Health Care Without Harm in November 2012, they estimated that from hospitals implementing a reprocessing program, cost savings over five years was about $57 per procedure, and that if hospitals nationwide adopted an SUD reprocessing intervention, cost savings would be $540 million annually, or $2.7 billion over five years.[19]\n\nEnvironmental \nRegulated medical waste (RMW), or \u201cred bag waste,\u201d is a waste expenditure that typically costs hospitals 6 to 10 times more to dispose of than regular solid waste.[17] Among the inventory of devices reprocessed annually, ninety-five percent (95%) are recycled at the end of their life cycle rather than sent to landfills.[20] A variety of otherwise reprocessable raw materials that end up in a hospital\u2019s RMW include stainless steel, aluminum, titanium, gold, polycarbonate and polyurethane. Reprocessing has allowed some hospitals to divert over 8,000 pounds of RMW from landfills each year, while larger systems can divert more than 50,000 pounds.[21]\n\nPhysician and Clinical Statements in Support \nAmerican College of Cardiology (ACC) (1999)[22]\nAssociation for Healthcare Resource and Materials Management (AHRMM) Reprocessing Advisory [23]\nAmerican Hospital Association (AHA) (2000) [24]\nAmerican Medical Association (AMA), Report of the Council on Scientific Affairs (I-00) (2000) [25]\nAmerican Nursing Association (ANA), (2010)[26]\nAssociation of periOperative Registered Nurses (AORN), Environmental Responsibility (2006)[27]\nPractice Greenhealth [28]\nThe Mayo Clinic (with AAOS and AHA), August 2, 2001 [29]\nList of Known Regulated Third-Party SUD Reprocessing Vendors \n\n\nRegulated Vendor\nLocation\n\n\nHygia Health Services[30]\nBirmingham, AL\n\n\nMedline ReNewal[31]\nRedmond, OR\n\n\nNEScientific[32]\nWaterbury, CT\n\n\nReNu Medical[33]\nEverett, WA\n\n\nSterilMed, Inc[34]\nMaple Grove, MN\n\n\nSteriPro Canada, Inc[35]\nToronto, Canada\n\n\nStryker Sustainability Solutions[36]\nLakeland, FL\n\n\nSureTek Medical[37]\nGreenville, SC\n\n\nVanguard (International)[38]\nBerlin, Germany\n\n\nThe Association of Medical Device Reprocessors (AMDR),[39] based in Washington, D.C., is the global trade association consisting of members of the regulated, commercial single-use medical device reprocessing and remanufacturing industry. AMDR was founded in 1997 and the commercial single-use medical device reprocessors in the association now serve a majority of U.S. hospitals, including all the country\u2019s Honor Roll hospitals, as ranked by U.S. News & World Report.\"[40]\n\n International Regulation of \u201cSingle-Use\u201d Medical Device Reprocessing \nThe reprocessing of SUDs is commonplace worldwide. Even in developed nations, including those that have reprocessing prohibitions in place, hospitals routinely reuse SUDs in an unregulated manner. In many cases (particularly in Africa and Asia), uncontrolled reuse of such devices is relatively common, if not the norm.[41]\n\nEuropean Union \nCurrently, the European Union (EU) does not have a single policy regarding the reprocessing of SUDs. However, it is in the process of revising its Medical Device Directive. In 1993, at the issuance of the last Medical Device Directive, the issue of medical device reprocessing was identified as in need of additional clarification and the European Commission was instructed to submit a report on the issue by 2010.[42] In August, 2010, the Commission released its report,[43] highlighting the risks of unregulated reprocessing. Ultimately, the European Commission released its proposal[44] and the European Parliament approved its draft[45] (9 October 2013). Both legislative versions propose to regulate reprocessing as manufacturing. The European Council is now set to approve its own version of the legislation. Ultimately, both the Council and Parliament will have to agree, meeting in Trialogue with the European Commission, on the final version of the legislation. It is hoped the final agreement on the regulation will completed in 2015.\nUntil then, regulation of reprocessing activities is left to the individual Member States. Since 2001, Germany has had in place a regulatory framework that does not distinguish between the reprocessing of \u201creusable\u201d and so-called \u201csingle-use\u201d medical devices. The guidelines, therefore, allow for SUD reprocessing if conformance with certain standards is achieved. The German Medical Devices Law and the Medical Devices Operator Ordinance regulate the reprocessing of medical devices and in doing so refer to the mutual recommendation by the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM) for the reprocessing of medical devices.[46] As a result, the RKI\u2019s requirements must be observed.\nInstitutions, which want to reprocess single-use medical devices, must adopt and implement a quality management system according to DIN EN ISO 13485:2007. Compliance with the quality management requirements is monitored annually by \u201cNotified Bodies\u201d that have been accredited by the Central Authority of the L\u00e4nder for Health Protection with regard to Medicinal Products and Medical Devices (ZLG).\nOther Member States, such as the United Kingdom, Spain and France,[47] discourage or prohibit SUD reprocessing. The majority of Member States in Europe do not have any national regulations regarding reprocessing.[48]\n\nAfrica and the Middle East \nThe lack of resources, including medical devices and distribution channels, \u201cnecessitates the reuse of single-use devices\u201d in much of Africa.[41] This includes the reuse of syringes and needles that have not been sterilized, and even rubber gloves. In the Middle East, available data indicates that reuse of SUDs is common throughout Arab countries (particularly for cardiac catheters), despite the absence of a regulatory framework. Reprocessing in both Africa and the Middle East is done at the user-facility level.[41]\n\nIsrael \nIsrael does not have regulations in place specific to the reprocessing of SUDs, but as a general matter, medical devices must be registered with the Ministry of Health (MOH) before they can be sold in the country. If a product is approved by the U.S. FDA, it will generally be registered by the MOH with no further testing requirements and, therefore, may be lawfully marketed in the country. Consistent with this policy, FDA-cleared reprocessed devices have been registered with MOH and are actively imported into the country.[49]\n\n Asia\/Japan \nThe reuse of SUDs in much of Asia is common, particularly for injection needles.[41] For the most part, there are no national regulations governing reuse of SUDs and, thus, third-party reprocessors do not offer their services in Asia. Rather, most reuse in Asia is conducted in an unregulated-manner at the user-facility level. Reprocessing is not currently regulated in Japan, but, available data indicates that the reuse of SUDs is relatively common. A 2003 survey found that 80 to 90 percent of hospitals reused SUDs.[41]\n\nAustralia \nAustralia enacted regulations regarding the reprocessing (\u201cremanufacturing\u201d in Australia) of SUDs in 2003.[50] Similar to the U.S., in Australia, all reprocessors (third-party, hospital, and OEM) must conform to medical device manufacturer requirements as regulated by the Therapeutic Goods Administration (TGA). Prior to implementation of these requirements, hospital reprocessing of SUDs was common.\n\nCanada \nHealth Canada does not currently regulate reprocessed single-use devices or the third-party companies that are reprocessing these devices for Canadian hospitals. Whether or not to reprocess a single-use device is determined by the territorial and provincial health ministries as well as hospital boards.[51] A number of provinces have adopted similar positions that allow for the reprocessing of SUDs if the third party reprocessor is regulated by the FDA.\n\nBritish Columbia \nBritish Columbia issued a policy to its health authorities stating that by January 1, 2008, all health authorities must have eliminated the reprocessing and reuse of critical contact SUDs, unless they have been reprocessed by a licensed third-party reprocessor that is certified by a national regulatory authority such as Health Canada or the U.S. Food and Drug Administration.[51] The policy was revised in 2011 with additional information that sharps (e.g. scalpel blades, drill bits, saw blades, shavers) and needles shall be single-use and shall not be reprocessed.\n\nManitoba \nManitoba does not permit hospitals to reuse SUDs in-house, but does permit hospitals to contract with an FDA regulated vendor, among other requirements.[52]\n\nAlberta \nAlberta Health Services issued a policy in 2012 prohibiting the reuse and reprocessing of both critical and semi-critical single-use medical devices.[53]\n\nNorthwest Territories \nSince 2005, the Northwest Territories have prohibited reprocessing. Specifically, the Northwest Territories Department of Health and Social Services revised its Hospital and Health Care Facility Standards Regulations to require that \u201ca disposable device intended to be used on a patient during a single procedure shall not be used on a patient for more than one procedure and shall not be used on another patient.\" [51]\n\nOntario \nIn 2006, the Ontario Ministry of Health and Long Term Care endorsed a guidance document developed by its Provincial Infectious Diseases Advisory Committee (PIDAC) advising that critical and semi-critical SUDs must not be reprocessed and reused, unless the reprocessing is done by a licensed reprocessor.[51]\n\nSaskatchewan \nIn 2013, The Saskatchewan Ministry of Health affirmed a policy outlining requirements for hospitals that reprocess SUDs. Consistent with the policies of other provinces, Saskatchewan requires, among other things, that hospitals outsource to an FDA regulated vendor.[54]\n\nReferences \n\n\n^ a b \"Reprocessing of Single-Use Devices\". Fda.gov. 2006-09-26. Retrieved 2013-10-24 . \n\n^ \"A Winning Approach | AMH Magazine - Preventing Infection in Medical Treatment\". AMH Magazine. Retrieved 2013-10-24 . \n\n^ Landro, Laura (2008-03-19). \"Hospitals Reuse Medical Devices To Lower Costs - WSJ.com\". Online.wsj.com. Retrieved 2013-10-24 . \n\n^ Rodak, Sabrina (2013-06-14). \"Reprocessing Saves Up to $20k Per OR Annually\". Beckersasc.com. Retrieved 2013-10-24 . \n\n^ a b \"Reuse of Medical Devices Labeled for Single-use\". Fda.gov. Retrieved 2013-10-24 . \n\n^ a b c \"Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"MDUFMA Frequently Asked Questions\". Fda.gov. Retrieved 2013-10-24 . \n\n^ Office, U. S. Government Accountability (2008-03-03). \"Reprocessed Single Use Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk\" (GAO-08\u2013147). GAO-08-147: Published: Jan 31, 2008. Publicly Released: Mar 3, 2008. \n\n^ \"Draft Guidance for Industry and FDA Staff - Processing\/Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"List of Single-Use Devices Known To Be Reprocessed or Considered for Reprocessing (Attachment 1)\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"List 2 - Reprocessed Single-Use Devices Subject to Premarket Notification Requirements That Now Require the Submission of Validation\". Fda.gov. Retrieved 2013-10-24 . \n\n^ Testimony of Dr. Daniel Schultz, Director, CDRH, FDA (September 26, 2006) (\"Congress mandated a number of new requirements for SUD reprocessors including, for certain SUDs, the pre-market submission of data to the agency that exceeded the requirements for the original manufacturers (OEMs)\" http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121067.htm \n\n^ \"Guidance for Industry and FDA Staff - Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Single-Use Medical Devices\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"68 Fed. Reg. 23139\" (PDF) . April 30, 2003. citing 21 U.S.C. \u00a7 360(o) (emphasis added). For a full description of the validation data reprocessors must submit on a premarket basis, including more particular guidance on cleaning, functional testing, and sterilization data requirements, see Guidance for Industry and FDA Staff: Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Medical Devices (Sept. 25, 2006), at 15 \n\n^ a b U.S. Government Accountability Office, GAO-08-147, Reprocessed Single-Use Medical Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk (January 2008), at 1 http:\/\/www.gao.gov\/new.items\/d08147.pdf; See also, GAO\u2019s 2000 report: \n\n^ \"Letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006\" (PDF) . Fda.gov. Retrieved 2013-10-24 . \n\n^ a b Sheehan, Kaeleigh. \"Reprocess and Reuse\". Greenhealth Magazine. Retrieved 2013-10-24 . \n\n^ \"Remanufactured Goods: An Overview\" (PDF) . Usitc.gov. Retrieved 2014-03-07 . \n\n^ SuSan Kaplan, Blair Sadler, Kevin little, Calvin Franz, and Peter OrrisS \"Can Sustainable Hospitals Help Bend the Health Care Cost Curve?\". The Commonwealth Fund. Retrieved 2013-10-24 . \n\n^ \"AMDR Statement\" (PDF) . Usitc.gov. Retrieved 2014-03-07 . \n\n^ \"Healthier Hospitals Initiative 2012 Milestone Report\" (PDF) . Healthierhosptials.org. Retrieved 2014-03-07 . \n\n^ \"Letter from American College of Cardiology to Senator Richard Durbin in support of reprocessing\" (PDF) . 1999. \n\n^ \"Reprocessing Advisory\". ahrmm.org. Retrieved 2014-03-30 . \n\n^ \"Letter from American Hospital Association to Senator Thad Cochran in support of reprocessing\" (PDF) . 1999. \n\n^ \"2000 Interim Meeting of the American Medical Association, Reports of the Council on Scientific Affairs\" (PDF) . \n\n^ \"American Nursing Association 2010 House of Delegates Resolution: Safety and Effectiveness of Reprocessed Single Use Devices in Healthcare\" (PDF) . 2010. \n\n^ (PDF) http:\/\/amdr.org\/documents\/APICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf. Missing or empty |title= (help) \n\n^ \"Frequently Asked Questions | Practice Greenhealth\". practicegreenhealth.org. Retrieved 2014-03-30 . \n\n^ \"Letter from Mayo Clinic to Secretary Tommy Thompson, Department of Health and Human Services\" (PDF) . 2001. \n\n^ http:\/\/www.hygia.net\/ Official Website \n\n^ http:\/\/www.medlinerenewal.com\/ Official Website \n\n^ http:\/\/www.mdreprocess.com\/ Official Website \n\n^ http:\/\/renumedical.com\/ Official Website \n\n^ http:\/\/www.sterilmed.com\/ Official Website \n\n^ http:\/\/www.steriprocanada.com\/ Official Website \n\n^ http:\/\/sustainability.stryker.com\/ Official Website \n\n^ http:\/\/suretekmedical.com\/ Official Website \n\n^ http:\/\/www.vanguard-healthcare.com\/ Official Website \n\n^ \"Home\". AMDR home page. Retrieved 14 May 2018 . \n\n^ \"AMDR members are serving all of U.S. News & World Report's \"honor roll\" hospitals\". AMDR Top Hopsitals. 2017-09-19. Retrieved 14 May 2018 . \n\n^ a b c d e Popp, Walter; Rasslan, Ossama; Unahalekhaka, Akeau; Brenner, Pola; Fischnaller, Edith; Fathy, Maha; Goldman, Carol; Gillespie, Elizabeth (July 2010). \"What is the use? An international look at reuse of single-use medical devices\". International Journal of Hygiene and Environmental Health. 213 (4): 302\u2013307. doi:10.1016\/j.ijheh.2010.04.003. PMID 20471316. \n\n^ \"Council Directive 93\/42\/EEC (14 June 1993), Article 12a, OJ L 169, 12.7.1993, p. 1.\" \n\n^ \"Report from the Commission to the European Parliament and the Council: Report on the Issue of the Reprocessing of Medical Devices in the European Union, in Accordance with Article 12a of Directive 93\/42\/EEC, European Commission (27 August 2010).\" \n\n^ \"European Commission, Proposal for a REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (26 September 2012).\" \n\n^ \"European Parliament, Report on the proposal for a regulation of the European Parliament and of the Council on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (COM(2012)0542 \u2013 C7-0318\/2012 \u2013 2012\/0266(COD)), Committee on the Environment, Public Health and Food Safety (9 October 2013).\" \n\n^ \"Hygienic Requirements for Processing of Medical Devices: Recommendation by the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI) and the Federal German Institute for Medical Drugs and Medical Products (BfArM) Concerning the \"Hygienic Requirements for Processing of Medical Devices,\" Robert Koch Institute: Recommendation (2001).\" \n\n^ Commission Report, supra note 2, at 6. See also, Circulaire DGS\/DH n 51 (December 29, 1994) Relative a l\u2019utilisation des dispositifs medicaux steriles a usage unique dans les etblissements de sant\u00e9 publics et prives (France), Ministerio de sanidad y consume, Royal Decree 414.1996 Sec. 5, (July 9, 1999) (Spain) and MHRA Device Bulletin: DB 2006(04) Single-Use Medical Devices: Implications and Consequences of Reuse (UK).\" \n\n^ Commission Report, supra note 2, at 6. See also, European Association of Medical Device Reprocessors.\" \n\n^ \"Medical Device Regulatory Requirements for Israel,\", U.S. International Trade Administration (May 2, 2005) http:\/\/www.ita.doc.gov\/td\/health\/israelregs.html \n\n^ \"Statement by the TGA on regulations for sterilisation of single use devices,\" Australian Government, Therapeutic Goods Administration (July 21, 2003) http:\/\/www.tga.gov.au\/archive\/media-2003-sud-030721.htm \n\n^ a b c d CADTH Report \"Issue Analysis Summary: The Reuse of Single-Use Medical Devices,\" Health Canada; Therapeutic Products Directorate (April 28, 2005) http:\/\/www.hc-sc.gc.ca\/dhp-mps\/alt_formats\/hpfb-dgpsa\/pdf\/md-im\/saprmd_ias_gcsrmm_raq_2005-06-09-eng.pdf. See also, \"Reprocessing Single-Use Medical Devices: An Update of the Clinical Evidence and An Environmental Scan of Policies in Canada,\" Canadian Agency for Drugs and Technologies in Health (June 23, 2010) http:\/\/www.cadth.ca\/media\/pdf\/ES8_Reprocessing_SUDs_e.pdf \n\n^ Manitoba Deputy Health Minister\u2019s Office (March 21, 2013) \n\n^ Alberta Health Services. Single Use Medical Devices Policy. May 1, 2012 http:\/\/www.albertahealthservices.ca\/6444.asp \n\n^ Saskatchewan Health, Deputy Minister\u2019s Office (June 27, 2013) \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing\">https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing<\/a>\n\t\t\t\t\tCategories: Healthcare termsRegulation of medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:17.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,328 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c9e7e589abaded1dc205bee7420521de_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Single-use_medical_device_reprocessing skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Single-use medical device reprocessing<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Single-use medical device reprocessing<\/b> is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disinfection\" class=\"mw-redirect\" title=\"Disinfection\" rel=\"external_link\" target=\"_blank\">disinfection<\/a>, cleaning, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remanufacturing\" title=\"Remanufacturing\" rel=\"external_link\" target=\"_blank\">remanufacturing<\/a>, testing, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Packaging_and_labeling\" title=\"Packaging and labeling\" rel=\"external_link\" target=\"_blank\">packaging and labeling<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> among other steps, of a used, (or, in some cases, a device opened from its original packaging but unused), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> to be put in service again. All reprocessed medical devices originally labeled for single use in the United States are subject to <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Food_and_Drug_Administration\" class=\"mw-redirect\" title=\"U.S. Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a> (FDA) manufacturing requirements and must meet strict cleaning, functionality, and sterility specifications prior to use.<sup id=\"rdp-ebb-cite_ref-fda_a_1-0\" class=\"reference\"><a href=\"#cite_note-fda_a-1\" rel=\"external_link\">[1]<\/a><\/sup> Although first regulated in the U.S., the reprocessing of medical devices, particularly those that are labeled \u201cSingle Use Device\u201d (SUDs), is a global practice with countries in Europe, Asia, Africa, and North America actively engaged in reprocessing.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Currently, approximately 2% of all SUDs on the U.S. market are eligible for reprocessing by a qualified third-party <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vendor\" title=\"Vendor\" rel=\"external_link\" target=\"_blank\">vendor<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> The U.S. revenue for reprocessed devices (not SUDs) is estimated to be around $400 million annually.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History_of_reprocessing_in_the_United_States\">History of reprocessing in the United States<\/span><\/h2>\n<p>The practice of reusing medical devices labeled for only one use began in hospitals in the late 1970s.<sup id=\"rdp-ebb-cite_ref-fda_5-0\" class=\"reference\"><a href=\"#cite_note-fda-5\" rel=\"external_link\">[5]<\/a><\/sup> After a thorough review by the U.S. FDA in 1999 and 2000,<sup id=\"rdp-ebb-cite_ref-fda_5-1\" class=\"reference\"><a href=\"#cite_note-fda-5\" rel=\"external_link\">[5]<\/a><\/sup> the agency released a guidance document for reprocessed SUDs that began regulating the sale of these reprocessed devices on the market,<sup id=\"rdp-ebb-cite_ref-Fda.gov_6-0\" class=\"reference\"><a href=\"#cite_note-Fda.gov-6\" rel=\"external_link\">[6]<\/a><\/sup> under the condition that third-party reprocessors would be treated as the manufacturer and would meet the same criteria as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Original_equipment_manufacturers\" class=\"mw-redirect\" title=\"Original equipment manufacturers\" rel=\"external_link\" target=\"_blank\">original equipment manufacturers<\/a> (OEMs) of the medical device.<sup id=\"rdp-ebb-cite_ref-Fda.gov_6-1\" class=\"reference\"><a href=\"#cite_note-Fda.gov-6\" rel=\"external_link\">[6]<\/a><\/sup> Following the implementation of FDA regulation, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Congress\" class=\"mw-redirect\" title=\"U.S. Congress\" rel=\"external_link\" target=\"_blank\">U.S. Congress<\/a> codified these standards and other requirements in the Medical Device User Fee Act of 2002.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"The_Single_Use_Label\">The Single Use Label<\/span><\/h3>\n<p>Original equipment manufacturers undergo a thorough analysis to determine whether a device should be single-use or reusable. Factors in determining to label a device single-use include but are not limited to possible infection\/sterility concerns and the risk of reduced efficacy. Depending on the device and its design, failure to completely clean a single-use device could lead to cross patient infection or there is the risk that the chemicals used to clean the device will themselves pose a risk to patients by being absorbed, for example, by the plastic from which the device is made and then subsequently leaching out into a patient's body. There can also be the risk of deterioration of the device when exposed to cleaning or sterilization processes which could lead to device malfunction. When a manufacturer designs and develops a product, it determines the materials used and how the device is labeled.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> In the U.S., to market a device as \u201c<a href=\"https:\/\/en.wikipedia.org\/wiki\/Reuse\" title=\"Reuse\" rel=\"external_link\" target=\"_blank\">reusable<\/a>\u201d, a manufacturer must provide increased data requirements and invest the resources necessary to demonstrate to FDA that the product can be safely reprocessed at the hospital level.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Unlike reusable devices, single-use devices are not sold with instructions on how they can be properly cleaned and sterilized nor have they been validated or tested for exposure to cleaning or sterilization processes, including chemical exposure and heat.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Commonly_reprocessed_SUDs\">Commonly reprocessed SUDs<\/span><\/h2>\n<p>Commonly reprocessed medical devices include lower-risk, U.S. FDA Class I non-invasive devices such as sequential compression sleeves, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tourniquet\" title=\"Tourniquet\" rel=\"external_link\" target=\"_blank\">tourniquet<\/a> cuffs, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_oximeter\" class=\"mw-redirect\" title=\"Pulse oximeter\" rel=\"external_link\" target=\"_blank\">pulse oximeter<\/a> sensors, to medium-risk, FDA Class II minimally invasive surgical devices including Ear, Nose and Throat microdebriders and cautery electrodes, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic\" class=\"mw-redirect\" title=\"Laparoscopic\" rel=\"external_link\" target=\"_blank\">laparoscopic<\/a> graspers, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps\" title=\"Forceps\" rel=\"external_link\" target=\"_blank\">forceps<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpels\" class=\"mw-redirect\" title=\"Scalpels\" rel=\"external_link\" target=\"_blank\">scalpels<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic\" class=\"mw-redirect\" title=\"Orthopedic\" rel=\"external_link\" target=\"_blank\">orthopedic<\/a> blades, bits, burs, <a href=\"https:\/\/en.wikipedia.org\/wiki\/External_fixation\" title=\"External fixation\" rel=\"external_link\" target=\"_blank\">external fixation<\/a> clamps, bolts and components, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrophysiological\" class=\"mw-redirect\" title=\"Electrophysiological\" rel=\"external_link\" target=\"_blank\">electrophysiological<\/a> cardiac <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheters\" class=\"mw-redirect\" title=\"Catheters\" rel=\"external_link\" target=\"_blank\">catheters<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> To date, the FDA has not approved for reprocessing any Class III, or higher risk, SUDs.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"U.S._regulations_for_reprocessed_SUDs\">U.S. regulations for reprocessed SUDs<\/span><\/h2>\n<p>The Medical Device User Fee and Modernization Act of 2002 (MDUFMA), and Medical Device User Fee Stabilization Act of 2005 were signed into law on October 26, 2002, and August 1, 2005, respectively. All medical devices including reprocessed devices are subject to premarket review by the U.S. FDA, unless the agency has, by regulation, declared the device to be exempt from premarket requirements.<sup id=\"rdp-ebb-cite_ref-fda_a_1-1\" class=\"reference\"><a href=\"#cite_note-fda_a-1\" rel=\"external_link\">[1]<\/a><\/sup> Unless exempt, the lower risk \u201cClass I\u201d and \u201cClass II\u201d devices, whether \u201coriginal\u201d or reprocessed, are required to have cleared premarket notification submissions (\u201c510(k)s\u201d).<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> With regard to premarket review, reprocessors are subject to more stringent regulation by FDA than are OEMs<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> because MDUFMA, require FDA to withdraw premarket notification exemptions for a significant number of previously exempt reprocessed devices, although \u201coriginal\u201d devices remain exempt from premarket review.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\nReprocessors must also validate the cleaning and sterilization methods they seek to use in the reprocessing of a SUD, and include in their 510(k) submissions \u201cvalidation data [...] regarding cleaning, sterilization, and functional performance\u201d to show that the reprocessed device \u201cwill remain substantially equivalent [...] after the maximum number of times the device is reprocessed as intended\u201d.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Both OEMs and reprocessors are subject to establishment registration and medical device listing; medical device reporting; medical device tracking; reports of corrections and removals, the quality system regulation (\u201cQSR\u201d); and labeling requirements.<sup id=\"rdp-ebb-cite_ref-Fda.gov_6-2\" class=\"reference\"><a href=\"#cite_note-Fda.gov-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Safety_and_efficacy_of_reprocessed_SUDs\">Safety and efficacy of reprocessed SUDs<\/span><\/h2>\n<p>FDA and the independent <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Government_Accountability_Office\" class=\"mw-redirect\" title=\"U.S. Government Accountability Office\" rel=\"external_link\" target=\"_blank\">U.S. Government Accountability Office<\/a> (GAO) have concluded that there is no evidence of harm to patients from FDA-regulated reprocessed SUDs. A 2008 GAO report found that of the over 320,000 adverse events filed with FDA between 2000 and 2006, only 65 adverse events \u201cactually involved or were suspected to involve a reprocessed SUD and that the reprocessed SUD was one of several possible causal factors in the adverse event. In reviewing these 65 reports, FDA found that the types of adverse events reported to be associated with the use of reprocessed SUDs were the same types of events that were reported for new devices\u201d.<sup id=\"rdp-ebb-cite_ref-GAO_a_15-0\" class=\"reference\"><a href=\"#cite_note-GAO_a-15\" rel=\"external_link\">[15]<\/a><\/sup> The 2008 GAO report concluded: \u201cAfter reviewing the available evidence \u2013 including FDA\u2019s process for identifying and investigating device-related adverse events reported to involve reprocessed SUDs, peer-reviewed studies published since 2000, and the results of our and FDA\u2019s consultations with hospital representatives \u2013 we found no reason to question FDA\u2019s analysis indicating that no causative link has been established between reported injuries or deaths and reprocessed SUDs\".<sup id=\"rdp-ebb-cite_ref-GAO_a_15-1\" class=\"reference\"><a href=\"#cite_note-GAO_a-15\" rel=\"external_link\">[15]<\/a><\/sup> In a separate letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006, FDA indicated that a total of 65,325 reports have been filed between 2003 and 2006 for the malfunction or injury associated with the first use of devices labeled for \u201csingle use.\u201d The same search produced 176 cases of apparent malfunction or injury associated with reprocessed devices. Upon analysis of the latter reports, FDA determined that these adverse events were not related to the reprocessing of the \u201csingle use\u201d device.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Benefits_of_reprocessing\">Benefits of reprocessing<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Economic\">Economic<\/span><\/h3>\n<p>FDA-regulated reprocessed devices cost between 40%-60% of an original device.<sup id=\"rdp-ebb-cite_ref-greenhealthmagazine_17-0\" class=\"reference\"><a href=\"#cite_note-greenhealthmagazine-17\" rel=\"external_link\">[17]<\/a><\/sup> Currently, reprocessors estimate that a typical 200-bed hospital, if taking advantage of a reprocessor\u2019s full product line, can save between $600,000 and $1 million a year and divert between 5,000 and 15,000 pounds of waste from landfills.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> According to a study by <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Commonwealth_Fund\" class=\"mw-redirect\" title=\"The Commonwealth Fund\" rel=\"external_link\" target=\"_blank\">The Commonwealth Fund<\/a> with funding from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Wood_Johnson_Foundation\" title=\"Robert Wood Johnson Foundation\" rel=\"external_link\" target=\"_blank\">Robert Wood Johnson Foundation<\/a> and Health Care Without Harm in November 2012, they estimated that from hospitals implementing a reprocessing program, cost savings over five years was about $57 per procedure, and that if hospitals nationwide adopted an SUD reprocessing intervention, cost savings would be $540 million annually, or $2.7 billion over five years.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Environmental\">Environmental<\/span><\/h3>\n<p>Regulated medical waste (RMW), or \u201cred bag waste,\u201d is a waste expenditure that typically costs hospitals 6 to 10 times more to dispose of than regular solid waste.<sup id=\"rdp-ebb-cite_ref-greenhealthmagazine_17-1\" class=\"reference\"><a href=\"#cite_note-greenhealthmagazine-17\" rel=\"external_link\">[17]<\/a><\/sup> Among the inventory of devices reprocessed annually, ninety-five percent (95%) are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recycled\" class=\"mw-redirect\" title=\"Recycled\" rel=\"external_link\" target=\"_blank\">recycled<\/a> at the end of their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Product_life_cycle\" class=\"mw-redirect\" title=\"Product life cycle\" rel=\"external_link\" target=\"_blank\">life cycle<\/a> rather than sent to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Landfills\" class=\"mw-redirect\" title=\"Landfills\" rel=\"external_link\" target=\"_blank\">landfills<\/a>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> A variety of otherwise reprocessable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Raw_materials\" class=\"mw-redirect\" title=\"Raw materials\" rel=\"external_link\" target=\"_blank\">raw materials<\/a> that end up in a hospital\u2019s RMW include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, aluminum, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, gold, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycarbonate\" title=\"Polycarbonate\" rel=\"external_link\" target=\"_blank\">polycarbonate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a>. Reprocessing has allowed some hospitals to divert over 8,000 pounds of RMW from landfills each year, while larger systems can divert more than 50,000 pounds.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Physician_and_Clinical_Statements_in_Support\">Physician and Clinical Statements in Support<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_College_of_Cardiology\" title=\"American College of Cardiology\" rel=\"external_link\" target=\"_blank\">American College of Cardiology<\/a> (ACC) (1999)<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><\/li>\n<li>Association for Healthcare Resource and Materials Management (AHRMM) Reprocessing Advisory <sup id=\"rdp-ebb-cite_ref-ahrmm_23-0\" class=\"reference\"><a href=\"#cite_note-ahrmm-23\" rel=\"external_link\">[23]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Hospital_Association\" title=\"American Hospital Association\" rel=\"external_link\" target=\"_blank\">American Hospital Association<\/a> (AHA) (2000) <sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Medical_Association\" title=\"American Medical Association\" rel=\"external_link\" target=\"_blank\">American Medical Association<\/a> (AMA), Report of the Council on Scientific Affairs (I-00) (2000) <sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Nursing_Association\" class=\"mw-redirect\" title=\"American Nursing Association\" rel=\"external_link\" target=\"_blank\">American Nursing Association<\/a> (ANA), (2010)<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Association_of_periOperative_Registered_Nurses\" title=\"Association of periOperative Registered Nurses\" rel=\"external_link\" target=\"_blank\">Association of periOperative Registered Nurses<\/a> (AORN), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ascquality.org\/Library\/singleusedevicereprocessingtoolkit\/AORN%20Guidance%20Statement%20on%20Reuse%20of%20Single%20Use%20Devices%202006.pdf\" target=\"_blank\">Environmental Responsibility (2006)<\/a><sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup><\/li>\n<li>Practice Greenhealth <sup id=\"rdp-ebb-cite_ref-practicegreenhealth_28-0\" class=\"reference\"><a href=\"#cite_note-practicegreenhealth-28\" rel=\"external_link\">[28]<\/a><\/sup><\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_Clinic\" title=\"Mayo Clinic\" rel=\"external_link\" target=\"_blank\">Mayo Clinic<\/a> (with AAOS and AHA), August 2, 2001 <sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"List_of_Known_Regulated_Third-Party_SUD_Reprocessing_Vendors\">List of Known Regulated Third-Party SUD Reprocessing Vendors<\/span><\/h2>\n<table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>Regulated Vendor<\/th>\n<th>Location\n<\/th><\/tr>\n<tr>\n<td>Hygia Health Services<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><\/td>\n<td>Birmingham, AL\n<\/td><\/tr>\n<tr>\n<td>Medline ReNewal<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup><\/td>\n<td>Redmond, OR\n<\/td><\/tr>\n<tr>\n<td>NEScientific<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><\/td>\n<td>Waterbury, CT\n<\/td><\/tr>\n<tr>\n<td>ReNu Medical<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><\/td>\n<td>Everett, WA\n<\/td><\/tr>\n<tr>\n<td>SterilMed, Inc<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup><\/td>\n<td>Maple Grove, MN\n<\/td><\/tr>\n<tr>\n<td>SteriPro Canada, Inc<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><\/td>\n<td>Toronto, Canada\n<\/td><\/tr>\n<tr>\n<td>Stryker Sustainability Solutions<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><\/td>\n<td>Lakeland, FL\n<\/td><\/tr>\n<tr>\n<td>SureTek Medical<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><\/td>\n<td>Greenville, SC\n<\/td><\/tr>\n<tr>\n<td>Vanguard (International)<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup><\/td>\n<td>Berlin, Germany\n<\/td><\/tr>\n<\/tbody><\/table>\n<p>The Association of Medical Device Reprocessors (AMDR),<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> based in Washington, D.C., is the global <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trade_association\" title=\"Trade association\" rel=\"external_link\" target=\"_blank\">trade association<\/a> consisting of members of the regulated, commercial single-use medical device reprocessing and remanufacturing industry. AMDR was founded in 1997 and the commercial single-use medical device reprocessors in the association now serve a majority of U.S. hospitals, including all the country\u2019s Honor Roll hospitals, as ranked by <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._News_%26_World_Report\" title=\"U.S. News & World Report\" rel=\"external_link\" target=\"_blank\">U.S. News & World Report<\/a>.\"<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-International_Regulation_of_.E2.80.9CSingle-Use.E2.80.9D_Medical_Device_Reprocessing\"><\/span><span class=\"mw-headline\" id=\"International_Regulation_of_\u201cSingle-Use\u201d_Medical_Device_Reprocessing\">International Regulation of \u201cSingle-Use\u201d Medical Device Reprocessing<\/span><\/h2>\n<p>The reprocessing of SUDs is commonplace worldwide. Even in developed nations, including those that have reprocessing prohibitions in place, hospitals routinely reuse SUDs in an unregulated manner. In many cases (particularly in Africa and Asia), uncontrolled reuse of such devices is relatively common, if not the norm.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-0\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"European_Union\">European Union<\/span><\/h3>\n<p>Currently, the European Union (EU) does not have a single policy regarding the reprocessing of SUDs. However, it is in the process of revising its Medical Device Directive. In 1993, at the issuance of the last Medical Device Directive, the issue of medical device reprocessing was identified as in need of additional clarification and the European Commission was instructed to submit a report on the issue by 2010.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> In August, 2010, the Commission released its report,<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> highlighting the risks of unregulated reprocessing. Ultimately, the European Commission released its proposal<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> and the European Parliament approved its draft<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> (9 October 2013). Both legislative versions propose to regulate reprocessing as manufacturing. The European Council is now set to approve its own version of the legislation. Ultimately, both the Council and Parliament will have to agree, meeting in Trialogue with the European Commission, on the final version of the legislation. It is hoped the final agreement on the regulation will completed in 2015.\n<\/p><p>Until then, regulation of reprocessing activities is left to the individual Member States. Since 2001, Germany has had in place a regulatory framework that does not distinguish between the reprocessing of \u201creusable\u201d and so-called \u201csingle-use\u201d medical devices. The guidelines, therefore, allow for SUD reprocessing if conformance with certain standards is achieved. The German Medical Devices Law and the Medical Devices Operator Ordinance regulate the reprocessing of medical devices and in doing so refer to the mutual recommendation by the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM) for the reprocessing of medical devices.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> As a result, the RKI\u2019s requirements must be observed.\n<\/p><p>Institutions, which want to reprocess single-use medical devices, must adopt and implement a quality management system according to DIN EN ISO 13485:2007. Compliance with the quality management requirements is monitored annually by \u201cNotified Bodies\u201d that have been accredited by the Central Authority of the L\u00e4nder for Health Protection with regard to Medicinal Products and Medical Devices (ZLG).\n<\/p><p>Other Member States, such as the United Kingdom, Spain and France,<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> discourage or prohibit SUD reprocessing. The majority of Member States in Europe do not have any national regulations regarding reprocessing.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Africa_and_the_Middle_East\">Africa and the Middle East<\/span><\/h3>\n<p>The lack of resources, including medical devices and distribution channels, \u201cnecessitates the reuse of single-use devices\u201d in much of Africa.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-1\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup> This includes the reuse of syringes and needles that have not been sterilized, and even rubber gloves. In the Middle East, available data indicates that reuse of SUDs is common throughout Arab countries (particularly for cardiac catheters), despite the absence of a regulatory framework. Reprocessing in both Africa and the Middle East is done at the user-facility level.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-2\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Israel\">Israel<\/span><\/h4>\n<p>Israel does not have regulations in place specific to the reprocessing of SUDs, but as a general matter, medical devices must be registered with the Ministry of Health (MOH) before they can be sold in the country. If a product is approved by the U.S. FDA, it will generally be registered by the MOH with no further testing requirements and, therefore, may be lawfully marketed in the country. Consistent with this policy, FDA-cleared reprocessed devices have been registered with MOH and are actively imported into the country.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Asia.2FJapan\"><\/span><span class=\"mw-headline\" id=\"Asia\/Japan\">Asia\/Japan<\/span><\/h3>\n<p>The reuse of SUDs in much of Asia is common, particularly for injection needles.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-3\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup> For the most part, there are no national regulations governing reuse of SUDs and, thus, third-party reprocessors do not offer their services in Asia. Rather, most reuse in Asia is conducted in an unregulated-manner at the user-facility level. Reprocessing is not currently regulated in Japan, but, available data indicates that the reuse of SUDs is relatively common. A 2003 survey found that 80 to 90 percent of hospitals reused SUDs.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-4\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Australia\">Australia<\/span><\/h3>\n<p>Australia enacted regulations regarding the reprocessing (\u201cremanufacturing\u201d in Australia) of SUDs in 2003.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> Similar to the U.S., in Australia, all reprocessors (third-party, hospital, and OEM) must conform to medical device manufacturer requirements as regulated by the Therapeutic Goods Administration (TGA). Prior to implementation of these requirements, hospital reprocessing of SUDs was common.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Canada\">Canada<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Canada\" title=\"Health Canada\" rel=\"external_link\" target=\"_blank\">Health Canada<\/a> does not currently regulate reprocessed single-use devices or the third-party companies that are reprocessing these devices for Canadian hospitals. Whether or not to reprocess a single-use device is determined by the territorial and provincial health ministries as well as hospital boards.<sup id=\"rdp-ebb-cite_ref-CADTH_a_51-0\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup> A number of provinces have adopted similar positions that allow for the reprocessing of SUDs if the third party reprocessor is regulated by the FDA.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"British_Columbia\">British Columbia<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/British_Columbia\" title=\"British Columbia\" rel=\"external_link\" target=\"_blank\">British Columbia<\/a> issued a policy to its health authorities stating that by January 1, 2008, all health authorities must have eliminated the reprocessing and reuse of critical contact SUDs, unless they have been reprocessed by a licensed third-party reprocessor that is certified by a national regulatory authority such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Canada\" title=\"Health Canada\" rel=\"external_link\" target=\"_blank\">Health Canada<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Food_and_Drug_Administration\" class=\"mw-redirect\" title=\"U.S. Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a>.<sup id=\"rdp-ebb-cite_ref-CADTH_a_51-1\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup> The policy was revised in 2011 with additional information that sharps (e.g. scalpel blades, drill bits, saw blades, shavers) and needles shall be single-use and shall not be reprocessed.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Manitoba\">Manitoba<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Manitoba\" title=\"Manitoba\" rel=\"external_link\" target=\"_blank\">Manitoba<\/a> does not permit hospitals to reuse SUDs in-house, but does permit hospitals to contract with an FDA regulated vendor, among other requirements.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Alberta\">Alberta<\/span><\/h4>\n<p>Alberta Health Services issued a policy in 2012 prohibiting the reuse and reprocessing of both critical and semi-critical single-use medical devices.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Northwest_Territories\">Northwest Territories<\/span><\/h4>\n<p>Since 2005, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Northwest_Territories\" title=\"Northwest Territories\" rel=\"external_link\" target=\"_blank\">Northwest Territories<\/a> have prohibited reprocessing. Specifically, the Northwest Territories Department of Health and Social Services revised its Hospital and Health Care Facility Standards Regulations to require that \u201ca disposable device intended to be used on a patient during a single procedure shall not be used on a patient for more than one procedure and shall not be used on another patient.\" <sup id=\"rdp-ebb-cite_ref-CADTH_a_51-2\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Ontario\">Ontario<\/span><\/h4>\n<p>In 2006, the Ontario Ministry of Health and Long Term Care endorsed a guidance document developed by its Provincial Infectious Diseases Advisory Committee (PIDAC) advising that critical and semi-critical SUDs must not be reprocessed and reused, unless the reprocessing is done by a licensed reprocessor.<sup id=\"rdp-ebb-cite_ref-CADTH_a_51-3\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Saskatchewan\">Saskatchewan<\/span><\/h4>\n<p>In 2013, The Saskatchewan Ministry of Health affirmed a policy outlining requirements for hospitals that reprocess SUDs. Consistent with the policies of other provinces, Saskatchewan requires, among other things, that hospitals outsource to an FDA regulated vendor.<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-fda_a-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fda_a_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda_a_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/\" target=\"_blank\">\"Reprocessing of Single-Use Devices\"<\/a>. Fda.gov. 2006-09-26<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocessing+of+Single-Use+Devices&rft.pub=Fda.gov&rft.date=2006-09-26&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amhmagazine.com\/article.php?article_id=818\" target=\"_blank\">\"A Winning Approach | AMH Magazine - Preventing Infection in Medical Treatment\"<\/a>. AMH Magazine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=A+Winning+Approach+%26%23124%3B+AMH+Magazine+-+Preventing+Infection+in+Medical+Treatment&rft.pub=AMH+Magazine&rft_id=http%3A%2F%2Fwww.amhmagazine.com%2Farticle.php%3Farticle_id%3D818&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Landro, Laura (2008-03-19). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wsj.com\/articles\/SB120588469924246975\" target=\"_blank\">\"Hospitals Reuse Medical Devices To Lower Costs - WSJ.com\"<\/a>. Online.wsj.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Hospitals+Reuse+Medical+Devices+To+Lower+Costs+-+WSJ.com&rft.pub=Online.wsj.com&rft.date=2008-03-19&rft.aulast=Landro&rft.aufirst=Laura&rft_id=https%3A%2F%2Fwww.wsj.com%2Farticles%2FSB120588469924246975&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Rodak, Sabrina (2013-06-14). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.beckersasc.com\/asc-supply-chain-materials-management\/reprocessing-saves-up-to-20k-per-or-annually.html\" target=\"_blank\">\"Reprocessing Saves Up to $20k Per OR Annually\"<\/a>. Beckersasc.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocessing+Saves+Up+to+%2420k+Per+OR+Annually&rft.pub=Beckersasc.com&rft.date=2013-06-14&rft.aulast=Rodak&rft.aufirst=Sabrina&rft_id=http%3A%2F%2Fwww.beckersasc.com%2Fasc-supply-chain-materials-management%2Freprocessing-saves-up-to-20k-per-or-annually.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-fda-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fda_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/NewsEvents\/Testimony\/ucm114926.htm\" target=\"_blank\">\"Reuse of Medical Devices Labeled for Single-use\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reuse+of+Medical+Devices+Labeled+for+Single-use&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FNewsEvents%2FTestimony%2Fucm114926.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Fda.gov-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Fda.gov_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fda.gov_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fda.gov_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/GuidanceDocuments\/ucm107164.htm\" target=\"_blank\">\"Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Enforcement+Priorities+for+Single-Use+Devices+Reprocessed+by+Third+Parties+and+Hospitals&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FGuidanceDocuments%2Fucm107164.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#19\">\"MDUFMA Frequently Asked Questions\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=MDUFMA+Frequently+Asked+Questions&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FOverview%2FMedicalDeviceUserFeeandModernizationActMDUFMA%2Fucm109208.htm%2319&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Office, U. S. Government Accountability (2008-03-03). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gao.gov\/products\/GAO-08-147\" target=\"_blank\">\"Reprocessed Single Use Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk\"<\/a> (GAO-08\u2013147). GAO-08-147: Published: Jan 31, 2008. Publicly Released: Mar 3, 2008.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Reprocessed+Single+Use+Devices%3A+FDA+Oversight+Has+Increased%2C+and+Available+Information+Does+Not+Indicate+That+Use+Presents+an+Elevated+Health+Risk&rft.issue=GAO-08%E2%80%93147&rft.date=2008-03-03&rft.aulast=Office&rft.aufirst=U.+S.+Government+Accountability&rft_id=http%3A%2F%2Fwww.gao.gov%2Fproducts%2FGAO-08-147&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/GuidanceDocuments\/ucm252999.htm\" target=\"_blank\">\"Draft Guidance for Industry and FDA Staff - Processing\/Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Draft+Guidance+for+Industry+and+FDA+Staff+-+Processing%2FReprocessing+Medical+Devices+in+Health+Care+Settings%3A+Validation+Methods+and+Labeling&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FGuidanceDocuments%2Fucm252999.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121218.htm\" target=\"_blank\">\"List of Single-Use Devices Known To Be Reprocessed or Considered for Reprocessing (Attachment 1)\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=List+of+Single-Use+Devices+Known+To+Be+Reprocessed+or+Considered+for+Reprocessing+%28Attachment+1%29&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2Fucm121218.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121213.htm\" target=\"_blank\">\"List 2 - Reprocessed Single-Use Devices Subject to Premarket Notification Requirements That Now Require the Submission of Validation\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=List+2+-+Reprocessed+Single-Use+Devices+Subject+to+Premarket+Notification+Requirements+That+Now+Require+the+Submission+of+Validation&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2Fucm121213.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Testimony of Dr. Daniel Schultz, Director, CDRH, FDA (September 26, 2006) (\"Congress mandated a number of new requirements for SUD reprocessors including, for certain SUDs, the pre-market submission of data to the agency that exceeded the requirements for the original manufacturers (OEMs)\" <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121067.htm\" target=\"_blank\">http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121067.htm<\/a><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#3\">\"Guidance for Industry and FDA Staff - Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Single-Use Medical Devices\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guidance+for+Industry+and+FDA+Staff+-+Medical+Device+User+Fee+and+Modernization+Act+of+2002%2C+Validation+Data+in+Premarket+Notification+Submissions+%28510%28k%29s%29+for+Reprocessed+Single-Use+Medical+Devices&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FGuidanceDocuments%2Fucm071434.htm%233&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/FR-2003-04-30\/pdf\/03-10413.pdf\" target=\"_blank\">\"68 Fed. Reg. 23139\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. April 30, 2003.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=68+Fed.+Reg.+23139&rft.date=2003-04-30&rft_id=http%3A%2F%2Fwww.gpo.gov%2Ffdsys%2Fpkg%2FFR-2003-04-30%2Fpdf%2F03-10413.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> citing 21 U.S.C. \u00a7 360(o) (emphasis added). For a full description of the validation data reprocessors must submit on a premarket basis, including more particular guidance on cleaning, functional testing, and sterilization data requirements, see Guidance for Industry and FDA Staff: Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Medical Devices (Sept. 25, 2006), at 15<\/span>\n<\/li>\n<li id=\"cite_note-GAO_a-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-GAO_a_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GAO_a_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">U.S. Government Accountability Office, GAO-08-147, Reprocessed Single-Use Medical Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk (January 2008), at 1 <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.gao.gov\/new.items\/d08147.pdf\" target=\"_blank\">http:\/\/www.gao.gov\/new.items\/d08147.pdf<\/a>; See also, GAO\u2019s 2000 report:<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/wp-content\/uploads\/2014\/03\/FDA-response-01.23.06.pdf\" target=\"_blank\">\"Letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+FDA+to+Congressman+Tom+Davis+and+Harry+Waxman+dated+January+23%2C+2006&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.amdr.org%2Fwp-content%2Fuploads%2F2014%2F03%2FFDA-response-01.23.06.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-greenhealthmagazine-17\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-greenhealthmagazine_17-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-greenhealthmagazine_17-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Sheehan, Kaeleigh. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/greenhealthmagazine.org\/reprocess-and-reuse\/\" target=\"_blank\">\"Reprocess and Reuse\"<\/a>. Greenhealth Magazine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocess+and+Reuse&rft.pub=Greenhealth+Magazine&rft.aulast=Sheehan&rft.aufirst=Kaeleigh&rft_id=http%3A%2F%2Fgreenhealthmagazine.org%2Freprocess-and-reuse%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usitc.gov\/publications\/332\/pub4356.pdf\" target=\"_blank\">\"Remanufactured Goods: An Overview\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Usitc.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Remanufactured+Goods%3A+An+Overview&rft.pub=Usitc.gov&rft_id=http%3A%2F%2Fwww.usitc.gov%2Fpublications%2F332%2Fpub4356.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">SuSan Kaplan, Blair Sadler, Kevin little, Calvin Franz, and Peter OrrisS <cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121218.htm\" target=\"_blank\">\"Can Sustainable Hospitals Help Bend the Health Care Cost Curve?\"<\/a>. The Commonwealth Fund<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Can+Sustainable+Hospitals+Help++Bend+the+Health+Care+Cost+Curve%3F&rft.pub=The+Commonwealth+Fund&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2Fucm121218.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usitc.gov\/press_room\/documents\/testimony\/332_525_015.pdf\" target=\"_blank\">\"AMDR Statement\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Usitc.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=AMDR+Statement&rft.pub=Usitc.gov&rft_id=http%3A%2F%2Fwww.usitc.gov%2Fpress_room%2Fdocuments%2Ftestimony%2F332_525_015.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/healthierhospitals.org\/sites\/default\/files\/IMCE\/public_files\/Pdfs\/hhi_2012_milestone_report.pdf\" target=\"_blank\">\"Healthier Hospitals Initiative 2012 Milestone Report\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Healthierhosptials.org<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Healthier+Hospitals+Initiative+2012+Milestone+Report&rft.pub=Healthierhosptials.org&rft_id=http%3A%2F%2Fhealthierhospitals.org%2Fsites%2Fdefault%2Ffiles%2FIMCE%2Fpublic_files%2FPdfs%2Fhhi_2012_milestone_report.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/documents\/ACCLtrtoRichardDurbin.pdf\" target=\"_blank\">\"Letter from American College of Cardiology to Senator Richard Durbin in support of reprocessing\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 1999.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+American+College+of+Cardiology+to+Senator+Richard+Durbin+in+support+of+reprocessing&rft.date=1999&rft_id=http%3A%2F%2Famdr.org%2Fdocuments%2FACCLtrtoRichardDurbin.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ahrmm-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ahrmm_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ahrmm.org\/ahrmm\/news_and_issues\/issues_and_initiatives\/reprocessing_advisory\/index.jsp\" target=\"_blank\">\"Reprocessing Advisory\"<\/a>. ahrmm.org<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocessing+Advisory&rft.pub=ahrmm.org&rft_id=http%3A%2F%2Fwww.ahrmm.org%2Fahrmm%2Fnews_and_issues%2Fissues_and_initiatives%2Freprocessing_advisory%2Findex.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/wp-content\/uploads\/2011\/03\/AHA-Ltr-to-Thad-Cochran.pdf\" target=\"_blank\">\"Letter from American Hospital Association to Senator Thad Cochran in support of reprocessing\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 1999.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+American+Hospital+Association+to+Senator+Thad+Cochran+in+support+of+reprocessing&rft.date=1999&rft_id=http%3A%2F%2Fwww.amdr.org%2Fwp-content%2Fuploads%2F2011%2F03%2FAHA-Ltr-to-Thad-Cochran.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/wp-content\/uploads\/2014\/10\/AMA-Report-on-Reuse_1.pdf\" target=\"_blank\">\"2000 Interim Meeting of the American Medical Association, Reports of the Council on Scientific Affairs\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=2000+Interim+Meeting+of+the+American+Medical+Association%2C+Reports+of+the+Council+on+Scientific+Affairs&rft_id=http%3A%2F%2Fwww.amdr.org%2Fwp-content%2Fuploads%2F2014%2F10%2FAMA-Report-on-Reuse_1.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nursingworld.org\/MainMenuCategories\/WorkplaceSafety\/Healthy-Work-Environment\/Environmental-Health\/PolicyIssues\/Single-Use-Devices.pdf\" target=\"_blank\">\"American Nursing Association 2010 House of Delegates Resolution: Safety and Effectiveness of Reprocessed Single Use Devices in Healthcare\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2010.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=American+Nursing+Association+2010+House+of+Delegates+Resolution%3A+Safety+and+Effectiveness+of+Reprocessed+Single+Use+Devices+in+Healthcare&rft.date=2010&rft_id=http%3A%2F%2Fwww.nursingworld.org%2FMainMenuCategories%2FWorkplaceSafety%2FHealthy-Work-Environment%2FEnvironmental-Health%2FPolicyIssues%2FSingle-Use-Devices.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"> <span class=\"cs1-format\">(PDF)<\/span> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/documents\/APICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf\" target=\"_blank\">http:\/\/amdr.org\/documents\/APICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft_id=http%3A%2F%2Famdr.org%2Fdocuments%2FAPICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Missing or empty <code class=\"cs1-code\">|title=<\/code> (<a href=\"#citation_missing_title\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-practicegreenhealth-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-practicegreenhealth_28-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/practicegreenhealth.org\/node\/16157\" target=\"_blank\">\"Frequently Asked Questions | Practice Greenhealth\"<\/a>. practicegreenhealth.org<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Frequently+Asked+Questions+%26%23124%3B+Practice+Greenhealth&rft.pub=practicegreenhealth.org&rft_id=https%3A%2F%2Fpracticegreenhealth.org%2Fnode%2F16157&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/documents\/MayoAAOSAHAltrtoThompson8-2-01.pdf\" target=\"_blank\">\"Letter from Mayo Clinic to Secretary Tommy Thompson, Department of Health and Human Services\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2001.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+Mayo+Clinic+to+Secretary+Tommy+Thompson%2C+Department+of+Health+and+Human+Services&rft.date=2001&rft_id=http%3A%2F%2Famdr.org%2Fdocuments%2FMayoAAOSAHAltrtoThompson8-2-01.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hygia.net\/\" target=\"_blank\">http:\/\/www.hygia.net\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.medlinerenewal.com\/\" target=\"_blank\">http:\/\/www.medlinerenewal.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.mdreprocess.com\/\" target=\"_blank\">http:\/\/www.mdreprocess.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/renumedical.com\/\" target=\"_blank\">http:\/\/renumedical.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.sterilmed.com\/\" target=\"_blank\">http:\/\/www.sterilmed.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.steriprocanada.com\/\" target=\"_blank\">http:\/\/www.steriprocanada.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/sustainability.stryker.com\/\" target=\"_blank\">http:\/\/sustainability.stryker.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/suretekmedical.com\/\" target=\"_blank\">http:\/\/suretekmedical.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.vanguard-healthcare.com\/\" target=\"_blank\">http:\/\/www.vanguard-healthcare.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/\" target=\"_blank\">\"Home\"<\/a>. <i>AMDR home page<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">14 May<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=AMDR+home+page&rft.atitle=Home&rft_id=http%3A%2F%2Fwww.amdr.org%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/2017\/09\/amdr-members-are-serving-all-of-u-s-news-world-reports-honor-roll-hospitals\/\" target=\"_blank\">\"AMDR members are serving all of U.S. News & World Report's \"honor roll\" hospitals\"<\/a>. <i>AMDR Top Hopsitals<\/i>. 2017-09-19<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">14 May<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=AMDR+Top+Hopsitals&rft.atitle=AMDR+members+are+serving+all+of+U.S.+News+%26+World+Report%27s+%22honor+roll%22+hospitals&rft.date=2017-09-19&rft_id=http%3A%2F%2Famdr.org%2F2017%2F09%2Famdr-members-are-serving-all-of-u-s-news-world-reports-honor-roll-hospitals%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Journal_a-41\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Journal_a_41-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Popp, Walter; Rasslan, Ossama; Unahalekhaka, Akeau; Brenner, Pola; Fischnaller, Edith; Fathy, Maha; Goldman, Carol; Gillespie, Elizabeth (July 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1438463910000441\" target=\"_blank\">\"What is the use? An international look at reuse of single-use medical devices\"<\/a>. <i>International Journal of Hygiene and Environmental Health<\/i>. <b>213<\/b> (4): 302\u2013307. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ijheh.2010.04.003\" target=\"_blank\">10.1016\/j.ijheh.2010.04.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20471316\" target=\"_blank\">20471316<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Hygiene+and+Environmental+Health&rft.atitle=What+is+the+use%3F+An+international+look+at+reuse+of+single-use+medical+devices&rft.volume=213&rft.issue=4&rft.pages=302-307&rft.date=2010-07&rft_id=info%3Adoi%2F10.1016%2Fj.ijheh.2010.04.003&rft_id=info%3Apmid%2F20471316&rft.aulast=Popp&rft.aufirst=Walter&rft.au=Rasslan%2C+Ossama&rft.au=Unahalekhaka%2C+Akeau&rft.au=Brenner%2C+Pola&rft.au=Fischnaller%2C+Edith&rft.au=Fathy%2C+Maha&rft.au=Goldman%2C+Carol&rft.au=Gillespie%2C+Elizabeth&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1438463910000441&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Council Directive 93\/42\/EEC (14 June 1993), Article 12a, OJ L 169, 12.7.1993, p. 1.\"<\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Report from the Commission to the European Parliament and the Council: Report on the Issue of the Reprocessing of Medical Devices in the European Union, in Accordance with Article 12a of Directive 93\/42\/EEC, European Commission (27 August 2010).\"<\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"European Commission, Proposal for a REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (26 September 2012).\"<\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"European Parliament, Report on the proposal for a regulation of the European Parliament and of the Council on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (COM(2012)0542 \u2013 C7-0318\/2012 \u2013 2012\/0266(COD)), Committee on the Environment, Public Health and Food Safety (9 October 2013).\"<\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Hygienic Requirements for Processing of Medical Devices: Recommendation by the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI) and the Federal German Institute for Medical Drugs and Medical Products (BfArM) Concerning the \"Hygienic Requirements for Processing of Medical Devices,\" Robert Koch Institute: Recommendation (2001).\"<\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Commission Report, supra note 2, at 6. See also, Circulaire DGS\/DH n 51 (December 29, 1994) Relative a l\u2019utilisation des dispositifs medicaux steriles a usage unique dans les etblissements de sant\u00e9 publics et prives (France), Ministerio de sanidad y consume, Royal Decree 414.1996 Sec. 5, (July 9, 1999) (Spain) and MHRA Device Bulletin: DB 2006(04) Single-Use Medical Devices: Implications and Consequences of Reuse (UK).\"<\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Commission Report, supra note 2, at 6. See also, European Association of Medical Device Reprocessors.\"<\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Medical Device Regulatory Requirements for Israel,\", U.S. International Trade Administration (May 2, 2005) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ita.doc.gov\/td\/health\/israelregs.html\" target=\"_blank\">http:\/\/www.ita.doc.gov\/td\/health\/israelregs.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Statement by the TGA on regulations for sterilisation of single use devices,\" Australian Government, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration\" title=\"Therapeutic Goods Administration\" rel=\"external_link\" target=\"_blank\">Therapeutic Goods Administration<\/a> (July 21, 2003) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.tga.gov.au\/archive\/media-2003-sud-030721.htm\" target=\"_blank\">http:\/\/www.tga.gov.au\/archive\/media-2003-sud-030721.htm<\/a><\/span>\n<\/li>\n<li id=\"cite_note-CADTH_a-51\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CADTH_a_51-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTH_a_51-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTH_a_51-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTH_a_51-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">CADTH Report \"Issue Analysis Summary: The Reuse of Single-Use Medical Devices,\" Health Canada; Therapeutic Products Directorate (April 28, 2005) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hc-sc.gc.ca\/dhp-mps\/alt_formats\/hpfb-dgpsa\/pdf\/md-im\/saprmd_ias_gcsrmm_raq_2005-06-09-eng.pdf\" target=\"_blank\">http:\/\/www.hc-sc.gc.ca\/dhp-mps\/alt_formats\/hpfb-dgpsa\/pdf\/md-im\/saprmd_ias_gcsrmm_raq_2005-06-09-eng.pdf<\/a>. See also, \"Reprocessing Single-Use Medical Devices: An Update of the Clinical Evidence and An Environmental Scan of Policies in Canada,\" Canadian Agency for Drugs and Technologies in Health (June 23, 2010) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.cadth.ca\/media\/pdf\/ES8_Reprocessing_SUDs_e.pdf\" target=\"_blank\">http:\/\/www.cadth.ca\/media\/pdf\/ES8_Reprocessing_SUDs_e.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Manitoba Deputy Health Minister\u2019s Office (March 21, 2013)<\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Alberta Health Services. Single Use Medical Devices Policy. May 1, 2012 <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.albertahealthservices.ca\/6444.asp\" target=\"_blank\">http:\/\/www.albertahealthservices.ca\/6444.asp<\/a><\/span>\n<\/li>\n<li id=\"cite_note-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-54\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Saskatchewan Health, Deputy Minister\u2019s Office (June 27, 2013)<\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181217094304\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.376 seconds\nReal time usage: 0.447 seconds\nPreprocessor visited node count: 1598\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 54220\/2097152 bytes\nTemplate argument size: 1174\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 93093\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.191\/10.000 seconds\nLua memory usage: 3.96 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 375.000 1 -total\n<\/p>\n<pre>71.75% 269.070 1 Template:Reflist\n46.07% 172.778 28 Template:Cite_web\n17.70% 66.393 1 Template:Orphan\n13.59% 50.953 1 Template:Draft_other\n12.85% 48.171 1 Template:Ambox\n 9.24% 34.655 2 Template:Cite_journal\n 0.74% 2.775 1 Template:Monthyear\n 0.71% 2.675 1 Template:Main_other\n 0.71% 2.662 2 Template:PAGENAMEU\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39722261-1!canonical and timestamp 20181217094303 and revision id 865904101\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Single_Use_Medical_Device_Reprocessing\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214714\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.158 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 150.354 1 - wikipedia:Single_Use_Medical_Device_Reprocessing\n100.00% 150.354 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8581-0!*!*!*!*!*!* and timestamp 20181217214714 and revision id 25010\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing\">https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c9e7e589abaded1dc205bee7420521de_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"c9e7e589abaded1dc205bee7420521de_timestamp":1545083234,"5afb8d61cafaef8f2b60892a52bd104d_type":"article","5afb8d61cafaef8f2b60892a52bd104d_title":"Sharps waste","5afb8d61cafaef8f2b60892a52bd104d_url":"https:\/\/www.limswiki.org\/index.php\/Sharps_waste","5afb8d61cafaef8f2b60892a52bd104d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSharps waste\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Sharps \u2013 like needles, syringes, lancets and other devices used at home to treat diabetes, arthritis, cancer, and other diseases \u2013 should be immediately disposed-of after use\nSharps waste is a form of biomedical waste composed of used \"sharps\", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as biohazardous waste and must be carefully handled. Common medical materials treated as sharps waste are:\n\nHypodermic needles\nDisposable scalpels and blades\nContaminated glass and some plastics\nContents \n\n1 Qualifying materials \n2 Dangers involved \n3 Sharps containers \n4 Injection technology \n5 In the developing world \n6 Further reading \n7 References \n8 External links \n\n\nQualifying materials \nIn addition to needles and blades, anything attached to them will also be considered sharps waste, such syringes and injection devices.\nBlades can include razors, scalpels, X-Acto knife, scissors, or any other medical items used for cutting in the medical setting, regardless of if they have been contaminated with biohazardous material. While glass and sharp plastic are considered sharps waste, their handling methods can vary.\nGlass items which have been contaminated with a biohazardous material will be treated with the same concern as needles and blades, even if unbroken. If glass is contaminated, it is still often treated as a sharp, because it can break during the disposal process. Contaminated plastic items which are not sharp can be disposed of in a biohazardous waste receptacle instead of a sharps container.\n\nDangers involved \nAs a biohazardous material, injuries from sharps waste can pose a large public health concern. By penetrating the skin, it is possible for this waste to spread blood-borne pathogens. The spread of these pathogens is directly responsible for the transmission of blood-borne diseases, such as hepatitis B (HBV), hepatitis C (HCV), and HIV. Health care professionals expose themselves to the risk of transmission of these diseases when handling sharps waste. The large volume handled by health care professionals on a daily basis increases the chance that an injury may occur.\nThe general public can occasionally be at risk to injuries from sharps waste as well when improperly disposed of by injection drug users.\n\nSharps containers \n A sharps container is specially designed for safe disposal of sharps waste.\nA sharps container is a hard plastic container that is used to safely dispose of hypodermic needles and other sharp medical instruments, such as an IV catheters and disposable scalpels. Sharps containers may be single use which are disposed of with the waste inside, or reusable which are robotically emptied and sterilized before being returned for re-use.\nNeedles are dropped into the container through an opening in the top. Needles should never be pushed or forced into the container, as damage to the container and\/or needlestick injuries may result. Sharps containers should not be filled above the indicated line, usually two-thirds full.\nIn North America, sharps containers are often red, and elsewhere are often yellow.\nAirports and large institutions commonly have sharps containers available in restrooms for safe disposal for users of injection drugs, such as insulin-dependent diabetics. People injecting drugs in their homes may substitute other hard-sided containers such as empty milk jugs for disposal of needles.\nExtreme care must be taken in the management and disposal of sharps waste. The goal in sharps waste management is to safely handle all materials until they can be properly disposed. The final step in the disposal of sharps waste is to dispose of them in an autoclave. A less common approach is to incinerate them; typically only chemotherapy sharps waste is incinerated. Steps must be taken along the way to minimize the risk of injury from this material, while maximizing the amount of sharps material disposed.[citation needed ]\nHealth care workers are to minimize their interaction with sharps waste by disposing of it in a sealable container. Attempts by health care workers to disassemble sharps waste is kept to a minimum. Strict hospital protocols and government regulations ensure that hospital workers handle sharps waste safely and dispose of it effectively.\nSelf-locking and sealable sharps containers are made of plastic so that the sharps can not easily penetrate through the sides. Such units are designed so that the whole container can be disposed of with other biohazardous waste. Single use sharps containers of various sizes are sold throughout the world. Large medical facilities may have their own 'mini' autoclave in which these sharps containers are disposed of with other medical wastes. This minimizes the distance the containers have to travel and the number of people to come in contact with the sharps waste. Smaller clinics or offices without such facilities are required by federal regulations to hire the services of a company that specializes in transporting and properly disposing of the hazardous wastes.\nNIOSH found through results from focus groups that accommodation, functionality, accessibility, and visibility are four areas of high importance to be able to ensure safe discarding of sharps. The studies found it was important to have containers that are easy to use with little need for training to be able to use. The containers should be visible in any areas that sharps are used and be placed in such degree that spillage and injury will not be likely to occur with use.[1]\nRecent legislation in France has stated that pharmaceutical companies supplying self injection medications are responsible for the disposal of spent needles. Previously popular needle clippers and caps are no longer acceptable as safety devices and either sharps box or needle destruction devices are required.[citation needed ]\nDisposal methods vary by country and locale, but common methods of disposal are either by truck service or, in the United States, by disposal of sharps through the mail. Truck service involves trained personnel collecting sharps waste, and often medical waste, at the point of generation and hauling it away by truck to a destruction facility. Similarly, the mail-back sharps disposal method allows generators to ship sharps waste to the disposal facility directly through the U.S. mail in specially designed and approved shipping containers. Mail-back sharps disposal allows waste generators to dispose of smaller amounts of sharps more economically than if they were to hire out a truck service.\n\nInjection technology \nWith more than sixteen billion injections administered annually worldwide,[2] they are the largest contributor to sharps waste. For this reason many new technologies surrounding injections have been developed, mostly related to safety mechanisms. As these technologies have been developed governments have attempted to make them commonplace to ensure sharps waste safety. In 2000, the Needlestick Safety and Prevention Act was passed, along with the 2001 Bloodborne Pathogens Standard.[3]\nSafety syringes help reduce occurrences of accidental needlesticks. One of the most recent developments has been the auto-disable injection device. These injection devices automatically disable after a single use. This can be done by retracting the needle back into the syringe or rendering the syringe plunger inoperable. With the injection device now inoperable, it cannot be reused. Shielding the needle after the injection is another approach for safe management of sharps. These are hands free methods usually involving a hinging cap that can be pressed on a table to seal the needle. Another technology in sharps waste management relating to injections is the needle remover. Varying approaches can be taken with the main goal to separate the needle from the syringe. This allows the sharp needle to be quarantined and disposed of separate from the syringe. There is debate around the use of these devices as they involved in additional step in the handling of sharps waste.\n\nIn the developing world \nSharps waste is of great concern in developing and transitional regions of the world. Factors such as high disease prevalence and lack of health care professionals amplify the dangers involved with sharps waste, and the cost of newer disposal technology makes them unlikely to be used. \nAs with the rest of the world injection wastes make up the largest portion of sharps waste. However, injection use is much more prevalent in this world segment. One of the contributors to this increase is a larger emphasis placed on injections for therapeutic purposes. It has been estimated that 95% of all injections in developing regions are for therapeutic purposes.[4] The average person has been estimated to receive up to 8.5 injections per year.[4] Newly developed injection technologies are rarely used to provide these injections due to added costs. Therefore, the majority of injections are given with standard disposable syringes in developing regions.[5]\nThe infrastructure of developing regions is not equipped to deal with this large volume of contaminated sharps waste. Contrary to the industrialized world, disposal incinerators and transportation networks are not always available. Cost restraints make the purchase of single use disposable containers unrealistic. Facilities are often overwhelmed with patients and understaffed with educated workers. Demand on these facilities can limit the emphasis or enforcement of waste disposal protocols. These factors leave a dangerous quantity of sharps waste in the environment. Contrasts between the industrialized and developing world segment can be seen in accidental needle stick injuries. These occur at a rate of .18 to .74 per person per year in industrialized nations and .93 to 4.68 per person per year in developing and transitional nations (Hutin, Hauri, Armstrong, 2003).[citation needed ]\nImproper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually.[6] 40-65% of new HBV and HCV are due to percutaneous occupational exposure.[7]\n\nFurther reading \nInnovation, diffusion and safety of a medical technology: a review of the literature on injection practices.[8]\nReferences \n\n\n^ URL=https:\/\/www.cdc.gov\/niosh\/stopsticks\/sharpsdisposal.html. Title= \"Stop Sticks Campaign\". Publisher= NIOSH. date of access= 17. September 17 \n\n^ WHO Archived 2006-05-25 at the Wayback Machine. World Health Organization (2004). Proposed agenda to evaluate the risks and benefits associated with using needle-removing devices. Switzerland. \n\n^ Jagger, J., De Carli, G., Perry, J., Puro, V., Ippolito, G. (2003). Chapter 31: Occupational Exposure to Bloodborne Pathogens: Epidemiology and Prevention. Prevention and Control of Nosocomial Infections (4th Ed). Lippincott, Williams, and Wilkins. \n\n^ a b Simonsen, L. Kane, A. Lloyd, J. Zaffran, M. Kane, M (1999). Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization, 77(10). \n\n^ Needle Remover Harner, C. (2004, October). Needle Remover Device Design Transfer Package. Retrieved September 7, 2005. \n\n^ Dziekan G, Chisolm D, Johns B, Rovira J, Hutin Y (2003). The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. Bulletin of the World Health Organization, 81(4) \n\n^ Pruss-Ustun A, Rapiti E, Hutin Y (2003). Sharps injuries: global burden of disease from sharps injuries to health-care workers. Geneva. World Health Organization, (WHO Environmental Burden of Disease Series, No. 3). \n\n^ Kotwal, Atul (March 2005). \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices\". Social Science & Medicine. 60 (5): 1133\u20131147. doi:10.1016\/j.socscimed.2004.06.044. \n\n\nExternal links \nEPA Recommended Needle Disposal Options for Self Injectors\nWHO Health Care Waste Management\nvteBiosolids, waste, and waste managementMajor types\nAgricultural wastewater\nBiodegradable waste\nBiomedical waste\nBrown waste\nChemical waste\nConstruction waste\nDemolition waste\nElectronic waste\nby country\nFood waste\nGreen waste\nHazardous waste\nHeat waste\nIndustrial waste\nLitter\nMarine debris\nMining waste\nMunicipal solid waste\nOpen defecation\nPost-consumer waste\nRadioactive waste\nScrap metal\nSewage\nToxic waste\nWastewater\nProcesses\nAnaerobic digestion\nBiodegradation\nComposting\nGarden waste dumping\nIllegal dumping\nIncineration\nLandfill\nLandfill mining\nMechanical biological treatment\nMechanical sorting\nOpen dump\nPhotodegradation\nRecycling\nResource recovery\nSewage treatment\nWaste collection\nWaste picking\nWaste sorting\nWaste trade\nWaste treatment\nWaste-to-energy\nCountries\nArmenia\nBangladesh\nBrazil\nHong Kong\nIndia\nKazakhstan\nNew Zealand\nRussia\nSwitzerland\nTaiwan\nThailand\nTurkey\nUK\nUS\nAgreements\nBamako Convention\nBasel Convention\nEU directives\nbatteries\nframework\nincineration\nlandfills\nRoHS\nvehicles\nwaste water\nWEEE\nLondon Convention\nOslo Convention\nOSPAR Convention\nOther topics\nBlue Ribbon Commission on America's Nuclear Future\nCleaner production\nDowncycling\nEco-industrial park\nExtended producer responsibility\nHigh-level radioactive waste management\nHistory of waste management\nLandfill fire\nSewage regulation and administration\nUpcycling\nWaste hierarchy\nWaste legislation\nWaste minimisation\nZero waste\n\n Waste portal\n Environment portal\n Category\n Commons\nConcepts\nIndex\nJournals\nLists\nOrganizations\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a 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class=\"firstHeading\" lang=\"en\">Sharps waste<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_(6321875537).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/37\/Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg\/220px-Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_(6321875537).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sharps \u2013 like needles, syringes, lancets and other devices used at home to treat diabetes, arthritis, cancer, and other diseases \u2013 should be immediately disposed-of after use<\/div><\/div><\/div>\n<p><b>Sharps waste<\/b> is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_waste\" title=\"Biomedical waste\" rel=\"external_link\" target=\"_blank\">biomedical waste<\/a> composed of used \"sharps\", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_hazard\" title=\"Biological hazard\" rel=\"external_link\" target=\"_blank\">biohazardous<\/a> waste and must be carefully handled. Common medical materials treated as sharps waste are:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needles\" class=\"mw-redirect\" title=\"Hypodermic needles\" rel=\"external_link\" target=\"_blank\">Hypodermic needles<\/a><\/li>\n<li>Disposable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpels<\/a> and blades<\/li>\n<li>Contaminated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> and some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">plastics<\/a><\/li><\/ul>\n\n<h2><span class=\"mw-headline\" id=\"Qualifying_materials\">Qualifying materials<\/span><\/h2>\n<p>In addition to needles and blades, anything attached to them will also be considered sharps waste, such syringes and injection devices.\n<\/p><p>Blades can include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Razor\" title=\"Razor\" rel=\"external_link\" target=\"_blank\">razors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpels<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-Acto_knife\" class=\"mw-redirect\" title=\"X-Acto knife\" rel=\"external_link\" target=\"_blank\">X-Acto knife<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>, or any other medical items used for cutting in the medical setting, regardless of if they have been contaminated with biohazardous material. While glass and sharp plastic are considered sharps waste, their handling methods can vary.\n<\/p><p>Glass items which have been contaminated with a biohazardous material will be treated with the same concern as needles and blades, even if unbroken. If glass is contaminated, it is still often treated as a sharp, because it can break during the disposal process. Contaminated plastic items which are not sharp can be disposed of in a receptacle instead of a sharps container.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Dangers_involved\">Dangers involved<\/span><\/h2>\n<p>As a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_hazard\" title=\"Biological hazard\" rel=\"external_link\" target=\"_blank\">biohazardous<\/a> material, injuries from sharps waste can pose a large public health concern. By penetrating the skin, it is possible for this waste to spread blood-borne pathogens. The spread of these pathogens is directly responsible for the transmission of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood-borne_disease\" title=\"Blood-borne disease\" rel=\"external_link\" target=\"_blank\">blood-borne diseases<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis_B\" title=\"Hepatitis B\" rel=\"external_link\" target=\"_blank\">hepatitis B<\/a> (HBV), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C\" title=\"Hepatitis C\" rel=\"external_link\" target=\"_blank\">hepatitis C<\/a> (HCV), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/HIV\" title=\"HIV\" rel=\"external_link\" target=\"_blank\">HIV<\/a>. Health care professionals expose themselves to the risk of transmission of these diseases when handling sharps waste. The large volume handled by health care professionals on a daily basis increases the chance that an injury may occur.\n<\/p><p>The general public can occasionally be at risk to injuries from sharps waste as well when improperly disposed of by injection drug users.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sharps_containers\">Sharps containers<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sharps_Container.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/Sharps_Container.jpg\/220px-Sharps_Container.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sharps_Container.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"#sharps_containers\" rel=\"external_link\">sharps container<\/a> is specially designed for safe disposal of sharps waste.<\/div><\/div><\/div>\n<p>A <b>sharps container<\/b> is a hard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_container\" title=\"Plastic container\" rel=\"external_link\" target=\"_blank\">plastic container<\/a> that is used to safely dispose of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle\" title=\"Hypodermic needle\" rel=\"external_link\" target=\"_blank\">hypodermic needles<\/a> and other sharp medical instruments, such as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">IV<\/a> catheters and disposable scalpels. Sharps containers may be single use which are disposed of with the waste inside, or reusable which are robotically emptied and sterilized before being returned for re-use.\n<\/p><p>Needles are dropped into the container through an opening in the top. Needles should never be pushed or forced into the container, as damage to the container and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needlestick_injury\" title=\"Needlestick injury\" rel=\"external_link\" target=\"_blank\">needlestick injuries<\/a> may result. Sharps containers should not be filled above the indicated line, usually two-thirds full.\n<\/p><p>In North America, sharps containers are often red, and elsewhere are often yellow.\n<\/p><p>Airports and large institutions commonly have sharps containers available in restrooms for safe disposal for users of injection drugs, such as insulin-dependent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic\" class=\"mw-redirect\" title=\"Diabetic\" rel=\"external_link\" target=\"_blank\">diabetics<\/a>. People injecting drugs in their homes may substitute other hard-sided containers such as empty milk jugs for disposal of needles.\n<\/p><p>Extreme care must be taken in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Waste_management\" title=\"Waste management\" rel=\"external_link\" target=\"_blank\">management<\/a> and disposal of sharps waste. The goal in sharps waste management is to safely handle all materials until they can be properly disposed. The final step in the disposal of sharps waste is to dispose of them in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclave<\/a>. A less common approach is to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incinerate\" class=\"mw-redirect\" title=\"Incinerate\" rel=\"external_link\" target=\"_blank\">incinerate<\/a> them; typically only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemotherapy\" title=\"Chemotherapy\" rel=\"external_link\" target=\"_blank\">chemotherapy<\/a> sharps waste is incinerated. Steps must be taken along the way to minimize the risk of injury from this material, while maximizing the amount of sharps material disposed.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Health care workers are to minimize their interaction with sharps waste by disposing of it in a sealable container. Attempts by health care workers to disassemble sharps waste is kept to a minimum. Strict <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospital<\/a> protocols and government regulations ensure that hospital workers handle sharps waste safely and dispose of it effectively.\n<\/p><p>Self-locking and sealable sharps containers are made of plastic so that the sharps can not easily penetrate through the sides. Such units are designed so that the whole container can be disposed of with other biohazardous waste. Single use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sharps_container\" class=\"mw-redirect\" title=\"Sharps container\" rel=\"external_link\" target=\"_blank\">sharps containers<\/a> of various sizes are sold throughout the world. Large medical facilities may have their own 'mini' autoclave in which these sharps containers are disposed of with other medical wastes. This minimizes the distance the containers have to travel and the number of people to come in contact with the sharps waste. Smaller clinics or offices without such facilities are required by federal regulations to hire the services of a company that specializes in transporting and properly disposing of the hazardous wastes.\n<\/p><p>NIOSH found through results from focus groups that accommodation, functionality, accessibility, and visibility are four areas of high importance to be able to ensure safe discarding of sharps. The studies found it was important to have containers that are easy to use with little need for training to be able to use. The containers should be visible in any areas that sharps are used and be placed in such degree that spillage and injury will not be likely to occur with use.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Recent legislation in <a href=\"https:\/\/en.wikipedia.org\/wiki\/France\" title=\"France\" rel=\"external_link\" target=\"_blank\">France<\/a> has stated that pharmaceutical companies supplying self injection medications are responsible for the disposal of spent needles. Previously popular needle clippers and caps are no longer acceptable as safety devices and either sharps box or needle destruction devices are required.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Disposal methods vary by country and locale, but common methods of disposal are either by truck service or, in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>, by disposal of sharps through the mail. Truck service involves trained personnel collecting sharps waste, and often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_waste\" class=\"mw-redirect\" title=\"Medical waste\" rel=\"external_link\" target=\"_blank\">medical waste<\/a>, at the point of generation and hauling it away by truck to a destruction facility. Similarly, the mail-back sharps disposal method allows generators to ship sharps waste to the disposal facility directly through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Postal_Service\" title=\"United States Postal Service\" rel=\"external_link\" target=\"_blank\">U.S. mail<\/a> in specially designed and approved shipping containers. Mail-back sharps disposal allows waste generators to dispose of smaller amounts of sharps more economically than if they were to hire out a truck service.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Injection_technology\">Injection technology<\/span><\/h2>\n<p>With more than sixteen billion injections administered annually worldwide,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> they are the largest contributor to sharps waste. For this reason many new technologies surrounding injections have been developed, mostly related to safety mechanisms. As these technologies have been developed governments have attempted to make them commonplace to ensure sharps waste safety. In 2000, the was passed, along with the 2001 .<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Safety_syringes\" class=\"mw-redirect\" title=\"Safety syringes\" rel=\"external_link\" target=\"_blank\">Safety syringes<\/a> help reduce occurrences of accidental needlesticks. One of the most recent developments has been the auto-disable injection device. These injection devices automatically disable after a single use. This can be done by retracting the needle back into the syringe or rendering the syringe plunger inoperable. With the injection device now inoperable, it cannot be reused. Shielding the needle after the injection is another approach for safe management of sharps. These are hands free methods usually involving a hinging cap that can be pressed on a table to seal the needle. Another technology in sharps waste management relating to injections is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_remover\" class=\"mw-redirect\" title=\"Needle remover\" rel=\"external_link\" target=\"_blank\">needle remover<\/a>. Varying approaches can be taken with the main goal to separate the needle from the syringe. This allows the sharp needle to be quarantined and disposed of separate from the syringe. There is debate around the use of these devices as they involved in additional step in the handling of sharps waste.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_the_developing_world\">In the developing world<\/span><\/h2>\n<p>Sharps waste is of great concern in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Developing_world\" class=\"mw-redirect\" title=\"Developing world\" rel=\"external_link\" target=\"_blank\">developing<\/a> and transitional regions of the world. Factors such as high disease prevalence and lack of health care professionals amplify the dangers involved with sharps waste, and the cost of newer disposal technology makes them unlikely to be used. \nAs with the rest of the world injection wastes make up the largest portion of sharps waste. However, injection use is much more prevalent in this world segment. One of the contributors to this increase is a larger emphasis placed on injections for therapeutic purposes. It has been estimated that 95% of all injections in developing regions are for therapeutic purposes.<sup id=\"rdp-ebb-cite_ref-Simonsen_4-0\" class=\"reference\"><a href=\"#cite_note-Simonsen-4\" rel=\"external_link\">[4]<\/a><\/sup> The average person has been estimated to receive up to 8.5 injections per year.<sup id=\"rdp-ebb-cite_ref-Simonsen_4-1\" class=\"reference\"><a href=\"#cite_note-Simonsen-4\" rel=\"external_link\">[4]<\/a><\/sup> Newly developed injection technologies are rarely used to provide these injections due to added costs. Therefore, the majority of injections are given with standard disposable syringes in developing regions.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>The infrastructure of developing regions is not equipped to deal with this large volume of contaminated sharps waste. Contrary to the industrialized world, disposal incinerators and transportation networks are not always available. Cost restraints make the purchase of single use disposable containers unrealistic. Facilities are often overwhelmed with patients and understaffed with educated workers. Demand on these facilities can limit the emphasis or enforcement of waste disposal protocols. These factors leave a dangerous quantity of sharps waste in the environment. Contrasts between the industrialized and developing world segment can be seen in accidental needle stick injuries. These occur at a rate of .18 to .74 per person per year in industrialized nations and .93 to 4.68 per person per year in developing and transitional nations (Hutin, Hauri, Armstrong, 2003).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Improper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> 40-65% of new HBV and HCV are due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">percutaneous<\/a> occupational exposure.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">URL=<a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.cdc.gov\/niosh\/stopsticks\/sharpsdisposal.html\" target=\"_blank\">https:\/\/www.cdc.gov\/niosh\/stopsticks\/sharpsdisposal.html<\/a>. Title= \"Stop Sticks Campaign\". Publisher= NIOSH. date of access= 17. September 17<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.uqconnect.net\/signfiles\/Files\/ScopeOfWorkNeedleRemoversDraft5.pdf\" target=\"_blank\">WHO<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060525023731\/http:\/\/www.uqconnect.net\/signfiles\/Files\/ScopeOfWorkNeedleRemoversDraft5.pdf\" target=\"_blank\">Archived<\/a> 2006-05-25 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. World Health Organization (2004). Proposed agenda to evaluate the risks and benefits associated with using needle-removing devices. Switzerland.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Jagger, J., De Carli, G., Perry, J., Puro, V., Ippolito, G. (2003). Chapter 31: Occupational Exposure to Bloodborne Pathogens: Epidemiology and Prevention. Prevention and Control of Nosocomial Infections (4th Ed). Lippincott, Williams, and Wilkins.<\/span>\n<\/li>\n<li id=\"cite_note-Simonsen-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Simonsen_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Simonsen_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Simonsen, L. Kane, A. Lloyd, J. Zaffran, M. Kane, M (1999). Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization, 77(10).<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthcarewaste.org\/documents\/PATH_needleRemover_design.pdf\" target=\"_blank\">Needle Remover<\/a> Harner, C. (2004, October). Needle Remover Device Design Transfer Package. Retrieved September 7, 2005.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dziekan G, Chisolm D, Johns B, Rovira J, Hutin Y (2003). The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. Bulletin of the World Health Organization, 81(4)<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Pruss-Ustun A, Rapiti E, Hutin Y (2003). Sharps injuries: global burden of disease from sharps injuries to health-care workers. Geneva. World Health Organization, (WHO Environmental Burden of Disease Series, No. 3).<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kotwal, Atul (March 2005). \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices\". <i>Social Science & Medicine<\/i>. <b>60<\/b> (5): 1133\u20131147. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.socscimed.2004.06.044\" target=\"_blank\">10.1016\/j.socscimed.2004.06.044<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Social+Science+%26+Medicine&rft.atitle=Innovation%2C+diffusion+and+safety+of+a+medical+technology%3A+a+review+of+the+literature+on+injection+practices&rft.volume=60&rft.issue=5&rft.pages=1133-1147&rft.date=2005-03&rft_id=info%3Adoi%2F10.1016%2Fj.socscimed.2004.06.044&rft.aulast=Kotwal&rft.aufirst=Atul&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASharps+waste\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.epa.gov\/waste\/nonhaz\/industrial\/medical\/med-home.pdf\" target=\"_blank\">EPA Recommended Needle Disposal Options for Self Injectors<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20051201192138\/http:\/\/www.healthcarewaste.org\/en\/115_overview.html\" target=\"_blank\">WHO Health Care Waste Management<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181207000901\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.216 seconds\nReal time usage: 0.307 seconds\nPreprocessor visited node count: 748\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 27405\/2097152 bytes\nTemplate argument size: 1542\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 6402\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.109\/10.000 seconds\nLua memory usage: 2.68 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 242.948 1 -total\n<\/p>\n<pre>46.34% 112.589 1 Template:Reflist\n35.71% 86.753 3 Template:Citation_needed\n33.98% 82.561 1 Template:Cite_journal\n27.49% 66.791 3 Template:Fix\n16.36% 39.745 6 Template:Category_handler\n15.22% 36.970 1 Template:Waste\n13.75% 33.414 1 Template:Navbox\n 9.26% 22.500 3 Template:Delink\n 4.87% 11.834 3 Template:Icon\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3410731-1!canonical and timestamp 20181207000900 and revision id 864711756\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sharps_waste\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214714\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.164 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.752 1 - wikipedia:Sharps_waste\n100.00% 156.752 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8580-0!*!*!*!*!*!* and timestamp 20181217214714 and revision id 25008\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sharps_waste\">https:\/\/www.limswiki.org\/index.php\/Sharps_waste<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5afb8d61cafaef8f2b60892a52bd104d_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/37\/Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg\/440px-Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/Sharps_Container.jpg\/440px-Sharps_Container.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Bedrijfsafval.jpg\/240px-Bedrijfsafval.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4c\/Dumpster-non.JPG\/32px-Dumpster-non.JPG"],"5afb8d61cafaef8f2b60892a52bd104d_timestamp":1545083234,"1cf942a9b4d4ec535b38698628d663dc_type":"article","1cf942a9b4d4ec535b38698628d663dc_title":"Retained surgical instruments","1cf942a9b4d4ec535b38698628d663dc_url":"https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments","1cf942a9b4d4ec535b38698628d663dc_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRetained surgical instruments\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA retained surgical instrument is any item inadvertently left behind in a patient\u2019s body in the course of surgery. There are few books about it and it is thought to be under reported.[1] As a preventable medical error, it occurs more frequently than \"wrong site\" surgery. The consequences of retained surgical tools include injury, repeated surgery, excess monetary cost, loss of hospital credibility and in some cases death of patient.[2][3][4]\n\nContents \n\n1 Mistakes and consequences \n\n1.1 Types of forgotten instruments \n1.2 Frequency \n1.3 Gossypiboma \n1.4 Consequences \n\n\n2 Contributing factors \n3 Retained Surgical Instruments and Unretrieved Device Fragments (UDF) \n4 Preventing incidents \n5 References \n\n\nMistakes and consequences \nIn any given typical surgery, an estimated 250\u2013300 surgical tools are used.[5] The number significantly increases to 600 when a larger surgery is performed, thus increasing the chance of the surgeon losing an instrument.[5]\n\nTypes of forgotten instruments \n SmartSponge system, an RFID system to aid doctors in tracking sponges and other surgical items during surgery\nThere are many different types of tools that have been left behind during a surgery. Common instruments are needles, knife blades, safety pins, scalpels, clamps, scissors, sponges, towels, and electrosurgical adapters. Also retained are tweezers, forceps, suction tips and tubes, scopes, ultrasound tissue disruptors, asepto bulbs,[6] cryotomes and cutting laser guides, and measuring devices. The single most common left behind object is a sponge.[7]\n\nFrequency \nThe estimate of how often this type of mistake happens is unclear. According to the U.S. Department of Health and Human Services, it is anywhere between 1 in 100 to 1 in 5000.[1] However a study done in 2008 reported to the Annals of Surgery that mistakes in tool and sponge counts happened in 12.5% of surgeries.[8] Additionally, the Patient Safety Monitor Alert, announced in 2003 that 1,500 tools were stitched into patients each year.[9] Khaled Sakhel, part of the Department of Obstetrics and Gynecology at the Eastern Virginia Medical School, reported that it is expected to occur at least once \u201cin every 1,000\u20131,500\u201d[6] stomach surgeries. \nAn exact count of how often this happens would be impossible to calculate. The Joint Commission on Accreditation for Healthcare Organization (JCAHO) stated that \u201cunintentionally retained foreign bod(ies) without major permanent loss of function\u201d[1] (qtd. in Gibbs) are not required to be reported. Nurses have been discouraged against reporting all errors because of the threat of malpractice and liability issues.[5] Estimates are \u201cundoubtedly low.\u201d[5]\n\nGossypiboma \nGossypiboma is the official name for a retained sponge\/towel after surgery. This word comes from the Latin word for cotton, gossypium, combined with the Swahili word for place of concealment, boma.[10] It is also commonly referred to as textilioma. This word combines textile, meaning cloth, and the suffix \u2013oma, which means growth or tumor.[10]\nA case of gossypiboma can be subtle and may not be discovered until months or even years after the surgery has been performed. In rare cases, a situation can be so severe that it is noticed immediately. Some of the ways gossypiboma can present itself are as a mass in the body or as a bowel tumor.[11] Immediately after surgery, a case of gossypiboma can commonly be mistaken for an abscess, especially when it is near a passage between organs (a \u2018fistula\u2019). In those cases where a sponge isn\u2019t discovered until much later, it may be impossible to tell the difference between gossypiboma and an \u2018intra-abdominal abscess\u2019.[10] This is because both cause air bubbles and \u201ccalcification of the cavity wall.\u201d[10] Gossypiboma is difficult to diagnose due to vague, inconsistent symptoms and images from x-rays that provide no solid evidence and unclear results. Because it is difficult to diagnose, emphasis has been put on the prevention of the mistake. The following techniques have been put into practice to prevent gossypiboma.\n\nRadiopaque marking: Before operation, sponges can be soaked through with \u2018radio-opaque marker\u2019. This allows a sponge to be easily seen on plain radiographs. When the markers are noticed, it can be assumed that it is revealing a retained sponge. A.P. Zbar, Surgical Directorate at Oldchurch and Harold Wood Hospitals stated \u201cthe diagnosis is easily made by plain abdominal radiography, when a radio-opaque marker is seen\u201d.[11] This method is flawed in that it doesn\u2019t work if the sponges have broken into smaller pieces over time.\nUltrasonography- Gossypiboma can be recognized with ultrasonography by \u201cthe presence of brightly echogenic wavy structures in a cystic mass showing posterior acoustic shadowing that changes in parallel with the direction of the ultrasound beam\u201d according to Zbar [11] and associates.\nComputerized Tomography (CT)- A surgical sponge on a CT will show air bubbles on soft tissue masses. The flaw with this technique is that gossypibomas are easily confused with abscesses.\nConsequences \nDangers of a tool or sponge left behind range anywhere from harmless to life-threatening. Surgical tools left in the body can puncture vital organs and blood vessels, causing internal bleeding. Sponges can fester inside a body, growing increasingly dangerous over time. Additional operations may be necessary, which can be costly and also take the surgical table away from other patients with more urgent needs. Michael Blum said \u201cThe incidents observed\u2026took an average of 13 minutes to resolve, a time lapse which can significantly impact the flow of a busy emergency or perioperative department.\u201d[8] Another danger is a sponge can be misdiagnosed, resulting in an unnecessary extreme surgery.[10] (see case study below) A radical surgery can be avoided by considering the possibility of a retained sponge or tool.[12]\n\nContributing factors \nMany studies have taken place to pinpoint the causes of tools being forgotten in hopes that they may be avoided in the future. It has been thought that the amount of blood lost in a surgery or the changing of nurses during the surgery would influence the risk of losing something, but studies do not support this. Human factors such as exhaustion, lack of tools necessary to aid in producing an accurate count, and a chaotic environment all have been seen to increase the risk of forgetting a tool.[13] These factors cannot be controlled and surgeons must learn to mitigate them.\nInaccurate counts are a main reason why tools can be left behind. Many cases of a retained instrument originally reported a correct sponge count when the patient was released.[1] An inaccurate count can occur when nurses are deprived of sleep, when the operation is particularly difficult, long, and mentally draining, when the operation is an emergency, or when there are unforeseen changes in the procedure. \nAn increased amount of chaos and distractions lead to a higher risk of a surgeon forgetting a tool. Mark Hulse from North Shore Medical Center said the following about surgery; \u201cIt\u2019s a process that\u2019s definitely subject to interruption and can be prone to errors. You\u2019re doing a hundred other things at the same time, and as much as you try to keep your attention on it [sponge counts] if the surgeon needs something, it\u2019s easy to get distracted.\u201d[8] Some aspects of surgery that can add to chaos are performing unforeseen changes in the procedure and undergoing emergency surgery.[14] Consequently, the emergency room is the place most likely to make mistakes.[15]\nStudies have shown having a high body mass index increases risk. Boston researchers found that a one-point increase in BMI related to a higher risk by 10%. The researchers suggest that \u201cthey [surgeons] chalk it up to more room in a patient in which to lose things.\u201d[16]\n\n Retained Surgical Instruments and Unretrieved Device Fragments (UDF) \nIn 2008, the US Food and Drug Administration (FDA) published a Public Health Notification advising on serious adverse events arising from fragments of medical devices left behind after surgical procedures, known as unretrieved device fragments (UDFs). The FDA's Centre for Devices and Radiological Health receives around 1000 adverse event reports each year relating to UDFs.[17][18] One major source of UDFs is from the failure of surgical instruments.[19]\nThere are many risks from UDFs. The FDA states:\n\"The adverse events reported include local tissue reaction, infection, perforation and obstruction of blood vessels, and death. Contributing factors may include biocompatibility of the device materials, location of the fragment, potential migration of the fragment, and patient anatomy. During MRI procedures, magnetic fields may cause metallic fragments to migrate, and radiofrequency fields may cause them to heat, causing internal tissue damage and\/or burns\"[19]\n\n<\/p>\nPreventing incidents \nImprovement in lowering the number of mistakes likely depends upon improving the surgical system, and not in individual scapegoating.[5] According to the Institute of Medicine, \u201cthe problem is not bad people; the problem is that the system needs to be made safer.\u201d[20]\nIn order to improve the system and reduce the number of accidents, some hospitals require four counts of sponges and instruments.[21] The first count happens when the instruments are being set up and the sponges unwrapped.[21] The next count is required right before surgery begins, another count as closure begins, and finally a count during skin closure.[21] This is a general guideline and there are different count methods according to different hospitals.[1]\nWhile careful counting could prevent some mistakes, counting carries its own risks. Sometimes the patient must be worked on immediately, leaving no time to count the instruments to be used beforehand. Another risk of counting after is having to leave the patient under anesthesia longer.[22] In addition, counting may not be entirely beneficial as counting is prone to human error and the majority of the cases of gossypiboma and other retained tools happen under a reported correct count.[8] Dr. Atul A. Gawande, a surgeon, said in an article published in The New England Journal of Medicine that \u201ceven though you're following procedures, the priority is the patient, not the procedures.\u201d[23]\nA new technique that is developing is similar to the Bar Code Medication Administration. The University of California at San Francisco and North Shore Medical Center have installed a \u201cbar coded sponge management system\u201d,[8] reasoning that technological error is smaller than human error.[8] Each surgical instrument has a bar code placed on it and nurses pass the items through a hand scanner. The bar code allows each sponge to be identified, resulting in little to no room for error. UCSF reported in April 2008 to have not had \"any unintended retained gauze or sponges\u201d since the installation of the system in April 2007.[8]\n\nReferences \n\n\n^ a b c d e Gibbs, Verna C. \u201cChapter 22. The Retained Surgical Sponge.\u201d \n\n^ \"General Instrument Sourcebook - KMedic\" (PDF) . Retrieved October 27, 2016 . \n\n^ \"Sterilized surgical instruments\". Archived from the original on October 27, 2016. Retrieved October 27, 2016 . \n\n^ Renee Nimitz, Surgical Instrumentation: an Interactive Approach (Saunders, 2010) 1416037020, pxiii \n\n^ a b c d e Institute of Medicine. To Err Is Human- Building a Safer Healthcare System pg.43 \n\n^ a b Sakhel, Khaled and James Hines. \u201cTo Forget is Human: the case of the retained bulb.\u201d Journal of Robotic Surgery pgs. 45\u201347 \n\n^ \u201cSurgical Instruments Left in Patient\u2019s Body.\u201d Nursing Link. \n\n^ a b c d e f g Gamble, Kate Huvane. \u201cNo Sponge Left Behind\u201d, Health Care Informatics. \n\n^ \"Emergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\" Patient Safety Monitor Alert. \n\n^ a b c d e Fortia, Mohamed El, Maroua Bendaoud, and Sumer Sethi. \"Abdominal Gossypiboma (Textilioma).\" Internet Journal of Radiology \n\n^ a b c Zbar AP, A. Agrawal, I.T.Saeedi, and MRA Utidjian. \u201cGossypiboma revisited: a case report and review of the literature.\u201d \n\n^ Rajagopal, Ambil F.R.C.S. and Joseph Martin M.S. \u201cGossypiboma-\u201cA Surgeon\u2019s Legacy.\u201d Diseases of the Colon and Rectum \n\n^ \u201cEmergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\u201d Patient Safety Monitor Alert. \n\n^ Gawande AA, et al. \u201cRisk Factors for Retained Instruments and Sponges After Surgery.\u201d N Engl J Med pg. 348 \n\n^ Institute of Medicine. To Err Is Human- Building a Safer Healthcare System. pg.37 \n\n^ Rasich, Paula. \u201cSurgical Tools.\u201d \n\n^ FDA. \"Unretrieved Device Fragments.\" \n\n^ Fischer, R. \"Danger: Beware of Unretrieved Device Fragments.\" \n\n^ a b Health Devices. \"Top 10 Technology Hazards.\" \n\n^ Institute of Medicine. To Err Is Human- Building a Safer Healthcare System. pg. 49 \n\n^ a b c Berguer, Ramon and Paul J. Heller. \"Preventing Sharps Injuries in the Operating Room.\" \n\n^ Smith, Carol. \u201cSurgical Tools Left in Five Patients.\u201d \n\n^ Grady, Denise. \u201cForgotten Surgical Tools 'Uncommon but Dangerous'.\u201d \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments\">https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments<\/a>\n\t\t\t\t\tCategories: Healthcare termsMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:03.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 840 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1cf942a9b4d4ec535b38698628d663dc_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Retained_surgical_instruments skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Retained surgical instruments<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>retained surgical instrument<\/b> is any item inadvertently left behind in a patient\u2019s body in the course of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. There are few books about it and it is thought to be under reported.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-0\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> As a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Preventable_medical_error\" class=\"mw-redirect\" title=\"Preventable medical error\" rel=\"external_link\" target=\"_blank\">preventable medical error<\/a>, it occurs more frequently than \"wrong site\" surgery. The consequences of retained surgical tools include injury, repeated surgery, excess monetary cost, loss of hospital credibility and in some cases death of patient.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Mistakes_and_consequences\">Mistakes and consequences<\/span><\/h2>\n<p>In any given typical surgery, an estimated 250\u2013300 surgical tools are used.<sup id=\"rdp-ebb-cite_ref-toerror_5-0\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup> The number significantly increases to 600 when a larger surgery is performed, thus increasing the chance of the surgeon losing an instrument.<sup id=\"rdp-ebb-cite_ref-toerror_5-1\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Types_of_forgotten_instruments\">Types of forgotten instruments<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ssagh.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Ssagh.jpg\/220px-Ssagh.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ssagh.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>SmartSponge system, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> system to aid doctors in tracking sponges and other surgical items during surgery<\/div><\/div><\/div>\n<p>There are many different types of tools that have been left behind during a surgery. Common instruments are needles, knife blades, safety pins, scalpels, clamps, scissors, sponges, towels, and electrosurgical adapters. Also retained are tweezers, forceps, suction tips and tubes, scopes, ultrasound tissue disruptors, asepto bulbs,<sup id=\"rdp-ebb-cite_ref-Sakhel_6-0\" class=\"reference\"><a href=\"#cite_note-Sakhel-6\" rel=\"external_link\">[6]<\/a><\/sup> cryotomes and cutting laser guides, and measuring devices. The single most common left behind object is a sponge.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Frequency\">Frequency<\/span><\/h3>\n<p>The estimate of how often this type of mistake happens is unclear. According to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Department_of_Health_and_Human_Services\" class=\"mw-redirect\" title=\"U.S. Department of Health and Human Services\" rel=\"external_link\" target=\"_blank\">U.S. Department of Health and Human Services<\/a>, it is anywhere between 1 in 100 to 1 in 5000.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-1\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> However a study done in 2008 reported to the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Annals_of_Surgery\" title=\"Annals of Surgery\" rel=\"external_link\" target=\"_blank\">Annals of Surgery<\/a><\/i> that mistakes in tool and sponge counts happened in 12.5% of surgeries.<sup id=\"rdp-ebb-cite_ref-Gamble_8-0\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Additionally, the <i>Patient Safety Monitor Alert<\/i>, announced in 2003 that 1,500 tools were stitched into patients each year.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Khaled Sakhel, part of the Department of Obstetrics and Gynecology at the Eastern Virginia Medical School, reported that it is expected to occur at least once \u201cin every 1,000\u20131,500\u201d<sup id=\"rdp-ebb-cite_ref-Sakhel_6-1\" class=\"reference\"><a href=\"#cite_note-Sakhel-6\" rel=\"external_link\">[6]<\/a><\/sup> stomach surgeries. \nAn exact count of how often this happens would be impossible to calculate. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a> on Accreditation for Healthcare Organization (JCAHO) stated that \u201cunintentionally retained foreign bod(ies) without major permanent loss of function\u201d<sup id=\"rdp-ebb-cite_ref-Gibbs_1-2\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> (qtd. in Gibbs) are not required to be reported. Nurses have been discouraged against reporting all errors because of the threat of malpractice and liability issues.<sup id=\"rdp-ebb-cite_ref-toerror_5-2\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup> Estimates are \u201cundoubtedly low.\u201d<sup id=\"rdp-ebb-cite_ref-toerror_5-3\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gossypiboma\">Gossypiboma<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gossypiboma\" title=\"Gossypiboma\" rel=\"external_link\" target=\"_blank\">Gossypiboma<\/a> is the official name for a retained sponge\/towel after surgery. This word comes from the Latin word for cotton, gossypium, combined with the Swahili word for place of concealment, boma.<sup id=\"rdp-ebb-cite_ref-fortia_10-0\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> It is also commonly referred to as textilioma. This word combines textile, meaning cloth, and the suffix \u2013oma, which means growth or tumor.<sup id=\"rdp-ebb-cite_ref-fortia_10-1\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>A case of gossypiboma can be subtle and may not be discovered until months or even years after the surgery has been performed. In rare cases, a situation can be so severe that it is noticed immediately. Some of the ways gossypiboma can present itself are as a mass in the body or as a bowel tumor.<sup id=\"rdp-ebb-cite_ref-zbar_11-0\" class=\"reference\"><a href=\"#cite_note-zbar-11\" rel=\"external_link\">[11]<\/a><\/sup> Immediately after surgery, a case of gossypiboma can commonly be mistaken for an abscess, especially when it is near a passage between organs (a \u2018fistula\u2019). In those cases where a sponge isn\u2019t discovered until much later, it may be impossible to tell the difference between gossypiboma and an \u2018intra-abdominal abscess\u2019.<sup id=\"rdp-ebb-cite_ref-fortia_10-2\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> This is because both cause air bubbles and \u201ccalcification of the cavity wall.\u201d<sup id=\"rdp-ebb-cite_ref-fortia_10-3\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> Gossypiboma is difficult to diagnose due to vague, inconsistent symptoms and images from x-rays that provide no solid evidence and unclear results. Because it is difficult to diagnose, emphasis has been put on the prevention of the mistake. The following techniques have been put into practice to prevent gossypiboma.\n<\/p>\n<ul><li>Radiopaque marking: Before operation, sponges can be soaked through with \u2018radio-opaque marker\u2019. This allows a sponge to be easily seen on plain radiographs. When the markers are noticed, it can be assumed that it is revealing a retained sponge. A.P. Zbar, Surgical Directorate at Oldchurch and Harold Wood Hospitals stated \u201cthe diagnosis is easily made by plain abdominal radiography, when a radio-opaque marker is seen\u201d.<sup id=\"rdp-ebb-cite_ref-zbar_11-1\" class=\"reference\"><a href=\"#cite_note-zbar-11\" rel=\"external_link\">[11]<\/a><\/sup> This method is flawed in that it doesn\u2019t work if the sponges have broken into smaller pieces over time.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonography\" class=\"mw-redirect\" title=\"Ultrasonography\" rel=\"external_link\" target=\"_blank\">Ultrasonography<\/a>- Gossypiboma can be recognized with ultrasonography by \u201cthe presence of brightly echogenic wavy structures in a cystic mass showing posterior acoustic shadowing that changes in parallel with the direction of the ultrasound beam\u201d according to Zbar <sup id=\"rdp-ebb-cite_ref-zbar_11-2\" class=\"reference\"><a href=\"#cite_note-zbar-11\" rel=\"external_link\">[11]<\/a><\/sup> and associates.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computerized_Tomography\" class=\"mw-redirect\" title=\"Computerized Tomography\" rel=\"external_link\" target=\"_blank\">Computerized Tomography<\/a> (CT)- A surgical sponge on a CT will show air bubbles on soft tissue masses. The flaw with this technique is that gossypibomas are easily confused with abscesses.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Consequences\">Consequences<\/span><\/h3>\n<p>Dangers of a tool or sponge left behind range anywhere from harmless to life-threatening. Surgical tools left in the body can puncture vital organs and blood vessels, causing internal bleeding. Sponges can fester inside a body, growing increasingly dangerous over time. Additional operations may be necessary, which can be costly and also take the surgical table away from other patients with more urgent needs. Michael Blum said \u201cThe incidents observed\u2026took an average of 13 minutes to resolve, a time lapse which can significantly impact the flow of a busy emergency or perioperative department.\u201d<sup id=\"rdp-ebb-cite_ref-Gamble_8-1\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Another danger is a sponge can be misdiagnosed, resulting in an unnecessary extreme surgery.<sup id=\"rdp-ebb-cite_ref-fortia_10-4\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> (see case study below) A radical surgery can be avoided by considering the possibility of a retained sponge or tool.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Contributing_factors\">Contributing factors<\/span><\/h2>\n<p>Many studies have taken place to pinpoint the causes of tools being forgotten in hopes that they may be avoided in the future. It has been thought that the amount of blood lost in a surgery or the changing of nurses during the surgery would influence the risk of losing something, but studies do not support this. Human factors such as exhaustion, lack of tools necessary to aid in producing an accurate count, and a chaotic environment all have been seen to increase the risk of forgetting a tool.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> These factors cannot be controlled and surgeons must learn to mitigate them.\n<\/p><p>Inaccurate counts are a main reason why tools can be left behind. Many cases of a retained instrument originally reported a correct sponge count when the patient was released.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-3\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> An inaccurate count can occur when nurses are deprived of sleep, when the operation is particularly difficult, long, and mentally draining, when the operation is an emergency, or when there are unforeseen changes in the procedure. \n<\/p><p>An increased amount of chaos and distractions lead to a higher risk of a surgeon forgetting a tool. Mark Hulse from North Shore Medical Center said the following about surgery; \u201cIt\u2019s a process that\u2019s definitely subject to interruption and can be prone to errors. You\u2019re doing a hundred other things at the same time, and as much as you try to keep your attention on it [sponge counts] if the surgeon needs something, it\u2019s easy to get distracted.\u201d<sup id=\"rdp-ebb-cite_ref-Gamble_8-2\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Some aspects of surgery that can add to chaos are performing unforeseen changes in the procedure and undergoing emergency surgery.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Consequently, the emergency room is the place most likely to make mistakes.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>Studies have shown having a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_mass_index\" title=\"Body mass index\" rel=\"external_link\" target=\"_blank\">body mass index<\/a> increases risk. Boston researchers found that a one-point increase in BMI related to a higher risk by 10%. The researchers suggest that \u201cthey [surgeons] chalk it up to more room in a patient in which to lose things.\u201d<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-Retained_Surgical_Instruments_and_Unretrieved_Device_Fragments_.28UDF.29\"><\/span><span class=\"mw-headline\" id=\"Retained_Surgical_Instruments_and_Unretrieved_Device_Fragments_(UDF)\">Retained Surgical Instruments and Unretrieved Device Fragments (UDF)<\/span><\/h2>\n<p>In 2008, the US Food and Drug Administration (FDA) published a Public Health Notification advising on serious adverse events arising from fragments of medical devices left behind after surgical procedures, known as unretrieved device fragments (UDFs). The FDA's Centre for Devices and Radiological Health receives around 1000 adverse event reports each year relating to UDFs.<sup id=\"rdp-ebb-cite_ref-FDA_17-0\" class=\"reference\"><a href=\"#cite_note-FDA-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Fischer_18-0\" class=\"reference\"><a href=\"#cite_note-Fischer-18\" rel=\"external_link\">[18]<\/a><\/sup> One major source of UDFs is from the failure of surgical instruments.<sup id=\"rdp-ebb-cite_ref-Health_Devices_19-0\" class=\"reference\"><a href=\"#cite_note-Health_Devices-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>There are many risks from UDFs. The FDA states:\n<p>\"The adverse events reported include local tissue reaction, infection, perforation and obstruction of blood vessels, and death. Contributing factors may include biocompatibility of the device materials, location of the fragment, potential migration of the fragment, and patient anatomy. During MRI procedures, magnetic fields may cause metallic fragments to migrate, and radiofrequency fields may cause them to heat, causing internal tissue damage and\/or burns\"<sup id=\"rdp-ebb-cite_ref-Health_Devices_19-1\" class=\"reference\"><a href=\"#cite_note-Health_Devices-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Preventing_incidents\">Preventing incidents<\/span><\/h2>\n<p>Improvement in lowering the number of mistakes likely depends upon improving the surgical system, and not in individual scapegoating.<sup id=\"rdp-ebb-cite_ref-toerror_5-4\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup> According to the Institute of Medicine, \u201cthe problem is not bad people; the problem is that the system needs to be made safer.\u201d<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>In order to improve the system and reduce the number of accidents, some hospitals require four counts of sponges and instruments.<sup id=\"rdp-ebb-cite_ref-Berguer_21-0\" class=\"reference\"><a href=\"#cite_note-Berguer-21\" rel=\"external_link\">[21]<\/a><\/sup> The first count happens when the instruments are being set up and the sponges unwrapped.<sup id=\"rdp-ebb-cite_ref-Berguer_21-1\" class=\"reference\"><a href=\"#cite_note-Berguer-21\" rel=\"external_link\">[21]<\/a><\/sup> The next count is required right before surgery begins, another count as closure begins, and finally a count during skin closure.<sup id=\"rdp-ebb-cite_ref-Berguer_21-2\" class=\"reference\"><a href=\"#cite_note-Berguer-21\" rel=\"external_link\">[21]<\/a><\/sup> This is a general guideline and there are different count methods according to different hospitals.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-4\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>While careful counting could prevent some mistakes, counting carries its own risks. Sometimes the patient must be worked on immediately, leaving no time to count the instruments to be used beforehand. Another risk of counting after is having to leave the patient under anesthesia longer.<sup id=\"rdp-ebb-cite_ref-Smith_22-0\" class=\"reference\"><a href=\"#cite_note-Smith-22\" rel=\"external_link\">[22]<\/a><\/sup> In addition, counting may not be entirely beneficial as counting is prone to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_error\" title=\"Human error\" rel=\"external_link\" target=\"_blank\">human error<\/a> and the majority of the cases of gossypiboma and other retained tools happen under a reported correct count.<sup id=\"rdp-ebb-cite_ref-Gamble_8-3\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Dr. Atul A. Gawande, a surgeon, said in an article published in <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_England_Journal_of_Medicine\" title=\"The New England Journal of Medicine\" rel=\"external_link\" target=\"_blank\">The New England Journal of Medicine<\/a><\/i> that \u201ceven though you're following procedures, the priority is the patient, not the procedures.\u201d<sup id=\"rdp-ebb-cite_ref-Grady_23-0\" class=\"reference\"><a href=\"#cite_note-Grady-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>A new technique that is developing is similar to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bar_Code_Medication_Administration\" class=\"mw-redirect\" title=\"Bar Code Medication Administration\" rel=\"external_link\" target=\"_blank\">Bar Code Medication Administration<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California_at_San_Francisco\" class=\"mw-redirect\" title=\"University of California at San Francisco\" rel=\"external_link\" target=\"_blank\">University of California at San Francisco<\/a> and North Shore Medical Center have installed a \u201cbar coded sponge management system\u201d,<sup id=\"rdp-ebb-cite_ref-Gamble_8-4\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> reasoning that technological error is smaller than human error.<sup id=\"rdp-ebb-cite_ref-Gamble_8-5\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Each surgical instrument has a bar code placed on it and nurses pass the items through a hand scanner. The bar code allows each sponge to be identified, resulting in little to no room for error. UCSF reported in April 2008 to have not had \"any unintended retained gauze or sponges\u201d since the installation of the system in April 2007.<sup id=\"rdp-ebb-cite_ref-Gamble_8-6\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Gibbs-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Gibbs_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Gibbs, Verna C. \u201cChapter 22. The Retained Surgical Sponge.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.teleflexmedicaloem.com\/pdf\/KMAD-4_General.pdf\" target=\"_blank\">\"General Instrument Sourcebook - KMedic\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 27,<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=General+Instrument+Sourcebook+-+KMedic&rft_id=http%3A%2F%2Fwww.teleflexmedicaloem.com%2Fpdf%2FKMAD-4_General.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetained+surgical+instruments\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.vubu-medical.de\/\" target=\"_blank\">\"Sterilized surgical instruments\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/6lZHpXbVN\" target=\"_blank\">Archived<\/a> from the original on October 27, 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 27,<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Sterilized+surgical+instruments&rft_id=https%3A%2F%2Fwww.vubu-medical.de%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetained+surgical+instruments\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Renee Nimitz, <i>Surgical Instrumentation: an Interactive Approach<\/i> (Saunders, 2010) 1416037020, pxiii<\/span>\n<\/li>\n<li id=\"cite_note-toerror-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-toerror_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Institute of Medicine. <i>To Err Is Human- Building a Safer Healthcare System<\/i> pg.43<\/span>\n<\/li>\n<li id=\"cite_note-Sakhel-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Sakhel_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sakhel_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Sakhel, Khaled and James Hines. \u201cTo Forget is Human: the case of the retained bulb.\u201d <i>Journal of Robotic Surgery<\/i> pgs. 45\u201347<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\u201cSurgical Instruments Left in Patient\u2019s Body.\u201d <i>Nursing Link.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-Gamble-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Gamble_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Gamble, Kate Huvane. \u201cNo Sponge Left Behind\u201d, <i>Health Care Informatics<\/i>.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Emergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\" <i>Patient Safety Monitor Alert<\/i>.<\/span>\n<\/li>\n<li id=\"cite_note-fortia-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fortia_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Fortia, Mohamed El, Maroua Bendaoud, and Sumer Sethi. \"Abdominal Gossypiboma (Textilioma).\" <i>Internet Journal of Radiology<\/i><\/span>\n<\/li>\n<li id=\"cite_note-zbar-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-zbar_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-zbar_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-zbar_11-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Zbar AP, A. Agrawal, I.T.Saeedi, and MRA Utidjian. \u201cGossypiboma revisited: a case report and review of the literature.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rajagopal, Ambil F.R.C.S. and Joseph Martin M.S. \u201cGossypiboma-\u201cA Surgeon\u2019s Legacy.\u201d <i>Diseases of the Colon and Rectum<\/i><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\u201cEmergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\u201d <i>Patient Safety Monitor Alert.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gawande AA, et al. \u201cRisk Factors for Retained Instruments and Sponges After Surgery.\u201d <i>N Engl J Med<\/i> pg. 348<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Institute of Medicine. <i>To Err Is Human- Building a Safer Healthcare System<\/i>. pg.37<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rasich, Paula. \u201cSurgical Tools.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-FDA-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDA_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">FDA. \"Unretrieved Device Fragments.\"<\/span>\n<\/li>\n<li id=\"cite_note-Fischer-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Fischer_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Fischer, R. \"Danger: Beware of Unretrieved Device Fragments.\"<\/span>\n<\/li>\n<li id=\"cite_note-Health_Devices-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Health_Devices_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Health_Devices_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Health Devices. \"Top 10 Technology Hazards.\"<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Institute of Medicine. <i>To Err Is Human- Building a Safer Healthcare System.<\/i> pg. 49<\/span>\n<\/li>\n<li id=\"cite_note-Berguer-21\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Berguer_21-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Berguer_21-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Berguer_21-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Berguer, Ramon and Paul J. Heller. \"Preventing Sharps Injuries in the Operating Room.\"<\/span>\n<\/li>\n<li id=\"cite_note-Smith-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Smith_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Smith, Carol. \u201cSurgical Tools Left in Five Patients.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-Grady-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Grady_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Grady, Denise. \u201cForgotten Surgical Tools 'Uncommon but Dangerous'.\u201d<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181216183732\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.160 seconds\nReal time usage: 0.184 seconds\nPreprocessor visited node count: 534\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2831\/2097152 bytes\nTemplate argument size: 155\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 16057\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.057\/10.000 seconds\nLua memory usage: 1.47 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 123.580 1 Template:Reflist\n100.00% 123.580 1 -total\n<\/p>\n<pre>75.78% 93.644 2 Template:Cite_web\n 2.35% 2.904 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:25184288-1!canonical and timestamp 20181216183732 and revision id 857340463\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Retained_surgical_instruments\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214713\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.136 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 130.292 1 - wikipedia:Retained_surgical_instruments\n100.00% 130.292 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8579-0!*!*!*!*!*!* and timestamp 20181217214713 and revision id 25007\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments\">https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1cf942a9b4d4ec535b38698628d663dc_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Ssagh.jpg\/440px-Ssagh.jpg"],"1cf942a9b4d4ec535b38698628d663dc_timestamp":1545083233,"7cc66603d9a9b5bb883b85a69555dc82_type":"article","7cc66603d9a9b5bb883b85a69555dc82_title":"Operating theater","7cc66603d9a9b5bb883b85a69555dc82_url":"https:\/\/www.limswiki.org\/index.php\/Operating_theater","7cc66603d9a9b5bb883b85a69555dc82_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOperating theater\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2017) (Learn how and when to remove this template message)\n Inside a modern operating room\nAn operating theater (also known as a good room, operating suite, theatre (British English), operation suite or OR) is a facility within a hospital where surgical operations are carried out in an aseptic environment.\nHistorically, the term \"operating theatre\" referred to a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery. Contemporary operating rooms are devoid of a theatre setting, making the term \"operating theater\" a misnomer. There are only two old-style operating theaters left, both of which are preserved as part of museums.\n\nContents \n\n1 Operating rooms \n\n1.1 Operating room equipment \n\n\n2 Surgeon and assistants' equipment \n3 History \n\n3.1 Surviving operating theaters \n\n\n4 Popular culture \n5 See also \n6 References \n\n\nOperating rooms \nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2009) (Learn how and when to remove this template message)\nOperating rooms are spacious, easy to clean in a cleanroom, and well-lit, typically with overhead surgical lights, and may have viewing screens and monitors. Operating rooms are generally windowless and feature controlled temperature and humidity. Special air handlers filter the air and maintain a slightly elevated pressure. Electricity support has backup systems in case of a black-out. Rooms are supplied with wall suction, oxygen, and possibly other anesthetic gases. Key equipment consists of the operating table and the anesthesia cart. In addition, there are tables to set up instruments. There is storage space for common surgical supplies. There are containers for disposables. Outside the operating room is a dedicated scrubbing area that is used by surgeons, anesthetists, ODPs (operating department practitioners), and nurses prior to surgery. An operating room will have a map to enable the terminal cleaner to realign the operating table and equipment to the desired layout during cleaning.\nSeveral operating rooms are part of the operating suite that forms a distinct section within a health-care facility. Besides the operating rooms and their wash rooms, it contains rooms for personnel to change, wash, and rest, preparation and recovery rooms(s), storage and cleaning facilities, offices, dedicated corridors, and possibly other supportive units. In larger facilities, the operating suite is climate- and air-controlled, and separated from other departments so that only authorized personnel have access.\n\nOperating room equipment \n \nThe operating table in the center of the room can be raised, lowered, and tilted in any direction.\nThe operating room lights are over the table to provide bright light, without shadows, during surgery.\nThe anesthesia machine is at the head of the operating table. This machine has tubes that connect to the patient to assist him or her in breathing during surgery, and built-in monitors that help control the mixture of gases in the breathing circuit.\nThe anesthesia cart is next to the anesthesia machine. It contains the medications, equipment, and other supplies that the anesthesiologist may need.\nSterile instruments to be used during surgery are arranged on a stainless steel table.\nAn electronic monitor (which records the heart rate and respiratory rate by adhesive patches that are placed on the patient's chest).\nThe pulse oximeter machine attaches to the patient's finger with an elastic band aid. It measures the amount of oxygen contained in the blood.\n Hybrid operating room for cardiovascular surgery at Gemelli Hospital in Rome\nAutomated blood pressure measuring machine that automatically inflates the blood pressure cuff on patient's arm.\nAn electrocautery machine uses high frequency electrical signals to cauterize or seal off blood vessels and may also be used to cut through tissue with a minimal amount of bleeding.\nIf surgery requires, a Heart-lung machine, or other specialized equipment, may be brought into the room. Heart lung machine takes the temporary control of the heart and lung during the surgery maintaining the circulation of blood and oxygen content of the body\nAdvances in technology now support Hybrid Operating Rooms, which integrate diagnostic imaging systems such as MRI and Cardiac Catheterization into the operating room to assist surgeons in specialized Neurological and Cardiac procedures.\n Surgeon and assistants' equipment \nPeople in the operating room wear PPE (personal protective equipment) to help prevent bacteria from infecting the surgical incision. This PPE includes the following:\n\nSimilar to normal Cleanrooms, germless.\nA protective cap covering their hair\nMasks over their lower face, covering their mouths and noses with minimal gaps to prevent inhalation of plume or airborne microbes\nShades or glasses over their eyes, including specialized colored glasses for use with different lasers. a fiber-optic headlight may be attached for greater visibility\nSterile gloves; usually latex-free due to latex sensitivity which affects some health care workers and patients\nLong gowns, with the bottom of the gown no closer than six inches to the ground.\nProtective covers on their shoes\nIf x-rays are expected to be used, lead aprons\/neck covers are used to prevent overexposure to radiation\nThe surgeon may also wear special glasses that help him\/her to see more clearly. The circulating nurse and anesthesiologist will not wear a gown in the OR because they are not a part of the sterile team. They must keep a distance of 12-16 inches from any sterile object, person, or field.\n\nHistory \n The Agnew Clinic, 1889, by Thomas Eakins, showing the tiered arrangement of observers watching the operation.\n An operating room in the United States, c. 1960. Heart-Lung Machine with rotating disc oxygenator\nEarly operating theatres in an educational setting have had raised tables or chairs at the center for performing operations surrounded by several rows of seats for students and other spectators to observe the case in progress. The surgeons wore street clothes with an apron to protect them from blood stains, and they operated bare-handed with unsterilized instruments and supplies.[citation needed ]\nIn 1884 German surgeon Gustav Neuber implemented a comprehensive set of restrictions to ensure sterilization and aseptic operating conditions through the use of gowns, caps, and shoe covers, all of which were cleansed in his newly invented autoclave.[1] In 1885 he designed and built a private hospital in the woods where the walls, floors and hands, arms and faces of staff were washed with mercuric chloride, instruments were made with flat surfaces and the shelving was easy-to-clean glass. Neuber also introduced separate operating theaters for infected and uninfected patients and the use of heated and filtered air in the theater to eliminate germs.[2] In 1890 surgical gloves were introduced to the practice of medicine by William Halsted.[3] Aseptic surgery was pioneered in the United States by Charles McBurney.[4]\n\nSurviving operating theaters \n Old Operating Theatre in London\nOne of the oldest surviving operating theaters is the Old Operating Theatre in London. Built in 1822, it is now a museum of surgical history. Another theater still exists at the University of Padua, in Italy, inside Palazzo Bo. It was commissioned by the anatomist Girolamo Fabrizio d'Acquapendente in 1594. Another famous operating theater is the Ether Dome in Boston. Built in 1824, it is now a conference room and tourist attraction. Pennsylvania Hospital in Philadelphia also boasts its own surviving operating theater, built in 1804.[5]\n\nPopular culture \nIn the \"Homer's Triple Bypass\" episode of The Simpsons, Homer Simpson has an operation performed on him in an operating theater.\nIn Lemony Snicket's The Hostile Hospital, Count Olaf disguises his henchmen as doctors and tries to perform a \"cranioectomy\" (decapitation) on Violet Baudelaire for a live audience in an operating theater.\nMany scenes of the Cinemax series The Knick, set in the fictional Knickerbocker Hospital in New York City in 1900 and 1901, are set in the hospital's operating theatre, which has tiered seating surrounding the operating table from which other surgeons, students, or just interested spectators can watch the surgical procedures.\nIn The Terminal Man a large number of hospital staff watch an experimental epilepsy surgery being performed, while one of the spectators explains the procedure.\nIn the Seinfeld episode \"The Junior Mint,\" Jerry and Kramer witness a surgery being performed from the seats of an operating theater. The patient's health seems to take a turn for the worse after Jerry accidentally drops a Junior Mint candy from his seat into the patient's open chest cavity.\nSee also \nAnatomical theater\nHybrid operating room\nPatient identifier\nReferences \n\n\n^ Deysine, M (2003). Hernia infections: pathophysiology, diagnosis, treatment, prevention. Informa Health Care. pp. 13. ISBN 0-8247-4612-0. \n\n^ Bishop, WJ (1995). The Early history of surgery. Barnes & Noble. pp. 169. ISBN 1-56619-798-8. \n\n^ Porter, R (2001). The Cambridge illustrated history of medicine. Cambridge University Press. pp. 376. ISBN 0-521-00252-4. \n\n^ Gross, E (1990). This day in American history. Verlag f\u00fcr die Deutsche Wirtschaft. pp. 61. ISBN 1-55570-046-2. \n\n^ \"Pennsylvania Hospital History: Virtual Tour - Surgical Amphitheatre\". www.uphs.upenn.edu. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Operating_theater\">https:\/\/www.limswiki.org\/index.php\/Operating_theater<\/a>\n\t\t\t\t\tCategory: Healthcare settingsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 18:09.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 806 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7cc66603d9a9b5bb883b85a69555dc82_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Operating_theater skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Operating theater<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:292px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Operating_theatre.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e6\/Operating_theatre.jpg\/290px-Operating_theatre.jpg\" width=\"290\" height=\"218\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Operating_theatre.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Inside a modern operating room<\/div><\/div><\/div>\n<p>An <b>operating theater<\/b> (also known as a <b>good room<\/b>, <b>operating suite<\/b>, <b>theatre<\/b> (British English), <b>operation suite<\/b> or <b>OR<\/b>) is a facility within a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospital<\/a> where surgical operations are carried out in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asepsis\" title=\"Asepsis\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> environment.\n<\/p><p>Historically, the term \"operating theatre\" referred to a non-sterile, tiered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Theater_(building)\" class=\"mw-redirect\" title=\"Theater (building)\" rel=\"external_link\" target=\"_blank\">theater<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amphitheater\" class=\"mw-redirect\" title=\"Amphitheater\" rel=\"external_link\" target=\"_blank\">amphitheater<\/a> in which students and other spectators could watch surgeons perform surgery. Contemporary operating rooms are devoid of a theatre setting, making the term \"operating theater\" a misnomer. There are only two old-style operating theaters left, both of which are preserved as part of museums.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Operating_rooms\">Operating rooms<\/span><\/h2>\n\n<p>Operating rooms are spacious, easy to clean in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleanroom\" title=\"Cleanroom\" rel=\"external_link\" target=\"_blank\">cleanroom<\/a>, and well-lit, typically with overhead <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_lighting\" title=\"Surgical lighting\" rel=\"external_link\" target=\"_blank\">surgical lights<\/a>, and may have viewing screens and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_monitor\" class=\"mw-redirect\" title=\"Medical monitor\" rel=\"external_link\" target=\"_blank\">monitors<\/a>. Operating rooms are generally windowless and feature controlled temperature and humidity. Special air handlers filter the air and maintain a slightly elevated pressure. Electricity support has backup systems in case of a black-out. Rooms are supplied with wall suction, oxygen, and possibly other anesthetic gases. Key equipment consists of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_table\" title=\"Operating table\" rel=\"external_link\" target=\"_blank\">operating table<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia_cart\" title=\"Anesthesia cart\" rel=\"external_link\" target=\"_blank\">anesthesia cart<\/a>. In addition, there are tables to set up instruments. There is storage space for common surgical supplies. There are containers for disposables. Outside the operating room is a dedicated scrubbing area that is used by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeons<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthetist\" class=\"mw-redirect\" title=\"Anesthetist\" rel=\"external_link\" target=\"_blank\">anesthetists<\/a>, ODPs (operating department practitioners), and nurses prior to surgery. An operating room will have a map to enable the terminal cleaner to realign the operating table and equipment to the desired layout during cleaning.\n<\/p><p>Several operating rooms are part of the operating suite that forms a distinct section within a health-care facility. Besides the operating rooms and their wash rooms, it contains rooms for personnel to change, wash, and rest, preparation and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recovery_room\" class=\"mw-redirect\" title=\"Recovery room\" rel=\"external_link\" target=\"_blank\">recovery rooms<\/a>(s), storage and cleaning facilities, offices, dedicated corridors, and possibly other supportive units. In larger facilities, the operating suite is climate- and air-controlled, and separated from other departments so that only authorized personnel have access.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Operating_room_equipment\">Operating room equipment<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Sala de Cirurgia Hospital de Est\u00e2ncia.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\/220px-Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><\/div><\/div><\/div>\n<ul><li>The operating table in the center of the room can be raised, lowered, and tilted in any direction.<\/li>\n<li>The operating room lights are over the table to provide bright light, without shadows, during surgery.<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia_machine\" class=\"mw-redirect\" title=\"Anesthesia machine\" rel=\"external_link\" target=\"_blank\">anesthesia machine<\/a> is at the head of the operating table. This machine has tubes that connect to the patient to assist him or her in breathing during surgery, and built-in monitors that help control the mixture of gases in the breathing circuit.<\/li>\n<li>The anesthesia cart is next to the anesthesia machine. It contains the medications, equipment, and other supplies that the anesthesiologist may need.<\/li>\n<li>Sterile instruments to be used during surgery are arranged on a stainless steel table.<\/li>\n<li>An electronic monitor (which records the heart rate and respiratory rate by adhesive patches that are placed on the patient's chest).<\/li>\n<li>The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It measures the amount of oxygen contained in the blood.<\/li><\/ul>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hybrid_operating_theatre_gemelli_rome.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Hybrid_operating_theatre_gemelli_rome.jpg\/400px-Hybrid_operating_theatre_gemelli_rome.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hybrid_operating_theatre_gemelli_rome.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hybrid_operating_room\" title=\"Hybrid operating room\" rel=\"external_link\" target=\"_blank\">Hybrid operating room<\/a> for cardiovascular surgery at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agostino_Gemelli_University_Polyclinic\" title=\"Agostino Gemelli University Polyclinic\" rel=\"external_link\" target=\"_blank\">Gemelli Hospital<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rome\" title=\"Rome\" rel=\"external_link\" target=\"_blank\">Rome<\/a><\/div><\/div><\/div>\n<ul><li>Automated blood pressure measuring machine that automatically inflates the blood pressure cuff on patient's arm.<\/li>\n<li>An electrocautery machine uses high frequency electrical signals to cauterize or seal off blood vessels and may also be used to cut through tissue with a minimal amount of bleeding.<\/li>\n<li>If surgery requires, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart-lung_machine\" class=\"mw-redirect\" title=\"Heart-lung machine\" rel=\"external_link\" target=\"_blank\">Heart-lung machine<\/a>, or other specialized equipment, may be brought into the room. Heart lung machine takes the temporary control of the heart and lung during the surgery maintaining the circulation of blood and oxygen content of the body<\/li>\n<li>Advances in technology now support Hybrid Operating Rooms, which integrate diagnostic imaging systems such as MRI and Cardiac Catheterization into the operating room to assist surgeons in specialized Neurological and Cardiac procedures.<\/li><\/ul>\n<h2><span id=\"rdp-ebb-Surgeon_and_assistants.27_equipment\"><\/span><span class=\"mw-headline\" id=\"Surgeon_and_assistants'_equipment\">Surgeon and assistants' equipment<\/span><\/h2>\n<p>People in the operating room wear PPE (personal protective equipment) to help prevent bacteria from infecting the surgical incision. This PPE includes the following:\n<\/p>\n<ul><li>Similar to normal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleanroom\" title=\"Cleanroom\" rel=\"external_link\" target=\"_blank\">Cleanrooms<\/a>, germless.<\/li>\n<li>A protective cap covering their hair<\/li>\n<li>Masks over their lower face, covering their mouths and noses with minimal gaps to prevent inhalation of plume or airborne microbes<\/li>\n<li>Shades or glasses over their eyes, including specialized colored glasses for use with different lasers. a fiber-optic headlight may be attached for greater visibility<\/li>\n<li>Sterile gloves; usually latex-free due to latex sensitivity which affects some health care workers and patients<\/li>\n<li>Long gowns, with the bottom of the gown no closer than six inches to the ground.<\/li>\n<li>Protective covers on their shoes<\/li>\n<li>If x-rays are expected to be used, lead aprons\/neck covers are used to prevent overexposure to radiation<\/li><\/ul>\n<p>The surgeon may also wear special glasses that help him\/her to see more clearly. The circulating nurse and anesthesiologist will not wear a gown in the OR because they are not a part of the sterile team. They must keep a distance of 12-16 inches from any sterile object, person, or field.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:The_Agnew_Clinic_-_Thomas_Eakins.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/The_Agnew_Clinic_-_Thomas_Eakins.jpg\/220px-The_Agnew_Clinic_-_Thomas_Eakins.jpg\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:The_Agnew_Clinic_-_Thomas_Eakins.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Agnew_Clinic\" title=\"The Agnew Clinic\" rel=\"external_link\" target=\"_blank\">The Agnew Clinic<\/a><\/i>, 1889, by Thomas Eakins, showing the tiered arrangement of observers watching the operation.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hospital_Operating_Room_(FDA_042)_(8250274128).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/97\/Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg\/220px-Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg\" width=\"220\" height=\"281\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hospital_Operating_Room_(FDA_042)_(8250274128).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An operating room in the United States, c. 1960. Heart-Lung Machine with rotating disc oxygenator<\/div><\/div><\/div>\n<p>Early operating theatres in an educational setting have had raised tables or chairs at the center for performing operations surrounded by several rows of seats for students and other spectators to observe the case in progress. The surgeons wore street clothes with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apron\" title=\"Apron\" rel=\"external_link\" target=\"_blank\">apron<\/a> to protect them from blood stains, and they operated bare-handed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">unsterilized<\/a> instruments and supplies.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In 1884 German surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gustav_Adolf_Neuber\" title=\"Gustav Adolf Neuber\" rel=\"external_link\" target=\"_blank\">Gustav Neuber<\/a> implemented a comprehensive set of restrictions to ensure sterilization and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asepsis\" title=\"Asepsis\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> operating conditions through the use of gowns, caps, and shoe covers, all of which were cleansed in his newly invented <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclave<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> In 1885 he designed and built a private hospital in the woods where the walls, floors and hands, arms and faces of staff were washed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury(II)_chloride\" title=\"Mercury(II) chloride\" rel=\"external_link\" target=\"_blank\">mercuric chloride<\/a>, instruments were made with flat surfaces and the shelving was easy-to-clean glass. Neuber also introduced separate operating theaters for infected and uninfected patients and the use of heated and filtered air in the theater to eliminate germs.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> In 1890 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_glove\" title=\"Medical glove\" rel=\"external_link\" target=\"_blank\">surgical gloves<\/a> were introduced to the practice of medicine by <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Halsted\" class=\"mw-redirect\" title=\"William Halsted\" rel=\"external_link\" target=\"_blank\">William Halsted<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Aseptic surgery was pioneered in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_McBurney_(surgeon)\" title=\"Charles McBurney (surgeon)\" rel=\"external_link\" target=\"_blank\">Charles McBurney<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Surviving_operating_theaters\">Surviving operating theaters<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Old_Operating_Theatre.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Old_Operating_Theatre.jpg\/220px-Old_Operating_Theatre.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Old_Operating_Theatre.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Old Operating Theatre in London<\/div><\/div><\/div>\n<p>One of the oldest surviving operating theaters is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Old_Operating_Theatre\" class=\"mw-redirect\" title=\"Old Operating Theatre\" rel=\"external_link\" target=\"_blank\">Old Operating Theatre<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/London\" title=\"London\" rel=\"external_link\" target=\"_blank\">London<\/a>. Built in 1822, it is now a museum of surgical history. Another theater still exists at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Padua\" title=\"University of Padua\" rel=\"external_link\" target=\"_blank\">University of Padua<\/a>, in Italy, inside Palazzo Bo. It was commissioned by the anatomist Girolamo Fabrizio d'Acquapendente in 1594. Another famous operating theater is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ether_Dome\" title=\"Ether Dome\" rel=\"external_link\" target=\"_blank\">Ether Dome<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston\" title=\"Boston\" rel=\"external_link\" target=\"_blank\">Boston<\/a>. Built in 1824, it is now a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conference_hall\" title=\"Conference hall\" rel=\"external_link\" target=\"_blank\">conference room<\/a> and tourist attraction. Pennsylvania Hospital in Philadelphia also boasts its own surviving operating theater, built in 1804.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Popular_culture\">Popular culture<\/span><\/h2>\n<ul><li>In the \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Homer%27s_Triple_Bypass\" title=\"Homer's Triple Bypass\" rel=\"external_link\" target=\"_blank\">Homer's Triple Bypass<\/a>\" episode of <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Simpsons\" title=\"The Simpsons\" rel=\"external_link\" target=\"_blank\">The Simpsons<\/a><\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homer_Simpson\" title=\"Homer Simpson\" rel=\"external_link\" target=\"_blank\">Homer Simpson<\/a> has an operation performed on him in an operating theater.<\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lemony_Snicket\" title=\"Lemony Snicket\" rel=\"external_link\" target=\"_blank\">Lemony Snicket<\/a>'s <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Hostile_Hospital\" title=\"The Hostile Hospital\" rel=\"external_link\" target=\"_blank\">The Hostile Hospital<\/a><\/i>, Count Olaf disguises his henchmen as doctors and tries to perform a \"cranioectomy\" (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Decapitation\" title=\"Decapitation\" rel=\"external_link\" target=\"_blank\">decapitation<\/a>) on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Violet_Baudelaire\" class=\"mw-redirect\" title=\"Violet Baudelaire\" rel=\"external_link\" target=\"_blank\">Violet Baudelaire<\/a> for a live audience in an operating theater.<\/li>\n<li>Many scenes of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cinemax\" title=\"Cinemax\" rel=\"external_link\" target=\"_blank\">Cinemax<\/a> series <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Knick\" title=\"The Knick\" rel=\"external_link\" target=\"_blank\">The Knick<\/a><\/i>, set in the fictional Knickerbocker Hospital in New York City in 1900 and 1901, are set in the hospital's operating theatre, which has tiered seating surrounding the operating table from which other surgeons, students, or just interested spectators can watch the surgical procedures.<\/li>\n<li>In <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Terminal_Man_(film)\" title=\"The Terminal Man (film)\" rel=\"external_link\" target=\"_blank\">The Terminal Man<\/a><\/i> a large number of hospital staff watch an experimental <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy_surgery\" title=\"Epilepsy surgery\" rel=\"external_link\" target=\"_blank\">epilepsy surgery<\/a> being performed, while one of the spectators explains the procedure.<\/li>\n<li>In the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Seinfeld\" title=\"Seinfeld\" rel=\"external_link\" target=\"_blank\">Seinfeld<\/a><\/i> episode \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Junior_Mint\" title=\"The Junior Mint\" rel=\"external_link\" target=\"_blank\">The Junior Mint<\/a>,\" Jerry and Kramer witness a surgery being performed from the seats of an operating theater. The patient's health seems to take a turn for the worse after Jerry accidentally drops a Junior Mint candy from his seat into the patient's open chest cavity.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_theatre\" title=\"Anatomical theatre\" rel=\"external_link\" target=\"_blank\">Anatomical theater<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hybrid_operating_room\" title=\"Hybrid operating room\" rel=\"external_link\" target=\"_blank\">Hybrid operating room<\/a><\/li>\n<li>Patient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Identifier\" title=\"Identifier\" rel=\"external_link\" target=\"_blank\">identifier<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Deysine, M (2003). <i>Hernia infections: pathophysiology, diagnosis, treatment, prevention<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informa\" title=\"Informa\" rel=\"external_link\" target=\"_blank\">Informa Health Care<\/a>. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=A7AzezHNMDUC&pg=PA13\" target=\"_blank\">13<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8247-4612-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Hernia+infections%3A+pathophysiology%2C+diagnosis%2C+treatment%2C+prevention&rft.pages=13&rft.pub=Informa+Health+Care&rft.date=2003&rft.isbn=0-8247-4612-0&rft.aulast=Deysine&rft.aufirst=M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bishop, WJ (1995). <i>The Early history of surgery<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Barnes_%26_Noble\" title=\"Barnes & Noble\" rel=\"external_link\" target=\"_blank\">Barnes & Noble<\/a>. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=Yds0EJ3nh8AC&pg=PA169\" target=\"_blank\">169<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-56619-798-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Early+history+of+surgery&rft.pages=169&rft.pub=Barnes+%26+Noble&rft.date=1995&rft.isbn=1-56619-798-8&rft.aulast=Bishop&rft.aufirst=WJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Porter, R (2001). <i>The Cambridge illustrated history of medicine<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cambridge_University_Press\" title=\"Cambridge University Press\" rel=\"external_link\" target=\"_blank\">Cambridge University Press<\/a>. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=VsyYXczSmhgC&pg=PA376\" target=\"_blank\">376<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-521-00252-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Cambridge+illustrated+history+of+medicine&rft.pages=376&rft.pub=Cambridge+University+Press&rft.date=2001&rft.isbn=0-521-00252-4&rft.aulast=Porter&rft.aufirst=R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Gross, E (1990). <i>This day in American history<\/i>. Verlag f\u00fcr die Deutsche Wirtschaft. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=tQ9eEattl4MC&pg=PA61\" target=\"_blank\">61<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-55570-046-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=This+day+in+American+history&rft.pages=61&rft.pub=Verlag+f%C3%BCr+die+Deutsche+Wirtschaft&rft.date=1990&rft.isbn=1-55570-046-2&rft.aulast=Gross&rft.aufirst=E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.uphs.upenn.edu\/paharc\/tour\/tour5.html\" target=\"_blank\">\"Pennsylvania Hospital History: Virtual Tour - Surgical Amphitheatre\"<\/a>. <i>www.uphs.upenn.edu<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.uphs.upenn.edu&rft.atitle=Pennsylvania+Hospital+History%3A+Virtual+Tour+-+Surgical+Amphitheatre&rft_id=http%3A%2F%2Fwww.uphs.upenn.edu%2Fpaharc%2Ftour%2Ftour5.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181210214724\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.168 seconds\nReal time usage: 0.247 seconds\nPreprocessor visited node count: 578\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 18956\/2097152 bytes\nTemplate argument size: 640\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12901\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.078\/10.000 seconds\nLua memory usage: 2.6 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 188.125 1 -total\n<\/p>\n<pre>48.01% 90.313 1 Template:Reflist\n36.63% 68.914 4 Template:Cite_book\n30.19% 56.793 1 Template:Refimprove\n22.14% 41.659 2 Template:Ambox\n14.68% 27.621 1 Template:Citation_needed\n12.92% 24.305 1 Template:Fix\n 5.66% 10.648 2 Template:Category_handler\n 5.45% 10.246 1 Template:Unreferenced_section\n 5.18% 9.754 1 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:384886-1!canonical and timestamp 20181210214724 and revision id 872934325\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_theater\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214713\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 132.588 1 - wikipedia:Operating_theater\n100.00% 132.588 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8213-0!*!*!*!*!*!* and timestamp 20181217214713 and revision id 24363\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Operating_theater\">https:\/\/www.limswiki.org\/index.php\/Operating_theater<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7cc66603d9a9b5bb883b85a69555dc82_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e6\/Operating_theatre.jpg\/580px-Operating_theatre.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\/440px-Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Hybrid_operating_theatre_gemelli_rome.jpg\/800px-Hybrid_operating_theatre_gemelli_rome.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/The_Agnew_Clinic_-_Thomas_Eakins.jpg\/440px-The_Agnew_Clinic_-_Thomas_Eakins.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/97\/Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg\/440px-Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Old_Operating_Theatre.jpg\/440px-Old_Operating_Theatre.jpg"],"7cc66603d9a9b5bb883b85a69555dc82_timestamp":1545083233,"01459832dca0b3aa9299ecec4ba67886_type":"article","01459832dca0b3aa9299ecec4ba67886_title":"MELISA","01459832dca0b3aa9299ecec4ba67886_url":"https:\/\/www.limswiki.org\/index.php\/MELISA","01459832dca0b3aa9299ecec4ba67886_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMELISA\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the blood test. For other uses, see Melisa (disambiguation).\nA MELISA (Memory Lymphocyte Immunostimulation Assay) test is a blood test that detects type IV hypersensitivity to metals, chemicals, environmental toxins and molds from one single blood sample. The test does not measure toxicity \u2013 that is to say, it will not measure the amounts of a harmful substance in the patient's blood. It measures if the patient is allergic to it.\nTwo articles have concluded that the MELISA test is not useful for diagnosis since a large number of false positive results will be obtained.[1][2] A subsequent study confirmed MELISA as reproducible, sensitive, specific, and reliable for detecting metal sensitivity in metal-sensitive patients.[3]\n\nContents \n\n1 Mechanism \n2 Applications \n\n2.1 Occupational medicine \n2.2 Dentistry \n2.3 Chronic diseases \n\n\n3 Validity \n4 See also \n5 References \n\n\nMechanism \nA MELISA test measures a so-called type-IV delayed hypersensitivity reaction. In contrast to a type-I allergy, which is mediated by IgE antibodies and is often tested using an ELISA test, a type-IV hypersensitivity reaction is mediated by T-lymphocytes (or memory lymphocytes) that have had prior contact with a given allergen.[4] In genetically predisposed individuals, an ongoing everyday exposure to allergens can induce the type-IV hypersensitivity with a resulting allergic reaction.[5]\nThe test procedure is a cell culture and requires live memory lymphocytes. Lymphocytes are isolated and cultured in an incubator for five days. A portion of the blood is kept intact (unexposed to allergens) to serve as a negative control. A second portion is exposed to a universal allergen, such as Pokeweed, to serve as a positive control. Finally, the third portion of the blood is exposed to the suspected allergen in several different concentrations, to ensure that the conditions in vitro are as similar as possible to the ones in vivo.\nAs an example, if a patient has a suspected allergy to dental amalgams, then the allergens tested for will be the metals most commonly used in dental amalgams, such as mercury, silver, tin, and copper.[6][7][8] If a patient has a suspected contact allergy to nickel then the test can be used to test for nickel allergy.[9] This is especially useful in individuals who have clinical symptoms (contact dermatitis) but a negative patch test.[10][11] The lymphocyte reaction to such an allergen is measured by two separate technologies: one based on the uptake of a radioactive isotope by dividing lymphocytes (proliferation); the other by classical microscopy evaluation (transformation). The level of reactivity is measured as a Stimulation Index (SI), against the na\u00efve lymphocytes from the unexposed sample (negative control). Viability and reactivity is determined by cell count as well as reaction to the positive control.[12][13]\n\nApplications \nOccupational medicine \nThe MELISA test is used in occupational medicine and environmental health. It has been used to screen workers exposed to metals, chemicals or other allergens in their workplace. This is what the test was developed for originally, at the Astra (now Astra-Zeneca) laboratories in Stockholm, Sweden. In the U.S., a similar technique (LTT) is routinely used to screen for Beryllium allergy in asymptomatic workers exposed to Beryllium dust.[14][15] Other occupations that use sensitivity testing include construction work, mining, electrical work, rubber\/wood\/ paper\/textile industry work, dentistry, hairdressing, and painting.[16] The MELISA test is used to screen, diagnose and monitor the immune response of susceptible or affected individuals.\n\nDentistry \nIn Europe, the test is commonly used in dentistry to test for allergy to dental restorative materials, braces and prostheses.[13]\n\nChronic diseases \nThe test is also used to determine whether metal allergy is a factor behind chronic diseases such as chronic fatigue syndrome[17] and multiple sclerosis.[18] The authors hypothesize that if the immune system is constantly staging an allergic reaction to a metal present in the body, this will alert the HPA axis inducing fatigue-like symptoms. A study[19] of 930 fatigue patients showed 62% testing MELISA-positive to metal allergy. Of those who removed the offending metals, 76% improved, but there was no placebo control. Metal allergy is not recognized by scientists as an accepted cause of chronic fatigue syndrome or multiple sclerosis.\n\nValidity \nTo test whether patients with symptoms attributed to dental amalgam differed from healthy controls, a study compared 23 amalgam patients, 30 healthy blood donors with amalgam and 10 healthy subjects without amalgam using MELISA and other tests. The researchers found that a high frequency of positive results was obtained among healthy subjects with or without dental amalgam, and concluded that the test cannot be used as an objective test for mercury allergy.[1]\nAnother study used 34 patients to test the sensitivity and specificity if the MELISA test, and concluded that it is not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.[2]\nHowever, according to the MELISA Foundation the studies are flawed, mainly due to the incorrect selection of patients included as well as the use of patch test as a gold standard for the measurement of metal allergy.[20] The clinical relevance of the test has been shown by the decrease of patient-reported metal-specific responses following the removal of the allergy-causing metals (however the trial did not have a placebo control).[21][22]\n\nSee also \nhttp:\/\/www.melisa.org\nReferences \n\n\n^ a b Cederbrant K, Gunnarsson LG, Hultman P, Norda R, Tibbling-Grahn L (Aug 1999). \"In vitro lymphoproliferative assays with HgCl2 cannot identify patients with systemic symptoms attributed to dental amalgam\". J Dent Res. 78 (8): 1450\u20138. doi:10.1177\/00220345990780081101. PMID 10439033. \n\n^ a b Cederbrant K, Hultman P, Marcusson JA, Tibbling L (Mar 1997). \"In vitro lymphocyte proliferation as compared to patch test using gold, palladium and nickel\". Int Arch Allergy Immunol. 112 (3): 212\u20137. doi:10.1159\/000237456. PMID 9066505. \n\n^ Valentine-Thon E, Schiawara HW (February\u2013April 2003). \"Validity of MELISA for metal sensitivity testing\". Neuro Endocrinol Lett. 24 (1\u20132): 57\u201364. PMID 12743534. \n\n^ Stejskal VD, Forsbeck M, Nilsson R (June 1990). \"Lymphocyte transformation test for diagnosis of isothiazolinone allergy in man\". J Invest Dermatol. 94 (6): 798\u2013802. doi:10.1111\/1523-1747.ep12874656. PMID 1693940. \n\n^ Willis CM, Young E, Brandon DR, Wilkinson JD (September 1986). \"Immunopathological and ultrastructural findings in human allergic and irritant contact dermatitis\". Br J Dermatol. 115 (3): 305\u201316. doi:10.1111\/j.1365-2133.1986.tb05745.x. PMID 3530310. \n\n^ Silvennoinen-Kassinen S, Niinim\u00e4ki A (September 1984). \"Gold sensitivity blast transformation\". Contact Derm. 11 (3): 156\u20138. doi:10.1111\/j.1600-0536.1984.tb00962.x. PMID 6437738. \n\n^ Stejskal VD, Forsbeck M, Cederbrant KE, Asteman O (January 1996). \"Mercury-specific lymphocytes: an indication of mercury allergy in man\". J Clin Immunol. 16 (1): 31\u201340. doi:10.1007\/BF01540970. PMID 8926283. \n\n^ Marcusson JA (May 1996). \"Contact allergies to nickel sulfate, gold sodium thiosulfate and palladium chloride in patients claiming side-effects from dental alloy components\". Contact Derm. 34 (5): 320\u20133. doi:10.1111\/j.1600-0536.1996.tb02215.x. PMID 8807223. \n\n^ Everness KM, Gawkrodger DJ, Botham PA, Hunter JA (March 1990). \"The discrimination between nickel-sensitive and non-nickel-sensitive subjects by an in vitro lymphocyte transformation test\". Br J Dermatol. 122 (3): 293\u20138. doi:10.1111\/j.1365-2133.1990.tb08276.x. PMID 2322494. \n\n^ Klas PA, Corey G, Storrs FJ, Chan SC, Hanifin JM (February 1996). \"Allergic and irritant patch test reactions and atopic disease\". Contact Derm. 34 (2): 121\u20134. doi:10.1111\/j.1600-0536.1996.tb02143.x. PMID 8681540. \n\n^ Rietschel RL (May 1996). \"Reproducibility of patch-test results\". Lancet. 347 (9010): 1202. doi:10.1016\/S0140-6736(96)90731-X. PMID 8622447. \n\n^ Sachs B, Merk H (2001). \"Demonstration and characterization of drug-specific lymphocyte reactivity in drug allergies\". Allergy Clin Immunol Int: J World Allergy Org. 13 (3): 91\u20138. doi:10.1027\/0838-1925.13.3.91. Archived from the original on 2006-10-26. \n\n^ a b Stejskal VD, Cederbrant K, Lindvall A, Forsbeck M (1994). \"MELISA \u2013 an in vitro tool for the study of metal allergy\". Toxicol in Vitro. 8 (5): 991\u20131000. doi:10.1016\/0887-2333(94)90233-X. PMID 20693060. \n\n^ Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS (July 1991). \"Reexamination of the blood lymphocyte transformation test in the diagnosis of chronic beryllium disease\". J Allergy Clin Immunol. 88 (1): 54\u201360. doi:10.1016\/0091-6749(91)90300-D. PMID 2071785. Archived from the original on 2014-08-15. \n\n^ Newman LS (October 1996). \"Significance of the blood beryllium lymphocyte proliferation test\". Environ. Health Perspect. 104 (Suppl 5): 953\u20136. doi:10.2307\/3433017. JSTOR 3433017. PMC 1469695 . PMID 8933041. \n\n^ Bach FH, Hirschhorn K (1964). \"Lymphocyte interaction: a potential histocompatibility test in vitro\". Science. 143 (3608): 813\u20134. doi:10.1126\/science.143.3608.813. PMID 14088078. \n\n^ Sterzl I, Proch\u00e1zkov\u00e1 J, Hrd\u00e1 P, B\u00e1rtov\u00e1 J, Matucha P, Stejskal VD (1999). \"Mercury and nickel allergy: risk factors in fatigue and autoimmunity\". Neuro Endocrinol Lett. 20 (3\u20134): 221\u20138. PMID 11462117. \n\n^ Stejskal VD, Danersund A, Lindvall A, et al. (1999). \"Metal-specific lymphocytes: biomarkers of sensitivity in man\". Neuro Endocrinol Lett. 20 (5): 289\u201398. PMID 11460087. \n\n^ Stejskal VD, Danersund A, Lindvall A, Hudecek R, Nordman V, Yaqob A, Mayer W, Bieger W, Lindh U (1999). \"Metal-specific lymphocytes: biomarkers of sensitivity in man\". Neuro Endocrinol Lett. 20 (5): 289\u2013298. PMID 11460087. \n\n^ http:\/\/www.melisa.org\/critique.php \n\n^ Stejskal V, Hudecek R, Stejskal J, Sterzl I (2006). \"Diagnosis and treatment of metal-induced side-effects\". Neuro Endocrinol Lett. 27 (Suppl 1): 7\u201316. PMID 17261999. \n\n^ Valentine-Thon E, M\u00fcller K, Guzzi G, Kreisel S, Ohnsorge P, Sandkamp M (2006). \"LTT-MELISA\u00ae is clinically relevant for detecting and monitoring metal sensitivity\". Neuro Endocrinol Lett. 27 (Suppl 1): 17\u201324. PMID 17261998. \n\n\nvteMedical tests used in immunology and for inflammation (CPT 86000\u201386849)ImmunologyImmunoprecipitation\nChromatin immunoprecipitation\nImmunodiffusion\nOuchterlony double immunodiffusion\nRadial immunodiffusion\nImmunoelectrophoresis\nCounterimmunoelectrophoresis\nImmunoassay\nELISA\nELISPOT\nEnzyme Multiplied Immunoassay Technique\nRAST test\nRadioimmunoassay\nRadiobinding assay\nImmunofluorescence\nAgglutination\nHemagglutination\/Hemagglutinin\nCoombs test\nLatex fixation test\nOther\nDiagnostic immunology\nNephelometry\nComplement fixation test\nImmunocytochemistry\nImmunohistochemistry\nDirect fluorescent antibody\nEpitope mapping\nSkin allergy test\nPatch test\nInflammation\nC-reactive protein\nProcalcitonin\nTotal complement activity\nMELISA\nComplete blood count\nlymphocyte count\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/MELISA\">https:\/\/www.limswiki.org\/index.php\/MELISA<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:02.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 344 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","01459832dca0b3aa9299ecec4ba67886_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-MELISA skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">MELISA<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the blood test. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melisa_(disambiguation)\" class=\"mw-disambig\" title=\"Melisa (disambiguation)\" rel=\"external_link\" target=\"_blank\">Melisa (disambiguation)<\/a>.<\/div>\n<p>A <b>MELISA<\/b> (<b>Memory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lymphocyte\" title=\"Lymphocyte\" rel=\"external_link\" target=\"_blank\">Lymphocyte<\/a> Immunostimulation <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assay\" title=\"Assay\" rel=\"external_link\" target=\"_blank\">Assay<\/a><\/b>) test is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">blood test<\/a> that detects <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_IV_hypersensitivity\" title=\"Type IV hypersensitivity\" rel=\"external_link\" target=\"_blank\">type IV hypersensitivity<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metals<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical\" class=\"mw-redirect\" title=\"Chemical\" rel=\"external_link\" target=\"_blank\">chemicals<\/a>, environmental toxins and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mold\" title=\"Mold\" rel=\"external_link\" target=\"_blank\">molds<\/a> from one single <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sample\" class=\"mw-redirect\" title=\"Blood sample\" rel=\"external_link\" target=\"_blank\">blood sample<\/a>. The test does not measure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicity\" title=\"Toxicity\" rel=\"external_link\" target=\"_blank\">toxicity<\/a> \u2013 that is to say, it will not measure the amounts of a harmful substance in the patient's blood. It measures if the patient is allergic to it.\n<\/p><p>Two articles have concluded that the MELISA test is not useful for diagnosis since a large number of false positive results will be obtained.<sup id=\"rdp-ebb-cite_ref-Cederbrant1999_1-0\" class=\"reference\"><a href=\"#cite_note-Cederbrant1999-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Cederbrant1997_2-0\" class=\"reference\"><a href=\"#cite_note-Cederbrant1997-2\" rel=\"external_link\">[2]<\/a><\/sup> A subsequent study confirmed MELISA as reproducible, sensitive, specific, and reliable for detecting metal sensitivity in metal-sensitive patients.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<p>A MELISA test measures a so-called type-IV delayed hypersensitivity reaction. In contrast to a type-I allergy, which is mediated by IgE <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibody\" title=\"Antibody\" rel=\"external_link\" target=\"_blank\">antibodies<\/a> and is often tested using an <a href=\"https:\/\/en.wikipedia.org\/wiki\/ELISA\" title=\"ELISA\" rel=\"external_link\" target=\"_blank\">ELISA<\/a> test, a type-IV hypersensitivity reaction is mediated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/T-lymphocyte\" class=\"mw-redirect\" title=\"T-lymphocyte\" rel=\"external_link\" target=\"_blank\">T-lymphocytes<\/a> (or memory lymphocytes) that have had prior contact with a given <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergen\" title=\"Allergen\" rel=\"external_link\" target=\"_blank\">allergen<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> In genetically predisposed individuals, an ongoing everyday exposure to allergens can induce the type-IV hypersensitivity with a resulting allergic reaction.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>The test procedure is a cell culture and requires live memory lymphocytes. Lymphocytes are isolated and cultured in an incubator for five days. A portion of the blood is kept intact (unexposed to allergens) to serve as a negative control. A second portion is exposed to a universal allergen, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pokeweed\" class=\"mw-redirect\" title=\"Pokeweed\" rel=\"external_link\" target=\"_blank\">Pokeweed<\/a>, to serve as a positive control. Finally, the third portion of the blood is exposed to the suspected allergen in several different concentrations, to ensure that the conditions in vitro are as similar as possible to the ones in vivo.\n<\/p><p>As an example, if a patient has a suspected allergy to dental <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amalgam_(dentistry)\" title=\"Amalgam (dentistry)\" rel=\"external_link\" target=\"_blank\">amalgams<\/a>, then the allergens tested for will be the metals most commonly used in dental amalgams, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">mercury<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">silver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tin\" title=\"Tin\" rel=\"external_link\" target=\"_blank\">tin<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> If a patient has a suspected contact allergy to nickel then the test can be used to test for nickel allergy.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> This is especially useful in individuals who have clinical symptoms (contact dermatitis) but a negative patch test.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> The lymphocyte reaction to such an allergen is measured by two separate technologies: one based on the uptake of a radioactive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isotope\" title=\"Isotope\" rel=\"external_link\" target=\"_blank\">isotope<\/a> by dividing lymphocytes (proliferation); the other by classical microscopy evaluation (transformation). The level of reactivity is measured as a Stimulation Index (SI), against the na\u00efve lymphocytes from the unexposed sample (negative control). Viability and reactivity is determined by cell count as well as reaction to the positive control.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Stejskal92_13-0\" class=\"reference\"><a href=\"#cite_note-Stejskal92-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Occupational_medicine\">Occupational medicine<\/span><\/h3>\n<p>The MELISA test is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_safety_and_health\" title=\"Occupational safety and health\" rel=\"external_link\" target=\"_blank\">occupational medicine<\/a> and environmental health. It has been used to screen workers exposed to metals, chemicals or other allergens in their workplace. This is what the test was developed for originally, at the Astra (now Astra-Zeneca) laboratories in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stockholm\" title=\"Stockholm\" rel=\"external_link\" target=\"_blank\">Stockholm<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sweden\" title=\"Sweden\" rel=\"external_link\" target=\"_blank\">Sweden<\/a>. In the U.S., a similar technique (LTT) is routinely used to screen for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beryllium\" title=\"Beryllium\" rel=\"external_link\" target=\"_blank\">Beryllium<\/a> allergy in asymptomatic workers exposed to Beryllium dust.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Other occupations that use sensitivity testing include construction work, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mining\" title=\"Mining\" rel=\"external_link\" target=\"_blank\">mining<\/a>, electrical work, rubber\/wood\/ paper\/textile industry work, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentistry\" title=\"Dentistry\" rel=\"external_link\" target=\"_blank\">dentistry<\/a>, hairdressing, and painting.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> The MELISA test is used to screen, diagnose and monitor the immune response of susceptible or affected individuals.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dentistry\">Dentistry<\/span><\/h3>\n<p>In Europe, the test is commonly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentistry\" title=\"Dentistry\" rel=\"external_link\" target=\"_blank\">dentistry<\/a> to test for allergy to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_restorative_materials\" class=\"mw-redirect\" title=\"Dental restorative materials\" rel=\"external_link\" target=\"_blank\">dental restorative materials<\/a>, braces and prostheses.<sup id=\"rdp-ebb-cite_ref-Stejskal92_13-1\" class=\"reference\"><a href=\"#cite_note-Stejskal92-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chronic_diseases\">Chronic diseases<\/span><\/h3>\n<p>The test is also used to determine whether metal allergy is a factor behind chronic diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_fatigue_syndrome\" title=\"Chronic fatigue syndrome\" rel=\"external_link\" target=\"_blank\">chronic fatigue syndrome<\/a><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a>.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> The authors hypothesize that if the immune system is constantly staging an allergic reaction to a metal present in the body, this will alert the <a href=\"https:\/\/en.wikipedia.org\/wiki\/HPA_axis\" class=\"mw-redirect\" title=\"HPA axis\" rel=\"external_link\" target=\"_blank\">HPA axis<\/a> inducing fatigue-like symptoms. A study<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> of 930 fatigue patients showed 62% testing MELISA-positive to metal allergy. Of those who removed the offending metals, 76% improved, but there was no placebo control. Metal allergy is not recognized by scientists as an accepted cause of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_fatigue_syndrome\" title=\"Chronic fatigue syndrome\" rel=\"external_link\" target=\"_blank\">chronic fatigue syndrome<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Validity\">Validity<\/span><\/h2>\n<p>To test whether patients with symptoms attributed to dental amalgam differed from healthy controls, a study compared 23 amalgam patients, 30 healthy blood donors with amalgam and 10 healthy subjects without amalgam using MELISA and other tests. The researchers found that a high frequency of positive results was obtained among healthy subjects with or without dental amalgam, and concluded that the test cannot be used as an objective test for mercury allergy.<sup id=\"rdp-ebb-cite_ref-Cederbrant1999_1-1\" class=\"reference\"><a href=\"#cite_note-Cederbrant1999-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Another study used 34 patients to test the sensitivity and specificity if the MELISA test, and concluded that it is not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.<sup id=\"rdp-ebb-cite_ref-Cederbrant1997_2-1\" class=\"reference\"><a href=\"#cite_note-Cederbrant1997-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>However, according to the MELISA Foundation the studies are flawed, mainly due to the incorrect selection of patients included as well as the use of patch test as a gold standard for the measurement of metal allergy.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> The clinical relevance of the test has been shown by the decrease of patient-reported metal-specific responses following the removal of the allergy-causing metals (however the trial did not have a placebo control).<sup id=\"rdp-ebb-cite_ref-Stejskal2006_21-0\" class=\"reference\"><a href=\"#cite_note-Stejskal2006-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Valentine-Thon2006_22-0\" class=\"reference\"><a href=\"#cite_note-Valentine-Thon2006-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.melisa.org\" target=\"_blank\">http:\/\/www.melisa.org<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Cederbrant1999-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cederbrant1999_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cederbrant1999_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cederbrant K, Gunnarsson LG, Hultman P, Norda R, Tibbling-Grahn L (Aug 1999). \"In vitro lymphoproliferative assays with HgCl2 cannot identify patients with systemic symptoms attributed to dental amalgam\". <i>J Dent Res<\/i>. <b>78<\/b> (8): 1450\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F00220345990780081101\" target=\"_blank\">10.1177\/00220345990780081101<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10439033\" target=\"_blank\">10439033<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Dent+Res&rft.atitle=In+vitro+lymphoproliferative+assays+with+HgCl2+cannot+identify+patients+with+systemic+symptoms+attributed+to+dental+amalgam&rft.volume=78&rft.issue=8&rft.pages=1450-8&rft.date=1999-08&rft_id=info%3Adoi%2F10.1177%2F00220345990780081101&rft_id=info%3Apmid%2F10439033&rft.aulast=Cederbrant&rft.aufirst=K&rft.au=Gunnarsson%2C+LG&rft.au=Hultman%2C+P&rft.au=Norda%2C+R&rft.au=Tibbling-Grahn%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Cederbrant1997-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cederbrant1997_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cederbrant1997_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cederbrant K, Hultman P, Marcusson JA, Tibbling L (Mar 1997). \"In vitro lymphocyte proliferation as compared to patch test using gold, palladium and nickel\". <i>Int Arch Allergy Immunol<\/i>. <b>112<\/b> (3): 212\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000237456\" target=\"_blank\">10.1159\/000237456<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9066505\" target=\"_blank\">9066505<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Arch+Allergy+Immunol&rft.atitle=In+vitro+lymphocyte+proliferation+as+compared+to+patch+test+using+gold%2C+palladium+and+nickel&rft.volume=112&rft.issue=3&rft.pages=212-7&rft.date=1997-03&rft_id=info%3Adoi%2F10.1159%2F000237456&rft_id=info%3Apmid%2F9066505&rft.aulast=Cederbrant&rft.aufirst=K&rft.au=Hultman%2C+P&rft.au=Marcusson%2C+JA&rft.au=Tibbling%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Valentine-Thon E, Schiawara HW (February\u2013April 2003). \"Validity of MELISA for metal sensitivity testing\". <i>Neuro Endocrinol Lett<\/i>. <b>24<\/b> (1\u20132): 57\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12743534\" target=\"_blank\">12743534<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuro+Endocrinol+Lett.&rft.atitle=Validity+of+MELISA+for+metal+sensitivity+testing&rft.volume=24&rft.issue=1%E2%80%932&rft.pages=57-64&rft.date=2003-02%2F2003-04&rft_id=info%3Apmid%2F12743534&rft.aulast=Valentine-Thon&rft.aufirst=E&rft.au=Schiawara%2C+HW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal VD, Forsbeck M, Nilsson R (June 1990). \"Lymphocyte transformation test for diagnosis of isothiazolinone allergy in man\". <i>J Invest Dermatol<\/i>. <b>94<\/b> (6): 798\u2013802. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2F1523-1747.ep12874656\" target=\"_blank\">10.1111\/1523-1747.ep12874656<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1693940\" target=\"_blank\">1693940<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Invest+Dermatol&rft.atitle=Lymphocyte+transformation+test+for+diagnosis+of+isothiazolinone+allergy+in+man&rft.volume=94&rft.issue=6&rft.pages=798-802&rft.date=1990-06&rft_id=info%3Adoi%2F10.1111%2F1523-1747.ep12874656&rft_id=info%3Apmid%2F1693940&rft.aulast=Stejskal&rft.aufirst=VD&rft.au=Forsbeck%2C+M&rft.au=Nilsson%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Willis CM, Young E, Brandon DR, Wilkinson JD (September 1986). \"Immunopathological and ultrastructural findings in human allergic and irritant contact dermatitis\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Br_J_Dermatol\" class=\"mw-redirect\" title=\"Br J Dermatol\" rel=\"external_link\" target=\"_blank\">Br J Dermatol<\/a><\/i>. <b>115<\/b> (3): 305\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1365-2133.1986.tb05745.x\" target=\"_blank\">10.1111\/j.1365-2133.1986.tb05745.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3530310\" target=\"_blank\">3530310<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Br+J+Dermatol&rft.atitle=Immunopathological+and+ultrastructural+findings+in+human+allergic+and+irritant+contact+dermatitis&rft.volume=115&rft.issue=3&rft.pages=305-16&rft.date=1986-09&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2133.1986.tb05745.x&rft_id=info%3Apmid%2F3530310&rft.aulast=Willis&rft.aufirst=CM&rft.au=Young%2C+E&rft.au=Brandon%2C+DR&rft.au=Wilkinson%2C+JD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Silvennoinen-Kassinen S, Niinim\u00e4ki A (September 1984). \"Gold sensitivity blast transformation\". <i>Contact Derm<\/i>. <b>11<\/b> (3): 156\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0536.1984.tb00962.x\" target=\"_blank\">10.1111\/j.1600-0536.1984.tb00962.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6437738\" target=\"_blank\">6437738<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Contact+Derm.&rft.atitle=Gold+sensitivity+blast+transformation&rft.volume=11&rft.issue=3&rft.pages=156-8&rft.date=1984-09&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0536.1984.tb00962.x&rft_id=info%3Apmid%2F6437738&rft.aulast=Silvennoinen-Kassinen&rft.aufirst=S&rft.au=Niinim%C3%A4ki%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal VD, Forsbeck M, Cederbrant KE, Asteman O (January 1996). \"Mercury-specific lymphocytes: an indication of mercury allergy in man\". <i>J Clin Immunol<\/i>. <b>16<\/b> (1): 31\u201340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF01540970\" target=\"_blank\">10.1007\/BF01540970<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8926283\" target=\"_blank\">8926283<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Clin+Immunol.&rft.atitle=Mercury-specific+lymphocytes%3A+an+indication+of+mercury+allergy+in+man&rft.volume=16&rft.issue=1&rft.pages=31-40&rft.date=1996-01&rft_id=info%3Adoi%2F10.1007%2FBF01540970&rft_id=info%3Apmid%2F8926283&rft.aulast=Stejskal&rft.aufirst=VD&rft.au=Forsbeck%2C+M&rft.au=Cederbrant%2C+KE&rft.au=Asteman%2C+O&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Marcusson JA (May 1996). \"Contact allergies to nickel sulfate, gold sodium thiosulfate and palladium chloride in patients claiming side-effects from dental alloy components\". <i>Contact Derm<\/i>. <b>34<\/b> (5): 320\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0536.1996.tb02215.x\" target=\"_blank\">10.1111\/j.1600-0536.1996.tb02215.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8807223\" target=\"_blank\">8807223<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Contact+Derm.&rft.atitle=Contact+allergies+to+nickel+sulfate%2C+gold+sodium+thiosulfate+and+palladium+chloride+in+patients+claiming+side-effects+from+dental+alloy+components&rft.volume=34&rft.issue=5&rft.pages=320-3&rft.date=1996-05&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0536.1996.tb02215.x&rft_id=info%3Apmid%2F8807223&rft.au=Marcusson+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Everness KM, Gawkrodger DJ, Botham PA, Hunter JA (March 1990). \"The discrimination between nickel-sensitive and non-nickel-sensitive subjects by an in vitro lymphocyte transformation test\". <i>Br J Dermatol<\/i>. <b>122<\/b> (3): 293\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1365-2133.1990.tb08276.x\" target=\"_blank\">10.1111\/j.1365-2133.1990.tb08276.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2322494\" target=\"_blank\">2322494<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Br+J+Dermatol&rft.atitle=The+discrimination+between+nickel-sensitive+and+non-nickel-sensitive+subjects+by+an+in+vitro+lymphocyte+transformation+test&rft.volume=122&rft.issue=3&rft.pages=293-8&rft.date=1990-03&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2133.1990.tb08276.x&rft_id=info%3Apmid%2F2322494&rft.aulast=Everness&rft.aufirst=KM&rft.au=Gawkrodger%2C+DJ&rft.au=Botham%2C+PA&rft.au=Hunter%2C+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Klas PA, Corey G, Storrs FJ, Chan SC, Hanifin JM (February 1996). \"Allergic and irritant patch test reactions and atopic disease\". <i>Contact Derm<\/i>. <b>34<\/b> (2): 121\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0536.1996.tb02143.x\" target=\"_blank\">10.1111\/j.1600-0536.1996.tb02143.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8681540\" target=\"_blank\">8681540<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Contact+Derm.&rft.atitle=Allergic+and+irritant+patch+test+reactions+and+atopic+disease&rft.volume=34&rft.issue=2&rft.pages=121-4&rft.date=1996-02&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0536.1996.tb02143.x&rft_id=info%3Apmid%2F8681540&rft.aulast=Klas&rft.aufirst=PA&rft.au=Corey%2C+G&rft.au=Storrs%2C+FJ&rft.au=Chan%2C+SC&rft.au=Hanifin%2C+JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rietschel RL (May 1996). \"Reproducibility of patch-test results\". <i>Lancet<\/i>. <b>347<\/b> (9010): 1202. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" 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rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sachs B, Merk H (2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061026212549\/http:\/\/verlag.hanshuber.com\/ezm\/index.php?ezm=ACI&la=e&ShowAbstract=9428&IssueID=927\" target=\"_blank\">\"Demonstration and characterization of drug-specific lymphocyte reactivity in drug allergies\"<\/a>. <i>Allergy Clin Immunol Int: J World Allergy Org<\/i>. <b>13<\/b> (3): 91\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1027%2F0838-1925.13.3.91\" target=\"_blank\">10.1027\/0838-1925.13.3.91<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/verlag.hanshuber.com\/ezm\/index.php?ezm=ACI&la=e&ShowAbstract=9428&IssueID=927\" target=\"_blank\">the original<\/a> on 2006-10-26.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Allergy+Clin+Immunol+Int%3A+J+World+Allergy+Org.&rft.atitle=Demonstration+and+characterization+of+drug-specific+lymphocyte+reactivity+in+drug+allergies&rft.volume=13&rft.issue=3&rft.pages=91-8&rft.date=2001&rft_id=info%3Adoi%2F10.1027%2F0838-1925.13.3.91&rft.aulast=Sachs&rft.aufirst=B&rft.au=Merk%2C+H&rft_id=http%3A%2F%2Fverlag.hanshuber.com%2Fezm%2Findex.php%3Fezm%3DACI%26la%3De%26ShowAbstract%3D9428%26IssueID%3D927&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Stejskal92-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Stejskal92_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stejskal92_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal VD, Cederbrant K, Lindvall A, Forsbeck M (1994). \"MELISA \u2013 an in vitro tool for the study of metal allergy\". <i>Toxicol in Vitro<\/i>. <b>8<\/b> (5): 991\u20131000. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0887-2333%2894%2990233-X\" target=\"_blank\">10.1016\/0887-2333(94)90233-X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20693060\" target=\"_blank\">20693060<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Toxicol+in+Vitro&rft.atitle=MELISA+%E2%80%93+an+in+vitro+tool+for+the+study+of+metal+allergy&rft.volume=8&rft.issue=5&rft.pages=991-1000&rft.date=1994&rft_id=info%3Adoi%2F10.1016%2F0887-2333%2894%2990233-X&rft_id=info%3Apmid%2F20693060&rft.aulast=Stejskal&rft.aufirst=VD&rft.au=Cederbrant%2C+K&rft.au=Lindvall%2C+A&rft.au=Forsbeck%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS (July 1991). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.is\/20140815073419\/http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/0091-6749(91)90300-D\" target=\"_blank\">\"Reexamination of the blood lymphocyte transformation test in the diagnosis of chronic beryllium disease\"<\/a>. <i>J Allergy Clin Immunol<\/i>. <b>88<\/b> (1): 54\u201360. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0091-6749%2891%2990300-D\" target=\"_blank\">10.1016\/0091-6749(91)90300-D<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2071785\" target=\"_blank\">2071785<\/a>. 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href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8933041\" target=\"_blank\">8933041<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Environ.+Health+Perspect.&rft.atitle=Significance+of+the+blood+beryllium+lymphocyte+proliferation+test&rft.volume=104&rft.issue=Suppl+5&rft.pages=953-6&rft.date=1996-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1469695&rft_id=info%3Apmid%2F8933041&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F3433017&rft_id=info%3Adoi%2F10.2307%2F3433017&rft.au=Newman+LS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1469695&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bach FH, Hirschhorn K (1964). \"Lymphocyte interaction: a potential histocompatibility test in vitro\". <i>Science<\/i>. <b>143<\/b> (3608): 813\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.143.3608.813\" target=\"_blank\">10.1126\/science.143.3608.813<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14088078\" 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id=\"cite_note-Stejskal2006-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Stejskal2006_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal V, Hudecek R, Stejskal J, Sterzl I (2006). \"Diagnosis and treatment of metal-induced side-effects\". <i>Neuro Endocrinol Lett<\/i>. <b>27<\/b> (Suppl 1): 7\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17261999\" target=\"_blank\">17261999<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuro+Endocrinol+Lett.&rft.atitle=Diagnosis+and+treatment+of+metal-induced+side-effects&rft.volume=27&rft.issue=Suppl+1&rft.pages=7-16&rft.date=2006&rft_id=info%3Apmid%2F17261999&rft.aulast=Stejskal&rft.aufirst=V&rft.au=Hudecek%2C+R&rft.au=Stejskal%2C+J&rft.au=Sterzl%2C+I&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Valentine-Thon2006-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Valentine-Thon2006_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Valentine-Thon E, M\u00fcller K, Guzzi G, Kreisel S, Ohnsorge P, Sandkamp M (2006). \"LTT-MELISA\u00ae is clinically relevant for detecting and monitoring metal sensitivity\". <i>Neuro Endocrinol Lett<\/i>. <b>27<\/b> (Suppl 1): 17\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17261998\" target=\"_blank\">17261998<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuro+Endocrinol+Lett.&rft.atitle=LTT-MELISA%C2%AE+is+clinically+relevant+for+detecting+and+monitoring+metal+sensitivity&rft.volume=27&rft.issue=Suppl+1&rft.pages=17-24&rft.date=2006&rft_id=info%3Apmid%2F17261998&rft.aulast=Valentine-Thon&rft.aufirst=E&rft.au=M%C3%BCller%2C+K&rft.au=Guzzi%2C+G&rft.au=Kreisel%2C+S&rft.au=Ohnsorge%2C+P&rft.au=Sandkamp%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181211213916\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.352 seconds\nReal time usage: 0.416 seconds\nPreprocessor visited node count: 1068\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 58098\/2097152 bytes\nTemplate argument size: 102\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 62117\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.232\/10.000 seconds\nLua memory usage: 4.02 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 358.503 1 -total\n<\/p>\n<pre>80.13% 287.253 1 Template:Reflist\n69.70% 249.874 21 Template:Cite_journal\n11.54% 41.370 1 Template:About\n 4.62% 16.577 1 Template:Immunologic_techniques_and_tests\n 4.30% 15.415 2 Template:Navbox\n 0.75% 2.678 1 Template:Main_other\n 0.62% 2.208 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:15818810-1!canonical and timestamp 20181211213916 and revision id 865390352\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/MELISA\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214713\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.384 1 - wikipedia:MELISA\n100.00% 158.384 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8578-0!*!*!*!*!*!* and timestamp 20181217214712 and revision id 25006\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/MELISA\">https:\/\/www.limswiki.org\/index.php\/MELISA<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","01459832dca0b3aa9299ecec4ba67886_images":[],"01459832dca0b3aa9299ecec4ba67886_timestamp":1545083232,"0e5a509a721423b5cae83265bbb80c85_type":"article","0e5a509a721423b5cae83265bbb80c85_title":"Medical test","0e5a509a721423b5cae83265bbb80c85_url":"https:\/\/www.limswiki.org\/index.php\/Medical_test","0e5a509a721423b5cae83265bbb80c85_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical test\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMedical testX-ray of a hand. X-rays are a common medical test.MeSHD019937 [edit on Wikidata]\nA medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests relate to clinical chemistry and molecular diagnostics, and are typically performed in a medical laboratory.\n\nContents \n\n1 Types of tests \n\n1.1 By purpose \n\n1.1.1 Diagnostic \n1.1.2 Screening \n1.1.3 Monitoring \n\n\n1.2 By method \n1.3 By sample location \n\n\n2 Accuracy and precision \n3 Detection and quantification \n\n3.1 Positive or negative \n3.2 Continuous values \n\n\n4 Interpretation \n5 Risks \n6 Indications \n7 Standard for the reporting and assessment \n8 See also \n9 Notes and references \n\n\nTypes of tests \nBy purpose \nMedical tests can be classified by their purposes, the most common of which are diagnosis, screening and evaluation.\n\nDiagnostic \n Lung scintigraphy evaluating lung cancer\nA diagnostic test is a procedure performed to confirm or determine the presence of disease in an individual suspected of having a disease, usually following the report of symptoms, or based on other medical test results.[1][2] This includes posthumous diagnosis. Examples of such tests are:\n\nUsing nuclear medicine to examine a patient suspected of having a lymphoma.\nMeasuring the blood sugar in a person suspected of having diabetes mellitus after periods of increased urination.\nTaking a complete blood count of an individual experiencing a high fever to check for a bacterial infection.[1]\nMonitoring electrocardiogram readings on a patient suffering chest pain to diagnose or determine any heart irregularities.[3]\nScreening \nMain article: Screening (medicine)\nScreening refers to a medical test or series of tests used to detect or predict the presence of disease in at risk individuals within a defined group such as a population, family, or workforce.[4][5] Screenings may be performed to monitor disease prevalence, manage epidemiology, aid in prevention, or strictly for statistical purposes.[6]\nExamples of screenings include measuring the level of TSH in the blood of a newborn infant as part of newborn screening for congenital hypothyroidism,[7] checking for Lung cancer in non-smoking individuals who are exposed to second-hand smoke in an unregulated working environment, and Pap smear screening for prevention or early detection of cervical cancer.\n\nMonitoring \nMain article: Monitoring (medicine)\nSome medical tests are used to monitor the progress of, or response to medical treatment.\n\nBy method \nMost test methods can be classified into one of the following broad groups:\n\nPatient observations, which may be photographed or recorded\nQuestions asked when taking an individual\u2019s medical history\nTests performed in a physical examination\nRadiologic tests, in which, for example, x-rays are used to form an image of a body target. These tests often involve administration of a contrast agent.\nIn vivo diagnostics which test in the body, such as:\nManometry[8]\nAdministering a diagnostic agent and measuring the body's response, as in the gluten challenge test, contraction stress test, bronchial challenge test, oral food challenge, or the ACTH stimulation test.\nIn vitro diagnostics which test a sample of tissue or bodily fluids,[9][10] such as:\nMicrobiological culturing, which determines the presence or absence of microbes in a sample from the body, and usually targeted at detecting pathogenic bacteria.\nGenetic testing\nBlood Glucose testing [11]\nLiver function testing [12]\nCalcium testing [12]\nTesting for electrolytes in the blood, such as Sodium, Potassium, Creatinine, and Urea [13]\nBy sample location \nIn vitro tests can be classified according to the location of the sample being tested, including:\n\nBlood tests\nUrine tests, including naked eye exam of the urine\nStool tests, including naked eye exam of the feces\nSputum (phlegm), including naked eye exam of the sputum\nAccuracy and precision \nMain article: Accuracy and precision\nAccuracy of a laboratory test is its correspondence with the true value. Accuracy is maximized by calibrating laboratory equipment with reference material and by participating in external quality control programs.\nPrecision of a test is its reproducibility when it is repeated on the same sample. An imprecise test yields widely varying results on repeated measurement. Precision is monitored in laboratory by using control material.\nDetection and quantification \nTests performed in a physical examination are usually aimed at detecting a symptom or sign, and in these cases, a test that detects a symptom or sign is designated a positive test, and a test that indicated absence of a symptom or sign is designated a negative test, as further detailed in separate section below.\nA quantification of a target substance, a cell type or another specific entity is a common output of, for example, most blood tests. This is not only answering if a target entity is present or absent, but also how much is present. In blood tests, the quantification is relatively well specified, such as given in mass concentration, while most other tests may be quantifications as well although less specified, such as a sign of being \"very pale\" rather than \"slightly pale\". Similarly, radiologic images are technically quantifications of radiologic opacity of tissues.\nEspecially in the taking of a medical history, there is no clear limit between a detecting or quantifying test versus rather descriptive information of an individual. For example, questions regarding the occupation or social life of an individual may be regarded as tests that can be regarded as positive or negative for the presence of various risk factors, or they may be regarded as \"merely\" descriptive, although the latter may be at least as clinically important.\n\nPositive or negative \nThe result of a test aimed at detection of an entity may be positive or negative: this has nothing to do with a bad prognosis, but rather means that the test worked or not, and a certain parameter that was evaluated was present or not. For example, a negative screening test for breast cancer means that no sign of breast cancer could be found (which is in fact very positive for the patient).\nThe classification of tests into either positive or negative gives a binary classification, with resultant ability to perform bayesian probability and performance metrics of tests, including calculations of sensitivity and specificity.\n\nContinuous values \nTests whose results are of continuous values, such as most blood values, can be interpreted as they are, or they can be converted to a binary ones by defining a cutoff value, with test results being designated as positive or negative depending on whether the resultant value is higher or lower than the cutoff.\n\nInterpretation \nFurther information: Pre- and post-test probability\nIn the finding of a pathognomonic sign or symptom it is almost certain that the target condition is present, and in the absence of finding a sine qua non sign or symptom it is almost certain that the target condition is absent. In reality, however, the subjective probability of the presence of a condition is never exactly 100% or 0%, so tests are rather aimed at estimating a post-test probability of a condition or other entity.\nMost diagnostic tests basically use a reference group to establish performance data such as predictive values, likelihood ratios and relative risks, which are then used to interpret the post-test probability for an individual.\nIn monitoring tests of an individual, the test results from previous tests on that individual may be used as a reference to interpret subsequent tests.\n\nRisks \nSome medical testing procedures have associated health risks, and even require general anesthesia, such as the mediastinoscopy.[14] Other tests, such as the blood test or pap smear have little to no direct risks.[15] Medical tests may also have indirect risks, such as the stress of testing, and riskier tests may be required as follow-up for a (potentially) false positive test result. Consult the health care provider (including physicians, physician assistants, and nurse practitioners) prescribing any test for further information.\n\nIndications \nEach test has its own indications and contraindications. An indication is a valid medical reason to perform the test. A contraindication is a valid medical reason to reject the test. For example, a basic cholesterol test may be indicated (medically appropriate) for a middle-aged person. However, if the same test was performed on that person very recently, then the existence of the previous test is a contraindication for the test (a medically valid reason to not perform it).\nInformation bias is the cognitive bias that causes healthcare providers to order tests that produce information that they do not realistically expect or intend to use for the purpose of making a medical decision. Medical tests are indicated when the information they produce will be used. For example, a screening mammogram is not indicated (not medically appropriate) for a woman who is dying, because even if breast cancer is found, she will die before any cancer treatment could begin.\nIn a simplified fashion, how much a test is indicated for an individual depends largely on its net benefit for that individual. Tests are chosen when the expected benefit is greater than the expected harm. The net benefit may roughly be estimated by:\n\n \n \n \n \n b\n \n n\n \n \n =\n Δ\n p\n ×\n \n r\n \n i\n \n \n ×\n (\n \n b\n \n i\n \n \n −\n \n h\n \n i\n \n \n )\n −\n \n h\n \n t\n \n \n \n \n {\\displaystyle b_{n}=\\Delta p\\times r_{i}\\times (b_{i}-h_{i})-h_{t}}\n \n\n \n\n<\/p>, where:\n\nbn is the net benefit of performing a test\n\u039bp is the absolute difference between pre- and posttest probability of conditions (such as diseases) that the test is expected to achieve. A major factor for such an absolute difference is the power of the test itself, such as can be described in terms of, for example, sensitivity and specificity or likelihood ratio. Another factor is the pre-test probability, with a lower pre-test probability resulting in a lower absolute difference, with the consequence that even very powerful tests achieve a low absolute difference for very unlikely conditions in an individual (such as rare diseases in the absenceower can make a great difference for highly suspected conditions. The probabilities in this sense may also need to be considered in context of conditions that are not primary targets of the test, such as profile-relative probabilities in a differential diagnostic procedure.\nri is the rate of how much probability differences are expected to result in changes in interventions (such as a change from \"no treatment\" to \"administration of low-dose medical treatment\"). For example, if the only expected effect of a medical test is to make one disease more likely compared to another, but the two diseases have the same treatment (or neither can be treated), then, this factor is very low and the test is probably without value for the individual in this aspect.\nbi is the benefit of changes in interventions for the individual\nhi is the harm of changes in interventions for the individual, such as side effects of medical treatment\nht is the harm caused by the test itself.\nSome additional factors that influence a decision whether a medical test should be performed or not included: cost of the test, availability of additional tests, potential interference with subsequent test (such as an abdominal palpation potentially inducing intestinal activity whose sounds interfere with a subsequent abdominal auscultation), time taken for the test or other practical or administrative aspects. The possible benefits of a diagnostic test may also be weighed against the costs of unnecessary tests and resulting unnecessary follow-up and possibly even unnecessary treatment of incidental findings.[16]\nIn some cases, tests being performed are expected to have no benefit for the individual being tested. Instead, the results may be useful for the establishment of statistics in order to improve health care for other individuals. Patients may give informed consent to undergo medical tests that will benefit other people.\n\nStandard for the reporting and assessment \nThe QUADAS-2 revision is available.[17]\n\nSee also \n\nBlood culture\nChemical test\nGold standard (test)\nMedical sign\nMolecular diagnostics\nNailbed assessment\nTest panel\nPoint-of-care testing\n\nNotes and references \n\n\n^ a b Al-Gwaiz LA, Babay HH (2007). \"The diagnostic value of absolute neutrophil count, band count and morphological changes of neutrophils in predicting bacterial infections\". Med Princ Pract. 16 (5): 344\u2013347. doi:10.1159\/000104806. PMID 17709921. \n\n^ Harvard.edu\r\nGuide to Diagnostic Tests from Harvard Health \n\n^ Harvard.edu \n\n^ Ratcliffe JM, Halperin WE, Frazier TM, Sundin DS, Delaney L, Hornung RW (1986). \"The prevalence of screening: a report from the National Institute of Occupational Safety and the Health National Occupational Hazard Survey\". Journal of Occupational Medicine. 28 (10): 906\u2013912. doi:10.1097\/00043764-198610000-00003. PMID 3021937. \n\n^ Osha.gov\r\n\nUS Dept. of Labor - Occupational Safety and Health Admin. \n\n^ Murthy LI, Halperin WE (1995). \"Medical Screening and Biological Monitoring: A guide to the literature for physicians\". Journal of Occupational and Environmental Medicine. 37 (2): 170\u2013184. doi:10.1097\/00043764-199502000-00016. PMID 7655958. \n\n^ Moltz KC, Postellon DC (1994). \"Congenital hypothyroidism and mental development\". Comprehensive Therapy. 20 (6): 342\u2013346. PMID 8062543. \n\n^ OSA | Design of a high-sensor count fibre optic manometry catheter for in-vivo colonic diagnostics \n\n^ Directive 98\/79\/CE on in vitro diagnostic medical devices \n\n^ [1] \n\n^ Glucose Tests: The Test \n\n^ a b Liver Function Tests: At a Glance \n\n^ Electrolytes: At a Glance \n\n^ Harvard.edu \n\n^ Diagnostic Tests > Pap Smear, Harvard University, archived from the original on June 8, 2007 \n\n^ Jarvik J, Hollingworth W, Martin B, Emerson S, Gray D, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan S, Kreuter W, Deyo R (2003). \"Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial\". JAMA. 289 (21): 2810\u20138. doi:10.1001\/jama.289.21.2810. PMID 12783911. \n\n^ Whiting, Penny F.; Anne W.S. Rutjes; Marie E. Westwood; Susan Mallett; Jonathan J. Deeks; Johannes B. Reitsma; Mariska M.G. Leeflang; Jonathan A.C. Sterne; Patrick M.M. Bossuyt; QUADAS-2 Group (2011-10-18). \"QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies\". Annals of Internal Medicine. 155 (8): 529\u2013536. doi:10.7326\/0003-4819-155-8-201110180-00009. Archived from the original on 2012-02-11. Retrieved 2011-10-18 . \n\n\nvteMedical imaging (ICD-9-CM V3 87\u201388, ICD-10-PCS B, CPT 70010\u201379999)X-ray\/\r\nRadiography2DMedical:\nPneumoencephalography\nDental radiography\nSialography\nMyelography\nCXR\nBronchography\nAXR\nKUB\nDXA\/DXR\nUpper gastrointestinal series\/Small-bowel follow-through\/Lower gastrointestinal series\nCholangiography\/Cholecystography\nMammography\nPyelogram\nCystography\nArthrogram\nHysterosalpingography\nSkeletal survey\nAngiography\nAngiocardiography\nAortography\nVenography\nLymphogram\nIndustrial:\nRadiographic testing\nCT scanTechniques:\nGeneral operation of CT\nQuantitative CT\nHigh resolution CT\nX-ray microtomography\nElectron beam tomography\nTargets\nCoronary\nCalcium scan\nCT angiography\nAbdominal and pelvic CT\nVirtual colonoscopy\nCT angiography\nCoronary CT\nPulmonary CT\nHead CT\nThyroid CT\nWhole body imaging\nFull-body CT scan\nOther\nFluoroscopy\nDental panoramic radiography\nX-ray motion analysis\nMRI\nMRI of the brain\nMR neurography\nCardiac MRI\/Cardiac MRI perfusion\nMR angiography\nMR cholangiopancreatography\nBreast MRI\nFunctional MRI\nSequences\nDiffusion MRI\nPerfusion MRI\nTractography\nSynthetic MRI\nUltrasound\nEchocardiography\nDoppler ultrasonography\nDoppler echocardiography\nTTE\nTEE\nTranscranial Doppler\nIntravascular\nGynecologic\nObstetric\nEchoencephalography\nAbdominal ultrasonography\nTransrectal\nBreast ultrasound\nTransscrotal ultrasound\nCarotid ultrasonography\nContrast-enhanced\n3D ultrasound\nEndoscopic ultrasound\nEmergency ultrasound\nFAST\nPre-hospital ultrasound\nDuplex\nRadionuclide2D \/ scintigraphy\nCholescintigraphy\nScintimammography\nVentilation\/perfusion scan\nRadionuclide ventriculography\nRadionuclide angiography\nRadioisotope renography\nSestamibi parathyroid scintigraphy\nRadioactive iodine uptake test\nBone scintigraphy\nImmunoscintigraphy\nDacryoscintigraphy\nDMSA scan\nGastric emptying scan\nFull body:\nOctreotide scan\nGallium 67 scan\nIndium-111 WBC scan\n3D \/ ECTSPECT (gamma ray):\nMyocardial perfusion imaging\nPET (positron):\nBrain PET\nCardiac PET\nPET mammography\nPET-CT\nPET-MRI\nOptical\/Laser\nOptical tomography\nOptical coherence tomography\nConfocal microscopy\nEndomicroscopy\nOrthogonal polarization spectral imaging\nThermography\nnon-contact thermography\ncontact thermography\ndynamic angiothermography\n\nvteComponents and results of urine tests (CPT 81000\u201381099; R80\u2013R82, 791)Components\nAlbumin\nMyoglobin\nhCG\nLeukocyte esterase\nUrine pregnancy test\nKetone bodies\nGlucose\nUrobilinogen\nBilirubin\nCreatinine\nRBC\nWBC\nUrinary casts\nChemical properties\nUrine specific gravity\nUrine osmolality\nUrine pH\nUrine anion gap\nAbnormal findingsRed blood cells\nHematuria (Microscopic hematuria)\nWhite blood cells\nEosinophiluria\nProteinuria\nAlbuminuria\/Microalbuminuria\nMyoglobinuria\nHemoglobinuria\nSmall molecules\nGlycosuria\nKetonuria\nBilirubinuria\nHyperuricosuria\/Hypouricosuria\nAminoaciduria\nPathogens\nBacteriuria\nOther\nChyluria\nCrystalluria\nosmolality (Isosthenuria, Hypersthenuria)\n\nvteCommon for blood tests (CPT 82000\u201384999)Electrolytes\nSodium\nPotassium\nChloride\nCalcium\nRenal function\nCreatinine\nUrea\nBUN-to-creatinine ratio\nPlasma osmolality\nSerum osmolal gap\nAcid-base\nAnion gap\nArterial blood gas\nBase excess\nBicarbonate\nCO2 content\nIron tests\nFerritin\nSerum iron\nTransferrin saturation\nTotal iron-binding capacity\nTransferrin\nTransferrin receptor\nHormones\nACTH stimulation test\nThyroid function tests\nThyroid-stimulating hormone\nMetabolism\nBlood lipids\nCardiovascular\nCardiac marker\nTroponin test\nCPK-MB test\nLactate dehydrogenase\nMyoglobin\nGlycogen phosphorylase isoenzyme BB\nLiver function tests\nProteins\nHuman serum albumin\nSerum total protein\nALP\ntransaminases\nALT\nAST\nAST\/ALT ratio\nBilirubin\nUnconjugated\nConjugated\nPancreas\nAmylase\nLipase\nPancreatic lipase\n\nvteMyeloid blood tests (CPT 85002\u201385999)Clotting\nCBC\nPlatelet count\nMean platelet volume\nvWF:\nRistocetin-induced platelet aggregation\nclotting factors: \nProthrombin time\nPartial thromboplastin time\nThrombin time\nActivated clotting time\nother\/general: \ncoagulation\nBleeding time\nanimal enzyme\nReptilase time\nEcarin clotting time\nDilute Russell's viper venom time\nThromboelastography\nThrombodynamics test\nfibrinolysis: \nEuglobulin lysis time\nD-dimer\nRed blood cell indicesCBC \nRBC count\nHematocrit\nHemoglobin\nratios: \nMean corpuscular hemoglobin\nMean corpuscular hemoglobin concentration\nMean corpuscular volume\nRed blood cell distribution width\nFetal hemoglobin:\nApt\u2013Downey test\nKleihauer\u2013Betke test\nOther \nReticulocyte index\nHaptoglobin\nMentzer index\nCFU-GM\nNitro blue tetrazolium chloride test\nComplete blood count\nAbsolute neutrophil count\nOther\nBlood film\nLeucoerythroblastic\nBlood viscosity\nErythrocyte sedimentation rate\n\nvteMedical tests on Cerebrospinal fluid (CPT 82000-84999)Albumin\nCSF albumin\nCSF\/serum albumin ratio\nGlucose\nCSF glucose\nCSF\/serum glucose ratio\nOther\nBaricity\n\nvteMedical tests used in immunology and for inflammation (CPT 86000\u201386849)ImmunologyImmunoprecipitation\nChromatin immunoprecipitation\nImmunodiffusion\nOuchterlony double immunodiffusion\nRadial immunodiffusion\nImmunoelectrophoresis\nCounterimmunoelectrophoresis\nImmunoassay\nELISA\nELISPOT\nEnzyme Multiplied Immunoassay Technique\nRAST test\nRadioimmunoassay\nRadiobinding assay\nImmunofluorescence\nAgglutination\nHemagglutination\/Hemagglutinin\nCoombs test\nLatex fixation test\nOther\nDiagnostic immunology\nNephelometry\nComplement fixation test\nImmunocytochemistry\nImmunohistochemistry\nDirect fluorescent antibody\nEpitope mapping\nSkin allergy test\nPatch test\nInflammation\nC-reactive protein\nProcalcitonin\nTotal complement activity\nMELISA\nComplete blood count\nlymphocyte count\n\nvteAutoantibodiesAnti-nuclear antibody\nPBC:\nAnti-gp210\nAnti-p62\nAnti-sp100\nENA:\nAnti-topoisomerase\/Scl-70\nAnti-Jo1\nENA4\nAnti-Sm\nAnti-nRNP\nAnti-Ro\nAnti-La\nAnti-centromere\nAnti-dsDNA\nAnti-mitochondrial antibody\nAnti-cardiolipin\nAnti-cytoplasm antibody\nAnti-neutrophil cytoplasmic\nC-ANCA\nP-ANCA\nAnti-smooth muscle\nAnti-actin\nAnti-TPO\/Antimicrosomal\nCell membrane\nAnti-ganglioside\nAnti-GBM\nAnti-glutamate\nExtracellular\nAnti-thrombin\nLupus anticoagulant\nCoeliac disease:\nAnti-transglutaminase\nAnti-gliadin not autoantibody\nRA\nRheumatoid factor\/anti-IgG\nAnti-citrullinated peptide\nMultiple locations\nAnti-phospholipid\nAnti-apolipoprotein\n\nvteTransfusion medicineGeneral concepts\nApheresis (plasmapheresis, plateletpheresis, leukapheresis)\nBlood transfusion\nCoombs test (direct and indirect)\nCross-matching\nExchange transfusion\nInternational Society of Blood Transfusion\nIntraoperative blood salvage\nISBT 128\nTransfusion reactions\nBlood group systems \/\r\nblood types\nABO\nChido-Rodgers\nColton\nCromer\nDiego\nDombrock\nDuffy\nEr\nFORS\nGerbich\nGIL\nGLOB\nHh\nIi\nIndian\nJR\nJMH\nKell (Xk)\nKidd\nKnops\nLan\nLewis\nLutheran\nLW\nMNS\nOK\nP\nRaph\nRh and RHAG\nScianna\nT-Tn\nVel\nXg\nYt\nOther\nBlood products \/\r\nblood donation\nWhole blood\nPlatelets\nRed blood cells\nPlasma \/ Fresh frozen plasma \/ PF24 (Cryoprecipitate + Cryosupernatant)\nBlood substitutes\n\nvteMedical test: Infectious disease blood tests (CPT 87001\u201387999)Bacterial infection\nsyphilis\nVDRL\nrapid plasma reagin\nWassermann test\nFTA-ABS\nRickettsia\nWeil\u2013Felix test\nHelicobacter\nHelicoCARE direct\nStreptococcus\nantistreptolysin O titre\nViral infection\nHIV\nHIV test\nBDNA test\nmChip\nEpstein\u2013Barr virus\nmonospot test\nDengue fever\nNS1 antigen test\nProtozoan infection\ntoxoplasmosis\nSabin\u2013Feldman dye test\n\nvtePathologyPrinciples of pathology\nDisease\nInfection\nNeoplasia\nCause\nPathogenesis\nHemodynamics\nIschemia\nInflammation\nCell damage\nWound healing\nCellular adaptation\n\nAtrophy\nHypertrophy\nHyperplasia\nDysplasia\nMetaplasia\nSquamous\nGlandular<\/dd>\nCell death\n\nNecrosis\nCoagulative necrosis\nLiquefactive necrosis\nGangrenous necrosis\nCaseous necrosis\nFat necrosis\nFibrinoid necrosis<\/dd>\nProgrammed cell death\n\nApoptosis<\/dd>\nPyknosis\nKaryorrhexis\n\nKaryolysis\nAccumulations\npigment\nHemosiderin\nLipochrome\/Lipofuscin\nMelanin<\/dd>\nSteatosis\nAnatomical pathology\nSurgical pathology\nCytopathology\nAutopsy\nMolecular pathology\nForensic pathology\nOral and maxillofacial pathology\nGross examination\nHistopathology\nImmunohistochemistry\nElectron microscopy\nImmunofluorescence\nFluorescence in situ hybridization\nClinical pathology\nClinical chemistry\nHematopathology\nTransfusion medicine\nMedical microbiology\nDiagnostic immunology\nImmunopathology\nEnzyme assay\nMass spectrometry\nChromatography\nFlow cytometry\nBlood bank\nMicrobiological culture\nSerology\n\nvteMedical test: ElectrodiagnosisHeart\nElectrocardiography\nVectorcardiography\nMagnetocardiography\nCentral nervous system\nElectroencephalography (Intracranial EEG, stereoelectroencephalography)\nMagnetoencephalography\nPeripheral nervous system\nElectromyography (Facial electromyography)\nNerve conduction study\nEars\nElectrocochleography\nEyes\nElectronystagmography\nElectrooculography\nElectroretinography\nDigestive system\nElectrogastrogram\nMagnetogastrography\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_test\">https:\/\/www.limswiki.org\/index.php\/Medical_test<\/a>\n\t\t\t\t\tCategory: Healthcare termsHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0e5a509a721423b5cae83265bbb80c85_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_test skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical test<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>medical test<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_procedure\" title=\"Medical procedure\" rel=\"external_link\" target=\"_blank\">medical procedure<\/a> performed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">detect<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">diagnose<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">monitor<\/a> diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests relate to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_chemistry\" title=\"Clinical chemistry\" rel=\"external_link\" target=\"_blank\">clinical chemistry<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_diagnostics\" title=\"Molecular diagnostics\" rel=\"external_link\" target=\"_blank\">molecular diagnostics<\/a>, and are typically performed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_laboratory\" title=\"Medical laboratory\" rel=\"external_link\" target=\"_blank\">medical laboratory<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_tests\">Types of tests<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"By_purpose\">By purpose<\/span><\/h3>\n<p>Medical tests can be classified by their purposes, the most common of which are diagnosis, screening and evaluation.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Diagnostic\">Diagnostic<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lung_scintigraphy_keosys.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/Lung_scintigraphy_keosys.JPG\/220px-Lung_scintigraphy_keosys.JPG\" width=\"220\" height=\"138\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lung_scintigraphy_keosys.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Lung <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scintigraphy\" title=\"Scintigraphy\" rel=\"external_link\" target=\"_blank\">scintigraphy<\/a> evaluating lung cancer<\/div><\/div><\/div>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnostic_test\" class=\"mw-redirect\" title=\"Diagnostic test\" rel=\"external_link\" target=\"_blank\">diagnostic test<\/a> is a procedure performed to confirm or determine the presence of disease in an individual suspected of having a disease, usually following the report of symptoms, or based on other medical test results.<sup id=\"rdp-ebb-cite_ref-anc_1-0\" class=\"reference\"><a href=\"#cite_note-anc-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> This includes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posthumous_diagnosis\" class=\"mw-redirect\" title=\"Posthumous diagnosis\" rel=\"external_link\" target=\"_blank\">posthumous diagnosis<\/a>. Examples of such tests are:\n<\/p>\n<ul><li>Using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_medicine\" title=\"Nuclear medicine\" rel=\"external_link\" target=\"_blank\">nuclear medicine<\/a> to examine a patient suspected of having a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lymphoma\" title=\"Lymphoma\" rel=\"external_link\" target=\"_blank\">lymphoma<\/a>.<\/li>\n<li>Measuring the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sugar\" class=\"mw-redirect\" title=\"Blood sugar\" rel=\"external_link\" target=\"_blank\">blood sugar<\/a> in a person suspected of having <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus\" title=\"Diabetes mellitus\" rel=\"external_link\" target=\"_blank\">diabetes mellitus<\/a> after periods of increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urination\" title=\"Urination\" rel=\"external_link\" target=\"_blank\">urination<\/a>.<\/li>\n<li>Taking a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complete_blood_count\" title=\"Complete blood count\" rel=\"external_link\" target=\"_blank\">complete blood count<\/a> of an individual experiencing a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fever\" title=\"Fever\" rel=\"external_link\" target=\"_blank\">fever<\/a> to check for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacterial_infection\" class=\"mw-redirect\" title=\"Bacterial infection\" rel=\"external_link\" target=\"_blank\">bacterial infection<\/a>.<sup id=\"rdp-ebb-cite_ref-anc_1-1\" class=\"reference\"><a href=\"#cite_note-anc-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>Monitoring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiogram\" class=\"mw-redirect\" title=\"Electrocardiogram\" rel=\"external_link\" target=\"_blank\">electrocardiogram<\/a> readings on a patient suffering <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_pain\" title=\"Chest pain\" rel=\"external_link\" target=\"_blank\">chest pain<\/a> to diagnose or determine any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> irregularities.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h4><span class=\"mw-headline\" id=\"Screening\">Screening<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">Screening (medicine)<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">Screening<\/a> refers to a medical test or series of tests used to detect or predict the presence of disease in at risk individuals within a defined group such as a population, family, or workforce.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Screenings may be performed to monitor disease prevalence, manage epidemiology, aid in prevention, or strictly for statistical purposes.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Examples of screenings include measuring the level of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thyroid-stimulating_hormone\" title=\"Thyroid-stimulating hormone\" rel=\"external_link\" target=\"_blank\">TSH<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> of a newborn <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infant\" title=\"Infant\" rel=\"external_link\" target=\"_blank\">infant<\/a> as part of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Newborn_screening\" title=\"Newborn screening\" rel=\"external_link\" target=\"_blank\">newborn screening<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_hypothyroidism\" title=\"Congenital hypothyroidism\" rel=\"external_link\" target=\"_blank\">congenital hypothyroidism<\/a>,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> checking for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung_cancer\" title=\"Lung cancer\" rel=\"external_link\" target=\"_blank\">Lung cancer<\/a> in non-smoking individuals who are exposed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Passive_smoke\" class=\"mw-redirect\" title=\"Passive smoke\" rel=\"external_link\" target=\"_blank\">second-hand smoke<\/a> in an unregulated working environment, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pap_test\" title=\"Pap test\" rel=\"external_link\" target=\"_blank\">Pap smear<\/a> screening for prevention or early detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_cancer\" title=\"Cervical cancer\" rel=\"external_link\" target=\"_blank\">cervical cancer<\/a>.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Monitoring\">Monitoring<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">Monitoring (medicine)<\/a><\/div>\n<p>Some medical tests are used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">monitor<\/a> the progress of, or response to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapy\" title=\"Therapy\" rel=\"external_link\" target=\"_blank\">medical treatment<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"By_method\">By method<\/span><\/h3>\n<p>Most test methods can be classified into one of the following broad groups:\n<\/p>\n<ul><li>Patient observations, which may be photographed or recorded<\/li>\n<li>Questions asked when taking an individual\u2019s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_history\" title=\"Medical history\" rel=\"external_link\" target=\"_blank\">medical history<\/a><\/li>\n<li>Tests performed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_examination\" title=\"Physical examination\" rel=\"external_link\" target=\"_blank\">physical examination<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiologic\" class=\"mw-redirect\" title=\"Radiologic\" rel=\"external_link\" target=\"_blank\">Radiologic<\/a> tests, in which, for example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-rays\" class=\"mw-redirect\" title=\"X-rays\" rel=\"external_link\" target=\"_blank\">x-rays<\/a> are used to form an image of a body target. These tests often involve administration of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contrast_medium\" class=\"mw-redirect\" title=\"Contrast medium\" rel=\"external_link\" target=\"_blank\">contrast agent<\/a>.<\/li>\n<li><b>In vivo diagnostics<\/b> which test in the body, such as:\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Manometry\" title=\"Manometry\" rel=\"external_link\" target=\"_blank\">Manometry<\/a><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li>Administering a diagnostic agent and measuring the body's response, as in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluten_challenge_test\" title=\"Gluten challenge test\" rel=\"external_link\" target=\"_blank\">gluten challenge test<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contraction_stress_test\" title=\"Contraction stress test\" rel=\"external_link\" target=\"_blank\">contraction stress test<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchial_challenge_test\" title=\"Bronchial challenge test\" rel=\"external_link\" target=\"_blank\">bronchial challenge test<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_food_challenge\" title=\"Oral food challenge\" rel=\"external_link\" target=\"_blank\">oral food challenge<\/a>, or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ACTH_stimulation_test\" title=\"ACTH stimulation test\" rel=\"external_link\" target=\"_blank\">ACTH stimulation test<\/a>.<\/li><\/ul><\/li>\n<li><b><span id=\"rdp-ebb-In_vitro_diagnostics\">In vitro diagnostics<\/span><\/b> which test a sample of tissue or bodily fluids,<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> such as:\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microbiological_culture\" title=\"Microbiological culture\" rel=\"external_link\" target=\"_blank\">Microbiological culturing<\/a>, which determines the presence or absence of microbes in a sample from the body, and usually targeted at detecting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathogenic_bacteria\" title=\"Pathogenic bacteria\" rel=\"external_link\" target=\"_blank\">pathogenic bacteria<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Genetic_testing\" title=\"Genetic testing\" rel=\"external_link\" target=\"_blank\">Genetic testing<\/a><\/li>\n<li>Blood <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose\" title=\"Glucose\" rel=\"external_link\" target=\"_blank\">Glucose<\/a> testing <sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><\/li>\n<li>Liver function testing <sup id=\"rdp-ebb-cite_ref-labtestsonline.org.uk_12-0\" class=\"reference\"><a href=\"#cite_note-labtestsonline.org.uk-12\" rel=\"external_link\">[12]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">Calcium<\/a> testing <sup id=\"rdp-ebb-cite_ref-labtestsonline.org.uk_12-1\" class=\"reference\"><a href=\"#cite_note-labtestsonline.org.uk-12\" rel=\"external_link\">[12]<\/a><\/sup><\/li>\n<li>Testing for electrolytes in the blood, such as Sodium, Potassium, Creatinine, and Urea <sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li><\/ul><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"By_sample_location\">By sample location<\/span><\/h3>\n<p>In vitro tests can be classified according to the location of the sample being tested, including:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">Blood tests<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinalysis\" class=\"mw-redirect\" title=\"Urinalysis\" rel=\"external_link\" target=\"_blank\">Urine tests<\/a>, including naked eye exam of the urine<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stool_test\" title=\"Stool test\" rel=\"external_link\" target=\"_blank\">Stool tests<\/a>, including naked eye exam of the feces<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sputum\" title=\"Sputum\" rel=\"external_link\" target=\"_blank\">Sputum<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Phlegm\" title=\"Phlegm\" rel=\"external_link\" target=\"_blank\">phlegm<\/a>), including naked eye exam of the sputum<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Accuracy_and_precision\">Accuracy and precision<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accuracy_and_precision\" title=\"Accuracy and precision\" rel=\"external_link\" target=\"_blank\">Accuracy and precision<\/a><\/div>\n<ul><li><b>Accuracy<\/b> of a laboratory test is its correspondence with the true value. Accuracy is maximized by calibrating laboratory equipment with reference material and by participating in external quality control programs.<\/li>\n<li><b>Precision<\/b> of a test is its reproducibility when it is repeated on the same sample. An imprecise test yields widely varying results on repeated measurement. Precision is monitored in laboratory by using control material.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Detection_and_quantification\">Detection and quantification<\/span><\/h2>\n<p>Tests performed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_examination\" title=\"Physical examination\" rel=\"external_link\" target=\"_blank\">physical examination<\/a> are usually aimed at detecting a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Symptom\" title=\"Symptom\" rel=\"external_link\" target=\"_blank\">symptom<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_sign\" title=\"Medical sign\" rel=\"external_link\" target=\"_blank\">sign<\/a>, and in these cases, a test that detects a symptom or sign is designated a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positive_test\" class=\"mw-redirect\" title=\"Positive test\" rel=\"external_link\" target=\"_blank\">positive test<\/a>, and a test that indicated absence of a symptom or sign is designated a , as further detailed in separate section below.\n<\/p><p>A quantification of a target substance, a cell type or another specific entity is a common output of, for example, most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">blood tests<\/a>. This is not only answering <i>if<\/i> a target entity is present or absent, but also <i>how much<\/i> is present. In blood tests, the quantification is relatively well specified, such as given in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_concentration_(chemistry)\" title=\"Mass concentration (chemistry)\" rel=\"external_link\" target=\"_blank\">mass concentration<\/a>, while most other tests may be quantifications as well although less specified, such as a sign of being \"very <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pallor\" title=\"Pallor\" rel=\"external_link\" target=\"_blank\">pale<\/a>\" rather than \"slightly pale\". Similarly, radiologic images are technically quantifications of radiologic opacity of tissues.\n<\/p><p>Especially in the taking of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_history\" title=\"Medical history\" rel=\"external_link\" target=\"_blank\">medical history<\/a>, there is no clear limit between a detecting or quantifying test versus rather <i>descriptive<\/i> information of an individual. For example, questions regarding the occupation or social life of an individual may be regarded as tests that can be regarded as positive or negative for the presence of various risk factors, or they may be regarded as \"merely\" descriptive, although the latter may be at least as clinically important.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Positive_or_negative\">Positive or negative<\/span><\/h3>\n<p>The result of a test aimed at detection of an entity may be <b>positive<\/b> or <b>negative<\/b>: this has nothing to do with a bad <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prognosis\" title=\"Prognosis\" rel=\"external_link\" target=\"_blank\">prognosis<\/a>, but rather means that the test worked or not, and a certain parameter that was evaluated was present or not. For example, a negative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_test\" class=\"mw-redirect\" title=\"Screening test\" rel=\"external_link\" target=\"_blank\">screening test<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a> means that no sign of breast cancer could be found (which is in fact very positive for the patient).\n<\/p><p>The classification of tests into either positive or negative gives a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Binary_classification\" title=\"Binary classification\" rel=\"external_link\" target=\"_blank\">binary classification<\/a>, with resultant ability to perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bayesian_probability\" title=\"Bayesian probability\" rel=\"external_link\" target=\"_blank\">bayesian probability<\/a> and performance metrics of tests, including calculations of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensitivity_and_specificity\" title=\"Sensitivity and specificity\" rel=\"external_link\" target=\"_blank\">sensitivity and specificity<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Continuous_values\">Continuous values<\/span><\/h3>\n<p>Tests whose results are of continuous values, such as most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_values\" class=\"mw-redirect\" title=\"Blood values\" rel=\"external_link\" target=\"_blank\">blood values<\/a>, can be interpreted as they are, or they can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificially_binary_value\" class=\"mw-redirect\" title=\"Artificially binary value\" rel=\"external_link\" target=\"_blank\">converted to a binary ones<\/a> by defining a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cutoff_(reference_value)\" class=\"mw-redirect\" title=\"Cutoff (reference value)\" rel=\"external_link\" target=\"_blank\">cutoff value<\/a>, with test results being designated as positive or negative depending on whether the resultant value is higher or lower than the cutoff.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Interpretation\">Interpretation<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pre-_and_post-test_probability\" title=\"Pre- and post-test probability\" rel=\"external_link\" target=\"_blank\">Pre- and post-test probability<\/a><\/div>\n<p>In the finding of a <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathognomonic\" title=\"Pathognomonic\" rel=\"external_link\" target=\"_blank\">pathognomonic<\/a><\/i> sign or symptom it is almost certain that the target condition is present, and in the absence of finding a <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sine_qua_non\" title=\"Sine qua non\" rel=\"external_link\" target=\"_blank\">sine qua non<\/a><\/i> sign or symptom it is almost certain that the target condition is absent. In reality, however, the subjective probability of the presence of a condition is never exactly 100% or 0%, so tests are rather aimed at estimating a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Post-test_probability\" class=\"mw-redirect\" title=\"Post-test probability\" rel=\"external_link\" target=\"_blank\">post-test probability<\/a> of a condition or other entity.\n<\/p><p>Most diagnostic tests basically use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reference_group\" title=\"Reference group\" rel=\"external_link\" target=\"_blank\">reference group<\/a> to establish performance data such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Predictive_values\" class=\"mw-redirect\" title=\"Predictive values\" rel=\"external_link\" target=\"_blank\">predictive values<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Likelihood_ratios_in_diagnostic_testing\" title=\"Likelihood ratios in diagnostic testing\" rel=\"external_link\" target=\"_blank\">likelihood ratios<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relative_risk\" class=\"mw-redirect\" title=\"Relative risk\" rel=\"external_link\" target=\"_blank\">relative risks<\/a>, which are then used to interpret the post-test probability for an individual.\n<\/p><p>In monitoring tests of an individual, the test results from previous tests on that individual may be used as a reference to interpret subsequent tests.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Some medical testing procedures have associated health risks, and even require <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mediastinoscopy\" title=\"Mediastinoscopy\" rel=\"external_link\" target=\"_blank\">mediastinoscopy<\/a>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Other tests, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">blood test<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pap_smear\" class=\"mw-redirect\" title=\"Pap smear\" rel=\"external_link\" target=\"_blank\">pap smear<\/a> have little to no direct risks.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Medical tests may also have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)#Adverse_effects_of_screening\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">indirect risks<\/a>, such as the stress of testing, and riskier tests may be required as follow-up for a (potentially) <a href=\"https:\/\/en.wikipedia.org\/wiki\/False_positive\" class=\"mw-redirect\" title=\"False positive\" rel=\"external_link\" target=\"_blank\">false positive<\/a> test result. Consult the health care provider (including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physicians<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician_assistant\" title=\"Physician assistant\" rel=\"external_link\" target=\"_blank\">physician assistants<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nurse_practitioner\" title=\"Nurse practitioner\" rel=\"external_link\" target=\"_blank\">nurse practitioners<\/a>) prescribing any test for further information.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>Each test has its own <a href=\"https:\/\/en.wikipedia.org\/wiki\/Indication_(medicine)\" title=\"Indication (medicine)\" rel=\"external_link\" target=\"_blank\">indications<\/a> and contraindications. An <i>indication<\/i> is a valid medical reason to perform the test. A <i>contraindication<\/i> is a valid medical reason to reject the test. For example, a basic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholesterol_test\" class=\"mw-redirect\" title=\"Cholesterol test\" rel=\"external_link\" target=\"_blank\">cholesterol test<\/a> may be <i>indicated<\/i> (medically appropriate) for a middle-aged person. However, if the same test was performed on that person very recently, then the existence of the previous test is a contraindication for the test (a medically valid reason to not perform it).\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Information_bias_(psychology)\" title=\"Information bias (psychology)\" rel=\"external_link\" target=\"_blank\">Information bias<\/a> is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_bias\" title=\"Cognitive bias\" rel=\"external_link\" target=\"_blank\">cognitive bias<\/a> that causes healthcare providers to order tests that produce information that they do not realistically expect or intend to use for the purpose of making a medical decision. Medical tests are indicated when the information they produce will be used. For example, a screening mammogram is not indicated (not medically appropriate) for a woman who is dying, because even if breast cancer is found, she will die before any cancer treatment could begin.\n<\/p><p>In a simplified fashion, how much a test is indicated for an individual depends largely on its <i>net benefit<\/i> for that individual. Tests are chosen when the expected benefit is greater than the expected harm. The net benefit may roughly be estimated by:\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/64175fee57b3280abca7eb3105859bfc169bcdc3\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.838ex; width:29.54ex; height:2.843ex;\" alt=\"b_{n}=\\Delta p\\times r_{i}\\times (b_{i}-h_{i})-h_{t}\"\/><\/span>\n<\/p>\n<\/p><p>, where:\n<\/p>\n<ul><li><i>b<sub>n<\/sub><\/i> is the net benefit of performing a test<\/li>\n<li><i>\u039bp<\/i> is the absolute difference between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pre-_and_posttest_probability\" class=\"mw-redirect\" title=\"Pre- and posttest probability\" rel=\"external_link\" target=\"_blank\">pre- and posttest probability<\/a> of conditions (such as diseases) that the test is expected to achieve. A major factor for such an absolute difference is the power of the test itself, such as can be described in terms of, for example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensitivity_and_specificity\" title=\"Sensitivity and specificity\" rel=\"external_link\" target=\"_blank\">sensitivity and specificity<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Likelihood_ratios_in_diagnostic_testing\" title=\"Likelihood ratios in diagnostic testing\" rel=\"external_link\" target=\"_blank\">likelihood ratio<\/a>. Another factor is the pre-test probability, with a lower pre-test probability resulting in a lower absolute difference, with the consequence that even very powerful tests achieve a low absolute difference for very unlikely conditions in an individual (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rare_disease\" title=\"Rare disease\" rel=\"external_link\" target=\"_blank\">rare diseases<\/a> in the absenceower can make a great difference for highly suspected conditions. The probabilities in this sense may also need to be considered in context of conditions that are not primary targets of the test, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Differential_diagnosis#profile-relative_probability\" title=\"Differential diagnosis\" rel=\"external_link\" target=\"_blank\">profile-relative probabilities in a differential diagnostic procedure<\/a>.<\/li>\n<li><i>r<sub>i<\/sub><\/i> is the rate of how much <i>probability differences<\/i> are expected to result in <i>changes in interventions<\/i> (such as a change from \"no treatment\" to \"administration of low-dose medical treatment\"). For example, if the only expected effect of a medical test is to make one disease more likely compared to another, but the two diseases have the same treatment (or neither can be treated), then, this factor is very low and the test is probably without value for the individual in this aspect.<\/li>\n<li><i>b<sub>i<\/sub><\/i> is the benefit of <i>changes in interventions<\/i> for the individual<\/li>\n<li><i>h<sub>i<\/sub><\/i> is the harm of <i>changes in interventions<\/i> for the individual, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Side_effects\" class=\"mw-redirect\" title=\"Side effects\" rel=\"external_link\" target=\"_blank\">side effects<\/a> of medical treatment<\/li>\n<li><i>h<sub>t<\/sub><\/i> is the harm caused by the test itself.<\/li><\/ul>\n<p>Some additional factors that influence a decision whether a medical test should be performed or not included: cost of the test, availability of additional tests, potential interference with subsequent test (such as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_palpation\" class=\"mw-redirect\" title=\"Abdominal palpation\" rel=\"external_link\" target=\"_blank\">abdominal palpation<\/a> potentially inducing intestinal activity whose sounds interfere with a subsequent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_auscultation\" class=\"mw-redirect\" title=\"Abdominal auscultation\" rel=\"external_link\" target=\"_blank\">abdominal auscultation<\/a>), time taken for the test or other practical or administrative aspects. The possible benefits of a diagnostic test may also be weighed against the costs of unnecessary tests and resulting unnecessary follow-up and possibly even unnecessary treatment of incidental findings.<sup id=\"rdp-ebb-cite_ref-pmid12783911_16-0\" class=\"reference\"><a href=\"#cite_note-pmid12783911-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>In some cases, tests being performed are expected to have no benefit for the individual being tested. Instead, the results may be useful for the establishment of statistics in order to improve health care for other individuals. Patients may give <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informed_consent\" title=\"Informed consent\" rel=\"external_link\" target=\"_blank\">informed consent<\/a> to undergo medical tests that will benefit other people.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Standard_for_the_reporting_and_assessment\">Standard for the reporting and assessment<\/span><\/h2>\n<p>The QUADAS-2 revision is available.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 40em; -webkit-column-width: 40em; column-width: 40em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_culture\" title=\"Blood culture\" rel=\"external_link\" target=\"_blank\">Blood culture<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_test\" title=\"Chemical test\" rel=\"external_link\" target=\"_blank\">Chemical test<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gold_standard_(test)\" title=\"Gold standard (test)\" rel=\"external_link\" target=\"_blank\">Gold standard (test)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_sign\" title=\"Medical sign\" rel=\"external_link\" target=\"_blank\">Medical sign<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_diagnostics\" title=\"Molecular diagnostics\" rel=\"external_link\" target=\"_blank\">Molecular diagnostics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nailbed_assessment\" class=\"mw-redirect\" title=\"Nailbed assessment\" rel=\"external_link\" target=\"_blank\">Nailbed assessment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Test_panel\" title=\"Test panel\" rel=\"external_link\" target=\"_blank\">Test panel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Point-of-care_testing\" title=\"Point-of-care testing\" rel=\"external_link\" target=\"_blank\">Point-of-care testing<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes_and_references\">Notes and references<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-anc-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-anc_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-anc_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Al-Gwaiz LA, Babay HH (2007). \"The diagnostic value of absolute neutrophil count, band count and morphological changes of neutrophils in predicting bacterial infections\". <i>Med Princ Pract<\/i>. <b>16<\/b> (5): 344\u2013347. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000104806\" target=\"_blank\">10.1159\/000104806<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17709921\" target=\"_blank\">17709921<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Med+Princ+Pract&rft.atitle=The+diagnostic+value+of+absolute+neutrophil+count%2C+band+count+and+morphological+changes+of+neutrophils+in+predicting+bacterial+infections&rft.volume=16&rft.issue=5&rft.pages=344-347&rft.date=2007&rft_id=info%3Adoi%2F10.1159%2F000104806&rft_id=info%3Apmid%2F17709921&rft.aulast=Al-Gwaiz&rft.aufirst=LA&rft.au=Babay%2C+HH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/diagnostic-tests\/\" target=\"_blank\">Harvard.edu<\/a><br \/>Guide to Diagnostic Tests from Harvard Health<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/a_to_z\/electrocardiogram-ekg\" target=\"_blank\">Harvard.edu<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ratcliffe JM, Halperin WE, Frazier TM, Sundin DS, Delaney L, Hornung RW (1986). \"The prevalence of screening: a report from the National Institute of Occupational Safety and the Health National Occupational Hazard Survey\". <i>Journal of Occupational Medicine<\/i>. <b>28<\/b> (10): 906\u2013912. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00043764-198610000-00003\" target=\"_blank\">10.1097\/00043764-198610000-00003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3021937\" target=\"_blank\">3021937<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Occupational+Medicine&rft.atitle=The+prevalence+of+screening%3A+a+report+from+the+National+Institute+of+Occupational+Safety+and+the+Health+National+Occupational+Hazard+Survey&rft.volume=28&rft.issue=10&rft.pages=906-912&rft.date=1986&rft_id=info%3Adoi%2F10.1097%2F00043764-198610000-00003&rft_id=info%3Apmid%2F3021937&rft.aulast=Ratcliffe&rft.aufirst=JM&rft.au=Halperin%2C+WE&rft.au=Frazier%2C+TM&rft.au=Sundin%2C+DS&rft.au=Delaney%2C+L&rft.au=Hornung%2C+RW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.osha.gov\/SLTC\/medicalsurveillance\/screening.html\" target=\"_blank\">Osha.gov<\/a><br \/>\nUS Dept. of Labor - Occupational Safety and Health Admin.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Murthy LI, Halperin WE (1995). \"Medical Screening and Biological Monitoring: A guide to the literature for physicians\". <i>Journal of Occupational and Environmental Medicine<\/i>. <b>37<\/b> (2): 170\u2013184. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00043764-199502000-00016\" target=\"_blank\">10.1097\/00043764-199502000-00016<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7655958\" target=\"_blank\">7655958<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Occupational+and+Environmental+Medicine&rft.atitle=Medical+Screening+and+Biological+Monitoring%3A+A+guide+to+the+literature+for+physicians&rft.volume=37&rft.issue=2&rft.pages=170-184&rft.date=1995&rft_id=info%3Adoi%2F10.1097%2F00043764-199502000-00016&rft_id=info%3Apmid%2F7655958&rft.aulast=Murthy&rft.aufirst=LI&rft.au=Halperin%2C+WE&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moltz KC, Postellon DC (1994). \"Congenital hypothyroidism and mental development\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Comprehensive_Therapy\" title=\"Comprehensive Therapy\" rel=\"external_link\" target=\"_blank\">Comprehensive Therapy<\/a><\/i>. <b>20<\/b> (6): 342\u2013346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8062543\" target=\"_blank\">8062543<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Comprehensive+Therapy&rft.atitle=Congenital+hypothyroidism+and+mental+development&rft.volume=20&rft.issue=6&rft.pages=342-346&rft.date=1994&rft_id=info%3Apmid%2F8062543&rft.aulast=Moltz&rft.aufirst=KC&rft.au=Postellon%2C+DC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.opticsinfobase.org\/oe\/abstract.cfm?uri=oe-17-25-22423\" target=\"_blank\">OSA | Design of a high-sensor count fibre optic manometry catheter for in-vivo colonic diagnostics<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/eur-lex.europa.eu\/LexUriServ\/LexUriServ.do?uri=OJ:L:1998:331:0001:0037:EN:PDF\" target=\"_blank\">Directive 98\/79\/CE on in vitro diagnostic medical devices<\/a><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"#\/About-In-Vitro-Diagnostics\">[1]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.labtestsonline.org.uk\/understanding\/analytes\/glucose\/tab\/test\" target=\"_blank\">Glucose Tests: The Test<\/a><\/span>\n<\/li>\n<li id=\"cite_note-labtestsonline.org.uk-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-labtestsonline.org.uk_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-labtestsonline.org.uk_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.labtestsonline.org.uk\/understanding\/analytes\/liver-panel\/\" target=\"_blank\">Liver Function Tests: At a Glance<\/a><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.labtestsonline.org.uk\/understanding\/analytes\/lytes\" target=\"_blank\">Electrolytes: At a Glance<\/a><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/diagnostic-tests\/mediastinoscopy.htm\" target=\"_blank\">Harvard.edu<\/a><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070608072504\/http:\/\/www.health.harvard.edu\/diagnostic-tests\/pap-smear.htm\" target=\"_blank\"><i>Diagnostic Tests > Pap Smear<\/i><\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvard_University\" title=\"Harvard University\" rel=\"external_link\" target=\"_blank\">Harvard University<\/a>, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/diagnostic-tests\/pap-smear.htm\" target=\"_blank\">the original<\/a> on June 8, 2007<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Diagnostic+Tests+%3E+Pap+Smear&rft.pub=Harvard+University&rft_id=http%3A%2F%2Fwww.health.harvard.edu%2Fdiagnostic-tests%2Fpap-smear.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid12783911-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid12783911_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jarvik J, Hollingworth W, Martin B, Emerson S, Gray D, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan S, Kreuter W, Deyo R (2003). \"Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial\". <i>JAMA<\/i>. <b>289<\/b> (21): 2810\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.289.21.2810\" target=\"_blank\">10.1001\/jama.289.21.2810<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12783911\" target=\"_blank\">12783911<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=Rapid+magnetic+resonance+imaging+vs+radiographs+for+patients+with+low+back+pain%3A+a+randomized+controlled+trial&rft.volume=289&rft.issue=21&rft.pages=2810-8&rft.date=2003&rft_id=info%3Adoi%2F10.1001%2Fjama.289.21.2810&rft_id=info%3Apmid%2F12783911&rft.aulast=Jarvik&rft.aufirst=J&rft.au=Hollingworth%2C+W&rft.au=Martin%2C+B&rft.au=Emerson%2C+S&rft.au=Gray%2C+D&rft.au=Overman%2C+S&rft.au=Robinson%2C+D&rft.au=Staiger%2C+T&rft.au=Wessbecher%2C+F&rft.au=Sullivan%2C+S&rft.au=Kreuter%2C+W&rft.au=Deyo%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Whiting, Penny F.; Anne W.S. Rutjes; Marie E. Westwood; Susan Mallett; Jonathan J. Deeks; Johannes B. Reitsma; Mariska M.G. Leeflang; Jonathan A.C. Sterne; Patrick M.M. Bossuyt; QUADAS-2 Group (2011-10-18). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120211100230\/http:\/\/www.annals.org\/content\/155\/8\/529.abstract\" target=\"_blank\">\"QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies\"<\/a>. <i>Annals of Internal Medicine<\/i>. <b>155<\/b> (8): 529\u2013536. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7326%2F0003-4819-155-8-201110180-00009\" target=\"_blank\">10.7326\/0003-4819-155-8-201110180-00009<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.annals.org\/content\/155\/8\/529.abstract\" target=\"_blank\">the original<\/a> on 2012-02-11<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-10-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Internal+Medicine&rft.atitle=QUADAS-2%3A+A+Revised+Tool+for+the+Quality+Assessment+of+Diagnostic+Accuracy+Studies&rft.volume=155&rft.issue=8&rft.pages=529-536&rft.date=2011-10-18&rft_id=info%3Adoi%2F10.7326%2F0003-4819-155-8-201110180-00009&rft.aulast=Whiting&rft.aufirst=Penny+F.&rft.au=Anne+W.S.+Rutjes&rft.au=Marie+E.+Westwood&rft.au=Susan+Mallett&rft.au=Jonathan+J.+Deeks&rft.au=Johannes+B.+Reitsma&rft.au=Mariska+M.G.+Leeflang&rft.au=Jonathan+A.C.+Sterne&rft.au=Patrick+M.M.+Bossuyt&rft.au=QUADAS-2+Group&rft_id=http%3A%2F%2Fwww.annals.org%2Fcontent%2F155%2F8%2F529.abstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n\n\n\n\n\n\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1254\nCached time: 20181202064615\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.496 seconds\nReal time usage: 0.649 seconds\nPreprocessor visited node count: 1902\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 208417\/2097152 bytes\nTemplate argument size: 529\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 26201\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.173\/10.000 seconds\nLua memory usage: 4.39 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 386.575 1 -total\n<\/p>\n<pre>35.97% 139.044 1 Template:Reflist\n28.85% 111.545 6 Template:Cite_journal\n27.11% 104.783 21 Template:Navbox\n18.49% 71.482 1 Template:Infobox_interventions\n16.68% 64.482 1 Template:Infobox\n 6.57% 25.394 1 Template:Medical_imaging\n 5.20% 20.113 3 Template:Main\n 4.93% 19.075 1 Template:Myeloid_blood_tests\n 3.86% 14.926 1 Template:Col_div\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:12439068-1!canonical!math=5 and timestamp 20181202064615 and revision id 863479577\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_test\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214712\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.992 1 - wikipedia:Medical_test\n100.00% 158.992 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8206-0!*!*!*!*!*!* and timestamp 20181217214712 and revision id 24356\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_test\">https:\/\/www.limswiki.org\/index.php\/Medical_test<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0e5a509a721423b5cae83265bbb80c85_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/fb\/X-ray_by_Wilhelm_R%C3%B6ntgen_of_Albert_von_K%C3%B6lliker%27s_hand_-_18960123-02.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/Lung_scintigraphy_keosys.JPG\/440px-Lung_scintigraphy_keosys.JPG"],"0e5a509a721423b5cae83265bbb80c85_timestamp":1545083232,"1148193934d4fb36855d27dfafd5c25a_type":"article","1148193934d4fb36855d27dfafd5c25a_title":"Medical\u2013industrial complex","1148193934d4fb36855d27dfafd5c25a_url":"https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex","1148193934d4fb36855d27dfafd5c25a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical\u2013industrial complex\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Medical equipment and devices\nThe medical\u2013industrial complex is the network of corporations which supply health care services and products for a profit. The term is analogous to \"military\u2013industrial complex\" and builds from the social precedent of discussion on that concept.\nThe medical\u2013industrial complex is often discussed in the context of conflict of interest in the health care industry.\n\nContents \n\n1 Term \n2 Characteristics \n3 References \n4 Further reading \n\n\nTerm \nThe concept of a \"medical\u2013industrial complex\" was first advanced by Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled \"The Medical Industrial Complex\" and in a subsequent book (with Health-PAC), The American Health Empire: Power, Profits, and Politics (Random House, 1970). The concept was widely discussed throughout the 1970s, including reviews in the New England Journal of Medicine (November 4, 1971, 285:1095). It was further popularized in 1980, Arnold S. Relman while he served as editor of The New England Journal of Medicine.[1] in a paper titled \"The New Medical-Industrial Complex.\" Relman commented, \"The past decade has seen the rise of another kind of private \"industrial complex\" with an equally great potential for influence on public policy \u2014 this time in health care...\" Oddly, Relman added, \" In searching for information on this subject, I have found no standard literature and have had to draw on a variety of unconventional sources...\"[1] Subsequently, this paper and the concept have been discussed continually.[2] An updated history and analysis can be found in John Ehrenreich, \"Third Wave Capitalism: How Money, Power, and the Pursuit of Self-Interest have Imperiled the American Dream\" (Cornell University Press, May 2016).\n\nCharacteristics \nManufacturers of medical devices fund medical education programs and physicians and hospitals directly to adopt the use of their devices.[3]\nThe management of health care organizations by business staff rather than local medical practice is one of the trends of the increasing influence of the medical-industrial complex.[4]\nAnother trend is that increased pressure to generate profit for providing services can decrease the influence of creativity or innovation in medical research.[5]\nIn the 1970s profit-seeking companies became significant stakeholders in the United States healthcare system.[6]\nThe influence of economic policy on the practice of medicine has a long history.[7]\nBecause the General Agreement on Trade in Services regulates international marketplaces, in countries where the industrial-medical complex is more strong there can be legal limitations to consumer options for accessing diverse healthcare services.[8]\nBecause the industrial-medical complex funds continuing medical education, this education has a bias to promote the interests of its funders.[9]\n\nReferences \n\n\n^ a b Relman, Arnold S. (1980). \"The New Medical-Industrial Complex\". New England Journal of Medicine. 303 (17): 963\u2013970. doi:10.1056\/NEJM198010233031703. ISSN 0028-4793. \n\n^ Malina, Debra; Rosenbaum, Lisa (2015). \"Understanding Bias \u2014 The Case for Careful Study\". New England Journal of Medicine. 372 (20): 1959\u20131963. doi:10.1056\/NEJMms1502497. ISSN 0028-4793. PMID 25970055. \n\n^ Baggish, Michaels.; Nezhat, Camran (1992). \"The Medical\u2013Industrial Complex\". Journal of Gynecologic Surgery. 8 (3): v\u2013vi. doi:10.1089\/gyn.1992.8.v. ISSN 1042-4067. \n\n^ Maloney, FP (1998). \"The emerging medical\/industrial complex. The industrialization of medicine\". Physician Executive. 24 (2): 34\u20138. PMID 10180498. \n\n^ Stevens, CW; Glatstein, E (1996). \"Beware the Medical-Industrial Complex\". The Oncologist. 1 (4): IV\u2013V. PMID 10388005. \n\n^ Buchanan, Robert J. (Winter 1982). \"The Financial Status of the New Medical-Industrial Complex\". Inquiry. 19 (4): 308\u2013316. JSTOR 29771516. \n\n^ Jupiter, Jesse; Burke, Dennis (2013). \"Scott's parabola and the rise of the medical\u2013industrial complex\". HAND. 8 (3): 249\u2013252. doi:10.1007\/s11552-013-9526-5. ISSN 1558-9447. PMC 3745238 . \n\n^ Santos, MA; Passos, SR (August 2010). \"[International trade in health services and the medical industrial complex: implications for national health systems]\". Cadernos de Sa\u00fade P\u00fablica. 26 (8): 1483\u201393. PMID 21229208. \n\n^ Schofferman, Jerome (2011). \"The Medical-Industrial Complex, Professional Medical Associations, and Continuing Medical Education\". Pain Medicine. 12 (12): 1713\u20131719. doi:10.1111\/j.1526-4637.2011.01282.x. ISSN 1526-2375. \n\n\nFurther reading \nGeyman, John P. (2004-01-01). The Corporate Transformation of Health Care: Can the Public Interest Still Be Served?. Springer Publishing Company. ISBN 9780826124678. Retrieved 2015-05-14 . \nSchatman, Michael E. (2011). \"The Medical-Industrial Complex and Conflict of Interest in Pain Education\". Pain Medicine. 12 (12): 1710\u20131712. doi:10.1111\/j.1526-4637.2011.01284.x. ISSN 1526-2375. \nRosenthal, Elisabeth (2017). An American Sickness: How Healthcare Became Big Business and How You Can Take it Back. Penguin Press. ISBN 9780698407183. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex\">https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex<\/a>\n\t\t\t\t\tCategories: Economic termsHealthcare termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:00.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,130 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1148193934d4fb36855d27dfafd5c25a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical\u2013industrial_complex skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical\u2013industrial complex<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Beth-El_Industries_Isolation_chamber_inside_view.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Beth-El_Industries_Isolation_chamber_inside_view.jpg\/220px-Beth-El_Industries_Isolation_chamber_inside_view.jpg\" width=\"220\" height=\"294\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Beth-El_Industries_Isolation_chamber_inside_view.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Medical equipment and devices<\/div><\/div><\/div>\n<p>The <b>medical\u2013industrial complex<\/b> is the network of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corporations\" class=\"mw-redirect\" title=\"Corporations\" rel=\"external_link\" target=\"_blank\">corporations<\/a> which supply <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">health care<\/a> services and products for a profit. The term is analogous to \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Military%E2%80%93industrial_complex\" title=\"Military\u2013industrial complex\" rel=\"external_link\" target=\"_blank\">military\u2013industrial complex<\/a>\" and builds from the social precedent of discussion on that concept.\n<\/p><p>The medical\u2013industrial complex is often discussed in the context of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conflict_of_interest_in_the_health_care_industry\" class=\"mw-redirect\" title=\"Conflict of interest in the health care industry\" rel=\"external_link\" target=\"_blank\">conflict of interest in the health care industry<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Term\">Term<\/span><\/h2>\n<p>The concept of a \"medical\u2013industrial complex\" was first advanced by Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled \"The Medical Industrial Complex\" and in a subsequent book (with Health-PAC), The American Health Empire: Power, Profits, and Politics (Random House, 1970). The concept was widely discussed throughout the 1970s, including reviews in the New England Journal of Medicine (November 4, 1971, 285:1095). It was further popularized in 1980, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arnold_S._Relman\" title=\"Arnold S. Relman\" rel=\"external_link\" target=\"_blank\">Arnold S. Relman<\/a> while he served as editor of <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_England_Journal_of_Medicine\" title=\"The New England Journal of Medicine\" rel=\"external_link\" target=\"_blank\">The New England Journal of Medicine<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-Relman1980_1-0\" class=\"reference\"><a href=\"#cite_note-Relman1980-1\" rel=\"external_link\">[1]<\/a><\/sup> in a paper titled \"The New Medical-Industrial Complex.\" Relman commented, \"The past decade has seen the rise of another kind of private \"industrial complex\" with an equally great potential for influence on public policy \u2014 this time in health care...\" Oddly, Relman added, \" In searching for information on this subject, I have found no standard literature and have had to draw on a variety of unconventional sources...\"<sup id=\"rdp-ebb-cite_ref-Relman1980_1-1\" class=\"reference\"><a href=\"#cite_note-Relman1980-1\" rel=\"external_link\">[1]<\/a><\/sup> Subsequently, this paper and the concept have been discussed continually.<sup id=\"rdp-ebb-cite_ref-MalinaRosenbaum2015_2-0\" class=\"reference\"><a href=\"#cite_note-MalinaRosenbaum2015-2\" rel=\"external_link\">[2]<\/a><\/sup> An updated history and analysis can be found in John Ehrenreich, \"Third Wave Capitalism: How Money, Power, and the Pursuit of Self-Interest have Imperiled the American Dream\" (Cornell University Press, May 2016).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Characteristics\">Characteristics<\/span><\/h2>\n<p>Manufacturers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a> fund medical education programs and physicians and hospitals directly to adopt the use of their devices.<sup id=\"rdp-ebb-cite_ref-BaggishNezhat1992_3-0\" class=\"reference\"><a href=\"#cite_note-BaggishNezhat1992-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The management of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care_organization\" class=\"mw-redirect\" title=\"Health care organization\" rel=\"external_link\" target=\"_blank\">health care organizations<\/a> by business staff rather than local medical practice is one of the trends of the increasing influence of the medical-industrial complex.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Another trend is that increased pressure to generate profit for providing services can decrease the influence of creativity or innovation in medical research.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>In the 1970s profit-seeking companies became significant stakeholders in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care_in_the_United_States\" title=\"Health care in the United States\" rel=\"external_link\" target=\"_blank\">United States healthcare<\/a> system.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The influence of economic policy on the practice of medicine has a long history.<sup id=\"rdp-ebb-cite_ref-JupiterBurke2013_7-0\" class=\"reference\"><a href=\"#cite_note-JupiterBurke2013-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Because the <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_Agreement_on_Trade_in_Services\" title=\"General Agreement on Trade in Services\" rel=\"external_link\" target=\"_blank\">General Agreement on Trade in Services<\/a> regulates international marketplaces, in countries where the industrial-medical complex is more strong there can be legal limitations to consumer options for accessing diverse healthcare services.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Because the industrial-medical complex funds <a href=\"https:\/\/en.wikipedia.org\/wiki\/Continuing_medical_education\" title=\"Continuing medical education\" rel=\"external_link\" target=\"_blank\">continuing medical education<\/a>, this education has a bias to promote the interests of its funders.<sup id=\"rdp-ebb-cite_ref-Schofferman2011_9-0\" class=\"reference\"><a href=\"#cite_note-Schofferman2011-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Relman1980-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Relman1980_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Relman1980_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Relman, Arnold S. (1980). \"The New Medical-Industrial Complex\". <i>New England Journal of Medicine<\/i>. <b>303<\/b> (17): 963\u2013970. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJM198010233031703\" target=\"_blank\">10.1056\/NEJM198010233031703<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0028-4793\" target=\"_blank\">0028-4793<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=The+New+Medical-Industrial+Complex&rft.volume=303&rft.issue=17&rft.pages=963-970&rft.date=1980&rft_id=info%3Adoi%2F10.1056%2FNEJM198010233031703&rft.issn=0028-4793&rft.aulast=Relman&rft.aufirst=Arnold+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-MalinaRosenbaum2015-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MalinaRosenbaum2015_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Malina, Debra; Rosenbaum, Lisa (2015). \"Understanding Bias \u2014 The Case for Careful Study\". <i>New England Journal of Medicine<\/i>. <b>372<\/b> (20): 1959\u20131963. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMms1502497\" target=\"_blank\">10.1056\/NEJMms1502497<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0028-4793\" target=\"_blank\">0028-4793<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25970055\" target=\"_blank\">25970055<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Understanding+Bias+%E2%80%94+The+Case+for+Careful+Study&rft.volume=372&rft.issue=20&rft.pages=1959-1963&rft.date=2015&rft.issn=0028-4793&rft_id=info%3Apmid%2F25970055&rft_id=info%3Adoi%2F10.1056%2FNEJMms1502497&rft.aulast=Malina&rft.aufirst=Debra&rft.au=Rosenbaum%2C+Lisa&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BaggishNezhat1992-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BaggishNezhat1992_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Baggish, Michaels.; Nezhat, Camran (1992). \"The Medical\u2013Industrial Complex\". <i>Journal of Gynecologic Surgery<\/i>. <b>8<\/b> (3): v\u2013vi. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Fgyn.1992.8.v\" target=\"_blank\">10.1089\/gyn.1992.8.v<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1042-4067\" target=\"_blank\">1042-4067<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Gynecologic+Surgery&rft.atitle=The+Medical%E2%80%93Industrial+Complex&rft.volume=8&rft.issue=3&rft.pages=v-vi&rft.date=1992&rft_id=info%3Adoi%2F10.1089%2Fgyn.1992.8.v&rft.issn=1042-4067&rft.aulast=Baggish&rft.aufirst=Michaels.&rft.au=Nezhat%2C+Camran&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maloney, FP (1998). \"The emerging medical\/industrial complex. The industrialization of medicine\". <i>Physician Executive<\/i>. <b>24<\/b> (2): 34\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10180498\" target=\"_blank\">10180498<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physician+Executive&rft.atitle=The+emerging+medical%2Findustrial+complex.+The+industrialization+of+medicine.&rft.volume=24&rft.issue=2&rft.pages=34-8&rft.date=1998&rft_id=info%3Apmid%2F10180498&rft.aulast=Maloney&rft.aufirst=FP&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stevens, CW; Glatstein, E (1996). \"Beware the Medical-Industrial Complex\". <i>The Oncologist<\/i>. <b>1<\/b> (4): IV\u2013V. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10388005\" target=\"_blank\">10388005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Oncologist&rft.atitle=Beware+the+Medical-Industrial+Complex.&rft.volume=1&rft.issue=4&rft.pages=IV-V&rft.date=1996&rft_id=info%3Apmid%2F10388005&rft.aulast=Stevens&rft.aufirst=CW&rft.au=Glatstein%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Buchanan, Robert J. (Winter 1982). \"The Financial Status of the New Medical-Industrial Complex\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Inquiry_(health_journal)\" title=\"Inquiry (health journal)\" rel=\"external_link\" target=\"_blank\">Inquiry<\/a><\/i>. <b>19<\/b> (4): 308\u2013316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/29771516\" target=\"_blank\">29771516<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Inquiry&rft.atitle=The+Financial+Status+of+the+New+Medical-Industrial+Complex&rft.ssn=winter&rft.volume=19&rft.issue=4&rft.pages=308-316&rft.date=1982&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F29771516&rft.aulast=Buchanan&rft.aufirst=Robert+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-JupiterBurke2013-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-JupiterBurke2013_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jupiter, Jesse; Burke, Dennis (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3745238\" target=\"_blank\">\"Scott's parabola and the rise of the medical\u2013industrial complex\"<\/a>. <i>HAND<\/i>. <b>8<\/b> (3): 249\u2013252. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11552-013-9526-5\" target=\"_blank\">10.1007\/s11552-013-9526-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1558-9447\" target=\"_blank\">1558-9447<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3745238\" target=\"_blank\">3745238<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=HAND&rft.atitle=Scott%E2%80%99s+parabola+and+the+rise+of+the+medical%E2%80%93industrial+complex&rft.volume=8&rft.issue=3&rft.pages=249-252&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3745238&rft.issn=1558-9447&rft_id=info%3Adoi%2F10.1007%2Fs11552-013-9526-5&rft.aulast=Jupiter&rft.aufirst=Jesse&rft.au=Burke%2C+Dennis&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3745238&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Santos, MA; Passos, SR (August 2010). \"[International trade in health services and the medical industrial complex: implications for national health systems]\". <i>Cadernos de Sa\u00fade P\u00fablica<\/i>. <b>26<\/b> (8): 1483\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21229208\" target=\"_blank\">21229208<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cadernos+de+Sa%C3%BAde+P%C3%BAblica&rft.atitle=%5BInternational+trade+in+health+services+and+the+medical+industrial+complex%3A+implications+for+national+health+systems%5D.&rft.volume=26&rft.issue=8&rft.pages=1483-93&rft.date=2010-08&rft_id=info%3Apmid%2F21229208&rft.aulast=Santos&rft.aufirst=MA&rft.au=Passos%2C+SR&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Schofferman2011-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Schofferman2011_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schofferman, Jerome (2011). \"The Medical-Industrial Complex, Professional Medical Associations, and Continuing Medical Education\". <i>Pain Medicine<\/i>. <b>12<\/b> (12): 1713\u20131719. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1526-4637.2011.01282.x\" target=\"_blank\">10.1111\/j.1526-4637.2011.01282.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1526-2375\" target=\"_blank\">1526-2375<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pain+Medicine&rft.atitle=The+Medical-Industrial+Complex%2C+Professional+Medical+Associations%2C+and+Continuing+Medical+Education&rft.volume=12&rft.issue=12&rft.pages=1713-1719&rft.date=2011&rft_id=info%3Adoi%2F10.1111%2Fj.1526-4637.2011.01282.x&rft.issn=1526-2375&rft.aulast=Schofferman&rft.aufirst=Jerome&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Geyman, John P. (2004-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=rL_DbHkZQnwC&printsec=frontcover&dq=medical+corporations+health+care&hl=en&sa=X&ei=4eNUVaK0LsOggwSN1YGoCw&ved=0CDUQ6AEwAQ#v=onepage&q=medical%20corporations%20health%20care&f=false\" target=\"_blank\"><i>The Corporate Transformation of Health Care: Can the Public Interest Still Be Served?<\/i><\/a>. Springer Publishing Company. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780826124678<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-05-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Corporate+Transformation+of+Health+Care%3A+Can+the+Public+Interest+Still+Be+Served%3F&rft.pub=Springer+Publishing+Company&rft.date=2004-01-01&rft.isbn=9780826124678&rft.aulast=Geyman&rft.aufirst=John+P.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DrL_DbHkZQnwC%26printsec%3Dfrontcover%26dq%3Dmedical%2Bcorporations%2Bhealth%2Bcare%26hl%3Den%26sa%3DX%26ei%3D4eNUVaK0LsOggwSN1YGoCw%26ved%3D0CDUQ6AEwAQ%23v%3Donepage%26q%3Dmedical%2520corporations%2520health%2520care%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Schatman, Michael E. (2011). \"The Medical-Industrial Complex and Conflict of Interest in Pain Education\". <i>Pain Medicine<\/i>. <b>12<\/b> (12): 1710\u20131712. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1526-4637.2011.01284.x\" target=\"_blank\">10.1111\/j.1526-4637.2011.01284.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1526-2375\" target=\"_blank\">1526-2375<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pain+Medicine&rft.atitle=The+Medical-Industrial+Complex+and+Conflict+of+Interest+in+Pain+Education&rft.volume=12&rft.issue=12&rft.pages=1710-1712&rft.date=2011&rft_id=info%3Adoi%2F10.1111%2Fj.1526-4637.2011.01284.x&rft.issn=1526-2375&rft.aulast=Schatman&rft.aufirst=Michael+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Rosenthal, Elisabeth (2017). <i>An American Sickness: How Healthcare Became Big Business and How You Can Take it Back<\/i>. Penguin Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780698407183.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=An+American+Sickness%3A+How+Healthcare+Became+Big+Business+and+How+You+Can+Take+it+Back&rft.pub=Penguin+Press&rft.date=2017&rft.isbn=9780698407183&rft.aulast=Rosenthal&rft.aufirst=Elisabeth&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1264\nCached time: 20181210143947\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.196 seconds\nReal time usage: 0.238 seconds\nPreprocessor visited node count: 565\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 22612\/2097152 bytes\nTemplate argument size: 92\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 30352\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.136\/10.000 seconds\nLua memory usage: 3.79 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 200.037 1 -total\n<\/p>\n<pre>91.90% 183.835 1 Template:Reflist\n84.88% 169.789 10 Template:Cite_journal\n 4.86% 9.719 2 Template:Cite_book\n 1.43% 2.864 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:46704707-1!canonical and timestamp 20181210143947 and revision id 841426502\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical%E2%80%93industrial_complex\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214712\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.164 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 157.821 1 - wikipedia:Medical\u2013industrial_complex\n100.00% 157.821 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8577-0!*!*!*!*!*!* and timestamp 20181217214711 and revision id 25005\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex\">https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1148193934d4fb36855d27dfafd5c25a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/fc\/Beth-El_Industries_Isolation_chamber_inside_view.jpg"],"1148193934d4fb36855d27dfafd5c25a_timestamp":1545083231,"94d576c5d095ff5b727c95343fde5efa_type":"article","94d576c5d095ff5b727c95343fde5efa_title":"Medical equipment management","94d576c5d095ff5b727c95343fde5efa_url":"https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management","94d576c5d095ff5b727c95343fde5efa_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical equipment management\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n This article may require cleanup to meet Wikipedia's quality standards. No cleanup reason has been specified. Please help improve this article if you can. (December 2011) (Learn how and when to remove this template message)\nThis article includes a list of references, related reading or external links, but its sources remain unclear because it lacks inline citations. Please help to improve this article by introducing more precise citations. (March 2016) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nHealthcare Technology Management (sometimes referred to as clinical engineering, clinical engineering management, clinical technology management, healthcare technology management, medical equipment management, biomedical maintenance, biomedical equipment management, and biomedical engineering) is a term for the professionals who manage operations, analyze and improve utilization and safety, and support servicing healthcare technology. These healthcare technology managers are, much like other healthcare professionals referred to by various specialty or organizational hierarchy names.\nSome of the titles of healthcare technology management professionals are biomed, biomedical equipment technician, biomedical engineering technician, biomedical engineer, BMET, biomedical equipment management, biomedical equipment services, imaging service engineer, imaging specialist, clinical engineer technician, clinical engineering equipment technician, field service engineer, field clinical engineer, clinical engineer, and medical equipment repair person. Regardless of the various titles, these professionals offer services within and outside of healthcare settings to enhance the safety, utilization, and performance on medical devices, applications, and systems.\nThey are a fundamental part of managing, maintaining, and\/or designing medical devices, applications, and systems for use in various healthcare settings, from the home and the field to the doctor's office and the hospital.\nHTM includes the business processes used in interaction and oversight of the technology involved in the diagnosis, treatment, and monitoring of patients. The related policies and procedures govern activities such as the selection, planning, and acquisition of medical devices, and the inspection, acceptance, maintenance, and eventual retirement and disposal of medical equipment. \n\nContents \n\n1 Responsibilities of the Healthcare Technology Management Professional \n2 Equipment Control & Asset Management \n3 Work Order Management \n4 Data Quality Management \n5 Quality Assurance \n6 Patient Safety \n7 Risk management \n8 Hospital Safety Programs \n9 References \n\n\nResponsibilities of the Healthcare Technology Management Professional \nThe healthcare technology management professional's purpose is to ensure that equipment and systems used in patient care are operational, safe, and properly configured to meet the mission of the healthcare; that the equipment is used in an effective way consistent with the highest standards of care by educating the healthcare provider, equipment user, and patient; that the equipment is designed to limit the potential for loss, harm, or damage to the patient, provider, visitor, and facilities through various means of analysis prior to and during acquisition, monitoring and foreseeing problems during the lifecycle of the equipment, and collaborating with the parties who manufacture, design, regulate, or recommend safe medical devices and systems.\nSome but not all of the healthcare technology management professional's functions are:\n\nEquipment Control & Asset Management\nEquipment Inventories\nWork Order Management\nData Quality Management\nEquipment Maintenance Management\nEquipment Maintenance\nPersonnel Management\nQuality Assurance\nPatient Safety\nRisk Management\nHospital Safety Programs\nRadiation Safety\nMedical Gas Systems\nIn-Service Education & Training\nAccident Investigation\nAnalysis of Failures, Root Causes, and Human Factors\nSafe Medical Devices Act (SMDA) of 1990\nHealth Insurance Portability and Accountability Act (HIPAA)\nCareers in Facilities Management\n Equipment Control & Asset Management \nEvery medical treatment facility should have policies and processes on equipment control and asset management. Equipment control and asset management involves the management of medical devices within a facility and may be supported by automated information systems (e.g., enterprise resource planning (ERP) systems are often found in U.S. hospitals, and the U.S. military health system uses an advanced automated system known as the Defense Medical Logistics Standard Support (DMLSS) suite of applications) or may use a dedicated equipment management and maintenance software (e.g., BME Assistor). Equipment control begins with the receipt of a newly acquired equipment item and continues through the item's entire lifecycle. Newly acquired devices should be inspected by in-house or contracted biomedical equipment technicians (BMETs), who will receive an established equipment control\/asset number from the facilities equipment\/property manager. This control number is used to track and record maintenance actions in their database. This is similar to creating a new chart for a new patient who will be seen at the medical facility. Once an equipment control number is established, the device is safety inspected and readied for delivery to clinical and treatment areas in the facility. \nFacilities or healthcare delivery networks may rely on a combination of equipment service providers such as manufacturers, third-party services, in-house technicians, and remote support. Equipment managers are responsible for continuous oversight and responsibility for ensuring safe and effective equipment performance through full-service maintenance. Medical equipment managers are also responsible for technology assessment, planning and management in all areas within a medical treatment facility (e.g. developing policies and procedures for the medical equipment management plan, identifying trends and the need for staff education, resolution of defective biomedical equipment issues).\nThis industry is new, and there is not a clear line between IT and Bio-Med.\n\nWork Order Management \nWork order management involves systematic, measurable, and traceable methods to all acceptance\/initial inspections, preventive maintenance, and calibrations, or repairs by generating scheduled and unscheduled work orders. Work order management may be paper-based or computer-base and includes the maintenance of active (open or uncompleted) and completed work orders which provide a comprehensive maintenance history of all medical equipment devices used in the diagnosis, treatment, and management of patients. Work order management includes all safety, preventive, calibration, test, and repair services performed on all such medical devices. A comprehensive work order management system can also be used as a resource and workload management tool by managers responsible for personnel time, total number of hour\u2019s technician spent working on equipment, maximum repair dollar for one time repair, or total dollar allowed to spend repairing equipment versus replacement.\nPost-work order quality checks involve one of two methods: 100% audit of all work orders or statistical sampling of randomly selected work orders. Randomly selected work orders should place more stringent statistical controls based on the clinical criticality of the device involved. For example, 100% of items critical to patient treatment but only 50% of ancillary items may be selected for sampling. In an ideal setting, all work orders are checked, but available resources may dictate a less comprehensive approach. Work orders must be tracked regularly and all discrepancies must be corrected. Managers are responsible to identify equipment location\n\nData Quality Management \nAccurate, comprehensive data are needed in any automated medical equipment management system. Data quality initiatives can help to insure the accuracy of clinical\/biomedical engineering data. The data needed to establish basic, accurate, maintainable automated records for medical equipment management includes: nomenclature, manufacturer, nameplate model, serial number, acquisition cost, condition code, and maintenance assessment. Other useful data could include: warranty, location, other contractor agencies, scheduled maintenance due dates, and intervals. These fields are vital to ensure appropriate maintenance is performed, equipment is accounted for, and devices are safe for use in patient care.\n\nNomenclature: It defines what the device is, how, and the type of maintenance is to be performed. Common nomenclature systems are taken directly from the ECRI Institute Universal Medical Device Nomenclature System.\nManufacturer: This is the name of the company that received approval from the FDA to sell the device, also known as the Original Equipment Manufacturer (OEM).\nNameplate model: The model number is typically located on the front\/behind of the equipment or on the cover of the service manual and is provided by the OEM. E.g. Medtronic PhysioControl\u2019s Lifepak 10 Defibrillator can actually be any one of the following correct model numbers listed: 10-41, 10-43, 10 -47, 10-51, and 10-57.\nSerial number: This is usually found on the data plate as well, is a serialized number (could contain alpha characters) provided by the manufacturer. This number is crucial to device alerts and recalls.\nAcquisition cost: The total purchased price for an individual item or system. This cost should include installation, shipping, and other associated costs. These numbers are crucial for budgeting, maintenance expenditures, and depreciation reporting.\nCondition code: This code is mainly used when an item is turned in and should be changed when there are major changes to the device that could affect whether or not an item should be salvaged, destroyed, or used by another Medical Treatment Facility.\nMaintenance assessment: This assessment must be validated every time a BMET performs any kind of maintenance on a device.\nSeveral other management tools, such as equipment replacement planning and budgeting, depreciation calculations, and at the local level literature, repair parts, and supplies are directly related to one or more of these fundamental basics. Data Quality must be tracked monthly and all discrepancies must be corrected.\n\nQuality Assurance \nQuality Assurance is a way of identifying an item of supply or equipment as being defective. A good quality control\/engineering program improves quality of work and lessens the risk of staff\/patient injuries\/death.\n\nPatient Safety \nSafety of our patients\/staff is paramount to the success of our organizations mission. The Joint Commission publishes annual lists detailing \u201cNational Patient Safety Goals\u201d to be implemented by healthcare organizations. Goals are developed by experts in patient safety nurses, physicians, pharmacists, risk managers, and other professionals with patient-safety experience in a variety of settings. Patient safety is among the most important goals of every healthcare provider, and participation in a variety of committees and processes concerned with patient safety provides a way for biomedical managers and clinical engineering departments to gain visibility and positively affect their workplace.\n\nRisk management \nThis program helps the medical treatment facility avoid the likelihood of equipment-related risks, minimize liability of mishaps and incidents, and stay compliant with regulatory reporting requirements. The best practice is to use a rating system for every equipment type. For example, a risk-rating system might rate defibrillators as considered high risk, general-purpose infusion pumps as medium risk, electronic thermometers as low risk, and otoscopes as no significant risk. This system could be set up using Microsoft Excel or Access program for a manager's or technician's quick reference.\nIn addition, user error, equipment abuse, no problem\/fault found occurrences must be tracked to assist risk management personnel in determining whether additional clinical staff training must be performed.\nRisk management for IT networks incorporating medical devices will be covered by the standard ISO\/IEC 80001. Its purpose is: \"Recognizing that MEDICAL DEVICES are incorporated into IT-NETWORKS to achieve desirable benefits (for example, INTEROPERABILITY), this international standard defines the roles, responsibilities and activities that are necessary for RISK MANAGEMENT of IT-NETWORKS incorporating MEDICAL DEVICES to address the KEY PROPERTIES\". It resorts some basic ideas of ISO 20000 in the context of medical applications, e.g. configuration, incident, problem, change and release management, and risk analysis, control and evaluation according to ISO 14971. IEC 80001 \"applies to RESPONSIBLE ORGANIZATIONS, MEDICAL DEVICE manufacturers and other providers of information technologies for the purpose of comprehensive RISK MANAGEMENT\".\n\nHospital Safety Programs \nThe Joint Commission stipulates seven management plans for hospital accreditation. One of the seven is safety. Safety includes a range of hazards including mishaps, injuries on the job, and patient care hazards. The most common safety mishaps are \"needle-sticks\" (staff accidentally stick themselves with a needle) or patient injury during care. As a manager, ensure all staff and patients are safe within the facility. Note: it\u2019s everyone\u2019s responsibility!\nThere are several meetings that medical equipment managers are required to attend as the organizations technical representative:\n\nPatient Safety\nEnvironment of Care\nSpace Utilization Committee\nEquipment Review Board\nInfection Control (optional)\nEducational Requirements For Bio-Medical Engineer :\nStudents should take the most challenging science, math, and English courses available in high school. \nAll biomedical engineers have at least a bachelor's degree in engineering. Many have advanced graduate degrees as well. Courses of study include a sound background in mechanical, chemical, or industrial engineering, and specialized biomedical training. Most programs last from four to six years, and all states require biomedical engineers to pass examinations and be licensed.\nDuties & Responsibilities For Bio-Medical Engineer:\nDescription:\nBiomedical Engineers use engineering principles to solve health related and medical problems. They do a lot of research in conjunction with life scientists, chemists, and medical professionals to design medical devices like artificial hearts, pacemakers, dialysis machines, and surgical lasers. Some conduct research on biological and other life systems or investigate ways to modernize laboratory and clinical procedures. \nFrequently, biomedical engineers supervise biomedical equipment maintenance technicians, investigate medical equipment failure, and advise hospitals about purchasing and installing new equipment. \nBiomedical engineers work in hospitals, universities, industry, and research laboratories.\n\n<\/p>Working Conditions : \nBiomedical engineers work in offices, laboratories, workshops, manufacturing plants, clinics and hospitals. Some local travel may be required if medical equipment is located in various clinics or hospitals. \nMost biomedical engineers work standard weekday hours. Longer hours may be required to meet research deadlines, work with patients at times convenient to them, or work on medical equipment that is in use during daytime hours.\n\n<\/p>Duties : \nBiomedical engineers work closely with life scientists, chemists and medical professionals (physicians, nurses, therapists and technicians) on the engineering aspects of biological systems. \nDuties and responsibilities vary from one position to another but, in general, biomedical engineers:\n\n<\/p>\u2022\tdesign and develop medical devices such as artificial hearts and kidneys, pacemakers, artificial hips, surgical lasers, automated patient monitors and blood chemistry sensors.\n\u2022\tdesign and develop engineered therapies (for example, neural-integrative prostheses).\n\u2022\tadapt computer hardware or software for medical science or health care applications (for example, develop expert systems that assist in diagnosing diseases, medical imaging systems, models of different aspects of human physiology or medical data management).\n\u2022\tconduct research to test and modify known theories and develop new theories.\n\u2022\tensure the safety of equipment used for diagnosis, treatment and monitoring.\n\u2022\tinvestigate medical equipment failures and provide advice about the purchase and installation of new equipment.\n\u2022\tdevelop and evaluate quantitative models of biological processes and systems.\n\u2022\tapply engineering methods to answer basic questions about how the body works.\n\u2022\tcontribute to patient assessments.\n\u2022\tprepare and present reports for health professionals and the public.\n\u2022\tsupervise and train technologists and technicians.\nBiomedical engineers may work primarily in one or a combination of the following fields:\n\u2022\tbioinformatics \u2013 developing and using computer tools to collect and analyze data.\n\u2022\tbioinstrumentation \u2013 applying electronic and measurement techniques.\n\u2022\tbiomaterials \u2013 developing durable materials that are compatible with a biological environment.\n\u2022\tbiomechanics - applying knowledge of mechanics to biological or medical problems.\n\u2022\tbio-nano-engineering \u2013 developing novel structures of nanometer dimensions for application to biology, drug delivery, molecular diagnostics, microsystems and nanosystems.\n\u2022\tbiophotonics \u2013 applying and manipulating light, usually laser light, for sensing or imaging properties of biological tissue.\n\u2022\tcellular and tissue engineering \u2013 studying the anatomy, biochemistry and mechanics of cellular and sub-cellular structures, developing technology to repair, replace or regenerate living tissues and developing methods for controlling cell and tissue growth in the laboratory.\n\u2022\tclinical engineering \u2013 applying the latest technology to health care and health care systems in hospitals.\n\u2022\tgenomics and genetic engineering \u2013 mapping, sequencing and analyzing genomes (DNA), and applying molecular biology methods to manipulate the genetic material of cells, viruses and organisms.\n\u2022\tmedical or biological imaging \u2013 combining knowledge of a physical phenomenon (for example, sound, radiation or magnetism) with electronic processing, analysis and display.\n\u2022\tmolecular bioengineering \u2013 designing molecules for biomedical purposes and applying computational methods for simulating biomolecular interactions.\n\u2022\tsystems physiology - studying how systems function in living organisms.\n\u2022\ttherapeutic engineering \u2013 developing and discovering drugs and advanced materials and techniques for delivering drugs to local tissues with minimized side effects.\nThe National Institute for Occupational Safety and Health (NIOSH) developed the Occupational Health Safety Network (OHSN) to help hospitals manage their occupational safety and health data. OHSN, a secure electronic surveillance system, allows hospitals and other healthcare facilities to upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare personnel: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. OHSN can be used to meet regulatory and accreditation requirements of OSHA and The Joint Commission. OHSN enrollment is open to all healthcare facilities.\n\nReferences \nBowles, Roger \"Techcareers: Biomedical Equipment Technicians\" TSTC Publishing\nDyro, Joseph., Clinical Engineering Handbook (Biomedical Engineering).\nKhandpur, R. S. \"Biomedical Instrumentation: Technology and Applications\". McGraw Hills\nNorthrop, Robert B., \"Noninvasive Instrumentation and Measurement in Medical Diagnosis (Biomedical Engineering)\".\nWebb, Andrew G., \"Introduction to Biomedical Imaging (IEEE Press Series on Biomedical Engineering)\".\nYadin David, Wolf W. von Maltzahn, Michael R. Neuman, and Joseph D. Bronzino,. Clinical Engineering (Principles and Applications in Engineering).\nVillafa\u00f1e, Carlos CBET: \"Biomed: From the Student's Perspective\" (ISBN 978-1-61539-663-4). www.Biomedtechnicians.com.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management\">https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management<\/a>\n\t\t\t\t\tCategories: Healthcare termsMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 16:38.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 441 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","94d576c5d095ff5b727c95343fde5efa_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_equipment_management skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical equipment management<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Healthcare Technology Management<\/b> (sometimes referred to as clinical engineering, clinical engineering management, clinical technology management, healthcare technology management, medical equipment management, biomedical maintenance, biomedical equipment management, and biomedical engineering) is a term for the professionals who manage operations, analyze and improve utilization and safety, and support servicing healthcare technology. These healthcare technology managers are, much like other healthcare professionals referred to by various specialty or organizational hierarchy names.\n<\/p><p>Some of the titles of healthcare technology management professionals are biomed, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_Equipment_Technician\" class=\"mw-redirect\" title=\"Biomedical Equipment Technician\" rel=\"external_link\" target=\"_blank\">biomedical equipment technician<\/a>, biomedical engineering technician, biomedical engineer, BMET, biomedical equipment management, biomedical equipment services, imaging service engineer, imaging specialist, clinical engineer technician, clinical engineering equipment technician, field service engineer, field clinical engineer, clinical engineer, and medical equipment repair person. Regardless of the various titles, these professionals offer services within and outside of healthcare settings to enhance the safety, utilization, and performance on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a>, applications, and systems.\n<\/p><p>They are a fundamental part of managing, maintaining, and\/or designing medical devices, applications, and systems for use in various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Healthcare\" class=\"mw-redirect\" title=\"Healthcare\" rel=\"external_link\" target=\"_blank\">healthcare<\/a> settings, from the home and the field to the doctor's office and the hospital.\n<\/p><p>HTM includes the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Business_process\" title=\"Business process\" rel=\"external_link\" target=\"_blank\">business processes<\/a> used in interaction and oversight of the technology involved in the diagnosis, treatment, and monitoring of patients. The related policies and procedures govern activities such as the selection, planning, and acquisition of medical devices, and the inspection, acceptance, maintenance, and eventual retirement and disposal of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment\" title=\"Medical equipment\" rel=\"external_link\" target=\"_blank\">medical equipment<\/a>. \n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Responsibilities_of_the_Healthcare_Technology_Management_Professional\">Responsibilities of the Healthcare Technology Management Professional<\/span><\/h2>\n<p>The healthcare technology management professional's purpose is to ensure that equipment and systems used in patient care are operational, safe, and properly configured to meet the mission of the healthcare; that the equipment is used in an effective way consistent with the highest standards of care by educating the healthcare provider, equipment user, and patient; that the equipment is designed to limit the potential for loss, harm, or damage to the patient, provider, visitor, and facilities through various means of analysis prior to and during acquisition, monitoring and foreseeing problems during the lifecycle of the equipment, and collaborating with the parties who manufacture, design, regulate, or recommend safe medical devices and systems.\n<\/p><p>Some but not all of the healthcare technology management professional's functions are:\n<\/p>\n<ul><li>Equipment Control & <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asset_management\" title=\"Asset management\" rel=\"external_link\" target=\"_blank\">Asset Management<\/a><\/li>\n<li>Equipment Inventories<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Work_order\" title=\"Work order\" rel=\"external_link\" target=\"_blank\">Work Order<\/a> Management<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_quality\" title=\"Data quality\" rel=\"external_link\" target=\"_blank\">Data Quality<\/a> Management<\/li>\n<li>Equipment Maintenance Management<\/li>\n<li>Equipment Maintenance<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Personnel_management\" class=\"mw-redirect\" title=\"Personnel management\" rel=\"external_link\" target=\"_blank\">Personnel Management<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_assurance\" title=\"Quality assurance\" rel=\"external_link\" target=\"_blank\">Quality Assurance<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_safety\" title=\"Patient safety\" rel=\"external_link\" target=\"_blank\">Patient Safety<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Risk_management\" title=\"Risk management\" rel=\"external_link\" target=\"_blank\">Risk Management<\/a><\/li>\n<li>Hospital Safety Programs<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiation_safety\" class=\"mw-redirect\" title=\"Radiation safety\" rel=\"external_link\" target=\"_blank\">Radiation Safety<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_gas_supply\" title=\"Medical gas supply\" rel=\"external_link\" target=\"_blank\">Medical Gas<\/a> Systems<\/li>\n<li>In-Service Education & Training<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Accident_investigation\" class=\"mw-redirect\" title=\"Accident investigation\" rel=\"external_link\" target=\"_blank\">Accident Investigation<\/a><\/li>\n<li>Analysis of Failures, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Root_cause_analysis\" title=\"Root cause analysis\" rel=\"external_link\" target=\"_blank\">Root Causes<\/a>, and Human Factors<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Safe_Medical_Device_Amendments_of_1990\" title=\"Safe Medical Device Amendments of 1990\" rel=\"external_link\" target=\"_blank\">Safe Medical Devices Act (SMDA) of 1990<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Insurance_Portability_and_Accountability_Act\" title=\"Health Insurance Portability and Accountability Act\" rel=\"external_link\" target=\"_blank\">Health Insurance Portability and Accountability Act<\/a> (HIPAA)<\/li>\n<li>Careers in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Facility_management\" title=\"Facility management\" rel=\"external_link\" target=\"_blank\">Facilities Management<\/a><\/li><\/ul>\n<h2><span id=\"rdp-ebb-Equipment_Control_.26_Asset_Management\"><\/span><span class=\"mw-headline\" id=\"Equipment_Control_&_Asset_Management\">Equipment Control & Asset Management<\/span><\/h2>\n<p>Every <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_facility\" title=\"Health facility\" rel=\"external_link\" target=\"_blank\">medical treatment facility<\/a> should have policies and processes on equipment control and asset management. Equipment control and asset management involves the management of medical devices within a facility and may be supported by automated information systems (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enterprise_resource_planning\" title=\"Enterprise resource planning\" rel=\"external_link\" target=\"_blank\">enterprise resource planning<\/a> (ERP) systems are often found in U.S. hospitals, and the U.S. military health system uses an advanced automated system known as the Defense Medical Logistics Standard Support (DMLSS) suite of applications) or may use a dedicated equipment management and maintenance software (e.g., <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bmeassistor.in\" target=\"_blank\">BME Assistor<\/a>). Equipment control begins with the receipt of a newly acquired equipment item and continues through the item's entire lifecycle. Newly acquired devices should be inspected by in-house or contracted biomedical equipment technicians (BMETs), who will receive an established equipment control\/asset number from the facilities equipment\/property manager. This control number is used to track and record maintenance actions in their database. This is similar to creating a new chart for a new patient who will be seen at the medical facility. Once an equipment control number is established, the device is safety inspected and readied for delivery to clinical and treatment areas in the facility. \n<\/p><p>Facilities or healthcare delivery networks may rely on a combination of equipment service providers such as manufacturers, third-party services, in-house technicians, and remote support. Equipment managers are responsible for continuous oversight and responsibility for ensuring safe and effective equipment performance through full-service maintenance. Medical equipment managers are also responsible for technology assessment, planning and management in all areas within a medical treatment facility (e.g. developing policies and procedures for the medical equipment management plan, identifying trends and the need for staff education, resolution of defective biomedical equipment issues).\n<\/p><p>This industry is new, and there is not a clear line between IT and Bio-Med.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Work_Order_Management\">Work Order Management<\/span><\/h2>\n<p>Work order management involves systematic, measurable, and traceable methods to all acceptance\/initial inspections, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Preventive_maintenance\" title=\"Preventive maintenance\" rel=\"external_link\" target=\"_blank\">preventive maintenance<\/a>, and calibrations, or repairs by generating scheduled and unscheduled work orders. Work order management may be paper-based or computer-base and includes the maintenance of active (open or uncompleted) and completed work orders which provide a comprehensive maintenance history of all medical equipment devices used in the diagnosis, treatment, and management of patients. Work order management includes all safety, preventive, calibration, test, and repair services performed on all such medical devices. A comprehensive work order management system can also be used as a resource and workload management tool by managers responsible for personnel time, total number of hour\u2019s technician spent working on equipment, maximum repair dollar for one time repair, or total dollar allowed to spend repairing equipment versus replacement.\n<\/p><p>Post-work order quality checks involve one of two methods: 100% audit of all work orders or statistical sampling of randomly selected work orders. Randomly selected work orders should place more stringent statistical controls based on the clinical criticality of the device involved. For example, 100% of items critical to patient treatment but only 50% of ancillary items may be selected for sampling. In an ideal setting, all work orders are checked, but available resources may dictate a less comprehensive approach. Work orders must be tracked regularly and all discrepancies must be corrected. Managers are responsible to identify equipment location\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Data_Quality_Management\">Data Quality Management<\/span><\/h2>\n<p>Accurate, comprehensive data are needed in any automated medical equipment management system. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Quality_Management_System\" class=\"mw-redirect\" title=\"Clinical Quality Management System\" rel=\"external_link\" target=\"_blank\">Data quality initiatives<\/a> can help to insure the accuracy of clinical\/biomedical engineering data. The data needed to establish basic, accurate, maintainable automated records for medical equipment management includes: nomenclature, manufacturer, nameplate model, serial number, acquisition cost, condition code, and maintenance assessment. Other useful data could include: warranty, location, other contractor agencies, scheduled maintenance due dates, and intervals. These fields are vital to ensure appropriate maintenance is performed, equipment is accounted for, and devices are safe for use in patient care.\n<\/p>\n<ul><li>Nomenclature: It defines what the device is, how, and the type of maintenance is to be performed. Common nomenclature systems are taken directly from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ECRI_Institute\" title=\"ECRI Institute\" rel=\"external_link\" target=\"_blank\">ECRI Institute<\/a> Universal Medical Device Nomenclature System.<\/li>\n<li>Manufacturer: This is the name of the company that received approval from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/FDA\" class=\"mw-redirect\" title=\"FDA\" rel=\"external_link\" target=\"_blank\">FDA<\/a> to sell the device, also known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Original_equipment_manufacturer\" title=\"Original equipment manufacturer\" rel=\"external_link\" target=\"_blank\">Original Equipment Manufacturer<\/a> (OEM).<\/li>\n<li>Nameplate model: The model number is typically located on the front\/behind of the equipment or on the cover of the service manual and is provided by the OEM. E.g. Medtronic PhysioControl\u2019s Lifepak 10 Defibrillator can actually be any one of the following correct model numbers listed: 10-41, 10-43, 10 -47, 10-51, and 10-57.<\/li>\n<li>Serial number: This is usually found on the data plate as well, is a serialized number (could contain alpha characters) provided by the manufacturer. This number is crucial to device alerts and recalls.<\/li>\n<li>Acquisition cost: The total purchased price for an individual item or system. This cost should include installation, shipping, and other associated costs. These numbers are crucial for budgeting, maintenance expenditures, and depreciation reporting.<\/li>\n<li>Condition code: This code is mainly used when an item is turned in and should be changed when there are major changes to the device that could affect whether or not an item should be salvaged, destroyed, or used by another Medical Treatment Facility.<\/li>\n<li>Maintenance assessment: This assessment must be validated every time a BMET performs any kind of maintenance on a device.<\/li><\/ul>\n<p>Several other management tools, such as equipment replacement planning and budgeting, depreciation calculations, and at the local level literature, repair parts, and supplies are directly related to one or more of these fundamental basics. Data Quality must be tracked monthly and all discrepancies must be corrected.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Quality_Assurance\">Quality Assurance<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_Assurance\" class=\"mw-redirect\" title=\"Quality Assurance\" rel=\"external_link\" target=\"_blank\">Quality Assurance<\/a> is a way of identifying an item of supply or equipment as being defective. A good quality control\/engineering program improves quality of work and lessens the risk of staff\/patient injuries\/death.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Patient_Safety\">Patient Safety<\/span><\/h2>\n<p>Safety of our patients\/staff is paramount to the success of our organizations mission. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a> publishes annual lists detailing \u201cNational Patient Safety Goals\u201d to be implemented by healthcare organizations. Goals are developed by experts in patient safety nurses, physicians, pharmacists, risk managers, and other professionals with patient-safety experience in a variety of settings. Patient safety is among the most important goals of every healthcare provider, and participation in a variety of committees and processes concerned with patient safety provides a way for biomedical managers and clinical engineering departments to gain visibility and positively affect their workplace.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risk_management\">Risk management<\/span><\/h2>\n<p>This program helps the medical treatment facility avoid the likelihood of equipment-related risks, minimize liability of mishaps and incidents, and stay compliant with regulatory reporting requirements. The best practice is to use a rating system for every equipment type. For example, a risk-rating system might rate defibrillators as considered high risk, general-purpose infusion pumps as medium risk, electronic thermometers as low risk, and otoscopes as no significant risk. This system could be set up using Microsoft Excel or Access program for a manager's or technician's quick reference.\n<\/p><p>In addition, user error, equipment abuse, no problem\/fault found occurrences must be tracked to assist risk management personnel in determining whether additional clinical staff training must be performed.\n<\/p><p>Risk management for IT networks incorporating medical devices will be covered by the standard . Its purpose is: \"Recognizing that MEDICAL DEVICES are incorporated into IT-NETWORKS to achieve desirable benefits (for example, INTEROPERABILITY), this international standard defines the roles, responsibilities and activities that are necessary for RISK MANAGEMENT of IT-NETWORKS incorporating MEDICAL DEVICES to address the KEY PROPERTIES\". It resorts some basic ideas of <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_20000\" class=\"mw-redirect\" title=\"ISO 20000\" rel=\"external_link\" target=\"_blank\">ISO 20000<\/a> in the context of medical applications, e.g. configuration, incident, problem, change and release management, and risk analysis, control and evaluation according to <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_14971\" title=\"ISO 14971\" rel=\"external_link\" target=\"_blank\">ISO 14971<\/a>. IEC 80001 \"applies to RESPONSIBLE ORGANIZATIONS, MEDICAL DEVICE manufacturers and other providers of information technologies for the purpose of comprehensive RISK MANAGEMENT\".\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hospital_Safety_Programs\">Hospital Safety Programs<\/span><\/h2>\n<p>The Joint Commission stipulates seven management plans for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_accreditation\" title=\"Hospital accreditation\" rel=\"external_link\" target=\"_blank\">hospital accreditation<\/a>. One of the seven is safety. Safety includes a range of hazards including mishaps, injuries on the job, and patient care hazards. The most common safety mishaps are \"needle-sticks\" (staff accidentally stick themselves with a needle) or patient injury during care. As a manager, ensure all staff and patients are safe within the facility. Note: it\u2019s everyone\u2019s responsibility!\n<\/p><p>There are several meetings that medical equipment managers are required to attend as the organizations technical representative:\n<\/p>\n<ul><li>Patient Safety<\/li>\n<li>Environment of Care<\/li>\n<li>Space Utilization Committee<\/li>\n<li>Equipment Review Board<\/li>\n<li>Infection Control (optional)<\/li><\/ul>\n<p><b>Educational Requirements For Bio-Medical Engineer :<\/b>\nStudents should take the most challenging science, math, and English courses available in high school. \nAll biomedical engineers have at least a bachelor's degree in engineering. Many have advanced graduate degrees as well. Courses of study include a sound background in mechanical, chemical, or industrial engineering, and specialized biomedical training. Most programs last from four to six years, and all states require biomedical engineers to pass examinations and be licensed.\n<\/p><p><b>Duties & Responsibilities For Bio-Medical Engineer:<\/b>\n<p>Description:\nBiomedical Engineers use engineering principles to solve health related and medical problems. They do a lot of research in conjunction with life scientists, chemists, and medical professionals to design medical devices like artificial hearts, pacemakers, dialysis machines, and surgical lasers. Some conduct research on biological and other life systems or investigate ways to modernize laboratory and clinical procedures. \nFrequently, biomedical engineers supervise biomedical equipment maintenance technicians, investigate medical equipment failure, and advise hospitals about purchasing and installing new equipment. \nBiomedical engineers work in hospitals, universities, industry, and research laboratories.\n<\/p>\n<\/p><p><b>Working Conditions :<\/b> \n<p>Biomedical engineers work in offices, laboratories, workshops, manufacturing plants, clinics and hospitals. Some local travel may be required if medical equipment is located in various clinics or hospitals. \nMost biomedical engineers work standard weekday hours. Longer hours may be required to meet research deadlines, work with patients at times convenient to them, or work on medical equipment that is in use during daytime hours.\n<\/p>\n<\/p><p><b>Duties :<\/b> \n<p>Biomedical engineers work closely with life scientists, chemists and medical professionals (physicians, nurses, therapists and technicians) on the engineering aspects of biological systems. \nDuties and responsibilities vary from one position to another but, in general, biomedical engineers:\n<\/p>\n<\/p><p>\u2022\tdesign and develop medical devices such as artificial hearts and kidneys, pacemakers, artificial hips, surgical lasers, automated patient monitors and blood chemistry sensors.\n<\/p><p>\u2022\tdesign and develop engineered therapies (for example, neural-integrative prostheses).\n<\/p><p>\u2022\tadapt computer hardware or software for medical science or health care applications (for example, develop expert systems that assist in diagnosing diseases, medical imaging systems, models of different aspects of human physiology or medical data management).\n<\/p><p>\u2022\tconduct research to test and modify known theories and develop new theories.\n<\/p><p>\u2022\tensure the safety of equipment used for diagnosis, treatment and monitoring.\n<\/p><p>\u2022\tinvestigate medical equipment failures and provide advice about the purchase and installation of new equipment.\n<\/p><p>\u2022\tdevelop and evaluate quantitative models of biological processes and systems.\n<\/p><p>\u2022\tapply engineering methods to answer basic questions about how the body works.\n<\/p><p>\u2022\tcontribute to patient assessments.\n<\/p><p>\u2022\tprepare and present reports for health professionals and the public.\n<\/p><p>\u2022\tsupervise and train technologists and technicians.\n<\/p><p><b>Biomedical engineers may work primarily in one or a combination of the following fields:<\/b>\n<\/p><p>\u2022\t<b>bioinformatics<\/b> \u2013 developing and using computer tools to collect and analyze data.\n<\/p><p>\u2022\t<b>bioinstrumentation<\/b> \u2013 applying electronic and measurement techniques.\n<\/p><p>\u2022\t<b>biomaterials<\/b> \u2013 developing durable materials that are compatible with a biological environment.\n<\/p><p>\u2022\t<b>biomechanics<\/b> - applying knowledge of mechanics to biological or medical problems.\n<\/p><p>\u2022\t<b>bio-nano-engineering<\/b> \u2013 developing novel structures of nanometer dimensions for application to biology, drug delivery, molecular diagnostics, microsystems and nanosystems.\n<\/p><p>\u2022\t<b>biophotonics<\/b> \u2013 applying and manipulating light, usually laser light, for sensing or imaging properties of biological tissue.\n<\/p><p>\u2022\t<b>cellular and tissue engineering<\/b> \u2013 studying the anatomy, biochemistry and mechanics of cellular and sub-cellular structures, developing technology to repair, replace or regenerate living tissues and developing methods for controlling cell and tissue growth in the laboratory.\n<\/p><p>\u2022\t<b>clinical engineering<\/b> \u2013 applying the latest technology to health care and health care systems in hospitals.\n<\/p><p>\u2022\t<b>genomics and genetic engineering<\/b> \u2013 mapping, sequencing and analyzing genomes (DNA), and applying molecular biology methods to manipulate the genetic material of cells, viruses and organisms.\n<\/p><p>\u2022\t<b>medical or biological imaging<\/b> \u2013 combining knowledge of a physical phenomenon (for example, sound, radiation or magnetism) with electronic processing, analysis and display.\n<\/p><p>\u2022\t<b>molecular bioengineering<\/b> \u2013 designing molecules for biomedical purposes and applying computational methods for simulating biomolecular interactions.\n<\/p><p>\u2022\t<b>systems physiology<\/b> - studying how systems function in living organisms.\n<\/p><p>\u2022\t<b>therapeutic engineering<\/b> \u2013 developing and discovering drugs and advanced materials and techniques for delivering drugs to local tissues with minimized side effects.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_for_Occupational_Safety_and_Health\" title=\"National Institute for Occupational Safety and Health\" rel=\"external_link\" target=\"_blank\">National Institute for Occupational Safety and Health (NIOSH)<\/a> developed the <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/niosh\/topics\/ohsn\/\" target=\"_blank\">Occupational Health Safety Network (OHSN)<\/a> to help hospitals manage their occupational safety and health data. OHSN, a secure electronic surveillance system, allows hospitals and other healthcare facilities to upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare personnel: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. OHSN can be used to meet regulatory and accreditation requirements of OSHA and The Joint Commission. OHSN enrollment is open to all healthcare facilities.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li>Bowles, Roger \"Techcareers: Biomedical Equipment Technicians\" TSTC Publishing<\/li>\n<li>Dyro, Joseph., Clinical Engineering Handbook (Biomedical Engineering).<\/li>\n<li>Khandpur, R. S. \"Biomedical Instrumentation: Technology and Applications\". McGraw Hills<\/li>\n<li>Northrop, Robert B., \"Noninvasive Instrumentation and Measurement in Medical Diagnosis (Biomedical Engineering)\".<\/li>\n<li>Webb, Andrew G., \"Introduction to Biomedical Imaging (IEEE Press Series on Biomedical Engineering)\".<\/li>\n<li>Yadin David, Wolf W. von Maltzahn, Michael R. Neuman, and Joseph D. Bronzino,. Clinical Engineering (Principles and Applications in Engineering).<\/li>\n<li>Villafa\u00f1e, Carlos CBET: \"Biomed: From the Student's Perspective\" (<a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-61539-663-4). www.Biomedtechnicians.com.<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1255\nCached time: 20181217101851\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.176 seconds\nReal time usage: 0.257 seconds\nPreprocessor visited node count: 723\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 28023\/2097152 bytes\nTemplate argument size: 8022\/2097152 bytes\nHighest expansion depth: 19\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 1549\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.044\/10.000 seconds\nLua memory usage: 1.56 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 211.453 1 -total\n<\/p>\n<pre>88.58% 187.311 3 Template:Ambox\n70.60% 149.278 1 Template:Multiple_issues\n36.54% 77.256 1 Template:Cleanup\n29.27% 61.887 1 Template:ISBN\n19.32% 40.846 1 Template:Catalog_lookup_link\n17.18% 36.318 4 Template:Main_other\n14.81% 31.310 1 Template:Category_handler\n 9.98% 21.094 1 Template:No_footnotes\n 9.13% 19.316 1 Template:DMC\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:14621467-1!canonical and timestamp 20181217101851 and revision id 848540836\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment_management\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214711\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.148 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 142.377 1 - wikipedia:Medical_equipment_management\n100.00% 142.377 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8450-0!*!*!*!*!*!* and timestamp 20181217214711 and revision id 24699\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management\">https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","94d576c5d095ff5b727c95343fde5efa_images":[],"94d576c5d095ff5b727c95343fde5efa_timestamp":1545083231,"f3e83632cf521f2169bcf4025f12dafe_type":"article","f3e83632cf521f2169bcf4025f12dafe_title":"Implant failure","f3e83632cf521f2169bcf4025f12dafe_url":"https:\/\/www.limswiki.org\/index.php\/Implant_failure","f3e83632cf521f2169bcf4025f12dafe_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tImplant failure\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tImplant failure refers to the failure of any medical implant to meet the claims of its manufacturer or the health care provider which installs it. Implant failure can have any number of causes. The rates of failure vary for different implants.\nThe monitoring of the safety of implants is conducted within the context of broader pharmacovigilance.\n\nContents \n\n1 Common types of failure \n\n1.1 Material degradation \n1.2 Bacterial infection \n1.3 Hip replacement failure \n1.4 Pacemaker failure \n1.5 Cochlear implant failure \n1.6 Dental implant failure \n\n\n2 Responses to implant failure \n3 References \n4 Further reading \n5 External links \n\n\nCommon types of failure \nMaterial degradation \nImplant failure can occur due to the degradation of the material an implant is made of. With time, mechanical degradation, in the form of wear or fatigue, or electrochemical degradation, in the form of corrosion, can occur. Biotoxicity, particularly in metal implants, can arise due to ion release.\n\nBacterial infection \nImplants, made of synthetic materials, are naturally coated by a biofilm by the body, which may function as a favorable medium for bacteria growth.\nImplant failure due to bacterial infection of the implant can occur at any point of implant lifetime. Bacteria may already reside on the implant or be introduced during the implantation.\nTypical failure mechanisms include tissue damage and implant detachment due to bacteria generated biofilm.\n\nHip replacement failure \nHip replacement implants can fail. Outcomes are normally recorded in a joint replacement registry to ensure patterns are picked-up upon.\nIn 2013 Johnson & Johnson shared documents which indicated that 40% of a class of hip replacement implants which it manufactured had failed.[1]\n\nPacemaker failure \nMain article: Pacemaker failure\nPacemaker failure is the inability of an implanted artificial pacemaker to perform its intended function of regulating the beating of the heart. It is defined by the requirement of repeat surgical pacemaker-related procedure after the initial implantation. Causes of pacemaker failure included: lead related failure (lead migration, lead fracture, ventricular perforation), unit malfunction (battery failure or component malfunction), problems at the insertion site (infections, tissue breakdown, battery pack migration), and failures related to exposure to high voltage electricity or high intensity microwaves.[citation needed ]\n\nCochlear implant failure \nCochlear implants are used to treat severe to profound hearing loss by electrically stimulating the hearing nerve. Clinical symptoms of cochlear implant failure include auditory symptoms (tinnitus, buzzing, roaring, popping sounds), non-auditory symptoms (pain, shocking sensation, burning sensation, facial stimulation, itching), and decrease in the patient's hearing performance.[2] When such symptoms occur, the patient's clinical team evaluates the patient and the device using in-situ methods, and determines if revision surgery is necessary. The most commonly reported device failures are due to impacts, loss of hermeticity, and electrode lead malfunctions. Most manufacturers provide on their websites the survival rate of their marketed implants, although they are not required to do so. In order to improve and standardize failure reporting practices to the public, the AAMI is developing an American standard for cochlear implants in collaboration with the FDA, major cochlear implant manufacturers, the CALCE center for reliability, doctors, and clinicians.[3]\n\nDental implant failure \nMain article: Dental implant failure\nFailure of a dental implant is often related to the failure of the implant to osseointegrate correctly with the bone, or vice versa.[citation needed ] A dental implant is considered to be a failure if it is lost, mobile or shows peri-implant (around the implant) bone loss of greater than 1.0 mm in the first year and greater than 0.2 mm a year after.[4]\nDental implant failures have been studied.[5] Persons who smoke habitually prior to having dental implants are significantly more likely to have their implants fail.[6]\n\nResponses to implant failure \nIn 2012 Royal College of Surgeons of England and the British Orthopaedic Association called for increased regulation of implants to prevent implant failure.[7]\nA 2011 study by Dr. Diana Zuckerman and Paul Brown of the National Research Center for Women and Families, and Dr. Steven Nissen of the Cleveland Clinic, published in the Archives of Internal Medicine, showed that most medical devices recalled in the last five years for \u201cserious health problems or death\u201d had been previously approved by the FDA using the less stringent, and cheaper, 510(k) process. In a few cases the devices had been deemed so low-risk that they did not need FDA regulation. Of the 113 devices recalled, 35 were for cardiovacular issues.[8] This may lead to a reevaluation of FDA procedures and better oversight.\n\nReferences \n\n\n^ Meier, Barry (22 January 2013). \"Maker Aware of 40% Failure in Hip Implant - NYTimes.com\". The New York Times. New York: NYTC. ISSN 0362-4331. Retrieved 5 June 2013 . \n\n^ Balkany TJ; Hodges AV; Buchman CA; Luxford WM; Pillsbury CH; Roland PS; Shallop JK; Backous DD; Franz D; Graham JM; Hirsch B; Luntz M; Niparko JK; Patrick J; Payne SL; Telischi FF; Tobey EA; Truy E; Staller S (2005). \"Cochlear implant soft failures consensus development conference statement\". Otol. Neurotol. 26: 815\u20138. PMID 16015190. \n\n^ https:\/\/standards.aami.org\/kws\/public\/workgroup?wg_abbrev=CI \n\n^ Template:Tissue-integrated prostheses :osseointegration in clinical dentistry, Per-Ingavar Branemark, George A. Zarb, Tomas Albrektsson, 1985 \n\n^ Moy, P. K.; Medina, D.; Shetty, V.; Aghaloo, T. L. (2005). \"Dental implant failure rates and associated risk factors\". The International journal of oral & maxillofacial implants. 20 (4): 569\u2013577. PMID 16161741. \n\n^ De Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". Clinical Oral Implants Research. 5 (4): 260\u2013264. doi:10.1034\/j.1600-0501.1994.050410.x. PMID 7640341. \n\n^ Watt, Holly; Newell, Claire (24 Oct 2012). \"Faulty medical implants investigation: Patients failed by poor implant regulation, say surgeons - Telegraph\". The Daily Telegraph. London: TMG. ISSN 0307-1235. OCLC 49632006. Retrieved 5 June 2013 . \n\n^ Zuckerman, Diana (2011). \"Medical Device Recalls and the FDA Approval Process\". Archives of Internal Medicine. 171: 1006\u201311. doi:10.1001\/archinternmed.2011.30. PMID 21321283. \n\n\nFurther reading \nGroeger, Lisa (30 April 2012). \"Four Medical Implants That Escaped FDA Scrutiny - ProPublica\". propublica.org. Retrieved 5 June 2013 . \nWagenberg, B.; Froum, S. J. (2006). \"A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004\". The International journal of oral & maxillofacial implants. 21 (1): 71\u201380. PMID 16519184. \nDe Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". Clinical Oral Implants Research. 5 (4): 260\u2013264. doi:10.1034\/j.1600-0501.1994.050410.x. PMID 7640341. \nTang, L.; Eaton, J. W. (1995). \"Inflammatory responses to biomaterials\". American journal of clinical pathology. 103 (4): 466\u2013471. doi:10.1093\/ajcp\/103.4.466. PMID 7726145. \nPapageorgiou, S. N.; Zogakis, I. P.; Papadopoulos, M. A. (2012). \"Failure rates and associated risk factors of orthodontic miniscrew implants: A meta-analysis\". American Journal of Orthodontics and Dentofacial Orthopedics. 142 (5): 577\u2013595.e7. doi:10.1016\/j.ajodo.2012.05.016. PMID 23116500. \nExternal links \n2011 United States government report on implant safety\nFailed Implant Device Alliance, a grassroots organization advocating for implant safety\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Implant_failure\">https:\/\/www.limswiki.org\/index.php\/Implant_failure<\/a>\n\t\t\t\t\tCategories: Healthcare termsImplant-related medical conditionsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:58.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 633 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","f3e83632cf521f2169bcf4025f12dafe_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Implant_failure skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Implant failure<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Implant failure<\/b> refers to the failure of any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">medical implant<\/a> to meet the claims of its manufacturer or the health care provider which installs it. Implant failure can have any number of causes. The rates of failure vary for different implants.\n<\/p><p>The monitoring of the safety of implants is conducted within the context of broader <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacovigilance\" title=\"Pharmacovigilance\" rel=\"external_link\" target=\"_blank\">pharmacovigilance<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Common_types_of_failure\">Common types of failure<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Material_degradation\">Material degradation<\/span><\/h3>\n<p>Implant failure can occur due to the degradation of the material an implant is made of. With time, mechanical degradation, in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wear\" title=\"Wear\" rel=\"external_link\" target=\"_blank\">wear<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_(material)\" title=\"Fatigue (material)\" rel=\"external_link\" target=\"_blank\">fatigue<\/a>, or electrochemical degradation, in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">corrosion<\/a>, can occur. , particularly in metal implants, can arise due to ion release.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bacterial_infection\">Bacterial infection<\/span><\/h3>\n<p>Implants, made of synthetic materials, are naturally coated by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilm\" title=\"Biofilm\" rel=\"external_link\" target=\"_blank\">biofilm<\/a> by the body, which may function as a favorable medium for bacteria growth.\nImplant failure due to bacterial infection of the implant can occur at any point of implant lifetime. Bacteria may already reside on the implant or be introduced during the implantation.\nTypical failure mechanisms include tissue damage and implant detachment due to bacteria generated biofilm.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hip_replacement_failure\">Hip replacement failure<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">Hip replacement<\/a> implants can fail. Outcomes are normally recorded in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_registry\" title=\"Joint replacement registry\" rel=\"external_link\" target=\"_blank\">joint replacement registry<\/a> to ensure patterns are picked-up upon.\n<\/p><p>In 2013 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johnson_%26_Johnson\" title=\"Johnson & Johnson\" rel=\"external_link\" target=\"_blank\">Johnson & Johnson<\/a> shared documents which indicated that 40% of a class of hip replacement implants which it manufactured had failed.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pacemaker_failure\">Pacemaker failure<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker_failure\" title=\"Pacemaker failure\" rel=\"external_link\" target=\"_blank\">Pacemaker failure<\/a><\/div>\n<p>Pacemaker failure is the inability of an implanted artificial pacemaker to perform its intended function of regulating the beating of the heart. It is defined by the requirement of repeat surgical pacemaker-related procedure after the initial implantation. Causes of pacemaker failure included: lead related failure (lead migration, lead fracture, ventricular perforation), unit malfunction (battery failure or component malfunction), problems at the insertion site (infections, tissue breakdown, battery pack migration), and failures related to exposure to high voltage electricity or high intensity microwaves.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cochlear_implant_failure\">Cochlear implant failure<\/span><\/h3>\n<p>Cochlear implants are used to treat severe to profound hearing loss by electrically stimulating the hearing nerve. Clinical symptoms of cochlear implant failure include auditory symptoms (tinnitus, buzzing, roaring, popping sounds), non-auditory symptoms (pain, shocking sensation, burning sensation, facial stimulation, itching), and decrease in the patient's hearing performance.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> When such symptoms occur, the patient's clinical team evaluates the patient and the device using in-situ methods, and determines if revision surgery is necessary. The most commonly reported device failures are due to impacts, loss of hermeticity, and electrode lead malfunctions. Most manufacturers provide on their websites the survival rate of their marketed implants, although they are not required to do so. In order to improve and standardize failure reporting practices to the public, the AAMI is developing an American standard for cochlear implants in collaboration with the FDA, major cochlear implant manufacturers, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Center_for_Advanced_Life_Cycle_Engineering\" title=\"Center for Advanced Life Cycle Engineering\" rel=\"external_link\" target=\"_blank\">CALCE<\/a> center for reliability, doctors, and clinicians.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dental_implant_failure\">Dental implant failure<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant_failure\" class=\"mw-redirect\" title=\"Dental implant failure\" rel=\"external_link\" target=\"_blank\">Dental implant failure<\/a><\/div>\n<p>Failure of a dental implant is often related to the failure of the implant to osseointegrate correctly with the bone, or vice versa.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> A dental implant is considered to be a failure if it is lost, mobile or shows peri-implant (around the implant) bone loss of greater than 1.0 mm in the first year and greater than 0.2 mm a year after.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Dental implant failures have been studied.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Persons who <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smoking\" title=\"Smoking\" rel=\"external_link\" target=\"_blank\">smoke<\/a> habitually prior to having dental implants are significantly more likely to have their implants fail.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Responses_to_implant_failure\">Responses to implant failure<\/span><\/h2>\n<p>In 2012 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Royal_College_of_Surgeons_of_England\" title=\"Royal College of Surgeons of England\" rel=\"external_link\" target=\"_blank\">Royal College of Surgeons of England<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/British_Orthopaedic_Association\" title=\"British Orthopaedic Association\" rel=\"external_link\" target=\"_blank\">British Orthopaedic Association<\/a> called for increased regulation of implants to prevent implant failure.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>A 2011 study by Dr. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diana_Zuckerman\" title=\"Diana Zuckerman\" rel=\"external_link\" target=\"_blank\">Diana Zuckerman<\/a> and Paul Brown of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Research_Center_for_Women_and_Families\" class=\"mw-redirect\" title=\"National Research Center for Women and Families\" rel=\"external_link\" target=\"_blank\">National Research Center for Women and Families<\/a>, and Dr. Steven Nissen of the Cleveland Clinic, published in the Archives of Internal Medicine, showed that most medical devices recalled in the last five years for \u201cserious health problems or death\u201d had been previously approved by the FDA using the less stringent, and cheaper, 510(k) process. In a few cases the devices had been deemed so low-risk that they did not need FDA regulation. Of the 113 devices recalled, 35 were for cardiovacular issues.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> This may lead to a reevaluation of FDA procedures and better oversight.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Meier, Barry (22 January 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2013\/01\/23\/business\/jj-study-suggested-hip-device-could-fail-in-thousands-more.html?_r=0\" target=\"_blank\">\"Maker Aware of 40% Failure in Hip Implant - NYTimes.com\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times\" title=\"The New York Times\" rel=\"external_link\" target=\"_blank\">The New York Times<\/a><\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York,_NY\" class=\"mw-redirect\" title=\"New York, NY\" rel=\"external_link\" target=\"_blank\">New York<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_Times_Company\" class=\"mw-redirect\" title=\"New York Times Company\" rel=\"external_link\" target=\"_blank\">NYTC<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0362-4331\" target=\"_blank\">0362-4331<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 June<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Maker+Aware+of+40%25+Failure+in+Hip+Implant+-+NYTimes.com&rft.date=2013-01-22&rft.issn=0362-4331&rft.aulast=Meier&rft.aufirst=Barry&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2013%2F01%2F23%2Fbusiness%2Fjj-study-suggested-hip-device-could-fail-in-thousands-more.html%3F_r%3D0&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Balkany TJ; Hodges AV; Buchman CA; Luxford WM; Pillsbury CH; Roland PS; Shallop JK; Backous DD; Franz D; Graham JM; Hirsch B; Luntz M; <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Niparko\" title=\"John Niparko\" rel=\"external_link\" target=\"_blank\">Niparko JK<\/a>; Patrick J; Payne SL; Telischi FF; Tobey EA; Truy E; Staller S (2005). \"Cochlear implant soft failures consensus development conference statement\". <i>Otol. Neurotol<\/i>. <b>26<\/b>: 815\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16015190\" target=\"_blank\">16015190<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Otol.+Neurotol.&rft.atitle=Cochlear+implant+soft+failures+consensus+development+conference+statement&rft.volume=26&rft.pages=815-8&rft.date=2005&rft_id=info%3Apmid%2F16015190&rft.au=Balkany+TJ&rft.au=Hodges+AV&rft.au=Buchman+CA&rft.au=Luxford+WM&rft.au=Pillsbury+CH&rft.au=Roland+PS&rft.au=Shallop+JK&rft.au=Backous+DD&rft.au=Franz+D&rft.au=Graham+JM&rft.au=Hirsch+B&rft.au=Luntz+M&rft.au=Niparko+JK&rft.au=Patrick+J&rft.au=Payne+SL&rft.au=Telischi+FF&rft.au=Tobey+EA&rft.au=Truy+E&rft.au=Staller+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/standards.aami.org\/kws\/public\/workgroup?wg_abbrev=CI\" target=\"_blank\">https:\/\/standards.aami.org\/kws\/public\/workgroup?wg_abbrev=CI<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moy, P. K.; Medina, D.; Shetty, V.; Aghaloo, T. L. (2005). \"Dental implant failure rates and associated risk factors\". <i>The International journal of oral & maxillofacial implants<\/i>. <b>20<\/b> (4): 569\u2013577. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16161741\" target=\"_blank\">16161741<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+journal+of+oral+%26+maxillofacial+implants&rft.atitle=Dental+implant+failure+rates+and+associated+risk+factors&rft.volume=20&rft.issue=4&rft.pages=569-577&rft.date=2005&rft_id=info%3Apmid%2F16161741&rft.aulast=Moy&rft.aufirst=P.+K.&rft.au=Medina%2C+D.&rft.au=Shetty%2C+V.&rft.au=Aghaloo%2C+T.+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">De Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". <i>Clinical Oral Implants Research<\/i>. <b>5<\/b> (4): 260\u2013264. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.1994.050410.x\" target=\"_blank\">10.1034\/j.1600-0501.1994.050410.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7640341\" target=\"_blank\">7640341<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Implants+Research&rft.atitle=The+effect+of+smoking+on+early+implant+failure&rft.volume=5&rft.issue=4&rft.pages=260-264&rft.date=1994&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.1994.050410.x&rft_id=info%3Apmid%2F7640341&rft.aulast=De+Bruyn&rft.aufirst=H.&rft.au=Collaert%2C+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Watt, Holly; Newell, Claire (24 Oct 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.telegraph.co.uk\/health\/healthnews\/9631974\/Faulty-medical-implants-investigation-Patients-failed-by-poor-implant-regulation-say-surgeons.html\" target=\"_blank\">\"Faulty medical implants investigation: Patients failed by poor implant regulation, say surgeons - Telegraph\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Daily_Telegraph\" title=\"The Daily Telegraph\" rel=\"external_link\" target=\"_blank\">The Daily Telegraph<\/a><\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/London,_UK\" class=\"mw-redirect\" title=\"London, UK\" rel=\"external_link\" target=\"_blank\">London<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telegraph_Media_Group\" title=\"Telegraph Media Group\" rel=\"external_link\" target=\"_blank\">TMG<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0307-1235\" target=\"_blank\">0307-1235<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/49632006\" target=\"_blank\">49632006<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 June<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Daily+Telegraph&rft.atitle=Faulty+medical+implants+investigation%3A+Patients+failed+by+poor+implant+regulation%2C+say+surgeons+-+Telegraph&rft.date=2012-10-24&rft_id=info%3Aoclcnum%2F49632006&rft.issn=0307-1235&rft.aulast=Watt&rft.aufirst=Holly&rft.au=Newell%2C+Claire&rft_id=https%3A%2F%2Fwww.telegraph.co.uk%2Fhealth%2Fhealthnews%2F9631974%2FFaulty-medical-implants-investigation-Patients-failed-by-poor-implant-regulation-say-surgeons.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zuckerman, Diana (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=227466\" target=\"_blank\">\"Medical Device Recalls and the FDA Approval Process\"<\/a>. <i>Archives of Internal Medicine<\/i>. <b>171<\/b>: 1006\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchinternmed.2011.30\" target=\"_blank\">10.1001\/archinternmed.2011.30<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21321283\" target=\"_blank\">21321283<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Internal+Medicine&rft.atitle=Medical+Device+Recalls+and+the+FDA+Approval+Process&rft.volume=171&rft.pages=1006-11&rft.date=2011&rft_id=info%3Adoi%2F10.1001%2Farchinternmed.2011.30&rft_id=info%3Apmid%2F21321283&rft.aulast=Zuckerman&rft.aufirst=Diana&rft_id=http%3A%2F%2Farchinte.jamanetwork.com%2Farticle.aspx%3Farticleid%3D227466&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation web\">Groeger, Lisa (30 April 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.propublica.org\/special\/four-medical-implants-that-escaped-fda-scrutiny\" target=\"_blank\">\"Four Medical Implants That Escaped FDA Scrutiny - ProPublica\"<\/a>. <i>propublica.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 June<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=propublica.org&rft.atitle=Four+Medical+Implants+That+Escaped+FDA+Scrutiny+-+ProPublica&rft.date=2012-04-30&rft.aulast=Groeger&rft.aufirst=Lisa&rft_id=https%3A%2F%2Fwww.propublica.org%2Fspecial%2Ffour-medical-implants-that-escaped-fda-scrutiny&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Wagenberg, B.; Froum, S. J. (2006). \"A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004\". <i>The International journal of oral & maxillofacial implants<\/i>. <b>21<\/b> (1): 71\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16519184\" target=\"_blank\">16519184<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+journal+of+oral+%26+maxillofacial+implants&rft.atitle=A+retrospective+study+of+1925+consecutively+placed+immediate+implants+from+1988+to+2004&rft.volume=21&rft.issue=1&rft.pages=71-80&rft.date=2006&rft_id=info%3Apmid%2F16519184&rft.aulast=Wagenberg&rft.aufirst=B.&rft.au=Froum%2C+S.+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">De Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". <i>Clinical Oral Implants Research<\/i>. <b>5<\/b> (4): 260\u2013264. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.1994.050410.x\" target=\"_blank\">10.1034\/j.1600-0501.1994.050410.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7640341\" target=\"_blank\">7640341<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Implants+Research&rft.atitle=The+effect+of+smoking+on+early+implant+failure&rft.volume=5&rft.issue=4&rft.pages=260-264&rft.date=1994&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.1994.050410.x&rft_id=info%3Apmid%2F7640341&rft.aulast=De+Bruyn&rft.aufirst=H.&rft.au=Collaert%2C+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Tang, L.; Eaton, J. W. (1995). \"Inflammatory responses to biomaterials\". <i>American journal of clinical pathology<\/i>. <b>103<\/b> (4): 466\u2013471. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fajcp%2F103.4.466\" target=\"_blank\">10.1093\/ajcp\/103.4.466<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7726145\" target=\"_blank\">7726145<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+journal+of+clinical+pathology&rft.atitle=Inflammatory+responses+to+biomaterials&rft.volume=103&rft.issue=4&rft.pages=466-471&rft.date=1995&rft_id=info%3Adoi%2F10.1093%2Fajcp%2F103.4.466&rft_id=info%3Apmid%2F7726145&rft.aulast=Tang&rft.aufirst=L.&rft.au=Eaton%2C+J.+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Papageorgiou, S. N.; Zogakis, I. P.; Papadopoulos, M. A. (2012). \"Failure rates and associated risk factors of orthodontic miniscrew implants: A meta-analysis\". <i>American Journal of Orthodontics and Dentofacial Orthopedics<\/i>. <b>142<\/b> (5): 577\u2013595.e7. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ajodo.2012.05.016\" target=\"_blank\">10.1016\/j.ajodo.2012.05.016<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23116500\" target=\"_blank\">23116500<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Orthodontics+and+Dentofacial+Orthopedics&rft.atitle=Failure+rates+and+associated+risk+factors+of+orthodontic+miniscrew+implants%3A+A+meta-analysis&rft.volume=142&rft.issue=5&rft.pages=577-595.e7&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.ajodo.2012.05.016&rft_id=info%3Apmid%2F23116500&rft.aulast=Papageorgiou&rft.aufirst=S.+N.&rft.au=Zogakis%2C+I.+P.&rft.au=Papadopoulos%2C+M.+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gao.gov\/products\/GAO-11-556T\" target=\"_blank\">2011 United States government report on implant safety<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/fida-advocate.blogspot.com\/\" target=\"_blank\">Failed Implant Device Alliance<\/a>, a grassroots organization advocating for implant safety<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181210044315\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.252 seconds\nReal time usage: 0.337 seconds\nPreprocessor visited node count: 889\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 26531\/2097152 bytes\nTemplate argument size: 1003\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 26256\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.172\/10.000 seconds\nLua memory usage: 4.11 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 307.994 1 -total\n<\/p>\n<pre>56.95% 175.403 1 Template:Reflist\n39.65% 122.120 2 Template:Cite_news\n25.11% 77.349 2 Template:Citation_needed\n22.61% 69.638 2 Template:Fix\n15.76% 48.536 8 Template:Cite_journal\n12.24% 37.709 4 Template:Category_handler\n 8.50% 26.186 2 Template:Delink\n 8.21% 25.300 2 Template:Main\n 1.96% 6.022 1 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39588091-1!canonical and timestamp 20181210044315 and revision id 854933411\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_failure\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214711\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 131.973 1 - wikipedia:Implant_failure\n100.00% 131.973 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8196-0!*!*!*!*!*!* and timestamp 20181217214711 and revision id 24533\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Implant_failure\">https:\/\/www.limswiki.org\/index.php\/Implant_failure<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","f3e83632cf521f2169bcf4025f12dafe_images":[],"f3e83632cf521f2169bcf4025f12dafe_timestamp":1545083231,"9a987c700a3112a55a2b8d9a6ecb9a1f_type":"article","9a987c700a3112a55a2b8d9a6ecb9a1f_title":"Gossypiboma","9a987c700a3112a55a2b8d9a6ecb9a1f_url":"https:\/\/www.limswiki.org\/index.php\/Gossypiboma","9a987c700a3112a55a2b8d9a6ecb9a1f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tGossypiboma\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Mini-laparotomy revealed gossypiboma (grasped by the clamp).\n Surgical specimen (gossypiboma).\nGossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for a surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term \"gossypiboma\" is derived from the Latin gossypium (\u201ccotton wool, cotton\u201d) and the suffix -oma, meaning a tumor or growth, and describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma.[1][2] \"Textiloma\" is derived from textile (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.[1]\n\nContents \n\n1 Incidence and clinical presentation \n2 Prevention \n3 See also \n4 References \n5 External links \n\n\nIncidence and clinical presentation \nThe actual incidence of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations[2] and are most frequently discovered in the abdomen.[3] The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.[1]\nGossypibomas can often present, clinically or radiologically, similar to tumors and abscesses, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient morbidity.[3] Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an abscess may form with or without a secondary bacterial infection. The second reaction is an aseptic fibrinous response, resulting in tissue adhesions and encapsulation and eventually foreign body granuloma.[1] Symptoms may not present for long periods of time, sometimes months or years following surgery.[1]\n\nPrevention \nTo prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (AORN).[4] Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure.[5] Other guidelines have been promoted by the American College of Surgeons and the Joint Commission.[6]\nIn most countries, surgical sponges contain radiopaque material that can be readily identified in radiographic and CT images, facilitating detection.[1] In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940.[7] Some surgeons recommend routine postoperative X-ray films after surgery to reduce the likelihood of foreign body inclusion.[7]\n\nSee also \nRetained surgical instruments\nReferences \n\n\n^ a b c d e f Kim HS, Chung TS, Suh SH, Kim SY (April 2007). \"MR imaging findings of paravertebral gossypiboma\". AJNR Am J Neuroradiol. 28 (4): 709\u201313. PMID 17416826. \n\n^ a b Kiernan F, Joyce M, Byrnes CK, O'Grady H, Keane FB, Neary P (December 2008). \"Gossypiboma: a case report and review of the literature\". Ir J Med Sci. 177 (4): 389\u201391. doi:10.1007\/s11845-008-0197-0. PMID 18820991. \n\n^ a b Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J (December 2009). \"Imaging of gossypibomas: pictorial review\". AJR Am J Roentgenol. 193 (6 Suppl): S94\u2013101. doi:10.2214\/AJR.07.7132. PMID 19933682. \n\n^ \"Recommended practices for sponge, sharp, and instrument counts. AORN Recommended Practices Committee. Association of periOperative Registered Nurses\". AORN J. 70 (6): 1083\u20139. December 1999. doi:10.1016\/s0001-2092(06)62224-2. PMID 10635432. \n\n^ \"The Retained Surgical Sponge\", Agency for Healthcare Research and Quality \n\n^ Gibbs VC, Coakley FD, Reines HD (May 2007). \"Preventable errors in the operating room: retained foreign bodies after surgery--Part I\". Curr Probl Surg. 44 (5): 281\u2013337. doi:10.1067\/j.cpsurg.2007.03.002. PMID 17512832. \n\n^ a b Shyung LR, Chang WH, Lin SC, Shih SC, Kao CR, Chou SY (February 2005). \"Report of gossypiboma from the standpoint in medicine and law\". World J. Gastroenterol. 11 (8): 1248\u20139. PMC 4250725 . PMID 15754416. Archived from the original on 2012-05-05. \n\n\nCamazine, Brian. \"The persistent problem of the retained foreign body\". The Journal of Family Practice. \nExternal links \nCase description and discussion\nOhio University, Data Matrix Integrity Test\nA unified system for gossypiboma prevention\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Gossypiboma\">https:\/\/www.limswiki.org\/index.php\/Gossypiboma<\/a>\n\t\t\t\t\tCategory: Healthcare termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 566 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9a987c700a3112a55a2b8d9a6ecb9a1f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Gossypiboma skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Gossypiboma<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_01.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Gossypiboma_01.jpg\/220px-Gossypiboma_01.jpg\" width=\"220\" height=\"241\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_01.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Mini-laparotomy revealed gossypiboma (grasped by the clamp).<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_02.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Gossypiboma_02.jpg\/220px-Gossypiboma_02.jpg\" width=\"220\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_02.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Surgical specimen (gossypiboma).<\/div><\/div><\/div>\n<p><b>Gossypiboma<\/b>, <b>textiloma<\/b> or more broadly <b>Retained Foreign Object (RFO)<\/b> is the technical term for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> complications resulting from foreign materials, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_sponge\" class=\"mw-redirect\" title=\"Surgical sponge\" rel=\"external_link\" target=\"_blank\">surgical sponge<\/a>, accidentally left inside a patient's body. The term \"gossypiboma\" is derived from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Latin\" title=\"Latin\" rel=\"external_link\" target=\"_blank\">Latin<\/a> <i><a href=\"https:\/\/en.wiktionary.org\/wiki\/gossypium#Latin\" class=\"extiw\" title=\"wikt:gossypium\" rel=\"external_link\" target=\"_blank\">gossypium<\/a><\/i> (\u201ccotton wool, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cotton\" title=\"Cotton\" rel=\"external_link\" target=\"_blank\">cotton<\/a>\u201d) and the suffix <i><a href=\"https:\/\/en.wiktionary.org\/wiki\/-oma\" class=\"extiw\" title=\"wikt:-oma\" rel=\"external_link\" target=\"_blank\">-oma<\/a><\/i>, meaning a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a> or growth, and describes a mass within a patient's body comprising a cotton matrix surrounded by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body_granuloma\" title=\"Foreign body granuloma\" rel=\"external_link\" target=\"_blank\">foreign body granuloma<\/a>.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-0\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Kiernan_2-0\" class=\"reference\"><a href=\"#cite_note-Kiernan-2\" rel=\"external_link\">[2]<\/a><\/sup> \"Textiloma\" is derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Textile\" title=\"Textile\" rel=\"external_link\" target=\"_blank\">textile<\/a> (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-1\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Incidence_and_clinical_presentation\">Incidence and clinical presentation<\/span><\/h2>\n<p>The actual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incidence_(epidemiology)\" title=\"Incidence (epidemiology)\" rel=\"external_link\" target=\"_blank\">incidence<\/a> of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations<sup id=\"rdp-ebb-cite_ref-Kiernan_2-1\" class=\"reference\"><a href=\"#cite_note-Kiernan-2\" rel=\"external_link\">[2]<\/a><\/sup> and are most frequently discovered in the abdomen.<sup id=\"rdp-ebb-cite_ref-Manzella_et_al_3-0\" class=\"reference\"><a href=\"#cite_note-Manzella_et_al-3\" rel=\"external_link\">[3]<\/a><\/sup> The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-2\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Gossypibomas can often present, clinically or radiologically, similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumors<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abscess\" title=\"Abscess\" rel=\"external_link\" target=\"_blank\">abscesses<\/a>, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morbidity\" class=\"mw-redirect\" title=\"Morbidity\" rel=\"external_link\" target=\"_blank\">morbidity<\/a>.<sup id=\"rdp-ebb-cite_ref-Manzella_et_al_3-1\" class=\"reference\"><a href=\"#cite_note-Manzella_et_al-3\" rel=\"external_link\">[3]<\/a><\/sup> Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abscess\" title=\"Abscess\" rel=\"external_link\" target=\"_blank\">abscess<\/a> may form with or without a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Secondary_infection\" class=\"mw-redirect\" title=\"Secondary infection\" rel=\"external_link\" target=\"_blank\">secondary bacterial infection<\/a>. The second reaction is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aseptic\" class=\"mw-redirect\" title=\"Aseptic\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> fibrinous response, resulting in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_adhesion\" class=\"mw-redirect\" title=\"Tissue adhesion\" rel=\"external_link\" target=\"_blank\">tissue adhesions<\/a> and encapsulation and eventually <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body_granuloma\" title=\"Foreign body granuloma\" rel=\"external_link\" target=\"_blank\">foreign body granuloma<\/a>.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-3\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup> Symptoms may not present for long periods of time, sometimes months or years following surgery.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-4\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prevention\">Prevention<\/span><\/h2>\n<p>To prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (<a href=\"https:\/\/en.wikipedia.org\/wiki\/AORN\" class=\"mw-redirect\" title=\"AORN\" rel=\"external_link\" target=\"_blank\">AORN<\/a>).<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Other guidelines have been promoted by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_College_of_Surgeons\" title=\"American College of Surgeons\" rel=\"external_link\" target=\"_blank\">American College of Surgeons<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>In most countries, surgical sponges contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiodensity\" title=\"Radiodensity\" rel=\"external_link\" target=\"_blank\">radiopaque<\/a> material that can be readily identified in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiographic\" class=\"mw-redirect\" title=\"Radiographic\" rel=\"external_link\" target=\"_blank\">radiographic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> images, facilitating detection.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-5\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup> In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940.<sup id=\"rdp-ebb-cite_ref-Shyung_et_al_7-0\" class=\"reference\"><a href=\"#cite_note-Shyung_et_al-7\" rel=\"external_link\">[7]<\/a><\/sup> Some surgeons recommend routine postoperative <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> films after surgery to reduce the likelihood of foreign body inclusion.<sup id=\"rdp-ebb-cite_ref-Shyung_et_al_7-1\" class=\"reference\"><a href=\"#cite_note-Shyung_et_al-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Retained_surgical_instruments\" title=\"Retained surgical instruments\" rel=\"external_link\" target=\"_blank\">Retained surgical instruments<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Kim_et_al-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kim_et_al_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kim HS, Chung TS, Suh SH, Kim SY (April 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ajnr.org\/cgi\/pmidlookup?view=long&pmid=17416826\" target=\"_blank\">\"MR imaging findings of paravertebral gossypiboma\"<\/a>. <i>AJNR Am J Neuroradiol<\/i>. <b>28<\/b> (4): 709\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17416826\" target=\"_blank\">17416826<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJNR+Am+J+Neuroradiol&rft.atitle=MR+imaging+findings+of+paravertebral+gossypiboma&rft.volume=28&rft.issue=4&rft.pages=709-13&rft.date=2007-04&rft_id=info%3Apmid%2F17416826&rft.aulast=Kim&rft.aufirst=HS&rft.au=Chung%2C+TS&rft.au=Suh%2C+SH&rft.au=Kim%2C+SY&rft_id=http%3A%2F%2Fwww.ajnr.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D17416826&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Kiernan-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kiernan_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kiernan_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kiernan F, Joyce M, Byrnes CK, O'Grady H, Keane FB, Neary P (December 2008). \"Gossypiboma: a case report and review of the literature\". <i>Ir J Med Sci<\/i>. <b>177<\/b> (4): 389\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11845-008-0197-0\" target=\"_blank\">10.1007\/s11845-008-0197-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18820991\" target=\"_blank\">18820991<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ir+J+Med+Sci&rft.atitle=Gossypiboma%3A+a+case+report+and+review+of+the+literature&rft.volume=177&rft.issue=4&rft.pages=389-91&rft.date=2008-12&rft_id=info%3Adoi%2F10.1007%2Fs11845-008-0197-0&rft_id=info%3Apmid%2F18820991&rft.aulast=Kiernan&rft.aufirst=F&rft.au=Joyce%2C+M&rft.au=Byrnes%2C+CK&rft.au=O%27Grady%2C+H&rft.au=Keane%2C+FB&rft.au=Neary%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Manzella_et_al-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Manzella_et_al_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Manzella_et_al_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J (December 2009). \"Imaging of gossypibomas: pictorial review\". <i>AJR Am J Roentgenol<\/i>. <b>193<\/b> (6 Suppl): S94\u2013101. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2FAJR.07.7132\" target=\"_blank\">10.2214\/AJR.07.7132<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19933682\" target=\"_blank\">19933682<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR+Am+J+Roentgenol&rft.atitle=Imaging+of+gossypibomas%3A+pictorial+review&rft.volume=193&rft.issue=6+Suppl&rft.pages=S94-101&rft.date=2009-12&rft_id=info%3Adoi%2F10.2214%2FAJR.07.7132&rft_id=info%3Apmid%2F19933682&rft.aulast=Manzella&rft.aufirst=A&rft.au=Filho%2C+PB&rft.au=Albuquerque%2C+E&rft.au=Farias%2C+F&rft.au=Kaercher%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Recommended practices for sponge, sharp, and instrument counts. AORN Recommended Practices Committee. Association of periOperative Registered Nurses\". <i>AORN J<\/i>. <b>70<\/b> (6): 1083\u20139. December 1999. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0001-2092%2806%2962224-2\" target=\"_blank\">10.1016\/s0001-2092(06)62224-2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10635432\" target=\"_blank\">10635432<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AORN+J&rft.atitle=Recommended+practices+for+sponge%2C+sharp%2C+and+instrument+counts.+AORN+Recommended+Practices+Committee.+Association+of+periOperative+Registered+Nurses&rft.volume=70&rft.issue=6&rft.pages=1083-9&rft.date=1999-12&rft_id=info%3Adoi%2F10.1016%2Fs0001-2092%2806%2962224-2&rft_id=info%3Apmid%2F10635432&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ahrq.gov\/clinic\/ptsafety\/chap22.htm\" target=\"_blank\">\"The Retained Surgical Sponge\"<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agency_for_Healthcare_Research_and_Quality\" title=\"Agency for Healthcare Research and Quality\" rel=\"external_link\" target=\"_blank\">Agency for Healthcare Research and Quality<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gibbs VC, Coakley FD, Reines HD (May 2007). \"Preventable errors in the operating room: retained foreign bodies after surgery--Part I\". <i>Curr Probl Surg<\/i>. <b>44<\/b> (5): 281\u2013337. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1067%2Fj.cpsurg.2007.03.002\" target=\"_blank\">10.1067\/j.cpsurg.2007.03.002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17512832\" target=\"_blank\">17512832<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Curr+Probl+Surg&rft.atitle=Preventable+errors+in+the+operating+room%3A+retained+foreign+bodies+after+surgery--Part+I&rft.volume=44&rft.issue=5&rft.pages=281-337&rft.date=2007-05&rft_id=info%3Adoi%2F10.1067%2Fj.cpsurg.2007.03.002&rft_id=info%3Apmid%2F17512832&rft.aulast=Gibbs&rft.aufirst=VC&rft.au=Coakley%2C+FD&rft.au=Reines%2C+HD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Shyung_et_al-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Shyung_et_al_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Shyung_et_al_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shyung LR, Chang WH, Lin SC, Shih SC, Kao CR, Chou SY (February 2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120505172540\/http:\/\/www.wjgnet.com\/1007-9327\/11\/1248.asp\" target=\"_blank\">\"Report of gossypiboma from the standpoint in medicine and law\"<\/a>. <i>World J. Gastroenterol<\/i>. <b>11<\/b> (8): 1248\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4250725\" target=\"_blank\">4250725<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15754416\" target=\"_blank\">15754416<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wjgnet.com\/1007-9327\/11\/1248.asp\" target=\"_blank\">the original<\/a> on 2012-05-05.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+J.+Gastroenterol.&rft.atitle=Report+of+gossypiboma+from+the+standpoint+in+medicine+and+law&rft.volume=11&rft.issue=8&rft.pages=1248-9&rft.date=2005-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4250725&rft_id=info%3Apmid%2F15754416&rft.aulast=Shyung&rft.aufirst=LR&rft.au=Chang%2C+WH&rft.au=Lin%2C+SC&rft.au=Shih%2C+SC&rft.au=Kao%2C+CR&rft.au=Chou%2C+SY&rft_id=http%3A%2F%2Fwww.wjgnet.com%2F1007-9327%2F11%2F1248.asp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<ul><li><cite class=\"citation journal\">Camazine, Brian. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jfponline.com\/Pages.asp?AID=2068\" target=\"_blank\">\"The persistent problem of the retained foreign body\"<\/a>. <i>The Journal of Family Practice<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Family+Practice&rft.atitle=The+persistent+problem+of+the+retained+foreign+body&rft.au=Camazine%2C+Brian&rft_id=http%3A%2F%2Fwww.jfponline.com%2FPages.asp%3FAID%3D2068&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/brighamrad.harvard.edu\/Cases\/bwh\/hcache\/391\/full.html\" target=\"_blank\">Case description and discussion<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ent.ohiou.edu\/autoid\/datam417.pdf\" target=\"_blank\">Ohio University, Data Matrix Integrity Test<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kalyspo.com\" target=\"_blank\">A unified system for gossypiboma prevention<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181216122007\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.196 seconds\nReal time usage: 0.245 seconds\nPreprocessor visited node count: 453\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 13707\/2097152 bytes\nTemplate argument size: 75\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 21300\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.132\/10.000 seconds\nLua memory usage: 2.72 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 196.386 1 -total\n<\/p>\n<pre>97.68% 191.833 1 Template:Reflist\n88.62% 174.030 7 Template:Cite_journal\n 1.47% 2.884 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4087651-1!canonical and timestamp 20181216122006 and revision id 795242798\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gossypiboma\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214710\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.507 1 - wikipedia:Gossypiboma\n100.00% 145.507 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8576-0!*!*!*!*!*!* and timestamp 20181217214710 and revision id 25004\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Gossypiboma\">https:\/\/www.limswiki.org\/index.php\/Gossypiboma<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9a987c700a3112a55a2b8d9a6ecb9a1f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Gossypiboma_01.jpg\/440px-Gossypiboma_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Gossypiboma_02.jpg\/440px-Gossypiboma_02.jpg"],"9a987c700a3112a55a2b8d9a6ecb9a1f_timestamp":1545083230,"aec7ce92977c5ced7bcf01212f077879_type":"article","aec7ce92977c5ced7bcf01212f077879_title":"Companion diagnostic","aec7ce92977c5ced7bcf01212f077879_url":"https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic","aec7ce92977c5ced7bcf01212f077879_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCompanion diagnostic\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. 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(June 2016) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nCompanion diagnosticMedical diagnosticsPurposeto determine the correct therapeutic agent for an individual\nA companion diagnostic (CDx)[1] is a diagnostic test used as a companion to a therapeutic drug to determine its applicability to a specific person.[2]\nCompanion diagnostics are co-developed with drugs to aid in selecting or excluding patient groups for treatment with that particular drug on the basis of their biological characteristics that determine responders and non-responders to the therapy.[3]\nCompanion diagnostics are developed based on companion biomarkers, biomarkers that prospectively help predict likely response or severe toxicity.[4]\n\nSee also \nPersonalized medicine\nPrecision medicine\nReferences \n\n\n^ \"Pfizer Taps Foundation Medicine for CDx Development\". Clinical OMICs. 16 January 2018. Retrieved 19 January 2018 . \n\n^ \"Companion Diagnostics\" (Page Last Updated 07\/14\/2016) . FDA. Retrieved 26 September 2016 . \n\n^ Trusheim, MR; Burgess, B; Hu, SX; Long, T; Averbuch, SD; Flynn, AA; Lieftucht, A; Mazumder, A; Milloy, J; Shaw, PM; Swank, D; Wang, J; Berndt, ER; Goodsaid, F; Palmer, MC (31 October 2011). \"Quantifying factors for the success of stratified medicine\". Nature Reviews. Drug Discovery. 10 (11): 817\u201333. doi:10.1038\/nrd3557. PMID 22037040. \n\n^ Duffy, MJ; Crown, J (October 2013). \"Companion biomarkers: paving the pathway to personalized treatment for cancer\". Clinical chemistry. 59 (10): 1447\u201356. doi:10.1373\/clinchem.2012.200477. PMID 23656699. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic\">https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 408 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","aec7ce92977c5ced7bcf01212f077879_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Companion_diagnostic skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Companion diagnostic<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p>A <b>companion diagnostic<\/b> (CDx)<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnostic_test\" class=\"mw-redirect\" title=\"Diagnostic test\" rel=\"external_link\" target=\"_blank\">diagnostic test<\/a> used as a companion to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacology\" title=\"Pharmacology\" rel=\"external_link\" target=\"_blank\">therapeutic drug<\/a> to determine its applicability to a specific person.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Companion diagnostics are co-developed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug\" title=\"Drug\" rel=\"external_link\" target=\"_blank\">drugs<\/a> to aid in selecting or excluding patient groups for treatment with that particular drug on the basis of their biological characteristics that determine responders and non-responders to the therapy.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Companion diagnostics are developed based on <b>companion biomarkers<\/b>, biomarkers that prospectively help predict likely response or severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicity\" title=\"Toxicity\" rel=\"external_link\" target=\"_blank\">toxicity<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Personalized_medicine\" title=\"Personalized medicine\" rel=\"external_link\" target=\"_blank\">Personalized medicine<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Precision_medicine\" title=\"Precision medicine\" rel=\"external_link\" target=\"_blank\">Precision medicine<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.clinicalomics.com\/articles\/cancer-cdx-collaboration-brings-foundation-medicine-and-pfizer-together\/1433\" target=\"_blank\">\"Pfizer Taps Foundation Medicine for CDx Development\"<\/a>. <i>Clinical OMICs<\/i>. 16 January 2018<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 January<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+OMICs&rft.atitle=Pfizer+Taps+Foundation+Medicine+for+CDx+Development&rft.date=2018-01-16&rft_id=https%3A%2F%2Fwww.clinicalomics.com%2Farticles%2Fcancer-cdx-collaboration-brings-foundation-medicine-and-pfizer-together%2F1433&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/InVitroDiagnostics\/ucm407297.htm\" target=\"_blank\">\"Companion Diagnostics\"<\/a> <span class=\"cs1-format\">(Page Last Updated 07\/14\/2016)<\/span>. FDA<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 September<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Companion+Diagnostics&rft.pub=FDA&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FProductsandMedicalProcedures%2FInVitroDiagnostics%2Fucm407297.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Trusheim, MR; Burgess, B; Hu, SX; Long, T; Averbuch, SD; Flynn, AA; Lieftucht, A; Mazumder, A; Milloy, J; Shaw, PM; Swank, D; Wang, J; Berndt, ER; Goodsaid, F; Palmer, MC (31 October 2011). \"Quantifying factors for the success of stratified medicine\". <i>Nature Reviews. Drug Discovery<\/i>. <b>10<\/b> (11): 817\u201333. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrd3557\" target=\"_blank\">10.1038\/nrd3557<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22037040\" target=\"_blank\">22037040<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews.+Drug+Discovery&rft.atitle=Quantifying+factors+for+the+success+of+stratified+medicine.&rft.volume=10&rft.issue=11&rft.pages=817-33&rft.date=2011-10-31&rft_id=info%3Adoi%2F10.1038%2Fnrd3557&rft_id=info%3Apmid%2F22037040&rft.aulast=Trusheim&rft.aufirst=MR&rft.au=Burgess%2C+B&rft.au=Hu%2C+SX&rft.au=Long%2C+T&rft.au=Averbuch%2C+SD&rft.au=Flynn%2C+AA&rft.au=Lieftucht%2C+A&rft.au=Mazumder%2C+A&rft.au=Milloy%2C+J&rft.au=Shaw%2C+PM&rft.au=Swank%2C+D&rft.au=Wang%2C+J&rft.au=Berndt%2C+ER&rft.au=Goodsaid%2C+F&rft.au=Palmer%2C+MC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Duffy, MJ; Crown, J (October 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/clinchem.aaccjnls.org\/content\/59\/10\/1447.long\" target=\"_blank\">\"Companion biomarkers: paving the pathway to personalized treatment for cancer\"<\/a>. <i>Clinical chemistry<\/i>. <b>59<\/b> (10): 1447\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1373%2Fclinchem.2012.200477\" target=\"_blank\">10.1373\/clinchem.2012.200477<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23656699\" target=\"_blank\">23656699<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+chemistry&rft.atitle=Companion+biomarkers%3A+paving+the+pathway+to+personalized+treatment+for+cancer.&rft.volume=59&rft.issue=10&rft.pages=1447-56&rft.date=2013-10&rft_id=info%3Adoi%2F10.1373%2Fclinchem.2012.200477&rft_id=info%3Apmid%2F23656699&rft.aulast=Duffy&rft.aufirst=MJ&rft.au=Crown%2C+J&rft_id=http%3A%2F%2Fclinchem.aaccjnls.org%2Fcontent%2F59%2F10%2F1447.long&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181207083310\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.220 seconds\nReal time usage: 0.319 seconds\nPreprocessor visited node count: 878\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 36951\/2097152 bytes\nTemplate argument size: 8486\/2097152 bytes\nHighest expansion depth: 19\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11540\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.125\/10.000 seconds\nLua memory usage: 3.11 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 274.846 1 -total\n<\/p>\n<pre>48.90% 134.391 3 Template:Ambox\n46.94% 129.022 1 Template:Reflist\n40.03% 110.008 1 Template:Multiple_issues\n22.60% 62.110 1 Template:Cite_news\n16.47% 45.262 2 Template:Cite_journal\n13.68% 37.595 1 Template:Cleanup\n11.74% 32.267 1 Template:Infobox_diagnostic\n11.02% 30.282 1 Template:Underlinked\n10.38% 28.526 1 Template:Infobox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:42275348-1!canonical and timestamp 20181207083309 and revision id 872202158\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Companion_diagnostic\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214710\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.380 1 - wikipedia:Companion_diagnostic\n100.00% 145.380 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8575-0!*!*!*!*!*!* and timestamp 20181217214710 and revision id 25003\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic\">https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","aec7ce92977c5ced7bcf01212f077879_images":[],"aec7ce92977c5ced7bcf01212f077879_timestamp":1545083230,"b80050a8a33e647be9f7402bb654ba06_type":"article","b80050a8a33e647be9f7402bb654ba06_title":"Central sterile services department","b80050a8a33e647be9f7402bb654ba06_url":"https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department","b80050a8a33e647be9f7402bb654ba06_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCentral sterile services department\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe central sterile services department (CSSD), also called sterile processing department (SPD), sterile processing, central supply department (CSD), or central supply, is an integrated place in hospitals and other health care facilities that performs sterilization and other actions on medical devices, equipment and consumables; for subsequent use by health workers in the operating theatre of the hospital and also for other aseptic procedures, e.g. catheterization, wound stitching and bandaging in a medical, surgical, maternity or paediatric ward.[1]\n\nContents \n\n1 Background \n2 Sterilization methods in use \n3 Sterile processing technician \n4 Departments \n\n4.1 Decontamination \n4.2 Sterilization and storage \n4.3 Distribution \n\n\n5 See also \n6 References \n\n\nBackground \nThe operations of a sterile services department usually consist of the cleaning, disinfection, and sterilization of reusable medical equipment. Reusable medical equipment, or RME, can consist of any medical equipment from stainless steel surgical instrumentation, to IV pumps and crash carts. RME is separated into three classes: non-critical, semi-critical, and critical, with each class requiring a minimum level of reprocessing[2].\nNon-critical items, such as IV poles and pumps, require a minimum of intermediate level disinfection which can be accomplished with most hospital disinfectants[2].\nSemi-critical items are items that are expected to have contact with what an intact mucous membrane, and normally consists of endoscopes like those used in colonoscopies.\nThese items require high level disinfectants such as glutaraldehyde solution, peracetic acid, or hydrogen peroxide plasma[2].\n\n<\/p>Critical items, which include any instrument which will be introduced into a patient blood stream or in a normally sterile area of the body, require sterilization[2].\n\nSterilization methods in use \nMain article: Sterilization (microbiology)\nSterilization is the process of destroying all living organisms on an item and is the main task of most sterile services departments. Items to be sterilized must first be cleaned in a separate decontamination room and inspected for effectiveness, cleanliness and damage. There are multiple methods of sterilization, and which one is used is dependant on many factors including: operational cost, potential hazards to workers, efficacy, time, and composition of the materials being sterilized.\nIn the US, one of the cheapest and easiest methods is steam sterilization, where instrumentation trays and packages are placed in a chamber which is them filled with 250\u2013270 \u00b0F (121\u2013132 \u00b0C) steam, killing all microorganisms[3].\nSterilization can also be achieved using ethylene oxide (ETO) gas. This process was created in the 1950s by the US military[4] and is used on items that cannot withstand the high temperatures of steam sterilization. ETO sterilization takes far longer than steam sterilization and is hazardous to workers, so alternative methods were created in the 1990s. The most common method for sterilizing at low temperatures today is by using hydrogen peroxide plasma, which has near zero risk to workers and cycles take a fraction of the time of ETO sterilization.\nDepending on the healthcare facility's policy, there will be either an event related or time related sterile storage policy. If the policy is time related, an expiration date is placed on the sterile package, before being supplied to the end-user as a sterile product. If along the supply route, the sealed package got damaged or opened by a health worker, it needs to be returned to the CSSD for re-sterilization. If the healthcare facility's policy is event related, the package is considered sterile until an event occurs to compromise it's sterility (e.g. opened, dropped package, high humidity conditions, torn muslin wrap, etc.)\n\nSterile processing technician \nA sterile processing technician is someone who cleans and sterilizes used surgical instruments and other medical supplies so that they can be safely redistributed and reused on future patients. This work is usually centralized in a special department of the medical facility.\nJob titles include the following: \n\nSterile processing and distribution technician (SPD tech or CPD tech)\nCentral sterile supply technician (CSS tech)\nCentral processing technician (CPT)\nCentral service technician (CST)\nCertified Sterile Science Technician (CSST)\nSterile Science Associate(SSA)- Degree.\nSterile Scientist (SS)- Degree.\nMaster of Sterile Sciences (MSS)- Degree.\nDepartments \nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2018) (Learn how and when to remove this template message)\nSterile processing departments are typically divided into four major areas to accomplish the functions of decontamination, assembly and sterile processing, sterile storage, and distribution.\n\nDecontamination \nDecontaminating used surgical instruments and other medical devices\nOperating and maintaining special decontamination equipment like automatic washers\nInspecting decontaminated items to make sure they are clean\nAssembly\nOrganizing clean items and packaging them into appropriate instrument trays and sets\nSterilization and storage \nSterilizing assembled trays of instruments\nPrecisely operating and monitoring special sterilization equipment like autoclaves\nKeeping detailed records of items that have been cleaned, sterilized, and stored\nDistribution \nStocking crash carts\nOrganizing sterilized medical supplies\nEnsuring that sterile supplies don\u2019t become outdated \/ preventing event related sterility issues\nDelivering sterile supplies where they are needed and picking up dirty ones\nSee also \nAutoclave\nHospital warehouse\nSterilization (microbiology)\nReferences \n\n\n^ \"Sterilization basics\". University of Rochester. Retrieved 16 June 2016 . \n\n^ a b c d Health, Center for Devices and Radiological. \"Reprocessing of Reusable Medical Devices - What are Reusable Medical Devices?\". www.fda.gov. Retrieved 2018-10-17 . \n\n^ Rutala, W. A.; Stiegel, M. M.; Sarubbi, F. A. (1982-06-01). \"Decontamination of laboratory microbiological waste by steam sterilization\". Appl. Environ. Microbiol. 43 (6): 1311\u20131316. ISSN 0099-2240. PMID 7103486. \n\n^ Reichert, Marimargaret; Young, Jack H. (1997). Sterilization Technology for the Health Care Facility. Jones & Bartlett Learning. ISBN 9780834208384. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department\">https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department<\/a>\n\t\t\t\t\tCategory: Healthcare settingsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:52.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 468 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","b80050a8a33e647be9f7402bb654ba06_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Central_sterile_services_department skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Central sterile services department<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>The <b>central sterile services department<\/b> (<b>CSSD<\/b>), also called <b>sterile processing department<\/b> (<b>SPD<\/b>), <b>sterile processing<\/b>, <b>central supply department<\/b> (<b>CSD<\/b>), or <b>central supply<\/b>, is an integrated place in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospitals<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">health care<\/a> facilities that performs <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> and other actions on medical devices, equipment and consumables; for subsequent use by health workers in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_theatre\" class=\"mw-redirect\" title=\"Operating theatre\" rel=\"external_link\" target=\"_blank\">operating theatre<\/a> of the hospital and also for other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asepsis\" title=\"Asepsis\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> procedures, e.g. catheterization, wound stitching and bandaging in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical\" class=\"mw-redirect\" title=\"Medical\" rel=\"external_link\" target=\"_blank\">medical<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical\" class=\"mw-redirect\" title=\"Surgical\" rel=\"external_link\" target=\"_blank\">surgical<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maternity\" class=\"mw-redirect\" title=\"Maternity\" rel=\"external_link\" target=\"_blank\">maternity<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paediatric\" class=\"mw-redirect\" title=\"Paediatric\" rel=\"external_link\" target=\"_blank\">paediatric<\/a> ward.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<p>The operations of a sterile services department usually consist of the cleaning, disinfection, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> of reusable medical equipment. Reusable medical equipment, or RME, can consist of any medical equipment from stainless steel surgical instrumentation, to IV pumps and crash carts. RME is separated into three classes: non-critical, semi-critical, and critical, with each class requiring a minimum level of reprocessing<sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-0\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p><p>Non-critical items, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">IV<\/a> poles and pumps, require a minimum of intermediate level disinfection which can be accomplished with most hospital disinfectants<sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-1\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p><p>Semi-critical items are items that are expected to have contact with what an intact <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mucous_membrane\" title=\"Mucous membrane\" rel=\"external_link\" target=\"_blank\">mucous membrane<\/a>, and normally consists of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">endoscopes<\/a> like those used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colonoscopy\" title=\"Colonoscopy\" rel=\"external_link\" target=\"_blank\">colonoscopies<\/a>.\n<p>These items require high level <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disinfectant\" title=\"Disinfectant\" rel=\"external_link\" target=\"_blank\">disinfectants<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glutaraldehyde\" title=\"Glutaraldehyde\" rel=\"external_link\" target=\"_blank\">glutaraldehyde solution<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peracetic_acid\" title=\"Peracetic acid\" rel=\"external_link\" target=\"_blank\">peracetic acid<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)#Hydrogen_peroxide\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">hydrogen peroxide plasma<\/a><sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-2\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p>\n<\/p><p>Critical items, which include any instrument which will be introduced into a patient blood stream or in a normally sterile area of the body, require sterilization<sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-3\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sterilization_methods_in_use\">Sterilization methods in use<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">Sterilization (microbiology)<\/a><\/div>\n<p>Sterilization is the process of destroying all living organisms on an item and is the main task of most sterile services departments. Items to be sterilized must first be cleaned in a separate decontamination room and inspected for effectiveness, cleanliness and damage. There are multiple methods of sterilization, and which one is used is dependant on many factors including: operational cost, potential hazards to workers, efficacy, time, and composition of the materials being sterilized.\n<\/p><p>In the US, one of the cheapest and easiest methods is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Moist_heat_sterilization\" title=\"Moist heat sterilization\" rel=\"external_link\" target=\"_blank\">steam sterilization<\/a>, where instrumentation trays and packages are placed in a chamber which is them filled with 250\u2013270 \u00b0F (121\u2013132 \u00b0C) steam, killing all microorganisms<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>.\n<\/p><p>Sterilization can also be achieved using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ethylene oxide<\/a> (ETO) gas. This process was created in the 1950s by the US military<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> and is used on items that cannot withstand the high temperatures of steam sterilization. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide#Healthcare_sterilant\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ETO sterilization<\/a> takes far longer than steam sterilization and is hazardous to workers, so alternative methods were created in the 1990s. The most common method for sterilizing at low temperatures today is by using hydrogen peroxide plasma, which has near zero risk to workers and cycles take a fraction of the time of ETO sterilization.\n<\/p><p>Depending on the healthcare facility's policy, there will be either an event related or time related sterile storage policy. If the policy is time related, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Expiry_date\" class=\"mw-redirect\" title=\"Expiry date\" rel=\"external_link\" target=\"_blank\">expiration date<\/a> is placed on the sterile package, before being supplied to the end-user as a <i>sterile<\/i> product. If along the supply route, the sealed package got damaged or opened by a health worker, it needs to be returned to the CSSD for re-sterilization. If the healthcare facility's policy is event related, the package is considered sterile until an event occurs to compromise it's sterility (e.g. opened, dropped package, high humidity conditions, torn muslin wrap, etc.)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sterile_processing_technician\">Sterile processing technician<\/span><\/h2>\n<p>A sterile processing technician is someone who cleans and sterilizes used <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instruments\" class=\"mw-redirect\" title=\"Surgical instruments\" rel=\"external_link\" target=\"_blank\">surgical instruments<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_supplies\" class=\"mw-redirect\" title=\"Medical supplies\" rel=\"external_link\" target=\"_blank\">medical supplies<\/a> so that they can be safely redistributed and reused on future patients. This work is usually centralized in a special department of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_facility\" class=\"mw-redirect\" title=\"Medical facility\" rel=\"external_link\" target=\"_blank\">medical facility<\/a>.\n<\/p><p>Job titles include the following: \n<\/p>\n<ul><li>Sterile processing and distribution technician (SPD tech or CPD tech)<\/li>\n<li>Central sterile supply technician (CSS tech)<\/li>\n<li>Central processing technician (CPT)<\/li>\n<li>Central service technician (CST)<\/li>\n<li>Certified Sterile Science Technician (CSST)<\/li>\n<li>Sterile Science Associate(SSA)- Degree.<\/li>\n<li>Sterile Scientist (SS)- Degree.<\/li>\n<li>Master of Sterile Sciences (MSS)- Degree.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Departments\">Departments<\/span><\/h2>\n\n<p>Sterile processing departments are typically divided into four major areas to accomplish the functions of decontamination, assembly and sterile processing, sterile storage, and distribution.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Decontamination\">Decontamination<\/span><\/h3>\n<ul><li>Decontaminating used surgical instruments and other medical devices<\/li>\n<li>Operating and maintaining special decontamination equipment like automatic washers<\/li>\n<li>Inspecting decontaminated items to make sure they are clean<\/li>\n<li>Assembly<\/li>\n<li>Organizing clean items and packaging them into appropriate instrument trays and sets<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Sterilization_and_storage\">Sterilization and storage<\/span><\/h3>\n<ul><li>Sterilizing assembled trays of instruments<\/li>\n<li>Precisely operating and monitoring special sterilization equipment like autoclaves<\/li>\n<li>Keeping detailed records of items that have been cleaned, sterilized, and stored<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Distribution\">Distribution<\/span><\/h3>\n<ul><li>Stocking crash carts<\/li>\n<li>Organizing sterilized medical supplies<\/li>\n<li>Ensuring that sterile supplies don\u2019t become outdated \/ preventing event related sterility issues<\/li>\n<li>Delivering sterile supplies where they are needed and picking up dirty ones<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">Autoclave<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_warehouse\" title=\"Hospital warehouse\" rel=\"external_link\" target=\"_blank\">Hospital warehouse<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">Sterilization (microbiology)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.urmc.rochester.edu\/sterile\/basics.aspx\" target=\"_blank\">\"Sterilization basics\"<\/a>. University of Rochester<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 June<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Sterilization+basics&rft.pub=University+of+Rochester&rft_id=https%3A%2F%2Fwww.urmc.rochester.edu%2Fsterile%2Fbasics.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-fda.gov-what-is-rme-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fda.gov-what-is-rme_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda.gov-what-is-rme_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda.gov-what-is-rme_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda.gov-what-is-rme_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Health, Center for Devices and Radiological. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ReprocessingofReusableMedicalDevices\/ucm454619.htm\" target=\"_blank\">\"Reprocessing of Reusable Medical Devices - What are Reusable Medical Devices?\"<\/a>. <i>www.fda.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-10-17<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Reprocessing+of+Reusable+Medical+Devices+-+What+are+Reusable+Medical+Devices%3F&rft.aulast=Health&rft.aufirst=Center+for+Devices+and+Radiological&rft_id=https%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FProductsandMedicalProcedures%2FReprocessingofReusableMedicalDevices%2Fucm454619.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rutala, W. A.; Stiegel, M. M.; Sarubbi, F. A. (1982-06-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/aem.asm.org\/content\/43\/6\/1311\" target=\"_blank\">\"Decontamination of laboratory microbiological waste by steam sterilization\"<\/a>. <i>Appl. Environ. Microbiol<\/i>. <b>43<\/b> (6): 1311\u20131316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0099-2240\" target=\"_blank\">0099-2240<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7103486\" target=\"_blank\">7103486<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Appl.+Environ.+Microbiol.&rft.atitle=Decontamination+of+laboratory+microbiological+waste+by+steam+sterilization.&rft.volume=43&rft.issue=6&rft.pages=1311-1316&rft.date=1982-06-01&rft_id=info%3Apmid%2F7103486&rft.issn=0099-2240&rft.aulast=Rutala&rft.aufirst=W.+A.&rft.au=Stiegel%2C+M.+M.&rft.au=Sarubbi%2C+F.+A.&rft_id=https%3A%2F%2Faem.asm.org%2Fcontent%2F43%2F6%2F1311&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Reichert, Marimargaret; Young, Jack H. (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.co.uk\/books?id=HDzcboqJR9kC&dq=eto+sterilization+us+military&source=gbs_navlinks_s\" target=\"_blank\"><i>Sterilization Technology for the Health Care Facility<\/i><\/a>. Jones & Bartlett Learning. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780834208384.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Sterilization+Technology+for+the+Health+Care+Facility&rft.pub=Jones+%26+Bartlett+Learning&rft.date=1997&rft.isbn=9780834208384&rft.aulast=Reichert&rft.aufirst=Marimargaret&rft.au=Young%2C+Jack+H.&rft_id=https%3A%2F%2Fbooks.google.co.uk%2Fbooks%3Fid%3DHDzcboqJR9kC%26dq%3Deto%2Bsterilization%2Bus%2Bmilitary%26source%3Dgbs_navlinks_s&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181129163723\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.204 seconds\nReal time usage: 0.286 seconds\nPreprocessor visited node count: 402\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 14170\/2097152 bytes\nTemplate argument size: 171\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11904\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.118\/10.000 seconds\nLua memory usage: 3.99 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 244.583 1 -total\n<\/p>\n<pre>49.41% 120.840 1 Template:Reflist\n27.95% 68.368 2 Template:Cite_web\n20.05% 49.045 1 Template:Unreferenced_section\n17.98% 43.970 1 Template:Convert\n17.82% 43.592 1 Template:Unreferenced\n16.43% 40.186 1 Template:Ambox\n11.84% 28.950 1 Template:Main_article\n11.54% 28.226 1 Template:Cite_paper\n 3.01% 7.374 1 Template:Cite_book\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:38059582-1!canonical and timestamp 20181129163722 and revision id 865396486\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Central_sterile_services_department\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214709\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 132.465 1 - wikipedia:Central_sterile_services_department\n100.00% 132.465 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8574-0!*!*!*!*!*!* and timestamp 20181217214709 and revision id 25002\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department\">https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","b80050a8a33e647be9f7402bb654ba06_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"b80050a8a33e647be9f7402bb654ba06_timestamp":1545083229,"8242550c187fa50d6e13369341156e6c_type":"article","8242550c187fa50d6e13369341156e6c_title":"Biocompatibility","8242550c187fa50d6e13369341156e6c_url":"https:\/\/www.limswiki.org\/index.php\/Biocompatibility","8242550c187fa50d6e13369341156e6c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBiocompatibility\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2011) (Learn how and when to remove this template message)\nBiocompatibility is related to the behavior of biomaterials in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation.[1] The ambiguity of the term reflects the ongoing development of insights into how biomaterials interact with the human body and eventually how those interactions determine the clinical success of a medical device (such as pacemaker, hip replacement or stent). Modern medical devices and prostheses are often made of more than one material so it might not always be sufficient to talk about the biocompatibility of a specific material.[2]\nSince the immune response and repair functions in the body are so complicated it is not adequate to describe the biocompatibility of a single material in relation to a single cell type or tissue. Sometimes one hears of biocompatibility testing that is a large battery of in vitro test[3] that is used in accordance with ISO 10993 (or other similar standards) to determine if a certain material (or rather biomedical product) is biocompatible. These tests do not determine the biocompatibility of a material,[4] but they constitute an important step towards the animal testing and finally clinical trials that will determine the biocompatibility of the material in a given application, and thus medical devices such as implants or drug delivery devices[5].\n\n\nIUPAC definition\nBiocompatibility (biomedical therapy): Ability of a material to perform with an appropriate host response in a specific application.[6][a]\r\n\nBiocompatibility: Ability to be in contact with a living system without producing an adverse effect.[6]\n\n\nContents \n\n1 History \n2 Five definitions of biocompatibility \n3 Comments on the above five definitions \n\n3.1 \u2018Biocompatible\u2019 \n3.2 Suggested sub-definitions \n\n\n4 See also \n5 References \n\n\nHistory \nThe word biocompatibility seems to have been mentioned for the first time in peer-review journals and meetings in 1970 by RJ Hegyeli (Amer Chem Soc Annual Meeting abstract) and CA Homsy et al. (J Macromol Sci Chem A4:3,615, 1970). It took almost two decades before it began to be commonly used in scientific literature (see the graph below).\nRecently Williams (again) has been trying to reevaluate the current knowledge status regarding what factors determine clinical success. Doing so notes that an implant may not always have to be positively bioactive but it must not do any harm (either locally or systemically) (Williams, 2008).\n\nFive definitions of biocompatibility \n\"The quality of not having toxic or injurious effects on biological systems\".[7]\n\"The ability of a material to perform with an appropriate host response in a specific application\", Williams' definition.[8]\n\"Comparison of the tissue response produced through the close association of the implanted candidate material to its implant site within the host animal to that tissue response recognised and established as suitable with control materials\" - ASTM\n\"Refers to the ability of a biomaterial to perform its desired function with respect to a medical therapy, without eliciting any undesirable local or systemic effects in the recipient or beneficiary of that therapy, but generating the most appropriate beneficial cellular or tissue response in that specific situation, and optimising the clinically relevant performance of that therapy\".[9]\n\"Biocompatibility is the capability of a prosthesis implanted in the body to exist in harmony with tissue without causing deleterious changes\".[10]\nComments on the above five definitions \nThe Dorland Medical definition not recommended according to Williams Dictionary since it only defines biocompatibility as the absence of host response and does not include any desired or positive interactions between the host tissue and the biomaterials.\nThis is also called the \u201cWilliams definition\u201d or \u201cWilliam\u2019s definition\u201d.[11] It was defined in the European Society for Biomaterials Consensus Conference I and can more easily be found in \u2018The Williams Dictionary of Biomaterials\u2019.\nThe ASTM is not recommended according to Williams Dictionary since it only refers to local tissue responses, in animal models.\nThe fourth is an expansion or rather more precise version of the first definition noting both that low toxicity and the one should be aware of the different demands between various medical applications of the same material.\nThis section is empty. You can help by adding to it. (August 2014)\nAll these definitions deal with materials and not with devices. This is a drawback since many medical devices are made of more than one material. Much of the pre-clinical testing of the materials is not conducted on the devices but rather the material itself. But at some stage the testing will have to include the device since the shape, geometry and surface treatment etc. of the device will also affect its biocompatibility.\n\n \u2018Biocompatible\u2019 \nIn the literature, one quite often stumbles upon the adjective form, \u2018biocompatible\u2019. However, according to Williams\u2019 definition, this does not make any sense because biocompatibility is contextual, i.e. much more than just the material itself will determine the clinical outcome of the medical device of which the biomaterial is a part. This also points to one of the weaknesses with the current definition because a medical device usually is made of more than one material.\nMetallic glasses based on magnesium with zinc and calcium addition are tested as the potential biocompatible metallic biomaterials for biodegradable medical implants[12]\n\nSuggested sub-definitions \nThe scope of the first definition is so wide that D Williams tried to find suitable subgroups of applications in order to be able to make more narrow definitions. In the MDT article from 2003 the chosen supgroups and their definitions were:\n\nBiocompatibility of long-term implanted devices\nThe biocompatibility of a long-term implantable medical device refers to the ability of the device to perform its intended function, with the desired degree of incorporation in the host, without eliciting any undesirable local or systemic effects in that host.\nBiocompatibility of short-term implantable devices\nThe biocompatibility of a medical device that is intentionally placed within the cardiovascular system for transient diagnostic or therapeutic purposes refers to the ability of the device to carry out its intended function within flowing blood, with minimal interaction between device and blood that adversely affects device performance, and without inducing uncontrolled activation of cellular or plasma protein cascades.\nBiocompatibility of tissue-engineering products\nThe biocompatibility of a scaffold or matrix for a tissue-engineering products refers to the ability to perform as a substrate that will support the appropriate cellular activity, including the facilitation of molecular and mechanical signalling systems, in order to optimise tissue regeneration, without eliciting any undesirable effects in those cells, or inducing any undesirable local or systemic responses in the eventual host.\nIn these definitions the notion of biocompatibility is related to devices rather than to materials as compared to top three definitions. There was a consensus conference on biomaterial definitions in Sorrento September 15\u201316, 2005.[13]\n\nSee also \nBiocompatible material\nBiomaterial\nMedical device\nISO 10993\nMedical implant\nMedical grade silicone\nBovine submaxillary mucin coatings\nTitanium biocompatibility\nReferences \nFootnotes\n\n\n^ The more general definition could be adopted by the biomedical field.[6] \n\n\nNotes\n\n\n^ \"Biological Performance of Materials\", Jonathan Black,2006, ISBN 0-8493-3959-6 \n\n^ Considerations for the Biocompatibility Evaluation of Medical Devices, Kammula and Morris, Medical Device & Diagnostic Industry, May 2001 \n\n^ \u201cIn Vitro Biocompatibility Testing of Biomaterials and Medical Devices\u201d, U. Muller, Medical Device Technology, March 2008 \n\n^ \"Biocompatibility Safety Assessment of Medical Devices: FDA\/ISO and Japanese Guidelines\". Mddionline.com. Retrieved 20 November 2014 . \n\n^ Reshetov, I. V.; Starceva, O. I.; Istranov, A. L.; Vorona, B. N.; Lyundup, A. V.; Gulyaev, I. V.; Melnikov, D. V.; Shtansky, D. V.; Sheveyko, A. N. (2016). \"Three-dimensional biocompatible matrix for reconstructive surgery\". AIP Conference Proceedings. 1760 (1): 020056. doi:10.1063\/1.4960275. ISSN 0094-243X. \n\n^ a b c Vert, Michel (2012). \"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\" (PDF) . Pure and Applied Chemistry. 84 (2): 377\u2013410. doi:10.1351\/PAC-REC-10-12-04. \n\n^ Dorland's Medical Dictionary \n\n^ The Williams dictionary of Biomaterials, D.F. Williams, 1999, ISBN 0-85323-921-5 \n\n^ Williams, David F. (2008). \"On the mechanisms of biocompatibility\". Biomaterials. 29: 2941\u20132953. doi:10.1016\/j.biomaterials.2008.04.023. \n\n^ International dictionary of medicine and biology, E. L. Becker, S. I. Landau, & A. Manuila, 1986, New York: Wiley. \n\n^ Williams, D (Oct 2003). \"Revisiting the definition of biocompatibility\". Medical device technology. 14 (8): 10\u20133. PMID 14603712. \n\n^ Nowosielski R., Cesarz-Andraczke K., Sakiewicz P., Maciej A., Jak\u00f3bik-Kolon A., Babilas R., Corrosion of biocompatible Mg66+XZn30-XCa4 (X=0.2) bulk metallic glasses, Arch. Metall. Mater. 2016 vol. 61 iss. 2, s. 807-810, \n\n^ [1] Archived February 6, 2005, at the Wayback Machine. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biocompatibility\">https:\/\/www.limswiki.org\/index.php\/Biocompatibility<\/a>\n\t\t\t\t\tCategories: BiomaterialsScience termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 20:39.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 918 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8242550c187fa50d6e13369341156e6c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Biocompatibility skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Biocompatibility<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Biocompatibility<\/b> is related to the behavior of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials\" class=\"mw-redirect\" title=\"Biomaterials\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a> in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> The ambiguity of the term reflects the ongoing development of insights into how biomaterials interact with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_body\" title=\"Human body\" rel=\"external_link\" target=\"_blank\">human body<\/a> and eventually how those interactions determine the clinical success of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">pacemaker<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a>). Modern medical devices and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">prostheses<\/a> are often made of more than one material so it might not always be sufficient to talk about the biocompatibility of a specific material.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Since the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a> and repair functions in the body are so complicated it is not adequate to describe the biocompatibility of a single material in relation to a single cell type or tissue. Sometimes one hears of biocompatibility testing that is a large battery of <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vitro\" title=\"In vitro\" rel=\"external_link\" target=\"_blank\">in vitro<\/a> test<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> that is used in accordance with <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_10993\" title=\"ISO 10993\" rel=\"external_link\" target=\"_blank\">ISO 10993<\/a> (or other similar standards) to determine if a certain material (or rather biomedical product) is biocompatible. These tests do not determine the biocompatibility of a material,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> but they constitute an important step towards the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Animal_testing\" title=\"Animal testing\" rel=\"external_link\" target=\"_blank\">animal testing<\/a> and finally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trial\" title=\"Clinical trial\" rel=\"external_link\" target=\"_blank\">clinical trials<\/a> that will determine the biocompatibility of the material in a given application, and thus <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implants<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_delivery_device\" class=\"mw-redirect\" title=\"Drug delivery device\" rel=\"external_link\" target=\"_blank\">drug delivery devices<\/a><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>.\n<\/p>\n<div class=\"quotebox pullquote floatright\" style=\";\">\n<div class=\"quotebox-title\" style=\"\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Union_of_Pure_and_Applied_Chemistry\" title=\"International Union of Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">IUPAC<\/a> definition<\/div>\n<div class=\"quotebox-quote left-aligned\" style=\"\"><b>Biocompatibility (biomedical therapy)<\/b>: Ability of a material to perform with an appropriate host response in a specific application.<sup id=\"rdp-ebb-cite_ref-IUPAC1_6-0\" class=\"reference\"><a href=\"#cite_note-IUPAC1-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[a]<\/a><\/sup><br \/>\n<b>Biocompatibility<\/b>: Ability to be in contact with a living system without producing an adverse effect.<sup id=\"rdp-ebb-cite_ref-IUPAC1_6-2\" class=\"reference\"><a href=\"#cite_note-IUPAC1-6\" rel=\"external_link\">[6]<\/a><\/sup><\/div>\n<\/div>\n<div class=\"floatright\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Annualpublbiocompatibility19702007.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Annualpublbiocompatibility19702007.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e2\/Annualpublbiocompatibility19702007.jpg\/220px-Annualpublbiocompatibility19702007.jpg\" width=\"220\" height=\"154\" \/><\/a><\/div>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The word <i>biocompatibility<\/i> seems to have been mentioned for the first time in peer-review journals and meetings in 1970 by RJ Hegyeli (Amer Chem Soc Annual Meeting abstract) and CA Homsy et al. (J Macromol Sci Chem A4:3,615, 1970). It took almost two decades before it began to be commonly used in scientific literature (see the graph below).\n<\/p><p>Recently Williams (again) has been trying to reevaluate the current knowledge status regarding what factors determine clinical success. Doing so notes that an implant may not always have to be positively bioactive but it must not do any harm (either locally or systemically) (Williams, 2008).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Five_definitions_of_biocompatibility\">Five definitions of biocompatibility<\/span><\/h2>\n<ol><li>\"The quality of not having <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxic\" class=\"mw-redirect\" title=\"Toxic\" rel=\"external_link\" target=\"_blank\">toxic<\/a> or injurious effects on biological systems\".<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[7]<\/a><\/sup><\/li>\n<li>\"The ability of a material to perform with an appropriate host response in a specific application\", Williams' definition.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li>\"Comparison of the tissue response produced through the close association of the implanted candidate material to its implant site within the host animal to that tissue response recognised and established as suitable with control materials\" - <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM\" class=\"mw-redirect\" title=\"ASTM\" rel=\"external_link\" target=\"_blank\">ASTM<\/a><\/li>\n<li>\"Refers to the ability of a biomaterial to perform its desired function with respect to a medical therapy, without eliciting any undesirable local or systemic effects in the recipient or beneficiary of that therapy, but generating the most appropriate beneficial cellular or tissue response in that specific situation, and optimising the clinically relevant performance of that therapy\".<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>\"Biocompatibility is the capability of a prosthesis implanted in the body to exist in harmony with tissue without causing deleterious changes\".<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Comments_on_the_above_five_definitions\">Comments on the above five definitions<\/span><\/h2>\n<ol><li>The Dorland Medical definition not recommended according to Williams Dictionary since it only defines biocompatibility as the absence of host response and does not include any desired or positive interactions between the host tissue and the biomaterials.<\/li>\n<li>This is also called the \u201cWilliams definition\u201d or \u201cWilliam\u2019s definition\u201d.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[11]<\/a><\/sup> It was defined in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Society_for_Biomaterials\" title=\"European Society for Biomaterials\" rel=\"external_link\" target=\"_blank\">European Society for Biomaterials<\/a> Consensus Conference I and can more easily be found in \u2018The Williams Dictionary of Biomaterials\u2019.<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM\" class=\"mw-redirect\" title=\"ASTM\" rel=\"external_link\" target=\"_blank\">ASTM<\/a> is not recommended according to Williams Dictionary since it only refers to local tissue responses, in animal models.<\/li>\n<li>The fourth is an expansion or rather more precise version of the first definition noting both that low toxicity and the one should be aware of the different demands between various medical applications of the same material.<\/li>\n<li><\/li><\/ol>\n<p>All these definitions deal with materials and not with devices. This is a drawback since many medical devices are made of more than one material. Much of the of the materials is not conducted on the devices but rather the material itself. But at some stage the testing will have to include the device since the shape, geometry and surface treatment etc. of the device will also affect its biocompatibility.\n<\/p>\n<h3><span id=\"rdp-ebb-.E2.80.98Biocompatible.E2.80.99\"><\/span><span class=\"mw-headline\" id=\"\u2018Biocompatible\u2019\">\u2018Biocompatible\u2019<\/span><\/h3>\n<p>In the literature, one quite often stumbles upon the adjective form, \u2018biocompatible\u2019. However, according to Williams\u2019 definition, this does not make any sense because biocompatibility is contextual, i.e. much more than just the material itself will determine the clinical outcome of the medical device of which the biomaterial is a part. This also points to one of the weaknesses with the current definition because a medical device usually is made of more than one material.\n<\/p><p>Metallic glasses based on magnesium with zinc and calcium addition are tested as the potential biocompatible metallic biomaterials for biodegradable medical implants<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Suggested_sub-definitions\">Suggested sub-definitions<\/span><\/h3>\n<p>The scope of the first definition is so wide that D Williams tried to find suitable subgroups of applications in order to be able to make more narrow definitions. In the MDT article from 2003 the chosen supgroups and their definitions were:\n<\/p>\n<dl><dt>Biocompatibility of long-term <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implanted devices<\/a><\/dt>\n<dd>The biocompatibility of a long-term implantable medical device refers to the ability of the device to perform its intended function, with the desired degree of incorporation in the host, without eliciting any undesirable local or systemic effects in that host.<\/dd><\/dl>\n<dl><dt>Biocompatibility of short-term implantable devices<\/dt>\n<dd>The biocompatibility of a medical device that is intentionally placed within the cardiovascular system for transient diagnostic or therapeutic purposes refers to the ability of the device to carry out its intended function within flowing blood, with minimal interaction between device and blood that adversely affects device performance, and without inducing uncontrolled activation of cellular or plasma protein cascades.<\/dd><\/dl>\n<dl><dt>Biocompatibility of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue-engineering<\/a> products<\/dt>\n<dd>The biocompatibility of a scaffold or matrix for a tissue-engineering products refers to the ability to perform as a substrate that will support the appropriate cellular activity, including the facilitation of molecular and mechanical signalling systems, in order to optimise tissue regeneration, without eliciting any undesirable effects in those cells, or inducing any undesirable local or systemic responses in the eventual host.<\/dd><\/dl>\n<p>In these definitions the notion of biocompatibility is related to devices rather than to materials as compared to top three definitions. There was a consensus conference on biomaterial definitions in Sorrento September 15\u201316, 2005.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible_material\" class=\"mw-redirect\" title=\"Biocompatible material\" rel=\"external_link\" target=\"_blank\">Biocompatible material<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">Biomaterial<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Medical device<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_10993\" title=\"ISO 10993\" rel=\"external_link\" target=\"_blank\">ISO 10993<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">Medical implant<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_grade_silicone\" title=\"Medical grade silicone\" rel=\"external_link\" target=\"_blank\">Medical grade silicone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovine_submaxillary_mucin_coatings\" title=\"Bovine submaxillary mucin coatings\" rel=\"external_link\" target=\"_blank\">Bovine submaxillary mucin coatings<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_biocompatibility\" title=\"Titanium biocompatibility\" rel=\"external_link\" target=\"_blank\">Titanium biocompatibility<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<dl><dt>Footnotes<\/dt><\/dl>\n<div class=\"reflist\" style=\"list-style-type: lower-alpha;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The more general definition could be adopted by the biomedical field.<sup id=\"rdp-ebb-cite_ref-IUPAC1_6-1\" class=\"reference\"><a href=\"#cite_note-IUPAC1-6\" rel=\"external_link\">[6]<\/a><\/sup><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<dl><dt>Notes<\/dt><\/dl>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Biological Performance of Materials\", Jonathan Black,2006, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-3959-6<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mddionline.com\/article\/considerations-biocompatibility-evaluation-medical-devices\" target=\"_blank\"><i>Considerations for the Biocompatibility Evaluation of Medical Devices<\/i><\/a>, Kammula and Morris, Medical Device & Diagnostic Industry, May 2001<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.emdt.co.uk\/article\/vitro-biocompatibility-testing-biomaterials-and-medical-devices\" target=\"_blank\">\u201cIn Vitro Biocompatibility Testing of Biomaterials and Medical Devices\u201d<\/a>, U. Muller, Medical Device Technology, March 2008<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mddionline.com\/article\/biocompatibility-safety-assessment-medical-devices-fdaiso-and-japanese-guidelines\" target=\"_blank\">\"Biocompatibility Safety Assessment of Medical Devices: FDA\/ISO and Japanese Guidelines\"<\/a>. Mddionline.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 November<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Biocompatibility+Safety+Assessment+of+Medical+Devices%3A+FDA%2FISO+and+Japanese+Guidelines&rft.pub=Mddionline.com&rft_id=http%3A%2F%2Fwww.mddionline.com%2Farticle%2Fbiocompatibility-safety-assessment-medical-devices-fdaiso-and-japanese-guidelines&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Reshetov, I. V.; Starceva, O. I.; Istranov, A. L.; Vorona, B. N.; Lyundup, A. V.; Gulyaev, I. V.; Melnikov, D. V.; Shtansky, D. V.; Sheveyko, A. N. (2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/aip.scitation.org\/doi\/abs\/10.1063\/1.4960275\" target=\"_blank\">\"Three-dimensional biocompatible matrix for reconstructive surgery\"<\/a>. <i>AIP Conference Proceedings<\/i>. <b>1760<\/b> (1): 020056. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.4960275\" target=\"_blank\">10.1063\/1.4960275<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0094-243X\" target=\"_blank\">0094-243X<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AIP+Conference+Proceedings&rft.atitle=Three-dimensional+biocompatible+matrix+for+reconstructive+surgery&rft.volume=1760&rft.issue=1&rft.pages=020056&rft.date=2016&rft_id=info%3Adoi%2F10.1063%2F1.4960275&rft.issn=0094-243X&rft.aulast=Reshetov&rft.aufirst=I.+V.&rft.au=Starceva%2C+O.+I.&rft.au=Istranov%2C+A.+L.&rft.au=Vorona%2C+B.+N.&rft.au=Lyundup%2C+A.+V.&rft.au=Gulyaev%2C+I.+V.&rft.au=Melnikov%2C+D.+V.&rft.au=Shtansky%2C+D.+V.&rft.au=Sheveyko%2C+A.+N.&rft_id=http%3A%2F%2Faip.scitation.org%2Fdoi%2Fabs%2F10.1063%2F1.4960275&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-IUPAC1-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-IUPAC1_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IUPAC1_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IUPAC1_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vert, Michel (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pac.iupac.org\/publications\/pac\/pdf\/2012\/pdf\/8402x0377.pdf\" target=\"_blank\">\"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pure_and_Applied_Chemistry\" title=\"Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">Pure and Applied Chemistry<\/a><\/i>. <b>84<\/b> (2): 377\u2013410. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1351%2FPAC-REC-10-12-04\" target=\"_blank\">10.1351\/PAC-REC-10-12-04<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Terminology+for+biorelated+polymers+and+applications+%28IUPAC+Recommendations+2012%29&rft.volume=84&rft.issue=2&rft.pages=377-410&rft.date=2012&rft_id=info%3Adoi%2F10.1351%2FPAC-REC-10-12-04&rft.aulast=Vert&rft.aufirst=Michel&rft_id=http%3A%2F%2Fpac.iupac.org%2Fpublications%2Fpac%2Fpdf%2F2012%2Fpdf%2F8402x0377.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorland%27s_Medical_Dictionary\" class=\"mw-redirect\" title=\"Dorland's Medical Dictionary\" rel=\"external_link\" target=\"_blank\">Dorland's Medical Dictionary<\/a><\/i><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>The Williams dictionary of Biomaterials<\/i>, D.F. Williams, 1999, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-85323-921-5<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Williams, David F. (2008). \"On the mechanisms of biocompatibility\". <i>Biomaterials<\/i>. <b>29<\/b>: 2941\u20132953. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2008.04.023\" target=\"_blank\">10.1016\/j.biomaterials.2008.04.023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=On+the+mechanisms+of+biocompatibility&rft.volume=29&rft.pages=2941-2953&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.biomaterials.2008.04.023&rft.aulast=Williams&rft.aufirst=David+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>International dictionary of medicine and biology<\/i>, E. L. Becker, S. I. Landau, & A. Manuila, 1986, New York: Wiley.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Williams, D (Oct 2003). \"Revisiting the definition of biocompatibility\". <i>Medical device technology<\/i>. <b>14<\/b> (8): 10\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14603712\" target=\"_blank\">14603712<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+device+technology&rft.atitle=Revisiting+the+definition+of+biocompatibility.&rft.volume=14&rft.issue=8&rft.pages=10-3&rft.date=2003-10&rft_id=info%3Apmid%2F14603712&rft.aulast=Williams&rft.aufirst=D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Nowosielski R., Cesarz-Andraczke K., Sakiewicz P., Maciej A., Jak\u00f3bik-Kolon A., Babilas R., Corrosion of biocompatible Mg66+XZn30-XCa4 (X=0.2) bulk metallic glasses, Arch. Metall. Mater. 2016 vol. 61 iss. 2, s. 807-810,<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.esb2005.it\/satellite.html\" target=\"_blank\">[1]<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20050206100618\/http:\/\/www.esb2005.it\/satellite.html\" target=\"_blank\">Archived<\/a> February 6, 2005, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1267\nCached time: 20181217080759\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.272 seconds\nReal time usage: 0.372 seconds\nPreprocessor visited node count: 1074\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 19860\/2097152 bytes\nTemplate argument size: 1224\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 22739\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.114\/10.000 seconds\nLua memory usage: 3.5 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 333.510 1 -total\n<\/p>\n<pre>66.42% 221.527 2 Template:Reflist\n19.65% 65.551 4 Template:Cite_journal\n19.17% 63.918 1 Template:Refimprove\n18.86% 62.899 2 Template:ISBN\n15.88% 52.948 1 Template:Cite_web\n13.25% 44.185 2 Template:Ambox\n11.87% 39.587 2 Template:Catalog_lookup_link\n 9.32% 31.070 1 Template:Quote_box\n 4.42% 14.725 1 Template:Notelist\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1665878-1!canonical and timestamp 20181217080759 and revision id 814240424\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214709\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.173 seconds\nReal time usage: 0.271 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 262.800 1 - wikipedia:Biocompatibility\n100.00% 262.800 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8184-0!*!*!*!*!*!* and timestamp 20181217214709 and revision id 24330\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biocompatibility\">https:\/\/www.limswiki.org\/index.php\/Biocompatibility<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8242550c187fa50d6e13369341156e6c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/e\/e2\/Annualpublbiocompatibility19702007.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Wiki_letter_w_cropped.svg\/40px-Wiki_letter_w_cropped.svg.png"],"8242550c187fa50d6e13369341156e6c_timestamp":1545083229,"66f165c46927036533e0a0dd6571a8b1_type":"article","66f165c46927036533e0a0dd6571a8b1_title":"Assistive technology","66f165c46927036533e0a0dd6571a8b1_url":"https:\/\/www.limswiki.org\/index.php\/Assistive_technology","66f165c46927036533e0a0dd6571a8b1_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAssistive technology\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\n Hearing aid\nAssistive technology is an umbrella term that includes assistive, adaptive, and rehabilitative devices for people with disabilities or elderly population while also including the process used in selecting, locating, and using them. People who have disabilities often have difficulty performing activities of daily living (ADLs) independently, or even with assistance. ADLs are self-care activities that include toileting, mobility (ambulation), eating, bathing, dressing and grooming. Assistive technology can ameliorate the effects of disabilities that limit the ability to perform ADLs. Assistive technology promotes greater independence by enabling people to perform tasks they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks. For example, wheelchairs provide independent mobility for those who cannot walk, while assistive eating devices can enable people who cannot feed themselves to do so. Due to assistive technology, people with disabilities have an opportunity of a more positive and easygoing lifestyle, with an increase in \"social participation,\" \"security and control,\" and a greater chance to \"reduce institutional costs without significantly increasing household expenses.\"[1]\n\nContents \n\n1 Adaptive Technology \n2 Mobility impairments \n\n2.1 Wheelchairs \n2.2 Transfer devices \n2.3 Walkers \n2.4 Prosthesis \n\n\n3 Visual impairments \n\n3.1 Screen readers \n3.2 Braille and braille embossers \n3.3 Refreshable braille display \n3.4 Desktop video magnifier \n3.5 Screen magnification software \n3.6 Large-print and tactile keyboards \n3.7 Navigation Assistance \n3.8 Wearable Technology \n\n\n4 Personal emergency response systems \n5 Accessibility software \n6 Hearing impairments \n\n6.1 Hearing aids \n6.2 Assistive listening devices \n6.3 Amplified telephone equipment \n\n\n7 Augmentative and alternative communication \n8 Cognitive impairments \n\n8.1 Memory aids \n8.2 Educational software \n\n\n9 Eating Impairments \n10 In sports \n11 In education \n12 Computer accessibility \n13 Home automation \n14 Impacts \n15 See also \n16 References \n17 External links \n\n\nAdaptive Technology \nThe term adaptive technology is often used as the synonym for assistive technology; however, they are different terms. Assistive technology refers to \"any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities\",[2] while adaptive technology covers items that are specifically designed for persons with disabilities and would seldom be used by non-disabled persons. In other words, \"assistive technology is any object or system that increases or maintains the capabilities of people with disabilities,\" while adaptive technology is \"any object or system that is specifically designed for the purpose of increasing or maintaining the capabilities of people with disabilities.\"[3] Consequently, adaptive technology is a subset of assistive technology. Adaptive technology often refers specifically to electronic and information technology access.[4]\n\nMobility impairments \nWheelchairs \nMain article: Wheelchair\nWheelchairs are devices that can be manually propelled or electrically propelled, and that include a seating system and are designed to be a substitute for the normal mobility that most people have. Wheelchairs and other mobility devices allow people to perform mobility-related activities of daily living which include feeding, toileting, dressing, grooming, and bathing. The devices come in a number of variations where they can be propelled either by hand or by motors where the occupant uses electrical controls to manage motors and seating control actuators through a joystick, sip-and-puff control, or other input devices. Often there are handles behind the seat for someone else to do the pushing or input devices for caregivers. Wheelchairs are used by people for whom walking is difficult or impossible due to illness, injury, or disability. People with both sitting and walking disability often need to use a wheelchair or walker.\n\nTransfer devices \nMain article: Patient lift\nPatient transfer devices generally allow patients with impaired mobility to be moved by caregivers between beds, wheelchairs, commodes, toilets, chairs, stretchers, shower benches, automobiles, swimming pools, and other patient support systems (i.e., radiology, surgical, or examining tables). The most common devices are Patient lifts (for vertical transfer), Transfer benches, stretcher or convertible chairs (for lateral, supine transfer), sit-to-stand lifts (for moving patients from one seated position to another i.e., from wheelchairs to commodes), air bearing inflatable mattresses (for supine transfer i.e., transfer from a gurney to an operating room table), and sliding boards (usually used for transfer from a bed to a wheelchair). Highly dependent patients who cannot assist their caregiver in moving them often require a Patient lift (a floor or ceiling-suspended sling lift) which though invented in 1955 and in common use since the early 1960s is still considered the state-of-the-art transfer device by OSHA and the American Nursing Association.\n\nWalkers \nMain article: WalkerA walker or walking frame or Rollator is a tool for disabled people who need additional support to maintain balance or stability while walking. It consists of a frame that is about waist high, approximately twelve inches deep and slightly wider than the user. Walkers are also available in other sizes, such as for children, or for heavy people. Modern walkers are height-adjustable. The front two legs of the walker may or may not have wheels attached depending on the strength and abilities of the person using it. It is also common to see caster wheels or glides on the back legs of a walker with wheels on the front.[5]\nProsthesis \nMain article: ProsthesisA prosthesis, prosthetic, or prosthetic limb is a device that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control lost by trauma, disease, or defect. Prostheses are typically used to replace parts lost by injury (traumatic) or missing from birth (congenital) or to supplement defective body parts. Inside the body, artificial heart valves are in common use with artificial hearts and lungs seeing less common use but under active technology development. Other medical devices and aids that can be considered prosthetics include hearing aids, artificial eyes, palatal obturator, gastric bands, and dentures.\nProstheses are specifically not orthoses, although given certain circumstances a prosthesis might end up performing some or all of the same functionary benefits as an orthosis. Prostheses are technically the complete finished item. For instance, a C-Leg knee alone is not a prosthesis, but only a prosthetic component. The complete prosthesis would consist of the attachment system  to the residual limb \u2014 usually a \"socket\", and all the attachment hardware components all the way down to and including the terminal device. Keep this in mind as nomenclature is often interchanged.\nThe terms \"prosthetic\" and \"orthotic\" are adjectives used to describe devices such as a prosthetic knee. The terms \"prosthetics\" and \"orthotics\" are used to describe the respective allied health fields.\n\nVisual impairments \nMain article: Blindness \u00a7 Management\nMany people with serious visual impairments live independently, using a wide range of tools and techniques. Examples of assistive technology for visually impairment include screen readers, screen magnifiers, Braille embossers, desktop video magnifiers, and voice recorders.\n\nScreen readers \nMain article: Screen reader\nScreen readers are used to help the visually impaired to easily access electronic information. These software programs run on a computer in order to convey the displayed information through voice (text-to-speech) or braille (refreshable braille displays) in combination with magnification for low vision users in some cases. There are a variety of platforms and applications available for a variety of costs with differing feature sets.\nOne example of screen readers is Apple VoiceOver. This software is provided free of charge on all Apple devices. Apple VoiceOver includes the option to magnify the screen, control the keyboard, and provide verbal descriptions to describe what is happening on the screen. There are thirty languages to select from. It also has the capacity to read aloud file content, as well as web pages, E-mail messages, and word processing files.\n\n Braille is a system of raised dots representing letters, numbers, punctuation, and words.\nBraille and braille embossers \nMain article: Braille\nBraille is a system of raised dots formed into units called braille cells. A full braille cell is made up of six dots, with two parallel rows of three dots, but other combinations and quantities of dots represent other letters, numbers, punctuation marks, or words. People can then use their fingers to read the code of raised dots.\nA braille embosser is, simply put, a printer for braille. Instead of a standard printer adding ink onto a page, the braille embosser imprints the raised dots of braille onto a page. Some braille embossers combine both braille and ink so the documents can be read with either sight or touch.\n\nRefreshable braille display \nMain article: Refreshable braille display\nA refreshable braille display or braille terminal is an electro-mechanical device for displaying braille characters, usually by means of round-tipped pins raised through holes in a flat surface. Computer users who cannot use a computer monitor use it to read a braille output version of the displayed text.\n\nDesktop video magnifier \nMain article: Video magnifier\nDesktop video magnifiers are electronic devices that use a camera and a display screen to perform digital magnification of printed materials. They enlarge printed pages for those with low vision. A camera connects to a monitor that displays real-time images, and the user can control settings such as magnification, focus, contrast, underlining, highlighting, and other screen preferences. They come in a variety of sizes and styles; some are small and portable with handheld cameras, while others are much larger and mounted on a fixed stand.\n\nScreen magnification software \nMain article: Screen magnifier\nA screen magnifier is software that interfaces with a computer's graphical output to present enlarged screen content. It allows users to enlarge the texts and graphics on their computer screens for easier viewing. Similar to desktop video magnifiers, this technology assists people with low vision. After the user loads the software into their computer's memory, it serves as a kind of \"computer magnifying glass.\" Wherever the computer cursor moves, it enlarges the area around it. This allows greater computer accessibility for a wide range of visual abilities.\n\n This large-print keyboard has tactile elements and special keys for the visually impaired\nLarge-print and tactile keyboards \nA large-print keyboard has large letters printed on the keys. On the keyboard shown, the round buttons at the top control software which can magnify the screen (zoom in), change the background color of the screen, or make the mouse cursor on the screen larger. The \"bump dots\" on the keys, installed in this case by the organization using the keyboards, help the user find the right keys in a tactile way.\n\nNavigation Assistance \nAssistive technology for navigation has exploded on the IEEE Xplore database since 2000, with over 7,500 engineering articles written on assistive technologies and visual impairment in the past 25 years, and over 1,300 articles on solving the problem of navigation for people who are blind or visually impaired. As well, over 600 articles on augmented reality and visual impairment have appeared in the engineering literature since 2000. Most of these articles were published within the past 5 years, and the number of articles in this area is increasing every year. GPS, accelerometers, gyroscopes, and cameras can pinpoint the exact location of the user and provide information on what's in the immediate vicinity, and assistance in getting to a destination.\n\nWearable Technology \nMain article: Wearable technology\nWearable technology are smart electronic devices that can be worn on the body as an implant or an accessory. New technologies are exploring how the visually impaired can receive visual information through wearable devices.[6]\nSome wearable devices for visual impairment include:\n\neSight\nBrainport\nPersonal emergency response systems \nMain article: Telecare\n This voter with a manual dexterity disability is making choices on a touchscreen with a head dauber\nPersonal emergency response systems (PERS), or Telecare (UK term), are a particular sort of assistive technology that use electronic sensors connected to an alarm system to help caregivers manage risk and help vulnerable people stay independent at home longer. An example would be the systems being put in place for senior people such as fall detectors, thermometers (for hypothermia risk), flooding and unlit gas sensors (for people with mild dementia). Notably, these alerts can be customized to the particular person's risks. When the alert is triggered, a message is sent to a caregiver or contact center who can respond appropriately.\n\nAccessibility software \nMain article: Computer accessibility\nIn human\u2013computer interaction, computer accessibility (also known as accessible computing) refers to the accessibility of a computer system to all people, regardless of disability or severity of impairment, examples include web accessibility guidelines.[7] Another approach is for the user to present a token to the computer terminal, such as a smart card, that has configuration information to adjust the computer speed, text size, etc. to their particular needs. This is useful where users want to access public computer based terminals in Libraries, ATM, Information kiosks etc. The concept is encompassed by the CEN EN 1332-4 Identification Card Systems - Man-Machine Interface.[8] This development of this standard has been supported in Europe by SNAPI and has been successfully incorporated into the Lasseo specifications, but with limited success due to the lack of interest from public computer terminal suppliers.\n\nHearing impairments \nMain article: Assistive Technology for Deaf and Hard of Hearing\nPeople in the d\/Deaf and hard of hearing community have a more difficult time receiving auditory information as compared to hearing individuals. These individuals often rely on visual and tactile mediums for receiving and communicating information. The use of assistive technology and devices provides this community with various solutions to auditory communication needs by providing higher sound (for those who are hard of hearing), tactile feedback, visual cues and improved technology access. Individuals who are deaf or hard of hearing utilize a variety of assistive technologies that provide them with different access to information in numerous environments.[9] Most devices either provide amplified sound or alternate ways to access information through vision and\/or vibration. These technologies can be grouped into three general categories: Hearing Technology, alerting devices, and communication support.\n\nHearing aids \nMain article: Hearing aid\nA hearing aid or deaf aid is an electroacoustic device which is designed to amplify sound for the wearer, usually with the aim of making speech more intelligible, and to correct impaired hearing as measured by audiometry. This type of assistive technology helps people with hearing loss participate more fully in their hearing communities by allowing them to hear more clearly. They amplify any and all sound waves through use of a microphone, amplifier, and speaker. There is a wide variety of hearing aids available, including digital, in-the-ear, in-the-canal, behind-the-ear, and on-the-body aids.\n\nAssistive listening devices \nMain article: Assistive listening device\nAssistive listening devices include FM, infrared, and loop assistive listening devices. This type of technology allows people with hearing difficulties to focus on a speaker or subject by getting rid of extra background noises and distractions, making places like auditoriums, classrooms, and meetings much easier to participate in. The assistive listening device usually uses a microphone to capture an audio source near to its origin and broadcast it wirelessly over an FM (Frequency Modulation) transmission, IR (Infra Red) transmission, IL (Induction Loop) transmission, or other transmission methods. The person who is listening may use an FM\/IR\/IL Receiver to tune into the signal and listen at his\/her preferred volume.\n\nAmplified telephone equipment \nMain article: Telecommunications device for the deaf#Other devices for the deaf or hard of hearing\nThis type of assistive technology allows users to amplify the volume and clarity of their phone calls so that they can easily partake in this medium of communication. There are also options to adjust the frequency and tone of a call to suit their individual hearing needs. Additionally, there is a wide variety of amplified telephones to choose from, with different degrees of amplification. For example, a phone with 26 to 40 decibel is generally sufficient for mild hearing loss, while a phone with 71 to 90 decibel is better for more severe hearing loss.[10]\n\nAugmentative and alternative communication \nMain article: Augmentative and alternative communication\n An AAC user uses number coding on an eye gaze communication board\nAugmentative and alternative communication (AAC) is an umbrella term that encompasses methods of communication for those with impairments or restrictions on the production or comprehension of spoken or written language.[11] AAC systems are extremely diverse and depend on the capabilities of the user. They may be as basic as pictures on a board that are used to request food, drink, or other care; or they can be advanced speech generating devices, based on speech synthesis, that are capable of storing hundreds of phrases and words.[12]\n\nCognitive impairments \nMain article: Cognitive orthotics\nAssistive Technology for Cognition (ATC)[13] is the use of technology (usually high tech) to augment and assist cognitive processes such as attention, memory, self-regulation, navigation, emotion recognition and management, planning, and sequencing activity. Systematic reviews of the field have found that the number of ATC are growing rapidly, but have focused on memory and planning, that there is emerging evidence for efficacy, that a lot of scope exists to develop new ATC.[14] Examples of ATC include: NeuroPage which prompts users about meetings,[15] Wakamaru, which provides companionship and reminds users to take medicine and calls for help if something is wrong, and telephone Reassurance systems.[16]\n\nMemory aids \nMemory aids are any type of assistive technology that helps a user learn and remember certain information. Many memory aids are used for cognitive impairments such as reading, writing, or organizational difficulties. For example, a Smartpen records handwritten notes by creating both a digital copy and an audio recording of the text. Users simply tap certain parts of their notes, the pen saves it, and reads it back to them. From there, the user can also download their notes onto a computer for increased accessibility. Digital voice recorders are also used to record \"in the moment\" information for fast and easy recall at a later time.[17]\n\nEducational software \nMain article: Educational software\nEducational software is software that assists people with reading, learning, comprehension, and organizational difficulties. Any accommodation software such as text readers, notetakers, text enlargers, organization tools, word predictions, and talking word processors falls under the category of educational software.\n\nEating Impairments \nMain article: Assistive eating devices\nAdaptive eating devices include items commonly used by the general population like spoons and forks and plates. However they become assistive technology when they are modified to accommodate the needs of people who have difficultly using standard cutlery due to a disabling condition. Common modifications include increasing the size of the utensil handle to make it easier to grasp. Plates and bowls may have a guard on the edge that stops food being pushed off of the dish when it is being scooped. More sophisticated equipment for eating includes manual and powered feeding devices. These devices support those who have little or no hand and arm function and enable them to eat independently.\n\nIn sports \n A New York City Marathon competitor uses a racing wheelchair\nAssistive technology in sports is an area of technology design that is growing. Assistive technology is the array of new devices created to enable sports enthusiasts who have disabilities to play. Assistive technology may be used in adaptive sports, where an existing sport is modified to enable players with a disability to participate; or, assistive technology may be used to invent completely new sports with athletes with disabilities exclusively in mind.\nAn increasing number of people with disabilities are participating in sports, leading to the development of new assistive technology.[18] Assistive technology devices can be simple, or \"low-tech\", or they may use highly advanced technology. \"Low-tech\" devices can include velcro gloves and adaptive bands and tubes. \"High-tech\" devices can include all-terrain wheelchairs and adaptive bicycles.[19] Accordingly, assistive technology can be found in sports ranging from local community recreation to the elite Paralympic Games. More complex assistive technology devices have been developed over time, and as a result, sports for people with disabilities \"have changed from being a clinical therapeutic tool to an increasingly competition-oriented activity\".[20]\n\nIn education \nIn the United States there are two major pieces of legislation that govern the use of assistive technology within the school system. The first is Section 504 of the Rehabilitation Act of 1973 and the second being the Individuals with Disabilities Education Act (IDEA) which was first enacted in 1975 under the name The Education for All Handicapped Children Act. In 2004, during the reauthorization period for IDEA, the National Instructional Material Access Center (NIMAC) was created which provided a repository of accessible text including publisher's textbooks to students with a qualifying disability. Files provided are in XML format and used as a starting platform for braille readers, screen readers, and other digital text software.[21] IDEA defines assistive technology as follows: \"any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. (B) Exception.--The term does not include a medical device that is surgically implanted, or the replacement of such device.\"[22]\nAssistive technology in this area is broken down into low, mid, and high tech categories. Low tech encompasses equipment that is often low cost and does not include batteries or requires charging. Examples include adapted paper and pencil grips for writing or masks and color overlays for reading. Mid tech supports used in the school setting include the use of handheld spelling dictionaries and portable word processors used to keyboard writing. High tech supports involve the use of tablet devices and computers with accompanying software. Software supports for writing include the use of auditory feedback while keyboarding, word prediction for spelling, and speech to text. Supports for reading include the use of text to speech (TTS) software and font modification via access to digital text. Limited supports are available for math instruction and mostly consist of grid based software to allow younger students to keyboard equations and auditory feedback of more complex equations using MathML and Daisy.\n\nComputer accessibility \nMain article: Computer accessibility\n A sip-and-puff device which allows a person with substantial disability to make selections and navigate computerized interfaces by controlling inhalations and exhalations\nOne of the largest problems that affect people with disabilities is discomfort with prostheses.[23] An experiment performed in Massachusetts utilized 20 people with various sensors attached to their arms.[23] The subjects tried different arm exercises, and the sensors recorded their movements. All of the data helped engineers develop new engineering concepts for prosthetics.[23]\nAssistive technology may attempt to improve the ergonomics of the devices themselves such as Dvorak and other alternative keyboard layouts, which offer more ergonomic layouts of the keys.[24][25]\nAssistive technology devices have been created to enable people with disabilities to use modern touch screen mobile computers such as the iPad, iPhone and iPod touch. The Pererro is a plug and play adapter for iOS devices which uses the built in Apple VoiceOver feature in combination with a basic switch. This brings touch screen technology to those who were previously unable to use it. Apple, with the release of iOS 7 had introduced the ability to navigate apps using switch control. Switch access could be activated either through an external bluetooth connected switch, single touch of the screen, or use of right and left head turns using the device's camera. Additional accessibility features include the use of Assistive Touch which allows a user to access multi-touch gestures through pre-programmed onscreen buttons.\n\n<\/p>For users with physical disabilities a large variety of switches are available and customizable to the user's needs varying in size, shape, or amount of pressure required for activation. Switch access may be placed near any area of the body which has consistent and reliable mobility and less subject to fatigue. Common sites include the hands, head, and feet. Eye gaze and head mouse systems can also be used as an alternative mouse navigation. A user may utilize single or multiple switch sites and the process often involves a scanning through items on a screen and activating the switch once the desired object is highlighted.\n\nHome automation \nThe form of home automation called assistive domotics focuses on making it possible for elderly and disabled people to live independently. Home automation is becoming a viable option for the elderly and disabled who would prefer to stay in their own homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards elderly and disabled users. For example, automated prompts and reminders utilize motion sensors and pre-recorded audio messages; an automated prompt in the kitchen may remind the resident to turn off the oven, and one by the front door may remind the resident to lock the door.[26]\n\nImpacts \nOverall, assistive technology aims to allow people with disabilities to \"participate more fully in all aspects of life (home, school, and community)\" and increases their opportunities for \"education, social interactions, and potential for meaningful employment\".[27] It creates greater independence and control for disabled individuals. For example, in one study of 1,342 infants, toddlers and preschoolers, all with some kind of developmental, physical, sensory, or cognitive disability, the use of assistive technology created improvements in child development.[28] These included improvements in \"cognitive, social, communication, literacy, motor, adaptive, and increases in engagement in learning activities\".[29] Additionally, it has been found to lighten caregiver load.[30] Both family and professional caregivers benefit from assistive technology. Through its use, the time that a family member or friend would need to care for a patient significantly decreases. However, studies show that care time for a professional caregiver increases when assistive technology is used. Nonetheless, their work load is significantly easier as the assistive technology frees them of having to perform certain tasks.[31] There are several platforms that use machine learning to identify the appropriate assistive device to suggest to patients, making assistive devices more accessible.[32]\n\nSee also \n\n\n\nWikimedia Commons has media related to Assistive technology.\n\nAccessibility\nAssisted Living\nAssistive Living\nAugmentative and alternative communication\nBraille technology\nDesign for All (in ICT)\nDurable medical equipment\nMatching Person & Technology Model\nOATS: Open Source Assistive Technology Software\nOccupational Therapy\nTransgenerational design\nUniversal access to education\n\nReferences \nSource\nAmerican Speech-Language-Hearing Association. (2005). \"Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Position Statement\". Archived from the original on February 13, 2009. Retrieved January 23, 2009 . \nDeCoste, Denise C. (1997). \"Chapter 10: Introduction to Augmentative and Alternative Communication Systems\". In Glennen, Sharon; DeCoste, Denise C. Handbook Of Augmentative And Alternative Communication. San Diego, CA: Singular Publishing Group. ISBN 1-56593-684-1. \nSchlosser, R. W.; Wendt, O. (2008). \"Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review\". American Journal of Speech-Language Pathology. 17 (3): 212\u2013230. doi:10.1044\/1058-0360(2008\/021). PMID 18663107. \nBeukelman, David R.; Mirenda, Pat (2005). Augmentative & alternative communication: supporting children & adults with complex communication needs (3rd ed.). Paul H. Brookes Publishing Company. ISBN 978-1-55766-684-0. \nGalv\u00e3o Filho, T. (2009). \"Tecnologia Assistiva para uma Escola Inclusiva: apropria\u00e7\u00e3o, demandas e perspectivas. Tese (Doutorado em Educa\u00e7\u00e3o) \u2013 Faculdade de Educa\u00e7\u00e3o, Universidade Federal da Bahia, Salvador, Brazil\". \nMirenda, P. (2003). \"Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids\". Language, Speech, & Hearing Services in Schools. 34 (3): 203\u2013216. doi:10.1044\/0161-1461(2003\/017). \nMathy; Yorkston, K.; Guttman (2000). \"Augmentative Communication for Individuals with Amyotrophic Lateral Sclerosis\". In Beukelman, D.; Yorkston, K.; Reichle, J. Augmentative and Alternative Communication Disorders for Adults with Acquired Neurologic Disorders. Baltimore: P. H. Brookes Pub. ISBN 978-1-55766-473-0. \nJans, Deborah; Clark, Sue (1998). \"Chapter 6: High Technology Aids to Communication\". In Wilson, Allan. Augmentative Communication in Practice: An Introduction. University of Edinburgh. ISBN 978-1-898042-15-0. \nParette, H. P.; Brotherson, M. J; Huer, M. B. (2000). \"Giving families a voice in augmentative and alternative communication decision-making\". Education and Training in Mental Retardation and Developmental Disabilities. 35: 177\u2013190. \nNotes\n\n\n^ Parant, Aymeric; Schiano-Lomoriello, Sandrine; Marchan, Francis (October 2017). \"How would I live with a disability? Expectations of bio-psychosocial consequences and assistive technology use\". Disability and Rehabilitation. Assistive Technology. 12 (7): 681\u2013685. doi:10.1080\/17483107.2016.1218555. ISSN 1748-3115. PMID 27677931. \n\n^ \"Assistive Technology Act of 1998 | Section508.gov\". section508.gov. Retrieved 2016-04-04 . \n\n^ \"Tennessee Science Standards\" (PDF) . Retrieved 2012-10-05 . \n\n^ \"Assessing for Adaptive Technology Needs\". Retrieved 2012-10-05 . \n\n^ C. Barru\u00e9. Personalization and Shared Autonomy in Assistive Technologies. Ph. Thesis. Universitat Polit\u00e8cnica de Catalunya. 2012 \n\n^ Pardes, Arielle. \"The Wearables Giving Computer Vision to the Blind\". Wired. Wired. Retrieved 5 September 2017 . \n\n^ Web accessibility guidelines \n\n^ CEN EN 1332-4 Identification Card Systems - Man-Machine Interface \n\n^ \"Assistive Technology for Individuals who are Deaf or Hard of Hearing\" (PDF) . Retrieved 2015-11-08 . \n\n^ \"Guide to Amplified Phones\". assistech.com. Retrieved 2015-11-25 . \n\n^ ASHA (2005). \n\n^ Gilliam & Marquardt, pp. 356\u2013359. \n\n^ LoPresti, E.F., Mihailidis, A. & Kirsch, N. (2004). Assistive Technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation, 14, 5-39. \n\n^ Gillespie, A., Best, C. & O'Neill, B. (2012). Cognitive function and Assistive Technology for cognition: A systematic review. Journal of the International Neuropsychological Society, 18, 1-19. \n\n^ Wilson, et al. (1997). Evaluation of NeuroPage: A new memory aid. Journal of Neurology, Neurosurgery, and Psychiatry, 63, 113-115. \n\n^ assistivetech.net: Telephone Reassurance. Accessed 2009-08-06. \n\n^ \"Using External Aids to Compensate for Memory and Organizational Problems Post-TBI\". Retrieved 2015-11-30 . \n\n^ Scherer, Marcia; Stefano Federici (2012). Assistive Technology Assessment Handbook. CRC Press. p. 425. ISBN 9781439838655. \n\n^ \"Assistive technologies\". Spaulding Framingham. Retrieved September 5, 2012 . \n\n^ Scherer, Marcia; Stefano Federici (2012). Assistive Technology Assessment Handbook. CRC Press. p. 427. ISBN 9781439838655. \n\n^ \"National Instructional Materials Access Center\". \n\n^ \"Building the Legacy: IDEA 2004\". \n\n^ a b c Abdullah, Hussein A.; Tarry, Cole; Datta, Rahul.; Mittal, Gauri S.; Abderrahim, Mohamed (2007). \"Dynamic Biomechanical Model for Assessing and Monitoring Robot-Assisted Upper-Limb Therapy\". Journal of Rehabilitation Research and Development. 44 (1): 43\u201362. doi:10.1682\/JRRD.2006.03.0025. PMID 17551857. \n\n^ Chubon, R.A.; Hester, M.R. (1988). \"An enhanced standard computer keyboard system for single-finger and typing-stick typing\". Journal of Rehabilitation Research and Development. 25 (4): 17\u201324. PMID 2973523. \n\n^ Anson, D.; George, S.; Galup, R.; Shea, B.; Vetter, R. (2001). \"Efficiency of the Chubon versus the QWERTY keyboard\". Assistive-Technology. 13 (1): 40\u20135. doi:10.1080\/10400435.2001.10132032. PMID 12212435. \n\n^ Judd, Natasha. \"Assistive technology - devices to help with everyday living\". www.alzheimers.org.uk. Retrieved 2015-11-30 . \n\n^ \"Considering Assistive Technology | Center for Parent Information and Resources\". www.parentcenterhub.org. Retrieved 2015-11-25 . \n\n^ Desch, Larry W.; Gaebler-Spira, Deborah (2008-06-01). \"Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication\". Pediatrics. 121 (6): 1271\u20131280. doi:10.1542\/peds.2008-0695. ISSN 0031-4005. PMID 18519500. \n\n^ Dunst, Trivette; Hamby, Simkus (August 2013). \"Research Summary on Assistive Technology Interventions\" (PDF) . Community. Retrieved 24 November 2015 . \n\n^ Nicolson, Amy; Moir, Lois; Millsteed, Jeannine (22 March 2012). \"Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review\". Disability and Rehabilitation: Assistive Technology. 7 (5): 345\u2013349. doi:10.3109\/17483107.2012.667194. \n\n^ Anderson, Wayne L.; Wiener, Joshua M. (2015-06-01). \"The Impact of Assistive Technologies on Formal and Informal Home Care\". The Gerontologist. 55 (3): 422\u2013433. doi:10.1093\/geront\/gnt165. ISSN 0016-9013. \n\n^ https:\/\/www.atvisor.ai\/ \n\n\nExternal links \nvteDisabilityMain topics\nDisability\nDisability studies\nMedical model\nSocial model\nSociety for Disability Studies\nApproaches\nFreak show\nIEP\nInclusion\nLearning disability\nMainstreaming\nPhysical therapy\ndriver rehabilitation\nSpecial needs\nschool\neducation\nRights, Law, SupportRights\nAbleism\/Disablism\nDisability rights\nPejorative terms\nLaw\nAODA\nADA\nConvention on the Rights of Persons with Disabilities\nDeclaration on the Rights of Disabled Persons\nInternational Classification of Functioning, Disability and Health\nServices\nServices for mental disorders\nServices for the disabled\nSupport\nDLA\nODSP\nRail\nSSDI\nSSI\nStudents\nCNIB\nActivist groups\nCCD\nDPI\nMINDS\nReach Canada\nVisitability\nStructural and assistive\nActivities of daily living\nAssistive technology\nIndependent living\nMobility aid\nOrthotics and braces\nPersonal Care Assistant\nPhysical accessibility\nProsthetics\nUniversal 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","66f165c46927036533e0a0dd6571a8b1_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Assistive_technology skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Assistive technology<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hoergeraet_analog_050609.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Hoergeraet_analog_050609.jpg\/220px-Hoergeraet_analog_050609.jpg\" width=\"220\" height=\"141\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hoergeraet_analog_050609.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hearing aid<\/div><\/div><\/div>\n<p><b>Assistive technology<\/b> is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Umbrella_term\" title=\"Umbrella term\" rel=\"external_link\" target=\"_blank\">umbrella term<\/a> that includes assistive, adaptive, and rehabilitative devices for <a href=\"https:\/\/en.wikipedia.org\/wiki\/People_with_disabilities\" class=\"mw-redirect\" title=\"People with disabilities\" rel=\"external_link\" target=\"_blank\">people with disabilities<\/a> or elderly population while also including the process used in selecting, locating, and using them. People who have disabilities often have difficulty performing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\" title=\"Activities of daily living\" rel=\"external_link\" target=\"_blank\">activities of daily living<\/a> (ADLs) independently, or even with assistance. ADLs are self-care activities that include toileting, mobility (ambulation), eating, bathing, dressing and grooming. Assistive technology can ameliorate the effects of disabilities that limit the ability to perform ADLs. Assistive technology promotes greater independence by enabling people to perform tasks they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technology\" title=\"Technology\" rel=\"external_link\" target=\"_blank\">technology<\/a> needed to accomplish such tasks. For example, wheelchairs provide independent mobility for those who cannot walk, while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_eating_devices\" title=\"Assistive eating devices\" rel=\"external_link\" target=\"_blank\">assistive eating devices<\/a> can enable people who cannot feed themselves to do so. Due to assistive technology, people with disabilities have an opportunity of a more positive and easygoing lifestyle, with an increase in \"social participation,\" \"security and control,\" and a greater chance to \"reduce institutional costs without significantly increasing household expenses.\"<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Adaptive_Technology\">Adaptive Technology<\/span><\/h2>\n<p>The term adaptive technology is often used as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synonym\" title=\"Synonym\" rel=\"external_link\" target=\"_blank\">synonym<\/a> for assistive technology; however, they are different terms. Assistive technology refers to \"any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities\",<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> while adaptive technology covers items that are specifically designed for persons with disabilities and would seldom be used by non-disabled persons. In other words, \"assistive technology is any object or system that increases or maintains the capabilities of people with disabilities,\" while adaptive technology is \"any object or system that is specifically designed for the purpose of increasing or maintaining the capabilities of people with disabilities.\"<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Consequently, adaptive technology is a subset of assistive technology. Adaptive technology often refers specifically to electronic and information technology access.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mobility_impairments\">Mobility impairments<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Wheelchairs\">Wheelchairs<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wheelchair\" title=\"Wheelchair\" rel=\"external_link\" target=\"_blank\">Wheelchair<\/a><\/div>\n<p>Wheelchairs are devices that can be manually propelled or electrically propelled, and that include a seating system and are designed to be a substitute for the normal mobility that most people have. Wheelchairs and other mobility devices allow people to perform mobility-related <a href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\" title=\"Activities of daily living\" rel=\"external_link\" target=\"_blank\">activities of daily living<\/a> which include feeding, toileting, dressing, grooming, and bathing. The devices come in a number of variations where they can be propelled either by hand or by motors where the occupant uses electrical controls to manage motors and seating control actuators through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joystick\" title=\"Joystick\" rel=\"external_link\" target=\"_blank\">joystick<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sip-and-puff\" title=\"Sip-and-puff\" rel=\"external_link\" target=\"_blank\">sip-and-puff<\/a> control, or other input devices. Often there are handles behind the seat for someone else to do the pushing or input devices for caregivers. Wheelchairs are used by people for whom <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walking\" title=\"Walking\" rel=\"external_link\" target=\"_blank\">walking<\/a> is difficult or impossible due to illness, injury, or disability. People with both sitting and walking disability often need to use a wheelchair or walker.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Transfer_devices\">Transfer devices<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_lift\" title=\"Patient lift\" rel=\"external_link\" target=\"_blank\">Patient lift<\/a><\/div>\n<p>Patient transfer devices generally allow patients with impaired mobility to be moved by caregivers between beds, wheelchairs, commodes, toilets, chairs, stretchers, shower benches, automobiles, swimming pools, and other patient support systems (i.e., radiology, surgical, or examining tables). The most common devices are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_lift\" title=\"Patient lift\" rel=\"external_link\" target=\"_blank\">Patient lifts<\/a> (for vertical transfer), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transfer_bench\" title=\"Transfer bench\" rel=\"external_link\" target=\"_blank\">Transfer benches<\/a>, stretcher or convertible chairs (for lateral, supine transfer), sit-to-stand lifts (for moving patients from one seated position to another i.e., from wheelchairs to commodes), air bearing inflatable mattresses (for supine transfer i.e., transfer from a gurney to an operating room table), and sliding boards (usually used for transfer from a bed to a wheelchair). Highly dependent patients who cannot assist their caregiver in moving them often require a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_lift\" title=\"Patient lift\" rel=\"external_link\" target=\"_blank\">Patient lift<\/a> (a floor or ceiling-suspended sling lift) which though invented in 1955 and in common use since the early 1960s is still considered the state-of-the-art transfer device by OSHA and the American Nursing Association.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Walkers\">Walkers<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walker_(mobility)\" title=\"Walker (mobility)\" rel=\"external_link\" target=\"_blank\">Walker<\/a><\/div><p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walker_(mobility)\" title=\"Walker (mobility)\" rel=\"external_link\" target=\"_blank\">walker<\/a> or walking frame or Rollator is a tool for disabled people who need additional support to maintain balance or stability while walking. It consists of a frame that is about waist high, approximately twelve inches deep and slightly wider than the user. Walkers are also available in other sizes, such as for children, or for heavy people. Modern walkers are height-adjustable. The front two legs of the walker may or may not have wheels attached depending on the strength and abilities of the person using it. It is also common to see caster wheels or glides on the back legs of a walker with wheels on the front.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><h3><span class=\"mw-headline\" id=\"Prosthesis\">Prosthesis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">Prosthesis<\/a><\/div><p>A <b>prosthesis<\/b>, <b>prosthetic<\/b>, or <b>prosthetic limb<\/b> is a device that replaces a missing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_body\" title=\"Human body\" rel=\"external_link\" target=\"_blank\">body<\/a> part. It is part of the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomechatronics\" title=\"Biomechatronics\" rel=\"external_link\" target=\"_blank\">biomechatronics<\/a>, the science of using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_system\" class=\"mw-redirect\" title=\"Mechanical system\" rel=\"external_link\" target=\"_blank\">mechanical<\/a> devices with human <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skeleton\" title=\"Skeleton\" rel=\"external_link\" target=\"_blank\">skeleton<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nervous_systems\" class=\"mw-redirect\" title=\"Nervous systems\" rel=\"external_link\" target=\"_blank\">nervous systems<\/a> to assist or enhance motor control lost by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\" class=\"mw-redirect\" title=\"Trauma (medicine)\" rel=\"external_link\" target=\"_blank\">trauma<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disease\" title=\"Disease\" rel=\"external_link\" target=\"_blank\">disease<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_disorder\" class=\"mw-redirect\" title=\"Congenital disorder\" rel=\"external_link\" target=\"_blank\">defect<\/a>. Prostheses are typically used to replace parts lost by injury (traumatic) or missing from birth (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital\" class=\"mw-redirect\" title=\"Congenital\" rel=\"external_link\" target=\"_blank\">congenital<\/a>) or to supplement defective body parts. Inside the body, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">artificial heart valves<\/a> are in common use with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart\" title=\"Artificial heart\" rel=\"external_link\" target=\"_blank\">artificial hearts<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_lung\" title=\"Artificial lung\" rel=\"external_link\" target=\"_blank\">lungs<\/a> seeing less common use but under active technology development. Other medical devices and aids that can be considered prosthetics include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_aids\" class=\"mw-redirect\" title=\"Hearing aids\" rel=\"external_link\" target=\"_blank\">hearing aids<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">artificial eyes<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palatal_obturator\" title=\"Palatal obturator\" rel=\"external_link\" target=\"_blank\">palatal obturator<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adjustable_gastric_band\" title=\"Adjustable gastric band\" rel=\"external_link\" target=\"_blank\">gastric bands<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentures\" title=\"Dentures\" rel=\"external_link\" target=\"_blank\">dentures<\/a>.\n<\/p><p>Prostheses are specifically <i>not<\/i> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthoses\" class=\"mw-redirect\" title=\"Orthoses\" rel=\"external_link\" target=\"_blank\">orthoses<\/a>, although given certain circumstances a prosthesis might end up performing some or all of the same functionary benefits as an orthosis. Prostheses are technically the complete finished item. For instance, a C-Leg knee alone is <i>not<\/i> a prosthesis, but only a prosthetic <i>component<\/i>. The complete prosthesis would consist of the attachment system  to the residual limb \u2014 usually a \"socket\", and all the attachment hardware components all the way down to and including the terminal device. Keep this in mind as nomenclature is often interchanged.\n<\/p><p>The terms \"prosthetic\" and \"orthotic\" are adjectives used to describe devices such as a prosthetic knee. The terms \"prosthetics\" and \"orthotics\" are used to describe the respective allied health fields.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Visual_impairments\">Visual impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blindness#Management\" class=\"mw-redirect\" title=\"Blindness\" rel=\"external_link\" target=\"_blank\">Blindness \u00a7 Management<\/a><\/div>\n<p>Many people with serious visual impairments live independently, using a wide range of tools and techniques. Examples of assistive technology for visually impairment include screen readers, screen magnifiers, Braille embossers, desktop video magnifiers, and voice recorders.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Screen_readers\">Screen readers<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screen_reader\" title=\"Screen reader\" rel=\"external_link\" target=\"_blank\">Screen reader<\/a><\/div>\n<p>Screen readers are used to help the visually impaired to easily access electronic information. These software programs run on a computer in order to convey the displayed information through voice (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Text-to-speech\" class=\"mw-redirect\" title=\"Text-to-speech\" rel=\"external_link\" target=\"_blank\">text-to-speech<\/a>) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Braille\" title=\"Braille\" rel=\"external_link\" target=\"_blank\">braille<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Refreshable_braille_display\" title=\"Refreshable braille display\" rel=\"external_link\" target=\"_blank\">refreshable braille displays<\/a>) in combination with magnification for low vision users in some cases. There are a variety of platforms and applications available for a variety of costs with differing feature sets.\n<\/p><p>One example of screen readers is Apple <a href=\"https:\/\/en.wikipedia.org\/wiki\/VoiceOver\" title=\"VoiceOver\" rel=\"external_link\" target=\"_blank\">VoiceOver<\/a>. This software is provided free of charge on all Apple devices. Apple VoiceOver includes the option to magnify the screen, control the keyboard, and provide verbal descriptions to describe what is happening on the screen. There are thirty languages to select from. It also has the capacity to read aloud file content, as well as web pages, E-mail messages, and word processing files.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:English_braille_sample.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/f9\/English_braille_sample.jpg\/220px-English_braille_sample.jpg\" width=\"220\" height=\"176\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:English_braille_sample.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Braille is a system of raised dots representing letters, numbers, punctuation, and words.<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Braille_and_braille_embossers\">Braille and braille embossers<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Braille\" title=\"Braille\" rel=\"external_link\" target=\"_blank\">Braille<\/a><\/div>\n<p>Braille is a system of raised dots formed into units called braille cells. A full braille cell is made up of six dots, with two parallel rows of three dots, but other combinations and quantities of dots represent other letters, numbers, punctuation marks, or words. People can then use their fingers to read the code of raised dots.\n<\/p><p>A braille embosser is, simply put, a printer for braille. Instead of a standard printer adding ink onto a page, the braille embosser imprints the raised dots of braille onto a page. Some braille embossers combine both braille and ink so the documents can be read with either sight or touch.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Refreshable_braille_display\">Refreshable braille display<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refreshable_braille_display\" title=\"Refreshable braille display\" rel=\"external_link\" target=\"_blank\">Refreshable braille display<\/a><\/div>\n<p>A refreshable braille display or braille terminal is an electro-mechanical device for displaying braille characters, usually by means of round-tipped pins raised through holes in a flat surface. Computer users who cannot use a computer monitor use it to read a braille output version of the displayed text.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Desktop_video_magnifier\">Desktop video magnifier<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Video_magnifier\" title=\"Video magnifier\" rel=\"external_link\" target=\"_blank\">Video magnifier<\/a><\/div>\n<p>Desktop video magnifiers are electronic devices that use a camera and a display screen to perform digital magnification of printed materials. They enlarge printed pages for those with low vision. A camera connects to a monitor that displays real-time images, and the user can control settings such as magnification, focus, contrast, underlining, highlighting, and other screen preferences. They come in a variety of sizes and styles; some are small and portable with handheld cameras, while others are much larger and mounted on a fixed stand.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Screen_magnification_software\">Screen magnification software<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screen_magnifier\" title=\"Screen magnifier\" rel=\"external_link\" target=\"_blank\">Screen magnifier<\/a><\/div>\n<p>A screen magnifier is software that interfaces with a computer's graphical output to present enlarged screen content. It allows users to enlarge the texts and graphics on their computer screens for easier viewing. Similar to desktop video magnifiers, this technology assists people with low vision. After the user loads the software into their computer's memory, it serves as a kind of \"computer magnifying glass.\" Wherever the computer cursor moves, it enlarges the area around it. This allows greater computer accessibility for a wide range of visual abilities.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MAGic_Large_Print_Keyboard.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"MAGic Large Print This MAGic large-print keyboard has tactile elements and special keys for the visually impaired\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/MAGic_Large_Print_Keyboard.jpg\/220px-MAGic_Large_Print_Keyboard.jpg\" width=\"220\" height=\"114\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MAGic_Large_Print_Keyboard.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><center>This large-print keyboard has tactile elements and special keys for the visually impaired<\/center><\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Large-print_and_tactile_keyboards\">Large-print and tactile keyboards<\/span><\/h3>\n<p>A large-print keyboard has large letters printed on the keys. On the keyboard shown, the round buttons at the top control software which can magnify the screen (zoom in), change the background color of the screen, or make the mouse cursor on the screen larger. The \"bump dots\" on the keys, installed in this case by the organization using the keyboards, help the user find the right keys in a tactile way.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Navigation_Assistance\">Navigation Assistance<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/GPS_for_the_visually_impaired\" title=\"GPS for the visually impaired\" rel=\"external_link\" target=\"_blank\">Assistive technology for navigation<\/a> has exploded on the <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/Xplore\/home.jsp\" target=\"_blank\">IEEE Xplore database<\/a> since 2000, with over 7,500 engineering articles written on assistive technologies and visual impairment in the past 25 years, and over 1,300 articles on solving the problem of navigation for people who are blind or visually impaired. As well, over 600 articles on augmented reality and visual impairment have appeared in the engineering literature since 2000. Most of these articles were published within the past 5 years, and the number of articles in this area is increasing every year. GPS, accelerometers, gyroscopes, and cameras can pinpoint the exact location of the user and provide information on what's in the immediate vicinity, and assistance in getting to a destination.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Wearable_Technology\">Wearable Technology<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wearable_technology\" title=\"Wearable technology\" rel=\"external_link\" target=\"_blank\">Wearable technology<\/a><\/div>\n<p>Wearable technology are smart electronic devices that can be worn on the body as an implant or an accessory. New technologies are exploring how the visually impaired can receive visual information through wearable devices.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Some wearable devices for visual impairment include:\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ESight\" title=\"ESight\" rel=\"external_link\" target=\"_blank\">eSight<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brainport\" title=\"Brainport\" rel=\"external_link\" target=\"_blank\">Brainport<\/a><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Personal_emergency_response_systems\">Personal emergency response systems<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecare\" title=\"Telecare\" rel=\"external_link\" target=\"_blank\">Telecare<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Head-wand.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/0e\/Head-wand.jpg\/220px-Head-wand.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Head-wand.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>This voter with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manual_dexterity\" class=\"mw-redirect\" title=\"Manual dexterity\" rel=\"external_link\" target=\"_blank\">manual dexterity<\/a> disability is making choices on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Touchscreen\" title=\"Touchscreen\" rel=\"external_link\" target=\"_blank\">touchscreen<\/a> with a head dauber<\/div><\/div><\/div>\n<p> (PERS), or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecare\" title=\"Telecare\" rel=\"external_link\" target=\"_blank\">Telecare<\/a> (UK term), are a particular sort of assistive technology that use electronic sensors connected to an alarm system to help caregivers manage risk and help vulnerable people stay independent at home longer. An example would be the systems being put in place for senior people such as fall detectors, thermometers (for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypothermia\" title=\"Hypothermia\" rel=\"external_link\" target=\"_blank\">hypothermia<\/a> risk), flooding and unlit gas sensors (for people with mild <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a>). Notably, these alerts can be customized to the particular person's risks. When the alert is triggered, a message is sent to a caregiver or contact center who can respond appropriately.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Accessibility_software\">Accessibility software<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_accessibility\" title=\"Computer accessibility\" rel=\"external_link\" target=\"_blank\">Computer accessibility<\/a><\/div>\n<p>In human\u2013computer interaction, computer accessibility (also known as accessible computing) refers to the accessibility of a computer system to all people, regardless of disability or severity of impairment, examples include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Web_accessibility\" title=\"Web accessibility\" rel=\"external_link\" target=\"_blank\">web accessibility<\/a> guidelines.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Another approach is for the user to present a token to the computer terminal, such as a smart card, that has configuration information to adjust the computer speed, text size, etc. to their particular needs. This is useful where users want to access public computer based terminals in Libraries, ATM, Information kiosks etc. The concept is encompassed by the CEN EN 1332-4 Identification Card Systems - Man-Machine Interface.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> This development of this standard has been supported in Europe by <a href=\"https:\/\/en.wikipedia.org\/wiki\/SNAPI\" title=\"SNAPI\" rel=\"external_link\" target=\"_blank\">SNAPI<\/a> and has been successfully incorporated into the specifications, but with limited success due to the lack of interest from public computer terminal suppliers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hearing_impairments\">Hearing impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_Technology_for_Deaf_and_Hard_of_Hearing\" title=\"Assistive Technology for Deaf and Hard of Hearing\" rel=\"external_link\" target=\"_blank\">Assistive Technology for Deaf and Hard of Hearing<\/a><\/div>\n<p>People in the d\/Deaf and hard of hearing community have a more difficult time receiving auditory information as compared to hearing individuals. These individuals often rely on visual and tactile mediums for receiving and communicating information. The use of assistive technology and devices provides this community with various solutions to auditory communication needs by providing higher sound (for those who are hard of hearing), tactile feedback, visual cues and improved technology access. Individuals who are deaf or hard of hearing utilize a variety of assistive technologies that provide them with different access to information in numerous environments.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Most devices either provide amplified sound or alternate ways to access information through vision and\/or vibration. These technologies can be grouped into three general categories: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_Technology_for_Deaf_and_Hard_of_Hearing#Hearing_Technology\" title=\"Assistive Technology for Deaf and Hard of Hearing\" rel=\"external_link\" target=\"_blank\">Hearing Technology<\/a>, alerting devices, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_Technology_for_Deaf_and_Hard_of_Hearing#Communication_Support\" title=\"Assistive Technology for Deaf and Hard of Hearing\" rel=\"external_link\" target=\"_blank\">communication support<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hearing_aids\">Hearing aids<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_aid\" title=\"Hearing aid\" rel=\"external_link\" target=\"_blank\">Hearing aid<\/a><\/div>\n<p>A hearing aid or deaf aid is an electroacoustic device which is designed to amplify sound for the wearer, usually with the aim of making speech more intelligible, and to correct impaired hearing as measured by audiometry. This type of assistive technology helps people with hearing loss participate more fully in their hearing communities by allowing them to hear more clearly. They amplify any and all sound waves through use of a microphone, amplifier, and speaker. There is a wide variety of hearing aids available, including digital, in-the-ear, in-the-canal, behind-the-ear, and on-the-body aids.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Assistive_listening_devices\">Assistive listening devices<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_listening_device\" title=\"Assistive listening device\" rel=\"external_link\" target=\"_blank\">Assistive listening device<\/a><\/div>\n<p>Assistive listening devices include FM, infrared, and loop assistive listening devices. This type of technology allows people with hearing difficulties to focus on a speaker or subject by getting rid of extra background noises and distractions, making places like auditoriums, classrooms, and meetings much easier to participate in. The assistive listening device usually uses a microphone to capture an audio source near to its origin and broadcast it wirelessly over an FM (Frequency Modulation) transmission, IR (Infra Red) transmission, IL (Induction Loop) transmission, or other transmission methods. The person who is listening may use an FM\/IR\/IL Receiver to tune into the signal and listen at his\/her preferred volume.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Amplified_telephone_equipment\">Amplified telephone equipment<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecommunications_device_for_the_deaf\" title=\"Telecommunications device for the deaf\" rel=\"external_link\" target=\"_blank\">Telecommunications device for the deaf#Other devices for the deaf or hard of hearing<\/a><\/div>\n<p>This type of assistive technology allows users to amplify the volume and clarity of their phone calls so that they can easily partake in this medium of communication. There are also options to adjust the frequency and tone of a call to suit their individual hearing needs. Additionally, there is a wide variety of amplified telephones to choose from, with different degrees of amplification. For example, a phone with 26 to 40 decibel is generally sufficient for mild hearing loss, while a phone with 71 to 90 decibel is better for more severe hearing loss.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Augmentative_and_alternative_communication\">Augmentative and alternative communication<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Augmentative_and_alternative_communication\" title=\"Augmentative and alternative communication\" rel=\"external_link\" target=\"_blank\">Augmentative and alternative communication<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AAC_user_using_eye_gaze.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/AAC_user_using_eye_gaze.JPG\/220px-AAC_user_using_eye_gaze.JPG\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AAC_user_using_eye_gaze.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An AAC user uses number coding on an eye gaze communication board<\/div><\/div><\/div>\n<p><b>Augmentative and alternative communication (AAC)<\/b> is an umbrella term that encompasses methods of communication for those with impairments or restrictions on the production or comprehension of spoken or written language.<sup id=\"rdp-ebb-cite_ref-asha2005_11-0\" class=\"reference\"><a href=\"#cite_note-asha2005-11\" rel=\"external_link\">[11]<\/a><\/sup> AAC systems are extremely diverse and depend on the capabilities of the user. They may be as basic as pictures on a board that are used to request food, drink, or other care; or they can be advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_generating_device\" class=\"mw-redirect\" title=\"Speech generating device\" rel=\"external_link\" target=\"_blank\">speech generating devices<\/a>, based on speech synthesis, that are capable of storing hundreds of phrases and words.<sup id=\"rdp-ebb-cite_ref-GillamMarquardt2000_12-0\" class=\"reference\"><a href=\"#cite_note-GillamMarquardt2000-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cognitive_impairments\">Cognitive impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_orthotics\" title=\"Cognitive orthotics\" rel=\"external_link\" target=\"_blank\">Cognitive orthotics<\/a><\/div>\n<p>Assistive Technology for Cognition (ATC)<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> is the use of technology (usually high tech) to augment and assist cognitive processes such as attention, memory, self-regulation, navigation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emotion_recognition\" title=\"Emotion recognition\" rel=\"external_link\" target=\"_blank\">emotion recognition<\/a> and management, planning, and sequencing activity. Systematic reviews of the field have found that the number of ATC are growing rapidly, but have focused on memory and planning, that there is emerging evidence for efficacy, that a lot of scope exists to develop new ATC.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Examples of ATC include: which prompts users about meetings,<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wakamaru\" title=\"Wakamaru\" rel=\"external_link\" target=\"_blank\">Wakamaru<\/a>, which provides companionship and reminds users to take medicine and calls for help if something is wrong, and telephone Reassurance systems.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Memory_aids\">Memory aids<\/span><\/h3>\n<p>Memory aids are any type of assistive technology that helps a user learn and remember certain information. Many memory aids are used for cognitive impairments such as reading, writing, or organizational difficulties. For example, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_pen\" title=\"Digital pen\" rel=\"external_link\" target=\"_blank\">Smartpen<\/a> records handwritten notes by creating both a digital copy and an audio recording of the text. Users simply tap certain parts of their notes, the pen saves it, and reads it back to them. From there, the user can also download their notes onto a computer for increased accessibility. Digital voice recorders are also used to record \"in the moment\" information for fast and easy recall at a later time.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Educational_software\">Educational software<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Educational_software\" title=\"Educational software\" rel=\"external_link\" target=\"_blank\">Educational software<\/a><\/div>\n<p>Educational software is software that assists people with reading, learning, comprehension, and organizational difficulties. Any accommodation software such as text readers, notetakers, text enlargers, organization tools, word predictions, and talking word processors falls under the category of educational software.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Eating_Impairments\">Eating Impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_eating_devices\" title=\"Assistive eating devices\" rel=\"external_link\" target=\"_blank\">Assistive eating devices<\/a><\/div>\n<p>Adaptive eating devices include items commonly used by the general population like spoons and forks and plates. However they become assistive technology when they are modified to accommodate the needs of people who have difficultly using standard cutlery due to a disabling condition. Common modifications include increasing the size of the utensil handle to make it easier to grasp. Plates and bowls may have a guard on the edge that stops food being pushed off of the dish when it is being scooped. More sophisticated equipment for eating includes manual and powered feeding devices. These devices support those who have little or no hand and arm function and enable them to eat independently.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_sports\">In sports<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NYC_Marathon_wheelchair.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/NYC_Marathon_wheelchair.jpg\/220px-NYC_Marathon_wheelchair.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NYC_Marathon_wheelchair.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_City_Marathon\" title=\"New York City Marathon\" rel=\"external_link\" target=\"_blank\">New York City Marathon<\/a> competitor uses a racing wheelchair<\/div><\/div><\/div>\n<p>Assistive technology in sports is an area of technology design that is growing. Assistive technology is the array of new devices created to enable sports enthusiasts who have disabilities to play. Assistive technology may be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adaptive_sports\" class=\"mw-redirect\" title=\"Adaptive sports\" rel=\"external_link\" target=\"_blank\">adaptive sports<\/a>, where an existing sport is modified to enable players with a disability to participate; or, assistive technology may be used to invent completely new sports with athletes with disabilities exclusively in mind.\n<\/p><p>An increasing number of people with disabilities are participating in sports, leading to the development of new assistive technology.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Assistive technology devices can be simple, or \"low-tech\", or they may use highly advanced technology. \"Low-tech\" devices can include velcro gloves and adaptive bands and tubes. \"High-tech\" devices can include all-terrain wheelchairs and adaptive bicycles.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> Accordingly, assistive technology can be found in sports ranging from local community recreation to the elite <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paralympic_Games\" title=\"Paralympic Games\" rel=\"external_link\" target=\"_blank\">Paralympic Games<\/a>. More complex assistive technology devices have been developed over time, and as a result, sports for people with disabilities \"have changed from being a clinical therapeutic tool to an increasingly competition-oriented activity\".<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_education\">In education<\/span><\/h2>\n<p>In the United States there are two major pieces of legislation that govern the use of assistive technology within the school system. The first is Section 504 of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rehabilitation_Act_of_1973\" title=\"Rehabilitation Act of 1973\" rel=\"external_link\" target=\"_blank\">Rehabilitation Act of 1973<\/a> and the second being the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Individuals_with_Disabilities_Education_Act\" title=\"Individuals with Disabilities Education Act\" rel=\"external_link\" target=\"_blank\">Individuals with Disabilities Education Act<\/a> (IDEA) which was first enacted in 1975 under the name The Education for All Handicapped Children Act. In 2004, during the reauthorization period for IDEA, the National Instructional Material Access Center (NIMAC) was created which provided a repository of accessible text including publisher's textbooks to students with a qualifying disability. Files provided are in XML format and used as a starting platform for braille readers, screen readers, and other digital text software.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> IDEA defines assistive technology as follows: \"any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. (B) Exception.--The term does not include a medical device that is surgically implanted, or the replacement of such device.\"<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Assistive technology in this area is broken down into low, mid, and high tech categories. Low tech encompasses equipment that is often low cost and does not include batteries or requires charging. Examples include adapted paper and pencil grips for writing or masks and color overlays for reading. Mid tech supports used in the school setting include the use of handheld spelling dictionaries and portable word processors used to keyboard writing. High tech supports involve the use of tablet devices and computers with accompanying software. Software supports for writing include the use of auditory feedback while keyboarding, word prediction for spelling, and speech to text. Supports for reading include the use of text to speech (TTS) software and font modification via access to digital text. Limited supports are available for math instruction and mostly consist of grid based software to allow younger students to keyboard equations and auditory feedback of more complex equations using MathML and Daisy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Computer_accessibility\">Computer accessibility<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_accessibility\" title=\"Computer accessibility\" rel=\"external_link\" target=\"_blank\">Computer accessibility<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sip-and-puff_device.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/05\/Sip-and-puff_device.jpg\/220px-Sip-and-puff_device.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sip-and-puff_device.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sip-and-puff\" title=\"Sip-and-puff\" rel=\"external_link\" target=\"_blank\">sip-and-puff<\/a> device which allows a person with substantial disability to make selections and navigate computerized interfaces by controlling inhalations and exhalations<\/div><\/div><\/div>\n<p>One of the largest problems that affect people with disabilities is discomfort with prostheses.<sup id=\"rdp-ebb-cite_ref-hussein_23-0\" class=\"reference\"><a href=\"#cite_note-hussein-23\" rel=\"external_link\">[23]<\/a><\/sup> An experiment performed in Massachusetts utilized 20 people with various sensors attached to their arms.<sup id=\"rdp-ebb-cite_ref-hussein_23-1\" class=\"reference\"><a href=\"#cite_note-hussein-23\" rel=\"external_link\">[23]<\/a><\/sup> The subjects tried different arm exercises, and the sensors recorded their movements. All of the data helped engineers develop new engineering concepts for prosthetics.<sup id=\"rdp-ebb-cite_ref-hussein_23-2\" class=\"reference\"><a href=\"#cite_note-hussein-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>Assistive technology may attempt to improve the ergonomics of the devices themselves such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dvorak_Simplified_Keyboard\" title=\"Dvorak Simplified Keyboard\" rel=\"external_link\" target=\"_blank\">Dvorak<\/a> and other alternative keyboard layouts, which offer more ergonomic layouts of the keys.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<p>Assistive technology devices have been created to enable people with disabilities to use modern touch screen mobile computers such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPad\" title=\"IPad\" rel=\"external_link\" target=\"_blank\">iPad<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPhone\" title=\"IPhone\" rel=\"external_link\" target=\"_blank\">iPhone<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPod_touch\" class=\"mw-redirect\" title=\"IPod touch\" rel=\"external_link\" target=\"_blank\">iPod touch<\/a>. The Pererro is a plug and play adapter for <a href=\"https:\/\/en.wikipedia.org\/wiki\/IOS\" title=\"IOS\" rel=\"external_link\" target=\"_blank\">iOS<\/a> devices which uses the built in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apple_VoiceOver\" class=\"mw-redirect\" title=\"Apple VoiceOver\" rel=\"external_link\" target=\"_blank\">Apple VoiceOver<\/a> feature in combination with a basic switch. This brings touch screen technology to those who were previously unable to use it. Apple, with the release of iOS 7 had introduced the ability to navigate apps using switch control. Switch access could be activated either through an external bluetooth connected switch, single touch of the screen, or use of right and left head turns using the device's camera. Additional accessibility features include the use of Assistive Touch which allows a user to access multi-touch gestures through pre-programmed onscreen buttons.\n<\/p>\n<\/p><p>For users with physical disabilities a large variety of switches are available and customizable to the user's needs varying in size, shape, or amount of pressure required for activation. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Switch_access\" title=\"Switch access\" rel=\"external_link\" target=\"_blank\">Switch access<\/a> may be placed near any area of the body which has consistent and reliable mobility and less subject to fatigue. Common sites include the hands, head, and feet. Eye gaze and head mouse systems can also be used as an alternative mouse navigation. A user may utilize single or multiple switch sites and the process often involves a scanning through items on a screen and activating the switch once the desired object is highlighted.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Home_automation\">Home automation<\/span><\/h2>\n<p>The form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Home_automation\" title=\"Home automation\" rel=\"external_link\" target=\"_blank\">home automation<\/a> called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_domotics\" class=\"mw-redirect\" title=\"Assistive domotics\" rel=\"external_link\" target=\"_blank\">assistive domotics<\/a> focuses on making it possible for elderly and disabled people to live independently. Home automation is becoming a viable option for the elderly and disabled who would prefer to stay in their own homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards elderly and disabled users. For example, automated prompts and reminders utilize motion sensors and pre-recorded audio messages; an automated prompt in the kitchen may remind the resident to turn off the oven, and one by the front door may remind the resident to lock the door.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Impacts\">Impacts<\/span><\/h2>\n<p>Overall, assistive technology aims to allow people with disabilities to \"participate more fully in all aspects of life (home, school, and community)\" and increases their opportunities for \"education, social interactions, and potential for meaningful employment\".<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> It creates greater independence and control for disabled individuals. For example, in one study of 1,342 infants, toddlers and preschoolers, all with some kind of developmental, physical, sensory, or cognitive disability, the use of assistive technology created improvements in child development.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> These included improvements in \"cognitive, social, communication, literacy, motor, adaptive, and increases in engagement in learning activities\".<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> Additionally, it has been found to lighten caregiver load.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Both family and professional caregivers benefit from assistive technology. Through its use, the time that a family member or friend would need to care for a patient significantly decreases. However, studies show that care time for a professional caregiver increases when assistive technology is used. Nonetheless, their work load is significantly easier as the assistive technology frees them of having to perform certain tasks.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> There are several platforms that use machine learning to identify the appropriate assistive device to suggest to patients, making assistive devices more accessible.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 20em; -webkit-column-width: 20em; column-width: 20em; font-size:90%;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Accessibility\" title=\"Accessibility\" rel=\"external_link\" target=\"_blank\">Accessibility<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Assisted_Living\" class=\"mw-redirect\" title=\"Assisted Living\" rel=\"external_link\" target=\"_blank\">Assisted Living<\/a><\/li>\n<li><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Augmentative_and_alternative_communication\" title=\"Augmentative and alternative communication\" rel=\"external_link\" target=\"_blank\">Augmentative and alternative communication<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Braille_technology\" title=\"Braille technology\" rel=\"external_link\" target=\"_blank\">Braille technology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Design_for_All_(in_ICT)\" title=\"Design for All (in ICT)\" rel=\"external_link\" target=\"_blank\">Design for All (in ICT)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Durable_medical_equipment\" title=\"Durable medical equipment\" rel=\"external_link\" target=\"_blank\">Durable medical equipment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Matching_Person_%26_Technology_Model\" class=\"mw-redirect\" title=\"Matching Person & Technology Model\" rel=\"external_link\" target=\"_blank\">Matching Person & Technology Model<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/OATS\" title=\"OATS\" rel=\"external_link\" target=\"_blank\">OATS<\/a>: Open Source Assistive Technology Software<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_Therapy\" class=\"mw-redirect\" title=\"Occupational Therapy\" rel=\"external_link\" target=\"_blank\">Occupational Therapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transgenerational_design\" title=\"Transgenerational design\" rel=\"external_link\" target=\"_blank\">Transgenerational design<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Universal_access_to_education\" title=\"Universal access to education\" rel=\"external_link\" target=\"_blank\">Universal access to education<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<dl><dt>Source<\/dt><\/dl>\n<ul><li><span id=\"rdp-ebb-refASHA2005\" class=\"citation\"><cite class=\"citation web\">American Speech-Language-Hearing Association. (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090213100431\/http:\/\/asha.org\/docs\/html\/PS2005-00113.html\" target=\"_blank\">\"Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Position Statement\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.asha.org\/docs\/html\/PS2005-00113.html\" target=\"_blank\">the original<\/a> on February 13, 2009<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 23,<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Roles+and+Responsibilities+of+Speech-Language+Pathologists+With+Respect+to+Augmentative+and+Alternative+Communication%3A+Position+Statement&rft.date=2005&rft.au=American+Speech-Language-Hearing+Association.&rft_id=http%3A%2F%2Fwww.asha.org%2Fdocs%2Fhtml%2FPS2005-00113.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><\/span><\/li>\n<li><span id=\"rdp-ebb-refGlennenDeCoste\" class=\"citation\"><cite class=\"citation book\">DeCoste, Denise C. (1997). \"Chapter 10: Introduction to Augmentative and Alternative Communication Systems\". In Glennen, Sharon; DeCoste, Denise C. <i>Handbook Of Augmentative And Alternative Communication<\/i>. San Diego, CA: Singular Publishing Group. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-56593-684-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+10%3A+Introduction+to+Augmentative+and+Alternative+Communication+Systems&rft.btitle=Handbook+Of+Augmentative+And+Alternative+Communication&rft.place=San+Diego%2C+CA&rft.pub=Singular+Publishing+Group&rft.date=1997&rft.isbn=1-56593-684-1&rft.aulast=DeCoste&rft.aufirst=Denise+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refSchlosserWendt\" class=\"citation\"><cite class=\"citation journal\">Schlosser, R. W.; Wendt, O. (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/23133712\" target=\"_blank\">\"Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review\"<\/a>. <i>American Journal of Speech-Language Pathology<\/i>. <b>17<\/b> (3): 212\u2013230. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1044%2F1058-0360%282008%2F021%29\" target=\"_blank\">10.1044\/1058-0360(2008\/021)<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18663107\" target=\"_blank\">18663107<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Speech-Language+Pathology&rft.atitle=Effects+of+augmentative+and+alternative+communication+intervention+on+speech+production+in+children+with+autism%3A+a+systematic+review&rft.volume=17&rft.issue=3&rft.pages=212-230&rft.date=2008&rft_id=info%3Adoi%2F10.1044%2F1058-0360%282008%2F021%29&rft_id=info%3Apmid%2F18663107&rft.au=Schlosser%2C+R.+W.&rft.au=Wendt%2C+O.&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F23133712&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refBeukelmanMirenda\" class=\"citation\"><cite class=\"citation book\">Beukelman, David R.; Mirenda, Pat (2005). <i>Augmentative & alternative communication: supporting children & adults with complex communication needs<\/i> (3rd ed.). Paul H. Brookes Publishing Company. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-55766-684-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Augmentative+%26+alternative+communication%3A+supporting+children+%26+adults+with+complex+communication+needs&rft.edition=3rd&rft.pub=Paul+H.+Brookes+Publishing+Company&rft.date=2005&rft.isbn=978-1-55766-684-0&rft.au=Beukelman%2C+David+R.&rft.au=Mirenda%2C+Pat&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refGalv\u00e3o_Filho2009\" class=\"citation\"><cite class=\"citation journal\">Galv\u00e3o Filho, T. (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.galvaofilho.net\/tese.htm\" target=\"_blank\">\"Tecnologia Assistiva para uma Escola Inclusiva: apropria\u00e7\u00e3o, demandas e perspectivas. Tese (Doutorado em Educa\u00e7\u00e3o) \u2013 Faculdade de Educa\u00e7\u00e3o, Universidade Federal da Bahia, Salvador, Brazil\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Tecnologia+Assistiva+para+uma+Escola+Inclusiva%3A+apropria%C3%A7%C3%A3o%2C+demandas+e+perspectivas.+Tese+%28Doutorado+em+Educa%C3%A7%C3%A3o%29+%E2%80%93+Faculdade+de+Educa%C3%A7%C3%A3o%2C+Universidade+Federal+da+Bahia%2C+Salvador%2C+Brazil&rft.date=2009&rft.aulast=Galv%C3%A3o+Filho&rft.aufirst=T.&rft_id=http%3A%2F%2Fwww.galvaofilho.net%2Ftese.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refMirenda2003\" class=\"citation\"><cite class=\"citation journal\">Mirenda, P. (2003). \"Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids\". <i>Language, Speech, & Hearing Services in Schools<\/i>. <b>34<\/b> (3): 203\u2013216. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1044%2F0161-1461%282003%2F017%29\" target=\"_blank\">10.1044\/0161-1461(2003\/017)<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Language%2C+Speech%2C+%26+Hearing+Services+in+Schools&rft.atitle=Toward+Functional+Augmentative+and+Alternative+Communication+for+Students+With+Autism%3A+Manual+Signs%2C+Graphic+Symbols%2C+and+Voice+Output+Communication+Aids&rft.volume=34&rft.issue=3&rft.pages=203-216&rft.date=2003&rft_id=info%3Adoi%2F10.1044%2F0161-1461%282003%2F017%29&rft.aulast=Mirenda&rft.aufirst=P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refMathy2000\" class=\"citation\"><cite class=\"citation book\">Mathy; Yorkston, K.; Guttman (2000). \"Augmentative Communication for Individuals with Amyotrophic Lateral Sclerosis\". In Beukelman, D.; Yorkston, K.; Reichle, J. <i>Augmentative and Alternative Communication Disorders for Adults with Acquired Neurologic Disorders<\/i>. Baltimore: P. H. Brookes Pub. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-55766-473-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Augmentative+Communication+for+Individuals+with+Amyotrophic+Lateral+Sclerosis&rft.btitle=Augmentative+and+Alternative+Communication+Disorders+for+Adults+with+Acquired+Neurologic+Disorders&rft.place=Baltimore&rft.pub=P.+H.+Brookes+Pub.&rft.date=2000&rft.isbn=978-1-55766-473-0&rft.au=Mathy&rft.au=Yorkston%2C+K.&rft.au=Guttman&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refJansClark\" class=\"citation\"><cite class=\"citation book\">Jans, Deborah; Clark, Sue (1998). \"Chapter 6: High Technology Aids to Communication\". In Wilson, Allan. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.callscotland.org.uk\/Resources\/Books\/Augmentative-Communication-in-Practice\/\" target=\"_blank\"><i>Augmentative Communication in Practice: An Introduction<\/i><\/a>. University of Edinburgh. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-898042-15-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+6%3A+High+Technology+Aids+to+Communication&rft.btitle=Augmentative+Communication+in+Practice%3A+An+Introduction&rft.pub=University+of+Edinburgh&rft.date=1998&rft.isbn=978-1-898042-15-0&rft.au=Jans%2C+Deborah&rft.au=Clark%2C+Sue&rft_id=http%3A%2F%2Fwww.callscotland.org.uk%2FResources%2FBooks%2FAugmentative-Communication-in-Practice%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refParetteEtal2000\" class=\"citation\"><cite class=\"citation journal\">Parette, H. P.; Brotherson, M. J; Huer, M. B. (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/psycnet.apa.org\/psycinfo\/2001-17960-006\" target=\"_blank\">\"Giving families a voice in augmentative and alternative communication decision-making\"<\/a>. <i>Education and Training in Mental Retardation and Developmental Disabilities<\/i>. <b>35<\/b>: 177\u2013190.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Education+and+Training+in+Mental+Retardation+and+Developmental+Disabilities&rft.atitle=Giving+families+a+voice+in+augmentative+and+alternative+communication+decision-making&rft.volume=35&rft.pages=177-190&rft.date=2000&rft.aulast=Parette&rft.aufirst=H.+P.&rft.au=Brotherson%2C+M.+J&rft.au=Huer%2C+M.+B.&rft_id=http%3A%2F%2Fpsycnet.apa.org%2Fpsycinfo%2F2001-17960-006&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li><\/ul>\n<dl><dt>Notes<\/dt><\/dl>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Parant, Aymeric; Schiano-Lomoriello, Sandrine; Marchan, Francis (October 2017). \"How would I live with a disability? Expectations of bio-psychosocial consequences and assistive technology use\". <i>Disability and Rehabilitation. Assistive Technology<\/i>. <b>12<\/b> (7): 681\u2013685. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F17483107.2016.1218555\" target=\"_blank\">10.1080\/17483107.2016.1218555<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1748-3115\" target=\"_blank\">1748-3115<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27677931\" target=\"_blank\">27677931<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Disability+and+Rehabilitation.+Assistive+Technology&rft.atitle=How+would+I+live+with+a+disability%3F+Expectations+of+bio-psychosocial+consequences+and+assistive+technology+use&rft.volume=12&rft.issue=7&rft.pages=681-685&rft.date=2017-10&rft.issn=1748-3115&rft_id=info%3Apmid%2F27677931&rft_id=info%3Adoi%2F10.1080%2F17483107.2016.1218555&rft.aulast=Parant&rft.aufirst=Aymeric&rft.au=Schiano-Lomoriello%2C+Sandrine&rft.au=Marchan%2C+Francis&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/section508.gov\/assistive-technology-act-1998\" target=\"_blank\">\"Assistive Technology Act of 1998 | Section508.gov\"<\/a>. <i>section508.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-04-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=section508.gov&rft.atitle=Assistive+Technology+Act+of+1998+%7C+Section508.gov&rft_id=http%3A%2F%2Fsection508.gov%2Fassistive-technology-act-1998&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/glencoe.mcgraw-hill.com\/sites\/dl\/free\/0078901359\/594902\/AAT_v4.pdf\" target=\"_blank\">\"Tennessee Science Standards\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. 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Universitat Polit\u00e8cnica de Catalunya. 2012<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Pardes, Arielle. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/story\/wearables-for-the-blind\/\" target=\"_blank\">\"The Wearables Giving Computer Vision to the Blind\"<\/a>. <i>Wired<\/i>. Wired<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 September<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Wired&rft.atitle=The+Wearables+Giving+Computer+Vision+to+the+Blind&rft.aulast=Pardes&rft.aufirst=Arielle&rft_id=https%3A%2F%2Fwww.wired.com%2Fstory%2Fwearables-for-the-blind%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.learningdisabilities.org.uk\/page.cfm?pagecode=ISSIWD\" target=\"_blank\">Web accessibility guidelines<\/a><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cen.eu\/cen\/Sectors\/TechnicalCommitteesWorkshops\/CENTechnicalCommittees\/Pages\/TCStruc.aspx?param=6205&title=Personal%20identification,%20electronic%20signature%20and%20cards%20and%20their%20related%20systems%20and%20operations\" target=\"_blank\">CEN EN 1332-4 Identification Card Systems - Man-Machine Interface<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wati.org\/content\/supports\/free\/pdf\/Ch13-Hearing.pdf\" target=\"_blank\">\"Assistive Technology for Individuals who are Deaf or Hard of Hearing\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. 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(2004). Assistive Technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation, 14, 5-39.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gillespie, A., Best, C. & O'Neill, B. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/lse.academia.edu\/AlexGillespie\/Papers\/1347581\/Cognitive_function_and_assistive_technology_for_cognition_A_systematic_review\" target=\"_blank\">Cognitive function and Assistive Technology for cognition: A systematic review<\/a>. Journal of the International Neuropsychological Society, 18, 1-19.<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Wilson, et al. (1997). Evaluation of NeuroPage: A new memory aid. 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(1988). \"An enhanced standard computer keyboard system for single-finger and typing-stick typing\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Rehabilitation_Research_and_Development\" title=\"Journal of Rehabilitation Research and Development\" rel=\"external_link\" target=\"_blank\">Journal of Rehabilitation Research and Development<\/a><\/i>. <b>25<\/b> (4): 17\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2973523\" target=\"_blank\">2973523<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Rehabilitation+Research+and+Development&rft.atitle=An+enhanced+standard+computer+keyboard+system+for+single-finger+and+typing-stick+typing&rft.volume=25&rft.issue=4&rft.pages=17-24&rft.date=1988&rft_id=info%3Apmid%2F2973523&rft.au=Chubon%2C+R.A.&rft.au=Hester%2C+M.R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anson, D.; George, S.; Galup, R.; Shea, B.; Vetter, R. (2001). \"Efficiency of the Chubon versus the QWERTY keyboard\". <i>Assistive-Technology<\/i>. <b>13<\/b> (1): 40\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F10400435.2001.10132032\" target=\"_blank\">10.1080\/10400435.2001.10132032<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12212435\" target=\"_blank\">12212435<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Assistive-Technology&rft.atitle=Efficiency+of+the+Chubon+versus+the+QWERTY+keyboard&rft.volume=13&rft.issue=1&rft.pages=40-5&rft.date=2001&rft_id=info%3Adoi%2F10.1080%2F10400435.2001.10132032&rft_id=info%3Apmid%2F12212435&rft.au=Anson%2C+D.&rft.au=George%2C+S.&rft.au=Galup%2C+R.&rft.au=Shea%2C+B.&rft.au=Vetter%2C+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Judd, Natasha. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.alzheimers.org.uk\/site\/scripts\/documents_info.php?documentID=109\" target=\"_blank\">\"Assistive technology - devices to help with everyday living\"<\/a>. <i>www.alzheimers.org.uk<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-11-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.alzheimers.org.uk&rft.atitle=Assistive+technology+-+devices+to+help+with+everyday+living&rft.aulast=Judd&rft.aufirst=Natasha&rft_id=https%3A%2F%2Fwww.alzheimers.org.uk%2Fsite%2Fscripts%2Fdocuments_info.php%3FdocumentID%3D109&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.parentcenterhub.org\/repository\/considering-at\/\" target=\"_blank\">\"Considering Assistive Technology | Center for Parent Information and Resources\"<\/a>. <i>www.parentcenterhub.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-11-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.parentcenterhub.org&rft.atitle=Considering+Assistive+Technology+%7C+Center+for+Parent+Information+and+Resources&rft_id=http%3A%2F%2Fwww.parentcenterhub.org%2Frepository%2Fconsidering-at%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Desch, Larry W.; Gaebler-Spira, Deborah (2008-06-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pediatrics.aappublications.org\/content\/121\/6\/1271\" target=\"_blank\">\"Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication\"<\/a>. <i>Pediatrics<\/i>. <b>121<\/b> (6): 1271\u20131280. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1542%2Fpeds.2008-0695\" target=\"_blank\">10.1542\/peds.2008-0695<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0031-4005\" target=\"_blank\">0031-4005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18519500\" target=\"_blank\">18519500<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=Prescribing+Assistive-Technology+Systems%3A+Focus+on+Children+With+Impaired+Communication&rft.volume=121&rft.issue=6&rft.pages=1271-1280&rft.date=2008-06-01&rft.issn=0031-4005&rft_id=info%3Apmid%2F18519500&rft_id=info%3Adoi%2F10.1542%2Fpeds.2008-0695&rft.aulast=Desch&rft.aufirst=Larry+W.&rft.au=Gaebler-Spira%2C+Deborah&rft_id=http%3A%2F%2Fpediatrics.aappublications.org%2Fcontent%2F121%2F6%2F1271&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Dunst, Trivette; Hamby, Simkus (August 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/community.fpg.unc.edu\/sites\/community.fpg.unc.edu\/files\/resources\/Handout\/CONNECT-Handout-5-1.pdf\" target=\"_blank\">\"Research Summary on Assistive Technology Interventions\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Community<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 November<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Community&rft.atitle=Research+Summary+on+Assistive+Technology+Interventions&rft.date=2013-08&rft.au=Dunst%2C+Trivette&rft.au=Hamby%2C+Simkus&rft_id=http%3A%2F%2Fcommunity.fpg.unc.edu%2Fsites%2Fcommunity.fpg.unc.edu%2Ffiles%2Fresources%2FHandout%2FCONNECT-Handout-5-1.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nicolson, Amy; Moir, Lois; Millsteed, Jeannine (22 March 2012). \"Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Disability_and_Rehabilitation:_Assistive_Technology\" title=\"Disability and Rehabilitation: Assistive Technology\" rel=\"external_link\" target=\"_blank\">Disability and Rehabilitation: Assistive Technology<\/a><\/i>. <b>7<\/b> (5): 345\u2013349. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17483107.2012.667194\" target=\"_blank\">10.3109\/17483107.2012.667194<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Disability+and+Rehabilitation%3A+Assistive+Technology&rft.atitle=Impact+of+assistive+technology+on+family+caregivers+of+children+with+physical+disabilities%3A+a+systematic+review&rft.volume=7&rft.issue=5&rft.pages=345-349&rft.date=2012-03-22&rft_id=info%3Adoi%2F10.3109%2F17483107.2012.667194&rft.aulast=Nicolson&rft.aufirst=Amy&rft.au=Moir%2C+Lois&rft.au=Millsteed%2C+Jeannine&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anderson, Wayne L.; Wiener, Joshua M. (2015-06-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/academic.oup.com\/gerontologist\/article\/588347\/The\" target=\"_blank\">\"The Impact of Assistive Technologies on Formal and Informal Home Care\"<\/a>. <i>The Gerontologist<\/i>. <b>55<\/b> (3): 422\u2013433. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fgeront%2Fgnt165\" target=\"_blank\">10.1093\/geront\/gnt165<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0016-9013\" target=\"_blank\">0016-9013<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Gerontologist&rft.atitle=The+Impact+of+Assistive+Technologies+on+Formal+and+Informal+Home+Care&rft.volume=55&rft.issue=3&rft.pages=422-433&rft.date=2015-06-01&rft_id=info%3Adoi%2F10.1093%2Fgeront%2Fgnt165&rft.issn=0016-9013&rft.aulast=Anderson&rft.aufirst=Wayne+L.&rft.au=Wiener%2C+Joshua+M.&rft_id=https%3A%2F%2Facademic.oup.com%2Fgerontologist%2Farticle%2F588347%2FThe&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.atvisor.ai\/\" target=\"_blank\">https:\/\/www.atvisor.ai\/<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181211204418\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.580 seconds\nReal time usage: 0.707 seconds\nPreprocessor visited node count: 2115\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 91343\/2097152 bytes\nTemplate argument size: 559\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 76893\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.345\/10.000 seconds\nLua memory usage: 5.58 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 574.594 1 -total\n<\/p>\n<pre>31.50% 180.995 1 Template:Reflist\n27.88% 160.217 14 Template:Cite_web\n16.63% 95.539 11 Template:Cite_journal\n15.63% 89.786 1 Template:Commons_category\n13.69% 78.664 1 Template:Commons\n13.28% 76.309 1 Template:Sister_project\n12.71% 73.007 1 Template:Side_box\n10.99% 63.125 2 Template:If_then_show\n 6.64% 38.177 1 Template:Authority_control\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:653-1!canonical and timestamp 20181211204418 and revision id 871292764\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_technology\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214708\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.883 1 - wikipedia:Assistive_technology\n100.00% 156.883 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8573-0!*!*!*!*!*!* and timestamp 20181217214708 and revision id 25001\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Assistive_technology\">https:\/\/www.limswiki.org\/index.php\/Assistive_technology<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","66f165c46927036533e0a0dd6571a8b1_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Hoergeraet_analog_050609.jpg\/440px-Hoergeraet_analog_050609.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/f9\/English_braille_sample.jpg\/440px-English_braille_sample.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/MAGic_Large_Print_Keyboard.jpg\/440px-MAGic_Large_Print_Keyboard.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/0e\/Head-wand.jpg\/440px-Head-wand.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/AAC_user_using_eye_gaze.JPG\/440px-AAC_user_using_eye_gaze.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/NYC_Marathon_wheelchair.jpg\/440px-NYC_Marathon_wheelchair.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/05\/Sip-and-puff_device.jpg\/440px-Sip-and-puff_device.jpg"],"66f165c46927036533e0a0dd6571a8b1_timestamp":1545083228,"a0550ad91421c65fcff8f1e3ca9b41d9_type":"article","a0550ad91421c65fcff8f1e3ca9b41d9_title":"Adverse event","a0550ad91421c65fcff8f1e3ca9b41d9_url":"https:\/\/www.limswiki.org\/index.php\/Adverse_event","a0550ad91421c65fcff8f1e3ca9b41d9_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAdverse event\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor the House episode, see Adverse Events.\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2013) (Learn how and when to remove this template message)\nAn adverse event (AE) is any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. An adverse event (AE) can therefore be any unfavourable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product.[1]\nAEs in patients participating in clinical trials must be reported to the study sponsor and if required could be reported to local ethics committee . Adverse events categorized as \"serious\" ( results in death, illness requiring hospitalization, events deemed life-threatening, results in persistent or significant disability\/incapacity, a congenital anomaly\/birth defect or medically important condition) must be reported to the regulatory authorities immediately, whereas non-serious adverse events are merely documented in the annual summary sent to the regulatory authority.\nThe sponsor collects AE reports from the local researchers, and notifies all participating sites of the AEs at the other sites, as well as both the local investigators' and the sponsors' judgment of the seriousness of the AEs. This process allows the sponsor and all the local investigators access to a set of data that might suggest potential problems with the study treatment while the study is still ongoing.\n\nContents \n\n1 Types of adverse events \n2 Reporting of adverse events \n3 Grades of AE \n4 Database of adverse events \n5 See also \n6 References \n7 External links \n\n\nTypes of adverse events \nAll clinical trials have the potential to produce AEs. AEs are classified as serious or non-serious; expected or unexpected; and study-related, possibly study-related, or not study-related.\nFor example, while a study that tests the effectiveness of a new blood pressure cuff for a period of 10 minutes might seem innocuous, the potential exists for the patient's skin to be irritated by the device. Patients in that study might also die during that 10-minute period. Both skin irritation and sudden death would be considered AEs. In this case, the skin irritation would be classified as not serious, unexpected, and possibly study-related. The death would be classified as serious and unexpected (unless the patient was already at death's door). The local researcher would use his\/her medical judgment to determine whether the death could have been related to the study device.\nBoth the skin irritation and the death are unexpected events, and should alert the researcher to the potential existence of a problem with the device (for instance, it could have malfunctioned and shocked the patient). The researcher would report these AEs to the local Institutional Review Board and to the sponsor, and await direction on whether to stop the study. If the researcher feels there is an imminent danger posed by the device, he or she can use medical discretion to stop patients from participating in the study.\nAn adverse event can also be declared in the normal treatment of a patient which is suspected of being caused by the medication being taken or a medical device used in the treatment of the patient.\nIn Australia, 'Adverse EVENT' refers generically to medical errors of all kinds, surgical, medical or nursing related. The most recent available official study (1995) indicated 18,000 deaths per year are a result of hospital care. The Medical Error Action Group is lobbying for legislation to improve the reporting of AEs and through quality control, minimize the needless deaths.\n\nReporting of adverse events \nMain article: Monitoring in clinical trials\nResearchers participating in a clinical trial must report all adverse events to the drug regulatory authority of the respective country where the drug or device is to be registered [e.g. Food and Drug Administration (FDA) if it is US]. Serious AEs must be reported immediately; minor AEs are 'bundled' by the sponsor and submitted later.\n\nGrades of AE \nClinical trial results often report the number of grade 3 and grade 4 adverse events.\nGrades are defined:[2]\n\nGrade 1 Mild AE\nGrade 2 Moderate AE\nGrade 3 Severe AE\nGrade 4 Life-threatening or disabling AE\nGrade 5 Death related to AE\nDatabase of adverse events \nThe examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (July 2018) (Learn how and when to remove this template message)\nThe FDA provides a database for reporting of adverse events called the Manufacturer and User Facility Device Experience Database (MAUDE)[1]. The data consist of voluntary reports since June 1993, user facility reports since 1991, distributor reports since 1993, and manufacturer reports since August 1996, and is open for public view. Two private companies have also recently started providing access to analyzed adverse event information: Clarimed provides adverse event information for medical devices and AdverseEvents provides adverse event data for drugs.\n\nSee also \n\nClinical trial\nGood clinical practice (GCP)\nData monitoring committees\nSerious adverse event\nAdverse effect\nAdverse drug reaction\nPharmacovigilance\nEudraVigilance (European Union AE reporting and evaluating network)\nClinical Trials Directive (Directive 2001\/20\/EC by European Union)\nAdverse Event Reporting System\nYellow Card Scheme\n\nReferences \n\n\n^ ICH GCP \n\n^ Common Terminology Criteria for Adverse Events \n\n\nExternal links \nClinicalTrials.gov from US National Library of Medicine\nICH Website\nFDA Website\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Adverse_event\">https:\/\/www.limswiki.org\/index.php\/Adverse_event<\/a>\n\t\t\t\t\tCategory: Healthcare termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 467 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a0550ad91421c65fcff8f1e3ca9b41d9_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Adverse_event skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Adverse event<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For the House episode, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_Events\" title=\"Adverse Events\" rel=\"external_link\" target=\"_blank\">Adverse Events<\/a>.<\/div>\n\n<p>An <b>adverse event<\/b> (<b>AE<\/b>) is any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. An adverse event (AE) can therefore be any unfavourable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>AEs in patients participating in clinical trials must be reported to the study sponsor and if required could be reported to local ethics committee . Adverse events categorized as \"serious\" ( results in death, illness requiring hospitalization, events deemed life-threatening, results in persistent or significant disability\/incapacity, a congenital anomaly\/birth defect or medically important condition) must be reported to the regulatory authorities immediately, whereas non-serious adverse events are merely documented in the annual summary sent to the regulatory authority.\n<\/p><p>The sponsor collects AE reports from the local researchers, and notifies all participating sites of the AEs at the other sites, as well as both the local investigators' and the sponsors' judgment of the seriousness of the AEs. This process allows the sponsor and all the local investigators access to a set of data that might suggest potential problems with the study treatment while the study is still ongoing.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_adverse_events\">Types of adverse events<\/span><\/h2>\n<p>All clinical trials have the potential to produce AEs. AEs are classified as serious or non-serious; expected or unexpected; and study-related, possibly study-related, or not study-related.\n<\/p><p>For example, while a study that tests the effectiveness of a new blood pressure cuff for a period of 10 minutes might seem innocuous, the potential exists for the patient's skin to be irritated by the device. Patients in that study might also die during that 10-minute period. Both skin irritation and sudden death would be considered AEs. In this case, the skin irritation would be classified as not serious, unexpected, and possibly study-related. The death would be classified as serious and unexpected (unless the patient was already at death's door). The local researcher would use his\/her medical judgment to determine whether the death could have been related to the study device.\n<\/p><p>Both the skin irritation and the death are unexpected events, and should alert the researcher to the potential existence of a problem with the device (for instance, it could have malfunctioned and shocked the patient). The researcher would report these AEs to the local <a href=\"https:\/\/en.wikipedia.org\/wiki\/Institutional_Review_Board\" class=\"mw-redirect\" title=\"Institutional Review Board\" rel=\"external_link\" target=\"_blank\">Institutional Review Board<\/a> and to the sponsor, and await direction on whether to stop the study. If the researcher feels there is an imminent danger posed by the device, he or she can use medical discretion to stop patients from participating in the study.\n<\/p><p>An adverse event can also be declared in the normal treatment of a patient which is suspected of being caused by the medication being taken or a medical device used in the treatment of the patient.\n<\/p><p>In Australia, 'Adverse EVENT' refers generically to medical errors of all kinds, surgical, medical or nursing related. The most recent available official study (1995) indicated 18,000 deaths per year are a result of hospital care. The Medical Error Action Group is lobbying for legislation to improve the reporting of AEs and through quality control, minimize the needless deaths.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Reporting_of_adverse_events\">Reporting of adverse events<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_in_clinical_trials\" title=\"Monitoring in clinical trials\" rel=\"external_link\" target=\"_blank\">Monitoring in clinical trials<\/a><\/div>\n<p>Researchers participating in a clinical trial must report all adverse events to the drug regulatory authority of the respective country where the drug or device is to be registered [e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) if it is US]. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Serious_adverse_event\" title=\"Serious adverse event\" rel=\"external_link\" target=\"_blank\">Serious AEs<\/a> must be reported immediately; minor AEs are 'bundled' by the sponsor and submitted later.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Grades_of_AE\">Grades of AE<\/span><\/h2>\n<p>Clinical trial results often report the number of grade 3 and grade 4 adverse events.\nGrades are defined:<sup id=\"rdp-ebb-cite_ref-ctcaev_2-0\" class=\"reference\"><a href=\"#cite_note-ctcaev-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<ul><li>Grade 1 Mild AE<\/li>\n<li>Grade 2 Moderate AE<\/li>\n<li>Grade 3 Severe AE<\/li>\n<li>Grade 4 Life-threatening or disabling AE<\/li>\n<li>Grade 5 Death related to AE<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Database_of_adverse_events\">Database of adverse events<\/span><\/h2>\n\n<p>The FDA provides a database for reporting of adverse events called the <i>Manufacturer and User Facility Device Experience Database<\/i> (MAUDE)[1]. The data consist of voluntary reports since June 1993, user facility reports since 1991, distributor reports since 1993, and manufacturer reports since August 1996, and is open for public view. Two private companies have also recently started providing access to analyzed adverse event information: Clarimed provides adverse event information for medical devices and AdverseEvents provides adverse event data for drugs.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trial\" title=\"Clinical trial\" rel=\"external_link\" target=\"_blank\">Clinical trial<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Good_clinical_practice\" title=\"Good clinical practice\" rel=\"external_link\" target=\"_blank\">Good clinical practice<\/a> (GCP)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_monitoring_committee\" title=\"Data monitoring committee\" rel=\"external_link\" target=\"_blank\">Data monitoring committees<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Serious_adverse_event\" title=\"Serious adverse event\" rel=\"external_link\" target=\"_blank\">Serious adverse event<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_effect\" title=\"Adverse effect\" rel=\"external_link\" target=\"_blank\">Adverse effect<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_drug_reaction\" title=\"Adverse drug reaction\" rel=\"external_link\" target=\"_blank\">Adverse drug reaction<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacovigilance\" title=\"Pharmacovigilance\" rel=\"external_link\" target=\"_blank\">Pharmacovigilance<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/EudraVigilance\" title=\"EudraVigilance\" rel=\"external_link\" target=\"_blank\">EudraVigilance<\/a> (European Union AE reporting and evaluating network)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Trials_Directive\" title=\"Clinical Trials Directive\" rel=\"external_link\" target=\"_blank\">Clinical Trials Directive<\/a> (Directive 2001\/20\/EC by European Union)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_Event_Reporting_System\" title=\"Adverse Event Reporting System\" rel=\"external_link\" target=\"_blank\">Adverse Event Reporting System<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Yellow_Card_Scheme\" title=\"Yellow Card Scheme\" rel=\"external_link\" target=\"_blank\">Yellow Card Scheme<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">ICH GCP<\/span>\n<\/li>\n<li id=\"cite_note-ctcaev-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ctcaev_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ctep.cancer.gov\/protocolDevelopment\/electronic_applications\/docs\/ctcaev3.pdf\" target=\"_blank\">Common Terminology Criteria for Adverse Events<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.clinicaltrials.gov\/\" target=\"_blank\">ClinicalTrials.gov<\/a> from US <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Library_of_Medicine\" class=\"mw-redirect\" title=\"National Library of Medicine\" rel=\"external_link\" target=\"_blank\">National Library of Medicine<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ich.org\" target=\"_blank\">ICH Website<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/\" target=\"_blank\">FDA Website<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1329\nCached time: 20181129133127\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.104 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 378\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 11309\/2097152 bytes\nTemplate argument size: 239\/2097152 bytes\nHighest expansion depth: 10\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 727\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.037\/10.000 seconds\nLua memory usage: 1.3 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 128.004 1 -total\n<\/p>\n<pre>37.49% 47.987 1 Template:Refimprove\n35.51% 45.455 2 Template:Ambox\n21.78% 27.880 1 Template:For\n12.87% 16.470 1 Template:Globalize\/US\n10.66% 13.643 1 Template:Div_col\n 9.49% 12.153 1 Template:Globalize\n 6.12% 7.837 1 Template:Reflist\n 6.02% 7.704 1 Template:Main\n 2.69% 3.448 2 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2234553-1!canonical and timestamp 20181129133127 and revision id 858201907\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_event\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214708\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.140 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 134.737 1 - wikipedia:Adverse_event\n100.00% 134.737 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8572-0!*!*!*!*!*!* and timestamp 20181217214708 and revision id 25000\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Adverse_event\">https:\/\/www.limswiki.org\/index.php\/Adverse_event<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a0550ad91421c65fcff8f1e3ca9b41d9_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"a0550ad91421c65fcff8f1e3ca9b41d9_timestamp":1545083228,"db384186b2f2a397cbd511159e88f7ba_type":"article","db384186b2f2a397cbd511159e88f7ba_title":"Venipuncture","db384186b2f2a397cbd511159e88f7ba_url":"https:\/\/www.limswiki.org\/index.php\/Venipuncture","db384186b2f2a397cbd511159e88f7ba_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVenipuncture\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2007) (Learn how and when to remove this template message)\n Venipuncture\nPlay media Video of a venipuncture\nIn medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics, phlebotomists, dialysis technicians, and other nursing staff.[1] In veterinary medicine, the procedure is performed by veterinarians and veterinary technicians.\nIt is essential to follow a standard procedure for the collection of blood specimen to get the accurate laboratory results. Any kind of error in collection of blood or filing the test tubes may lead erroneous laboratory results.[2]\nVenipuncture is one of the most routinely performed invasive procedures and is carried out for any of five reasons: \n\nto obtain blood for diagnostic purposes;\nto monitor levels of blood components (Lavery & Ingram 2005);\nto administer therapeutic treatments including medications, nutrition, or chemotherapy;\nto remove blood due to excess levels of iron or erythrocytes (red blood cells); or\nto collect blood for later uses, mainly transfusion either in the donor or in another person.\nBlood analysis is an important diagnostic tool available to clinicians within healthcare.\nBlood is most commonly obtained from the superficial veins of the upper limb.[1] The median cubital vein, which lies within the cubital fossa anterior to the elbow, is close to the surface of the skin without many large nerves positioned nearby.\nMinute quantities of blood may be taken by fingersticks sampling and collected from infants by means of a heel stick or from scalp veins with a winged infusion needle.\nPhlebotomy (incision into a vein) is also the treatment of certain diseases such as hemochromatosis and primary and secondary polycythemia.\n\nContents \n\n1 Equipment \n\n1.1 Venipuncture with evacuated or vacuum tubes \n1.2 Additives and order of draw \n\n\n2 Venipuncture in children \n3 Venipuncture with needle and syringe \n4 Blood cultures \n5 Taking blood samples from animals \n6 Blood alcohol tests \n7 See also \n8 References \n9 External links \n\n\nEquipment \nThere are many ways in which blood can be drawn from a vein. The best method varies with the age of the patient, equipment available and tests required.\nMost blood collection in the US, UK, Canada and Hong Kong is done with an evacuated tube system, (two common systems are Vacutainer (Becton, Dickinson and company) and Vacuette (Greiner Bio-One). The equipment consists of a plastic adapter, a.k.a. tube or needle holder\/ hub, a hypodermic needle and a vacuum tube. Under certain circumstances, a syringe may be used, often with a butterfly needle, which is a plastic catheter attached to a short needle. In the developing world, the evacuated tube system is the preferred method of drawing blood\n\nVenipuncture with evacuated or vacuum tubes \n Vacutainer blood bottles\nGreiner Bio-One manufactured the first ever plastic evacuated blood collection tube in 1985 under the VACUETTE brand name. Today, many companies sell vacuum tubes as the patent for this device is now in the public domain. These tubes are manufactured with a specific volume of gas removed from the sealed tube. When a needle from a hub or transfer device is inserted into the stopper, the tube's vacuum automatically pulls in the required volume of blood.\nThe basic Evacuated Tube System (ETS) consists of a needle, a tube holder, and the evacuated tubes. The needle is attached to the tube holder by the phlebotomist prior to collection, or may come from the manufacturer as one unit. the needle protrudes through the end of the tube holder, and has a needle on each end. After first cleaning the venipuncture site and applying a tourniquet, the phlebotomist uncaps the needle attached to the tube holder, inserts the needle into the vein, then slides evacuated tubes into the tube holder, where the tube's stopper is pierced by the back end of the needle. The vacuum in the tube then automatically draws the needed blood directly from the patient's vein. Multiple vacuum tubes can be attached to and removed in turn from a single needle, allowing multiple samples to be obtained from a single procedure. This is possible due to the multiple sample sleeve, which is a flexible rubber fitting over the posterior end of the needle cannula which seals the needle until it is pushed out of the way. This keeps blood from freely draining out of the back of the needle inserted in the patient's vein, as each test tube is removed and the next impaled. Safety regulations require that needles come equipped with a sheath or safety device to cover the needle after the procedure to prevent accidental needle stick injury.\nFittings and adapters used to fill evacuated tubes from butterfly needle kits and syringes are also available.\nThere are several needle gauges for a phlebotomist to choose from. The most commonly used are as follows: a 21g (green top) needle, a 22g (black top) needle, a 21g (green label) butterfly needle, a 23g (blue label) butterfly needle, and a 25g (orange label) butterfly needle (however this needle is only used in pediatrics or extreme cases as it is so small that it can often result in hemolizing the blood sample). There are also a variety of tube and bottle sizes and volumes for different test requirements.[3]\n\nAdditives and order of draw \nThe test tubes in which blood is collected may contain one or more of several additives. In general, tests requiring whole blood call for blood samples collected in test tubes containing some form of the anticoagulant EDTA. EDTA chelates calcium to prevent clotting. EDTA is preferred for hematology tests because it does minimum damage to cell morphology. Sodium Citrate is the anticoagulant used in specimens collected for coagulation tests. The majority of chemistry and immunology tests are performed on serum, which is produced by clotting and then separating the blood specimen via centrifuge. These specimens are collected in either a non-additive tube or one containing a clotting activator. This clotting activator can interfere with some assays, and so a plain tube is recommended in these cases, but will delay testing. Tubes containing lithium heparin or sodium heparin are also commonly used for a variety of chemistry tests, as they do not require clotting and can be centrifuged immediately after collection. A combination of sodium fluoride and potassium oxalate is used for glucose tests, as these additives both prevent clotting and stop glycolosis, so that blood glucose levels are preserved after collection. another specialty tube is an opaque amber colored tube used to collect blood for light sensitive analytes, such as bilirubin.\nTest tubes are labeled with the additive they contain, but the stopper on each tube is color coded according to additive as well. While colors vary between manufacturers, stopper colors generally are associated with each additive as listed below. Because the additives from each tube can be left on the needle used to fill the tubes, they must be drawn in a specific order to ensure that cross contamination will not negatively affect testing of the samples if multiple tubes are to be drawn at once. The \"order of draw\" varies by collection method. Below in the order of draw generally required for the Evacuated Tube System (ETS) collection method are the most common tubes, listing additive and color:\n1. Blood cultures and sterile collections (culture bottles)\n2. Sodium citrate (light blue)\n3. No additive\/ Silica clot activator (red and black stripped or gold SST), (red)\n4. Lithium Heparin (Light Green PST)\n5. Sodium Heparin (green)\n6. K2 EDTA, K3 EDTA (Purple\/lavender), (pink), (white PPT)\n7. Sodium fluoride and potassium oxalate (grey)\n8. Tube for testing trace elements containing EDTA or clot activator or no additive (Navy\/royal blue)\n9. ACD (yellow) and any other tubes\n\nVenipuncture in children \nFurther information: Pain management in children\nUse of lidocaine iontophoresis is effective for reducing pain and alleviating distress during venipuncture in pediatric patients.[4] A needle-free powder lignocaine delivery system has been shown to decrease the pain of venipuncture in children.[5][6] Rapid dermal anesthesia can be achieved by local anesthetic infiltration, but it may evoke anxiety in children frightened by needles or distort the skin, making vascular access more difficult and increasing the risk of needle exposure to health care workers. Dermal anesthesia can also be achieved without needles by the topical application of local anesthetics or by lidocaine iontophoresis. By contrast, noninvasive dermal anesthesia can be established in 5\u201315 min without distorting underlying tissues by lidocaine iontophoresis, where a direct electric current facilitates dermal penetration of positively charged lidocaine molecules when placed under the positive electrode.\nOne study concluded that the iontophoretic administration of lidocaine was safe and effective in providing dermal anesthesia for venipuncture in children 6\u201317 years old. This technique may not be applicable to all children. Future studies may provide information on the minimum effective iontophoretic dose for dermal anesthesia in children and the comparison of the anesthetic efficacy and satisfaction of lidocaine iontophoresis with topical anesthetic creams and subcutaneous infiltration.[4]\nNon-pharmacological treatments for pain associated with venipuncture in children includes hypnosis and distraction. These treatments reduced self reported pain and when combined with cognitive-behavioural therapy (CBT) the reduction of pain was even greater. Other interventions have not been found to be effective and these are suggestion, blowing out air, and distraction with parent coaching did not differ from control for pain and distress.[7]\n\nVenipuncture with needle and syringe \nSome health care workers prefer to use a syringe-needle technique for venipuncture. Sarstedt manufactures a blood-drawing system S-Monovette that uses this principle. This method can be preferred on elderly patients, oncology patients, severely burned patients, obese patients or patients with unreliable or fragile veins. Because syringes are manually operated, the amount of suction applied may be easily controlled. This is particularly helpful with patients who have small veins that collapse under the suction of an evacuated tube. In children or other circumstances where the quantity of blood gained may be limited it can be helpful to know how much blood can be obtained before distributing it amongst the various additives that the laboratory will require.\n\nBlood cultures \nThere are times where a patient may require a blood culture collection. The culture will determine if the patient has pathogens in the blood. Normally blood is sterile. When drawing blood from cultures use a sterile solution such as Betadine rather than alcohol. This is done using sterile gloves, while not wiping away the surgical solution, touching the puncture site, or in any way compromising the sterile process. It is vital that the procedure is performed in as sterile a manner as possible as the persistent presence of skin commensals in blood cultures could indicate endocarditis but they are most often found as contaminants. \nIt is encouraged to use an abrasive method of skin preparation. This removes the upper layers of dead skin cells along with their contaminating bacteria. Povidone-iodine has traditionally been used but in the UK a 2% chlorhexidine in 70% ethanol or isopropyl alcohol solution is preferred and time must be allowed for it to dry. The tops of any containers used when drawing a blood culture should also be disinfected using a similar solution. Some labs will actively discourage iodine use where iodine is thought to degrade the rubber stopper through which blood enters the bottle, thus allowing contaminates to enter the container.\nThe blood is collected into special transport bottles, which are like vacuum tubes but shaped differently. The blood culture bottle contains transport media to preserve any microorganisms present while they are being transported to the laboratory for cultures. Because it is unknown whether the pathogens are anaerobic (living without oxygen) or aerobic (living with oxygen), blood is collected to test for both. The aerobic bottle is filled first, and then the anaerobic bottle is filled. However, if the collection is performed using a syringe, the anaerobic bottle is filled first. If a butterfly collection kit is used, the aerobic bottle is filled first, so that any air in the tubing is released into the oxygen-containing bottle.\nSpecially designed blood culture collection bottles eliminate the need for either the syringe or butterfly collection method. These specially designed bottles have long necks that fit into the evacuated tubes holders that are use for regular venipuncture collection. These bottles also allow for collection of other blood specimens via evacuated tubes, to be collected without additional venipuncture.\nThe amount of blood that is collected is critical for the optimal recovery of microorganisms. Up to 10mL of blood is typical, but can vary according to the recommends of the manufacturer of the collection bottle. Collection from infants and children are 1 to 5 mL. If too little blood is collected, the ratio of blood-to-nutrient broth will inhibit the growth of microorganisms. If too much blood is collected from the patient, the patient risks a hospital-induced anemia and the ratio of blood-to-nutrient broth will tilt in the opposite direction, which also is not conductive to optimal growth.\nThe bottles are then incubated in specialized units for 24 hours before a lab technician studies and\/or tests it. This step allows the very small numbers of bacteria (potentially 1 or 2 organisms) to multiply to a level which is sufficient for identification +\/-antibiotic resistance testing. Modern blood culture bottles have an indicator in the base which changes color in the presence of bacterial growth and can be read automatically by machine. (For this reason the barcoded stickers found on these bottles should not be removed as they are used by the laboratorys automated systems.)\n\nTaking blood samples from animals \nBlood samples from living laboratory animals may be collected using following methods:[8][9]\n\nBlood collection not requiring anesthesia:\nSaphenous vein (rat, mice, guinea pig)\nDorsal pedal vein (rat, mice)\nBlood collection requiring anesthesia (local\/general anesthesia):\nTail vein (rat, mice)\nTail snip (mice)\nOrbital sinus (rat, mice)[10]\nJugular vein (rat, mice)\nTemporary cannula (rat, mice)\nBlood vessel cannulation (guinea pig, ferret)\nTarsal vein (guinea pig)\nMarginal ear vein or artery (rabbit)\nTerminal procedure:\nCardiac puncture (rat, mice, guinea pig, rabbit, ferret)\nOrbital sinus (rat, mice)\nPosterior vena cava (rat, mice)\nThe volume of the blood sample collection is very important in experimental animals. All nonterminal blood collection without replacement of fluids is limited up to 10% of total circulating blood volume in healthy, normal, adult animals on a single occasion and collection may be repeated after three to four weeks. In case repeated blood samples are required at short intervals, a maximum of 0.6 ml\/kg\/day or 1.0% of an animal's total blood volume can be removed every 24 hours. The estimated blood volume in adult animals is 55 to 70 ml\/kg body weight. Care should be taken for older and obese animals. If blood collection volume exceeds more than 10% of total blood volume, fluid replacement may be required. Lactated Ringer's solution (LRS) is recommended as the best fluid replacement by National Institutes of Health (NIH). If the volume of blood collection exceeds more than 30% of the total circulatory blood volume, adequate care should be taken so that the animal does not suffer from hypovolemia.[9]\n\nBlood alcohol tests \nIt is generally not advisable to use isopropyl alcohol to cleanse the venipuncture site when obtaining a specimen for a blood alcohol test. This has been related largely to the potential legal implications associated with use of alcohol based cleaners that could theoretically impact analysis. Numerous police alcohol collection kits have been marketed that incorporate a sodium fluoride\/potassium oxalate preservative and non-alcohol based cleansing agents to ensure proper collection. Using soap and hot water or a povidone iodine swab are advisable alternatives to isopropyl alcohol in this case.\n\nSee also \n\nArterial blood is taken from an artery instead of a vein.\nBlood donation\nFingerstick\nNeonatal heel prick\nPhlebotomist\nVacutainer\n\nReferences \n\n\n^ a b Higgins, Dan (28 September 2004). \"Venepuncture\". Nursing Times. 100 (39): 30. \n\n^ Dg, Dayyal. \"PROCEDURES FOR THE COLLECTION OF BLOOD FOR HEMOTOLOGICAL INVESTIGATIONS\". BioScience Pakistan. BioScience Pakistan. ISSN 2521-5760. \n\n^ Perry, Sally (2007). \"Ask the Lab: Hemolyze blood specimens\". Nursing.advanceweb.com. Retrieved 2013-12-29 . \n\n^ a b Rose, John B.; Galinkin, Jeffrey L.; Jantzen, Ellen C.; Chiavacci, Rosetta M. (2002). \"A Study of Lidocaine Iontophoresis for Pediatric Venipuncture\". Anesthesia & Analgesia. 94 (4): 867. doi:10.1097\/00000539-200204000-00017. \n\n^ Lacroix, Helene (2008-10-01). \"A needle-free powder lignocaine delivery system reduced the pain of venipuncture in childrenCommentary\". Evidence-Based Nursing. 11 (4): 106\u2013106. doi:10.1136\/ebn.11.4.106. ISSN 1367-6539. PMID 18815318. \n\n^ Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2006-01-01). \"Liposomal lidocaine improved intravenous cannulation success rates in children\". Evidence-Based Nursing. 9 (1): 10\u201310. doi:10.1136\/ebn.9.1.10. ISSN 1367-6539. PMID 16437788. \n\n^ Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2007-07-01). \"Review: distraction, hypnosis, and combined cognitive-behavioural interventions reduce needle related pain and distress in children and adolescents\". Evidence-Based Nursing. 10 (3): 75\u201375. doi:10.1136\/ebn.10.3.75. ISSN 1367-6539. PMID 17596380. \n\n^ Hoff, J. (2000). \"Methods of Blood Collection in the Mouse\" (PDF) . Lab Animal. 29 (10): 47\u201353. \n\n^ a b Parasuraman, S; Raveendran, R; Kesavan, R (2010). \"Blood sample collection in small laboratory animals\". Journal of Pharmacology and Pharmacotherapeutics. 1 (2): 87\u201393. doi:10.4103\/0976-500X.72350. PMC 3043327 . PMID 21350616. \n\n^ Parasuraman S, Zhen KM, Raveendran R. Retro-orbital Blood Sample Collection in Rats-a Video Article. PTB Reports 1 (2), 37-40|DOI : 10.5530\/PTB.1.2.1|Available in http:\/\/www.ptbreports.org\/article\/41 \n\n\nExternal links \nPhlebotomy details\nvteVascular surgery ICD-9-CM V3 38\u201339, ICD-10-PCS 03\u20136Vascular and \r\nEndovascular surgeryArterial disease\nVascular bypass\nAngioplasty\nAtherectomy\nEndarterectomy\nCarotid endarterectomy\nStenting\nCarotid stenting\nVenous disease\nAmbulatory phlebectomy\nLaser surgery\nSclerotherapy\nVein stripping\nArterial and venous access\nVenous cutdown\nArteriotomy\nPhlebotomy\nAortic aneurysm \/ dissection:\nEndovascular aneurysm repair\nOpen aortic surgery\nOther\nCardiopulmonary bypass\nCardioplegia\nExtracorporeal membrane oxygenation\nVascular access\nRevascularization\nFirst rib resection\nSeldinger technique\nVascular snare\nMedical imagingAngiography\nDigital subtraction angiography\nCerebral angiography\nAortography\nFluorescein angiography\nRadionuclide angiography\nMagnetic resonance angiography\nVenography\nPortography\nImpedance phlebography\nUltrasound\nIntravascular ultrasound\nCarotid ultrasonography\nOther diagnostic\nAngioscopy\nAnkle brachial pressure index\nToe pressure\nTilt table test\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Venipuncture\">https:\/\/www.limswiki.org\/index.php\/Venipuncture<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog 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id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Venipuncture<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Venipuncture_using_a_BD_Vacutainer.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Venipuncture_using_a_BD_Vacutainer.JPG\/170px-Venipuncture_using_a_BD_Vacutainer.JPG\" width=\"170\" height=\"227\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Venipuncture_using_a_BD_Vacutainer.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Venipuncture<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_0\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:480px"><video id="mwe_player_1" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/480px--Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.jpg" controls="" preload="none" autoplay="" style="width:480px;height:480px" class="kskin" data-durationhint="15.072" data-startoffset="0" data-mwtitle="Video_of_venipuncture_(blood_draw_or_collection)_using_the_BD_Vacutainer_product..webm" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.480p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="SD VP9 (480P)" data-shorttitle="VP9 480P" data-transcodekey="480p.vp9.webm" data-width="480" data-height="480" data-bandwidth="609944" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.480p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="SD WebM (480P)" data-shorttitle="WebM 480P" data-transcodekey="480p.webm" data-width="480" data-height="480" data-bandwidth="1077240" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Original WebM file, 640 \u00d7 640 (1.25 Mbps)" data-shorttitle="WebM source" data-width="640" data-height="640" data-bandwidth="1246934" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="120" data-height="120" data-bandwidth="172872" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="160" data-height="160" data-bandwidth="201928" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="180" data-height="180" data-bandwidth="222392" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="240" data-height="240" data-bandwidth="254880" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="240" data-height="240" data-bandwidth="316408" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.360p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="360" data-height="360" data-bandwidth="361944" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="360" data-height="360" data-bandwidth="573392" data-framerate="60"\/><\/video><\/div>\"><img alt=\"File:Video of venipuncture (blood draw or collection) using the BD Vacutainer product..webm\" style=\"width:220px;height:220px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/220px--Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Video_of_venipuncture_(blood_draw_or_collection)_using_the_BD_Vacutainer_product..webm\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Video of a venipuncture<\/div><\/div><\/div>\n<p>In medicine, <b>venipuncture<\/b> or <b>venepuncture<\/b> is the process of obtaining intravenous access for the purpose of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">intravenous therapy<\/a> or for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sampling\" class=\"mw-redirect\" title=\"Blood sampling\" rel=\"external_link\" target=\"_blank\">blood sampling<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">venous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a>. In healthcare, this procedure is performed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_Laboratory_Scientist\" class=\"mw-redirect\" title=\"Medical Laboratory Scientist\" rel=\"external_link\" target=\"_blank\">medical laboratory scientists<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">medical practitioners<\/a>, some <a href=\"https:\/\/en.wikipedia.org\/wiki\/EMTs\" class=\"mw-redirect\" title=\"EMTs\" rel=\"external_link\" target=\"_blank\">EMTs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramedics\" class=\"mw-redirect\" title=\"Paramedics\" rel=\"external_link\" target=\"_blank\">paramedics<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phlebotomist\" class=\"mw-redirect\" title=\"Phlebotomist\" rel=\"external_link\" target=\"_blank\">phlebotomists<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" title=\"Dialysis\" rel=\"external_link\" target=\"_blank\">dialysis<\/a> technicians, and other nursing staff.<sup id=\"rdp-ebb-cite_ref-NT_2004_1-0\" class=\"reference\"><a href=\"#cite_note-NT_2004-1\" rel=\"external_link\">[1]<\/a><\/sup> In veterinary medicine, the procedure is performed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinarians\" class=\"mw-redirect\" title=\"Veterinarians\" rel=\"external_link\" target=\"_blank\">veterinarians<\/a> and veterinary technicians.\n<\/p><p>It is essential to follow a standard procedure for the collection of blood specimen to get the accurate laboratory results. Any kind of error in collection of blood or filing the test tubes may lead erroneous laboratory results.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Venipuncture is one of the most routinely performed invasive procedures and is carried out for any of five reasons: \n<\/p>\n<ol><li>to obtain blood for diagnostic purposes;<\/li>\n<li>to monitor levels of blood components (Lavery & Ingram 2005);<\/li>\n<li>to administer therapeutic treatments including medications, nutrition, or chemotherapy;<\/li>\n<li>to remove blood due to excess levels of iron or erythrocytes (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Red_blood_cell\" title=\"Red blood cell\" rel=\"external_link\" target=\"_blank\">red blood cells<\/a>); or<\/li>\n<li>to collect blood for later uses, mainly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_transfusion\" title=\"Blood transfusion\" rel=\"external_link\" target=\"_blank\">transfusion<\/a> either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autologous_blood_transfusion\" class=\"mw-redirect\" title=\"Autologous blood transfusion\" rel=\"external_link\" target=\"_blank\">in the donor<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_donation\" title=\"Blood donation\" rel=\"external_link\" target=\"_blank\">in another person<\/a>.<\/li><\/ol>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_analysis\" class=\"mw-redirect\" title=\"Blood analysis\" rel=\"external_link\" target=\"_blank\">Blood analysis<\/a> is an important diagnostic tool available to clinicians within healthcare.\n<\/p><p>Blood is most commonly obtained from the superficial veins of the upper limb.<sup id=\"rdp-ebb-cite_ref-NT_2004_1-1\" class=\"reference\"><a href=\"#cite_note-NT_2004-1\" rel=\"external_link\">[1]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Median_cubital_vein\" title=\"Median cubital vein\" rel=\"external_link\" target=\"_blank\">median cubital vein<\/a>, which lies within the cubital fossa anterior to the elbow, is close to the surface of the skin without many large nerves positioned nearby.\n<\/p><p>Minute quantities of blood may be taken by fingersticks sampling and collected from infants by means of a heel stick or from scalp veins with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Winged_infusion_needle\" class=\"mw-redirect\" title=\"Winged infusion needle\" rel=\"external_link\" target=\"_blank\">winged infusion needle<\/a>.\n<\/p><p>Phlebotomy (incision into a vein) is also the treatment of certain diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemochromatosis\" class=\"mw-redirect\" title=\"Hemochromatosis\" rel=\"external_link\" target=\"_blank\">hemochromatosis<\/a> and primary and secondary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycythemia\" title=\"Polycythemia\" rel=\"external_link\" target=\"_blank\">polycythemia<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Equipment\">Equipment<\/span><\/h2>\n<p>There are many ways in which blood can be drawn from a vein. The best method varies with the age of the patient, equipment available and tests required.\n<\/p><p>Most blood collection in the US, UK, Canada and Hong Kong is done with an evacuated tube system, (two common systems are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacutainer\" title=\"Vacutainer\" rel=\"external_link\" target=\"_blank\">Vacutainer<\/a> (Becton, Dickinson and company) and <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.gbo.com\" target=\"_blank\">Vacuette<\/a> (Greiner Bio-One). The equipment consists of a plastic adapter, a.k.a. tube or needle holder\/ hub, a hypodermic needle and a vacuum tube. Under certain circumstances, a syringe may be used, often with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterfly_needle\" class=\"mw-redirect\" title=\"Butterfly needle\" rel=\"external_link\" target=\"_blank\">butterfly needle<\/a>, which is a plastic catheter attached to a short needle. In the developing world, the evacuated tube system is the preferred method of drawing blood\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Venipuncture_with_evacuated_or_vacuum_tubes\">Venipuncture with evacuated or vacuum tubes<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vacutainer_blood_bottles.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Vacutainer_blood_bottles.jpg\/220px-Vacutainer_blood_bottles.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vacutainer_blood_bottles.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Vacutainer blood bottles<\/div><\/div><\/div>\n<p>Greiner Bio-One manufactured the first ever plastic evacuated blood collection tube in 1985 under the VACUETTE brand name. Today, many companies sell vacuum tubes as the patent for this device is now in the public domain. These tubes are manufactured with a specific volume of gas removed from the sealed tube. When a needle from a hub or transfer device is inserted into the stopper, the tube's vacuum automatically pulls in the required volume of blood.\n<\/p><p>The basic Evacuated Tube System (ETS) consists of a needle, a tube holder, and the evacuated tubes. The needle is attached to the tube holder by the phlebotomist prior to collection, or may come from the manufacturer as one unit. the needle protrudes through the end of the tube holder, and has a needle on each end. After first cleaning the venipuncture site and applying a tourniquet, the phlebotomist uncaps the needle attached to the tube holder, inserts the needle into the vein, then slides evacuated tubes into the tube holder, where the tube's stopper is pierced by the back end of the needle. The vacuum in the tube then automatically draws the needed blood directly from the patient's vein. Multiple vacuum tubes can be attached to and removed in turn from a single needle, allowing multiple samples to be obtained from a single procedure. This is possible due to the multiple sample sleeve, which is a flexible rubber fitting over the posterior end of the needle cannula which seals the needle until it is pushed out of the way. This keeps blood from freely draining out of the back of the needle inserted in the patient's vein, as each test tube is removed and the next impaled. Safety regulations require that needles come equipped with a sheath or safety device to cover the needle after the procedure to prevent accidental needle stick injury.\n<\/p><p>Fittings and adapters used to fill evacuated tubes from butterfly needle kits and syringes are also available.\n<\/p><p>There are several needle gauges for a phlebotomist to choose from. The most commonly used are as follows: a 21g (green top) needle, a 22g (black top) needle, a 21g (green label) butterfly needle, a 23g (blue label) butterfly needle, and a 25g (orange label) butterfly needle (however this needle is only used in pediatrics or extreme cases as it is so small that it can often result in hemolizing the blood sample). There are also a variety of tube and bottle sizes and volumes for different test requirements.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Additives_and_order_of_draw\">Additives and order of draw<\/span><\/h3>\n<p>The test tubes in which blood is collected may contain one or more of several additives. In general, tests requiring whole blood call for blood samples collected in test tubes containing some form of the anticoagulant <a href=\"https:\/\/en.wikipedia.org\/wiki\/EDTA\" class=\"mw-redirect\" title=\"EDTA\" rel=\"external_link\" target=\"_blank\">EDTA<\/a>. EDTA <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chelation\" title=\"Chelation\" rel=\"external_link\" target=\"_blank\">chelates<\/a> calcium to prevent clotting. EDTA is preferred for hematology tests because it does minimum damage to cell morphology. Sodium Citrate is the anticoagulant used in specimens collected for coagulation tests. The majority of chemistry and immunology tests are performed on serum, which is produced by clotting and then separating the blood specimen via centrifuge. These specimens are collected in either a non-additive tube or one containing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">clotting<\/a> activator. This clotting activator can interfere with some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assay\" title=\"Assay\" rel=\"external_link\" target=\"_blank\">assays<\/a>, and so a plain tube is recommended in these cases, but will delay testing. Tubes containing lithium heparin or sodium heparin are also commonly used for a variety of chemistry tests, as they do not require clotting and can be centrifuged immediately after collection. A combination of sodium fluoride and potassium oxalate is used for glucose tests, as these additives both prevent clotting and stop glycolosis, so that blood glucose levels are preserved after collection. another specialty tube is an opaque amber colored tube used to collect blood for light sensitive analytes, such as bilirubin.\n<\/p><p>Test tubes are labeled with the additive they contain, but the stopper on each tube is color coded according to additive as well. While colors vary between manufacturers, stopper colors generally are associated with each additive as listed below. Because the additives from each tube can be left on the needle used to fill the tubes, they must be drawn in a specific order to ensure that cross contamination will not negatively affect testing of the samples if multiple tubes are to be drawn at once. The \"order of draw\" varies by collection method. Below in the order of draw generally required for the Evacuated Tube System (ETS) collection method are the most common tubes, listing additive and color:\n<\/p><p>1. Blood cultures and sterile collections (culture bottles)\n<\/p><p>2. Sodium citrate (light blue)\n<\/p><p>3. No additive\/ Silica clot activator (red and black stripped or gold SST), (red)\n<\/p><p>4. Lithium Heparin (Light Green PST)\n<\/p><p>5. Sodium Heparin (green)\n<\/p><p>6. K2 EDTA, K3 EDTA (Purple\/lavender), (pink), (white PPT)\n<\/p><p>7. Sodium fluoride and potassium oxalate (grey)\n<\/p><p>8. Tube for testing trace elements containing EDTA or clot activator or no additive (Navy\/royal blue)\n<\/p><p>9. ACD (yellow) and any other tubes\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Venipuncture_in_children\">Venipuncture in children<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management_in_children\" title=\"Pain management in children\" rel=\"external_link\" target=\"_blank\">Pain management in children<\/a><\/div>\n<p>Use of lidocaine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iontophoresis\" title=\"Iontophoresis\" rel=\"external_link\" target=\"_blank\">iontophoresis<\/a> is effective for reducing pain and alleviating distress during venipuncture in pediatric patients.<sup id=\"rdp-ebb-cite_ref-rose_4-0\" class=\"reference\"><a href=\"#cite_note-rose-4\" rel=\"external_link\">[4]<\/a><\/sup> A needle-free powder <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lidocaine\" title=\"Lidocaine\" rel=\"external_link\" target=\"_blank\">lignocaine<\/a> delivery system has been shown to decrease the pain of venipuncture in children.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Rapid dermal anesthesia can be achieved by local anesthetic infiltration, but it may evoke anxiety in children frightened by needles or distort the skin, making vascular access more difficult and increasing the risk of needle exposure to health care workers. Dermal anesthesia can also be achieved without needles by the topical application of local anesthetics or by lidocaine iontophoresis. By contrast, noninvasive dermal anesthesia can be established in 5\u201315 min without distorting underlying tissues by lidocaine iontophoresis, where a direct electric current facilitates dermal penetration of positively charged lidocaine molecules when placed under the positive electrode.\n<\/p><p>One study concluded that the iontophoretic administration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lidocaine\" title=\"Lidocaine\" rel=\"external_link\" target=\"_blank\">lidocaine<\/a> was safe and effective in providing dermal anesthesia for venipuncture in children 6\u201317 years old. This technique may not be applicable to all children. Future studies may provide information on the minimum effective iontophoretic dose for dermal anesthesia in children and the comparison of the anesthetic efficacy and satisfaction of lidocaine iontophoresis with topical anesthetic creams and subcutaneous infiltration.<sup id=\"rdp-ebb-cite_ref-rose_4-1\" class=\"reference\"><a href=\"#cite_note-rose-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Non-pharmacological treatments for pain associated with venipuncture in children includes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypnosis\" title=\"Hypnosis\" rel=\"external_link\" target=\"_blank\">hypnosis<\/a> and distraction. These treatments reduced self reported pain and when combined with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\" title=\"Cognitive behavioral therapy\" rel=\"external_link\" target=\"_blank\">cognitive-behavioural therapy<\/a> (CBT) the reduction of pain was even greater. Other interventions have not been found to be effective and these are suggestion, blowing out air, and distraction with parent coaching did not differ from control for pain and distress.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Venipuncture_with_needle_and_syringe\">Venipuncture with needle and syringe<\/span><\/h2>\n<p>Some health care workers prefer to use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Syringe\" title=\"Syringe\" rel=\"external_link\" target=\"_blank\">syringe<\/a>-needle technique for venipuncture. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sarstedt\" title=\"Sarstedt\" rel=\"external_link\" target=\"_blank\">Sarstedt<\/a> manufactures a blood-drawing system that uses this principle. This method can be preferred on elderly patients, oncology patients, severely burned patients, obese patients or patients with unreliable or fragile veins. Because syringes are manually operated, the amount of suction applied may be easily controlled. This is particularly helpful with patients who have small veins that collapse under the suction of an evacuated tube. In children or other circumstances where the quantity of blood gained may be limited it can be helpful to know how much blood can be obtained before distributing it amongst the various additives that the laboratory will require.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Blood_cultures\">Blood cultures<\/span><\/h2>\n<p>There are times where a patient may require a blood culture collection. The culture will determine if the patient has pathogens in the blood. Normally blood is sterile. When drawing blood from cultures use a sterile solution such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Betadine\" class=\"mw-redirect\" title=\"Betadine\" rel=\"external_link\" target=\"_blank\">Betadine<\/a> rather than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcohol\" title=\"Alcohol\" rel=\"external_link\" target=\"_blank\">alcohol<\/a>. This is done using sterile gloves, while not wiping away the surgical solution, touching the puncture site, or in any way compromising the sterile process. It is vital that the procedure is performed in as sterile a manner as possible as the persistent presence of skin <a href=\"https:\/\/en.wikipedia.org\/wiki\/Commensal\" class=\"mw-redirect\" title=\"Commensal\" rel=\"external_link\" target=\"_blank\">commensals<\/a> in blood cultures could indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocarditis\" title=\"Endocarditis\" rel=\"external_link\" target=\"_blank\">endocarditis<\/a> but they are most often found as contaminants. \nIt is encouraged to use an abrasive method of skin preparation. This removes the upper layers of dead skin cells along with their contaminating bacteria. Povidone-iodine has traditionally been used but in the UK a 2% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorhexidine\" title=\"Chlorhexidine\" rel=\"external_link\" target=\"_blank\">chlorhexidine<\/a> in 70% ethanol or isopropyl alcohol solution is preferred and time must be allowed for it to dry. The tops of any containers used when drawing a blood culture should also be disinfected using a similar solution. Some labs will actively discourage iodine use where iodine is thought to degrade the rubber stopper through which blood enters the bottle, thus allowing contaminates to enter the container.\n<\/p><p>The blood is collected into special transport bottles, which are like vacuum tubes but shaped differently. The blood culture bottle contains transport media to preserve any microorganisms present while they are being transported to the laboratory for cultures. Because it is unknown whether the pathogens are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaerobic_organism\" title=\"Anaerobic organism\" rel=\"external_link\" target=\"_blank\">anaerobic<\/a> (living without oxygen) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerobic_organism\" title=\"Aerobic organism\" rel=\"external_link\" target=\"_blank\">aerobic<\/a> (living with oxygen), blood is collected to test for both. The aerobic bottle is filled first, and then the anaerobic bottle is filled. However, if the collection is performed using a syringe, the anaerobic bottle is filled first. If a butterfly collection kit is used, the aerobic bottle is filled first, so that any air in the tubing is released into the oxygen-containing bottle.\n<\/p><p>Specially designed blood culture collection bottles eliminate the need for either the syringe or butterfly collection method. These specially designed bottles have long necks that fit into the evacuated tubes holders that are use for regular venipuncture collection. These bottles also allow for collection of other blood specimens via evacuated tubes, to be collected without additional venipuncture.\n<\/p><p>The amount of blood that is collected is critical for the optimal recovery of microorganisms. Up to 10mL of blood is typical, but can vary according to the recommends of the manufacturer of the collection bottle. Collection from infants and children are 1 to 5 mL. If too little blood is collected, the ratio of blood-to-nutrient broth will inhibit the growth of microorganisms. If too much blood is collected from the patient, the patient risks a hospital-induced anemia and the ratio of blood-to-nutrient broth will tilt in the opposite direction, which also is not conductive to optimal growth.\n<\/p><p>The bottles are then incubated in specialized units for 24 hours before a lab technician studies and\/or tests it. This step allows the very small numbers of bacteria (potentially 1 or 2 organisms) to multiply to a level which is sufficient for identification +\/-antibiotic resistance testing. Modern blood culture bottles have an indicator in the base which changes color in the presence of bacterial growth and can be read automatically by machine. (For this reason the barcoded stickers found on these bottles should not be removed as they are used by the laboratorys automated systems.)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Taking_blood_samples_from_animals\">Taking blood samples from animals<\/span><\/h2>\n<p>Blood samples from living laboratory animals may be collected using following methods:<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Parasuraman2010_9-0\" class=\"reference\"><a href=\"#cite_note-Parasuraman2010-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<ul><li>Blood collection not requiring anesthesia:\n<ul><li>Saphenous vein (rat, mice, guinea pig)<\/li>\n<li>Dorsal pedal vein (rat, mice)<\/li><\/ul><\/li>\n<li>Blood collection requiring anesthesia (local\/general anesthesia):\n<ul><li>Tail vein (rat, mice)<\/li>\n<li>Tail snip (mice)<\/li>\n<li>Orbital sinus (rat, mice)<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Jugular vein (rat, mice)<\/li>\n<li>Temporary cannula (rat, mice)<\/li>\n<li>Blood vessel cannulation (guinea pig, ferret)<\/li>\n<li>Tarsal vein (guinea pig)<\/li>\n<li>Marginal ear vein or artery (rabbit)<\/li><\/ul><\/li>\n<li>Terminal procedure:\n<ul><li>Cardiac puncture (rat, mice, guinea pig, rabbit, ferret)<\/li>\n<li>Orbital sinus (rat, mice)<\/li>\n<li>Posterior vena cava (rat, mice)<\/li><\/ul><\/li><\/ul>\n<p>The volume of the blood sample collection is very important in experimental animals. All nonterminal blood collection without replacement of fluids is limited up to 10% of total circulating blood volume in healthy, normal, adult animals on a single occasion and collection may be repeated after three to four weeks. In case repeated blood samples are required at short intervals, a maximum of 0.6 ml\/kg\/day or 1.0% of an animal's total blood volume can be removed every 24 hours. The estimated blood volume in adult animals is 55 to 70 ml\/kg body weight. Care should be taken for older and obese animals. If blood collection volume exceeds more than 10% of total blood volume, fluid replacement may be required. Lactated Ringer's solution (LRS) is recommended as the best fluid replacement by National Institutes of Health (NIH). If the volume of blood collection exceeds more than 30% of the total circulatory blood volume, adequate care should be taken so that the animal does not suffer from hypovolemia.<sup id=\"rdp-ebb-cite_ref-Parasuraman2010_9-1\" class=\"reference\"><a href=\"#cite_note-Parasuraman2010-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Blood_alcohol_tests\">Blood alcohol tests<\/span><\/h2>\n<p>It is generally not advisable to use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isopropyl_alcohol\" title=\"Isopropyl alcohol\" rel=\"external_link\" target=\"_blank\">isopropyl alcohol<\/a> to cleanse the venipuncture site when obtaining a specimen for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_alcohol\" class=\"mw-redirect\" title=\"Blood alcohol\" rel=\"external_link\" target=\"_blank\">blood alcohol<\/a> test. This has been related largely to the potential legal implications associated with use of alcohol based cleaners that could theoretically impact analysis. Numerous police alcohol collection kits have been marketed that incorporate a sodium fluoride\/potassium oxalate preservative and non-alcohol based cleansing agents to ensure proper collection. Using soap and hot water or a povidone iodine swab are advisable alternatives to isopropyl alcohol in this case.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_blood\" title=\"Arterial blood\" rel=\"external_link\" target=\"_blank\">Arterial blood<\/a> is taken from an artery instead of a vein.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_donation\" title=\"Blood donation\" rel=\"external_link\" target=\"_blank\">Blood donation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fingerstick\" title=\"Fingerstick\" rel=\"external_link\" target=\"_blank\">Fingerstick<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neonatal_heel_prick\" title=\"Neonatal heel prick\" rel=\"external_link\" target=\"_blank\">Neonatal heel prick<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phlebotomist\" class=\"mw-redirect\" title=\"Phlebotomist\" rel=\"external_link\" target=\"_blank\">Phlebotomist<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacutainer\" title=\"Vacutainer\" rel=\"external_link\" target=\"_blank\">Vacutainer<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-NT_2004-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NT_2004_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NT_2004_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Higgins, Dan (28 September 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nursingtimes.net\/clinical-archive\/infection-control\/venepuncture\/204148.article\" target=\"_blank\">\"Venepuncture\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nursing_Times\" title=\"Nursing Times\" rel=\"external_link\" target=\"_blank\">Nursing Times<\/a><\/i>. <b>100<\/b> (39): 30.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nursing+Times&rft.atitle=Venepuncture&rft.volume=100&rft.issue=39&rft.pages=30&rft.date=2004-09-28&rft.aulast=Higgins&rft.aufirst=Dan&rft_id=https%3A%2F%2Fwww.nursingtimes.net%2Fclinical-archive%2Finfection-control%2Fvenepuncture%2F204148.article&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Dg, Dayyal. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bioscience.com.pk\/topics\/hemotology\/item\/796-procedures-for-the-collection-of-blood-for-hemotological-investigations\" target=\"_blank\">\"PROCEDURES FOR THE COLLECTION OF BLOOD FOR HEMOTOLOGICAL INVESTIGATIONS\"<\/a>. <i>BioScience Pakistan<\/i>. BioScience Pakistan. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2521-5760\" target=\"_blank\">2521-5760<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=BioScience+Pakistan&rft.atitle=PROCEDURES+FOR+THE+COLLECTION+OF+BLOOD+FOR+HEMOTOLOGICAL+INVESTIGATIONS&rft.issn=2521-5760&rft.aulast=Dg&rft.aufirst=Dayyal&rft_id=https%3A%2F%2Fwww.bioscience.com.pk%2Ftopics%2Fhemotology%2Fitem%2F796-procedures-for-the-collection-of-blood-for-hemotological-investigations&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Perry, Sally (2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/nursing.advanceweb.com\/Article\/Ask-the-Lab-Hemolyze-blood-specimens.aspx\" target=\"_blank\">\"Ask the Lab: Hemolyze blood specimens\"<\/a>. Nursing.advanceweb.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-12-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Ask+the+Lab%3A+Hemolyze+blood+specimens&rft.pub=Nursing.advanceweb.com&rft.date=2007&rft.aulast=Perry&rft.aufirst=Sally&rft_id=http%3A%2F%2Fnursing.advanceweb.com%2FArticle%2FAsk-the-Lab-Hemolyze-blood-specimens.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-rose-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-rose_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-rose_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rose, John B.; Galinkin, Jeffrey L.; Jantzen, Ellen C.; Chiavacci, Rosetta M. (2002). \"A Study of Lidocaine Iontophoresis for Pediatric Venipuncture\". <i>Anesthesia & Analgesia<\/i>. <b>94<\/b> (4): 867. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00000539-200204000-00017\" target=\"_blank\">10.1097\/00000539-200204000-00017<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+%26+Analgesia&rft.atitle=A+Study+of+Lidocaine+Iontophoresis+for+Pediatric+Venipuncture&rft.volume=94&rft.issue=4&rft.pages=867&rft.date=2002&rft_id=info%3Adoi%2F10.1097%2F00000539-200204000-00017&rft.aulast=Rose&rft.aufirst=John+B.&rft.au=Galinkin%2C+Jeffrey+L.&rft.au=Jantzen%2C+Ellen+C.&rft.au=Chiavacci%2C+Rosetta+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lacroix, Helene (2008-10-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ebn.bmj.com\/content\/11\/4\/106\" target=\"_blank\">\"A needle-free powder lignocaine delivery system reduced the pain of venipuncture in childrenCommentary\"<\/a>. <i>Evidence-Based Nursing<\/i>. <b>11<\/b> (4): 106\u2013106. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Febn.11.4.106\" target=\"_blank\">10.1136\/ebn.11.4.106<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1367-6539\" target=\"_blank\">1367-6539<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18815318\" target=\"_blank\">18815318<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Evidence-Based+Nursing&rft.atitle=A+needle-free+powder+lignocaine+delivery+system+reduced+the+pain+of+venipuncture+in+childrenCommentary&rft.volume=11&rft.issue=4&rft.pages=106-106&rft.date=2008-10-01&rft.issn=1367-6539&rft_id=info%3Apmid%2F18815318&rft_id=info%3Adoi%2F10.1136%2Febn.11.4.106&rft.aulast=Lacroix&rft.aufirst=Helene&rft_id=http%3A%2F%2Febn.bmj.com%2Fcontent%2F11%2F4%2F106&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2006-01-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ebn.bmj.com\/content\/9\/1\/10\" target=\"_blank\">\"Liposomal lidocaine improved intravenous cannulation success rates in children\"<\/a>. <i>Evidence-Based Nursing<\/i>. <b>9<\/b> (1): 10\u201310. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Febn.9.1.10\" target=\"_blank\">10.1136\/ebn.9.1.10<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1367-6539\" target=\"_blank\">1367-6539<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16437788\" target=\"_blank\">16437788<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Evidence-Based+Nursing&rft.atitle=Liposomal+lidocaine+improved+intravenous+cannulation+success+rates+in+children&rft.volume=9&rft.issue=1&rft.pages=10-10&rft.date=2006-01-01&rft.issn=1367-6539&rft_id=info%3Apmid%2F16437788&rft_id=info%3Adoi%2F10.1136%2Febn.9.1.10&rft.aulast=Ltd&rft.aufirst=BMJ+Publishing+Group+Ltd+and+RCN+Publishing+Company&rft_id=http%3A%2F%2Febn.bmj.com%2Fcontent%2F9%2F1%2F10&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2007-07-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ebn.bmj.com\/content\/10\/3\/75\" target=\"_blank\">\"Review: distraction, hypnosis, and combined cognitive-behavioural interventions reduce needle related pain and distress in children and adolescents\"<\/a>. <i>Evidence-Based Nursing<\/i>. <b>10<\/b> (3): 75\u201375. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Febn.10.3.75\" target=\"_blank\">10.1136\/ebn.10.3.75<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1367-6539\" target=\"_blank\">1367-6539<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17596380\" target=\"_blank\">17596380<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Evidence-Based+Nursing&rft.atitle=Review%3A+distraction%2C+hypnosis%2C+and+combined+cognitive-behavioural+interventions+reduce+needle+related+pain+and+distress+in+children+and+adolescents&rft.volume=10&rft.issue=3&rft.pages=75-75&rft.date=2007-07-01&rft.issn=1367-6539&rft_id=info%3Apmid%2F17596380&rft_id=info%3Adoi%2F10.1136%2Febn.10.3.75&rft.aulast=Ltd&rft.aufirst=BMJ+Publishing+Group+Ltd+and+RCN+Publishing+Company&rft_id=http%3A%2F%2Febn.bmj.com%2Fcontent%2F10%2F3%2F75&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hoff, J. (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.lawte.org\/materials\/hoff.pdf\" target=\"_blank\">\"Methods of Blood Collection in the Mouse\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Lab Animal<\/i>. <b>29<\/b> (10): 47\u201353.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lab+Animal&rft.atitle=Methods+of+Blood+Collection+in+the+Mouse&rft.volume=29&rft.issue=10&rft.pages=47-53&rft.date=2000&rft.aulast=Hoff&rft.aufirst=J.&rft_id=http%3A%2F%2Fwww.lawte.org%2Fmaterials%2Fhoff.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Parasuraman2010-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Parasuraman2010_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Parasuraman2010_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Parasuraman, S; Raveendran, R; Kesavan, R (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3043327\" target=\"_blank\">\"Blood sample collection in small laboratory animals\"<\/a>. <i>Journal of Pharmacology and Pharmacotherapeutics<\/i>. <b>1<\/b> (2): 87\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0976-500X.72350\" target=\"_blank\">10.4103\/0976-500X.72350<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3043327\" target=\"_blank\">3043327<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21350616\" target=\"_blank\">21350616<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pharmacology+and+Pharmacotherapeutics&rft.atitle=Blood+sample+collection+in+small+laboratory+animals&rft.volume=1&rft.issue=2&rft.pages=87-93&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3043327&rft_id=info%3Apmid%2F21350616&rft_id=info%3Adoi%2F10.4103%2F0976-500X.72350&rft.aulast=Parasuraman&rft.aufirst=S&rft.au=Raveendran%2C+R&rft.au=Kesavan%2C+R&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3043327&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Parasuraman S, Zhen KM, Raveendran R. Retro-orbital Blood Sample Collection in Rats-a Video Article. PTB Reports 1 (2), 37-40|DOI : 10.5530\/PTB.1.2.1|Available in <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ptbreports.org\/article\/41\" target=\"_blank\">http:\/\/www.ptbreports.org\/article\/41<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www-medlib.med.utah.edu\/WebPath\/TUTORIAL\/PHLEB\/PHLEB.html\" target=\"_blank\">Phlebotomy details<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1265\nCached time: 20181129155029\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.272 seconds\nReal time usage: 0.357 seconds\nPreprocessor visited node count: 834\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 45836\/2097152 bytes\nTemplate argument size: 180\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 27402\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.157\/10.000 seconds\nLua memory usage: 4.51 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 286.714 1 -total\n<\/p>\n<pre>60.89% 174.567 1 Template:Reflist\n42.61% 122.180 7 Template:Cite_journal\n18.73% 53.699 1 Template:More_citations_needed\n12.69% 36.373 1 Template:Ambox\n11.57% 33.162 2 Template:Cite_web\n 6.99% 20.047 3 Template:Navbox\n 6.79% 19.467 1 Template:Vascular_procedures\n 4.60% 13.182 1 Template:Col_div\n 4.54% 13.030 1 Template:See\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:234819-1!canonical and timestamp 20181129155028 and revision id 865400288\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Venipuncture\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214707\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.153 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.349 1 - wikipedia:Venipuncture\n100.00% 145.349 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8571-0!*!*!*!*!*!* and timestamp 20181217214707 and revision id 24999\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Venipuncture\">https:\/\/www.limswiki.org\/index.php\/Venipuncture<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","db384186b2f2a397cbd511159e88f7ba_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Venipuncture_using_a_BD_Vacutainer.JPG\/340px-Venipuncture_using_a_BD_Vacutainer.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Vacutainer_blood_bottles.jpg\/440px-Vacutainer_blood_bottles.jpg"],"db384186b2f2a397cbd511159e88f7ba_timestamp":1545083227,"3014f54069aaa56a07a85b820a8b84f8_type":"article","3014f54069aaa56a07a85b820a8b84f8_title":"Medical stitching","3014f54069aaa56a07a85b820a8b84f8_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques","3014f54069aaa56a07a85b820a8b84f8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical suture\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Suture.\nSurgical sutureSurgical suture on needle holder. Packaging shown above.[edit on Wikidata]\nSurgical suture is a medical device used to hold body tissues together after an injury or surgery. Application generally involves using a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Surgeons, physicians, dentists, podiatrists, eye doctors, registered nurses and other trained nursing personnel, medics, and clinical pharmacists typically engage in suturing. Surgical knots are used to secure the sutures.\n\nContents \n\n1 Needles \n2 Thread \n\n2.1 Materials \n2.2 Absorbability \n2.3 Sizes \n\n\n3 Techniques \n\n3.1 Placement \n3.2 Stitching interval and spacing \n3.3 Layers \n3.4 Removal \n3.5 Expansions \n\n\n4 Tissue adhesives \n5 History \n6 See also \n7 References \n8 External links \n\n\nNeedles \nEyed or reusable needles with holes (called eyes), which are supplied separate from their suture thread, are necessary for suture. The suture must be threaded on site, as is done when sewing in a recreational setting. The advantage of this is that any thread and needle combination is possible to suit the job at hand. Swaged, or atraumatic, needles with sutures comprise a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as \"atraumatic\".\nThere are several shapes of surgical needles. These include:\n\nStraight\n1\/4 circle\n3\/8 circle\n1\/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3.[1]\n5\/8 circle\ncompound curve\nhalf curved (also known as ski)\nhalf curved at both ends of a straight segment (also known as canoe)\nThe ski and canoe needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.\nNeedles may also be classified by their point geometry; examples include:\n\ntaper (needle body is round and tapers smoothly to a point)\ncutting (needle body is triangular and has a sharpened cutting edge on the inside curve)\nreverse cutting (cutting edge on the outside)\ntrocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)\nblunt points for sewing friable tissues\nside cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery\nFinally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These \"pop-offs\" are commonly used for interrupted sutures, where each suture is only passed once and then tied.\n\n\n\t\t\n\t\t\t\n\t\t\t\nEyed surgical needles which form 3\/8th of a circle, in different sizes.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nEyed surgical needles which are semicircular, in different sizes.\n\n\t\t\t\n\t\t\n\nSutures can withstand different amounts of force based on their size; this is quantified by the U.S.P. Needle Pull Specifications.\n\nThread \nMaterials \n Micrograph of a H&E stained tissue section showing a non-absorbable multi-filament surgical suture with a surrounding foreign-body giant cell reaction\nFurther information: Suture materials comparison chart\nSuture thread is made from numerous materials. The original sutures were made from biological materials, such as catgut suture and silk. These absorbed bodily fluids and could be foci of infection. Founder of gynecology J. Marion Sims invented the use of silver wire, which is anti-bacterial, for a suture. Most modern sutures are synthetic, including the absorbables polyglycolic acid, polylactic acid, Monocryl and polydioxanone as well as the non-absorbables nylon, polyester, PVDF and polypropylene.[2] The FDA first approved triclosan-coated sutures in 2002;[3] they have been shown to reduce the chances of wound infection.[4] Sutures come in very specific sizes and may be either absorbable (naturally biodegradable in the body) or non-absorbable. Sutures must be strong enough to hold tissue securely but flexible enough to be knotted. They must be hypoallergenic and avoid the \"wick effect\" that would allow fluids and thus infection to penetrate the body along the suture tract.\n\nAbsorbability \nAll sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. Absorbable suture materials include the original catgut as well as the newer synthetics polyglycolic acid, polylactic acid, polydioxanone, and caprolactone. \nAbsorbable (or resorbable) medical devices such as sutures are made of polymers. The polymer materials are based on one or more of five cyclic monomers: glycolide, l-lactide, p-dioxanone, trimethylene carbonate and \u03b5-caprolactone.[5]\nThey are broken down by various processes including hydrolysis (polyglycolic acid) and proteolytic enzymatic degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues.[6] In both cases, they will hold the body tissues together long enough to allow healing, but will disintegrate so that they do not leave foreign material or require further procedures. Initially, there is a foreign body reaction to the material, which is transient. After complete resorption only connective tissue will remain.[7][8][9][10] Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.\n\n Twelve nonabsorbable sutures in a person's lower back.\nNon-absorbable sutures are made of special silk or the synthetics polypropylene, polyester or nylon. Stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac surgery. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the heart (with its constant pressure and movement) or the bladder (with adverse chemical conditions). Non-absorbable sutures often cause less scarring because they provoke less immune response, and thus are used where cosmetic outcome is important. They may be removed after a certain time, or left permanently.\n\nSizes \nThe examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (December 2010) (Learn how and when to remove this template message)\nSuture sizes are defined by the United States Pharmacopeia (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2\/0) to #000000 (#6-0 or #6\/0).\nModern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.\n\n\n\nUSP\r\ndesignation\nCollagen\r\ndiameter (mm)\nSynthetic absorbable\r\ndiameter (mm)\nNon-absorbable\r\ndiameter (mm)\nAmerican \r\nwire gauge\n\n\n11-0\n\n\n0.01\n\n\n\n10-0\n0.02\n0.02\n0.02\n\n\n\n9-0\n0.03\n0.03\n0.03\n\n\n\n8-0\n0.05\n0.04\n0.04\n\n\n\n7-0\n0.07\n0.05\n0.05\n\n\n\n6-0\n0.1\n0.07\n0.07\n38\u201340\n\n\n5-0\n0.15\n0.1\n0.1\n35\u201338\n\n\n4-0\n0.2\n0.15\n0.15\n32\u201334\n\n\n3-0\n0.3\n0.2\n0.2\n29\u201332\n\n\n2-0\n0.35\n0.3\n0.3\n28\n\n\n0\n0.4\n0.35\n0.35\n26\u201327\n\n\n1\n0.5\n0.4\n0.4\n25\u201326\n\n\n2\n0.6\n0.5\n0.5\n23\u201324\n\n\n3\n0.7\n0.6\n0.6\n22\n\n\n4\n0.8\n0.6\n0.6\n21\u201322\n\n\n5\n\n0.7\n0.7\n20\u201321\n\n\n6\n\n\n0.8\n19\u201320\n\n\n7\n\n\n\n18\n\n\nTechniques \nSee also: Surgical knot\n A wound before and after suture closure. The closure incorporates five simple interrupted sutures and one vertical mattress suture (center) at the apex of the wound.\n Suturing two operation wounds with eleven simple stitches by a Cuban doctor. Sara, Guinea-Bissau, 1974.\nMany different techniques exist. The most common is the simple interrupted stitch;[11] it is indeed the simplest to perform and is called \"interrupted\" because the suture thread is cut between each individual stitch. The vertical and horizontal mattress stitch are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or continuous stitch is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The chest drain stitch and corner stitch are variations of the horizontal mattress.\nOther stitches or suturing techniques include:\n\nPurse-string suture, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound.[12][13]\nFigure 8 stitch\nSubcuticular stitch.\nPlacement \nSutures are placed by mounting a needle with attached suture into a needle holder. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a square knot or surgeon's knot. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,[14] since the blood supply may be impeded and thus increase infection and scarring.[15][16] Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal.[15] Placement varies based on the location,\n\nStitching interval and spacing \nSkin and other soft tissue can lengthen significantly under strain. To accommodate this lengthening, continuous stitches must have an adequate amount of slack. Jenkin's rule was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds.[16][17] A later study suggested 6:1 as the optimal ratio in abdominal closure.[18]\n\nLayers \nIn contrast to single layer suturing, two layer suturing generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example, Cesarean section can be performed with single or double layer suturing of the uterine incision.[19]\n\nRemoval \nWhereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound.\n\nDifferent parts of the body heal at different speeds. Common time to remove stitches will vary: facial wounds 3\u20135 days; scalp wound 7\u201310 days; limbs 10\u201314 days; joints 14 days; trunk of the body 7\u201310 days.[20]\n\nRemoval of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.\n\nExpansions \nA pledgeted suture is one that is supported by a pledget, that is, a small flat non-absorbent pad normally composed of polytetrafluoroethylene, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.[21]\n\nTissue adhesives \nTopical cyanoacrylate adhesives (industrially used as super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances\/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds.\nIn surgical incisions it does not work as well as sutures as the wounds often break open.[22]\nCyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.\n\nHistory \n Sewing wound after herniotomy, 1559\n Old refillable surgical thread supplier (middle of 20th century)\nThrough many millennia, various suture materials were used, debated, and remained largely unchanged. Needles were made of bone or metals such as silver, copper, and aluminium bronze wire. Sutures were made of plant materials (flax, hemp and cotton) or animal material (hair, tendons, arteries, muscle strips and nerves, silk, and catgut).\nThe earliest reports of surgical suture date to 3000 BC in ancient Egypt, and the oldest known suture is in a mummy from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician Sushruta, written in 500 BC.[23] The Greek father of medicine, Hippocrates, described suture techniques, as did the later Roman Aulus Cornelius Celsus. The 2nd-century Roman physician Galen described gut sutures.[24] In the 10th century, the catgut suture along with the surgery needle were developed by Abulcasis[25][26]. The catgut suture was similar to that of strings for violins, guitar, and tennis racquet and it involved harvesting sheep intestines.\nJoseph Lister endorsed the routine sterilization of all suture threads. He first attempted sterilization with the 1860s \"carbolic catgut,\" and chromic catgut followed two decades later. Sterile catgut was finally achieved in 1906 with iodine treatment.\nThe next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on polyvinyl alcohol in 1931. Polyesters were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester. Polyglycolic acid was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic polymer fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding Bovine Spongiform Encephalopathy. Silk suture is still used, mainly to secure surgical drains.\n\nSee also \n\nAlexis Carrel\nBarbed suture\nButterfly closure\nCheesewiring\nChitin\nCyanoacrylate\nKnots\nLigature\nList of medical topics\nSewing\nSurgical staple\nWound closure strips\n\nReferences \n\n\n^ Surgical Needle Guide from Novartis. Copyright 2005. \n\n^ \"Types of Sutures\". Dolphin Sutures. Retrieved 2014-01-07 . \n\n^ ETHICON Products (20 December 2002). \"ETHICON Receives FDA Clearance to Market VICRYL* Plus, First Ever Antibacterial Suture\". PRNewswire. Retrieved 25 January 2016 . \n\n^ Daoud, FC; Edmiston CE, Jr; Leaper, D (June 2014). \"Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence\". Surgical infections. 15 (3): 165\u201381. doi:10.1089\/sur.2013.177. PMC 4063374 . PMID 24738988. \n\n^ H\u00f6glund, Odd Viking (2012). A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation (PDF) . pp. 17\u201319. ISBN 978-91-576-7686-3. \n\n^ \"Suture Materials - Classification - Surgical Needles - TeachMeSurgery\". \n\n^ H\u00f6glund, Odd Viking (2012). A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation (PDF) . ISBN 978-91-576-7686-3. \n\n^ H\u00f6glund, Odd V; Ingman, Jessica; S\u00f6dersten, Fredrik; Hansson, Kerstin; Borg, Niklas; Lagerstedt, Anne-Sofie (2014). \"Ligation of the spermatic cord in dogs with a self-locking device of a resorbable polyglycolic based co-polymer \u2013 feasibility and long-term follow-up study\". BMC Research Notes. 7 (1): 825. doi:10.1186\/1756-0500-7-825. \n\n^ Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J. P. (5 October 2011). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". Hernia. 16 (2): 191\u2013197. doi:10.1007\/s10029-011-0885-y. \n\n^ Anderson, James M.; Rodriguez, Analiz; Chang, David T. (April 2008). \"Foreign body reaction to biomaterials\". Seminars in Immunology. 20 (2): 86\u2013100. doi:10.1016\/j.smim.2007.11.004. PMC 2327202 . \n\n^ Lammers, Richard L; Trott, Alexander T (2004). \"Chapter 36: Methods of Wound Closure\". In Roberts, James R; Hedges, Jerris R. Clinical Procedures in Emergency Medicine (4th ed.). Philadelphia: Saunders. p. 671. ISBN 0-7216-9760-7. \n\n^ Dorland's Medical Dictionary for Health Consumers. Copyright 2007 \n\n^ Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. \n\n^ Osterberg, B; Blomstedt, B (1979). \"Effect of suture materials on bacterial survival in infected wounds: An experimental study\". Acta Chir Scand. 145: 431. \n\n^ a b Macht, SD; Krizek, TJ (1978). \"Sutures and suturing - Current concepts\". Journal of Oral Surgery. 36: 710. \n\n^ a b Kirk, RM (1978). Basic Surgical Techniques. Edinburgh: Churchill Livingstone. \n\n^ Grossman, JA (1982). \"The repair of surface trauma\". Emergency Medicine. 14: 220. \n\n^ Varshney, S; Manek, P; Johnson, CD (September 1999). \"Six-fold suture:wound length ratio for abdominal closure\". Annals of the Royal College of Surgeons of England. 81 (5): 333\u20136. PMC 2503300 . PMID 10645176. \n\n^ Stark, M.; Chavkin, Y.; Kupfersztain, C.; Guedj, P.; Finkel, A. R. (1995). \"Evaluation of combinations of procedures in cesarean section\". International Journal of Gynecology & Obstetrics. 48 (3): 273\u20136. doi:10.1016\/0020-7292(94)02306-J. PMID 7781869. \n\n^ \"www.scribd.com\". \n\n^ \"Polytetrafluoroethylene Pledget\". \n\n^ Dumville, JC; Coulthard, P; Worthington, HV; Riley, P; Patel, N; Darcey, J; Esposito, M; van der Elst, M; van Waes, OJ (28 November 2014). \"Tissue adhesives for closure of surgical incisions\". The Cochrane Database of Systematic Reviews. 11: CD004287. doi:10.1002\/14651858.CD004287.pub4. PMID 25431843. \n\n^ Mysore, Venkataram. Acs(I) Textbook on Cutaneous and Aesthetic Surgery. Jaypee Brothers Medical Publishers Pvt. Ltd. pp. 125\u2013126. ISBN 9789350905913. Retrieved 25 January 2016 . \n\n^ Nutton, Dr Vivia (2005-07-30). Ancient Medicine. Taylor & Francis US. ISBN 9780415368483. Retrieved 21 November 2012 . \n\n^ Rooney, Anne (2009). The Story of Medicine. Arcturus Publishing. ISBN 9781848580398. \n\n^ Rakel, David; Rakel, Robert E. (2011). Textbook of Family Medicine E-Book. Elsevier Health Sciences. ISBN 1437735673. \n\n\nExternal links \n Media related to Surgical suture at Wikimedia Commons\n\nComputer modelling of sutures\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques\">https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 20:14.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 435 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3014f54069aaa56a07a85b820a8b84f8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_suture skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical suture<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suture_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Suture (disambiguation)\" rel=\"external_link\" target=\"_blank\">Suture<\/a>.<\/div>\n\n<p><b>Surgical suture<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> used to hold <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">body tissues<\/a> together after an injury or surgery. Application generally involves using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sewing_needle\" title=\"Sewing needle\" rel=\"external_link\" target=\"_blank\">needle<\/a> with an attached length of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thread_(yarn)\" title=\"Thread (yarn)\" rel=\"external_link\" target=\"_blank\">thread<\/a>. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Surgeons, physicians, dentists, podiatrists, eye doctors, registered nurses and other trained nursing personnel, medics, and clinical pharmacists typically engage in suturing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_knot\" title=\"Surgical knot\" rel=\"external_link\" target=\"_blank\">Surgical knots<\/a> are used to secure the sutures.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Needles\">Needles<\/span><\/h2>\n<p>Eyed or reusable needles with holes (called eyes), which are supplied separate from their suture thread, are necessary for suture. The suture must be threaded on site, as is done when sewing in a recreational setting. The advantage of this is that any thread and needle combination is possible to suit the job at hand. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swage\" class=\"mw-redirect\" title=\"Swage\" rel=\"external_link\" target=\"_blank\">Swaged<\/a>, or atraumatic, needles with sutures comprise a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swage\" class=\"mw-redirect\" title=\"Swage\" rel=\"external_link\" target=\"_blank\">swages<\/a> the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as \"atraumatic\".\n<\/p><p>There are several shapes of surgical needles. These include:\n<\/p>\n<ul><li>Straight<\/li>\n<li>1\/4 circle<\/li>\n<li>3\/8 circle<\/li>\n<li>1\/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>5\/8 circle<\/li>\n<li>compound curve<\/li>\n<li>half curved (also known as ski)<\/li>\n<li>half curved at both ends of a straight segment (also known as canoe)<\/li><\/ul>\n<p>The ski and canoe needle design allows curved needles to be straight enough to be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a>, where instruments are inserted into the abdominal cavity through narrow cannulas.\n<\/p><p>Needles may also be classified by their point geometry; examples include:\n<\/p>\n<ul><li>taper (needle body is round and tapers smoothly to a point)<\/li>\n<li>cutting (needle body is triangular and has a sharpened cutting edge on the inside curve)<\/li>\n<li>reverse cutting (cutting edge on the outside)<\/li>\n<li>trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)<\/li>\n<li>blunt points for sewing friable tissues<\/li>\n<li>side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery<\/li><\/ul>\n<p>Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These \"pop-offs\" are commonly used for interrupted sutures, where each suture is only passed once and then tied.\n<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:27.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HechtnaaldenB.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/HechtnaaldenB.jpg\/120px-HechtnaaldenB.jpg\" width=\"120\" height=\"95\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Eyed surgical needles which form 3\/8th of a circle, in different sizes.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:23.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HechtnaaldenG.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/HechtnaaldenG.jpg\/120px-HechtnaaldenG.jpg\" width=\"120\" height=\"103\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Eyed surgical needles which are semicircular, in different sizes.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<p>Sutures can withstand different amounts of force based on their size; this is quantified by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S.P._Needle_Pull_Specifications\" title=\"U.S.P. Needle Pull Specifications\" rel=\"external_link\" target=\"_blank\">U.S.P. Needle Pull Specifications<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Thread\">Thread<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture_micrograph.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9e\/Suture_micrograph.jpg\/220px-Suture_micrograph.jpg\" width=\"220\" height=\"164\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture_micrograph.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrograph\" title=\"Micrograph\" rel=\"external_link\" target=\"_blank\">Micrograph<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/H%26E_stain\" title=\"H&E stain\" rel=\"external_link\" target=\"_blank\">H&E stained<\/a> tissue section showing a non-absorbable multi-filament surgical suture with a surrounding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign-body_giant_cell\" title=\"Foreign-body giant cell\" rel=\"external_link\" target=\"_blank\">foreign-body giant cell<\/a> reaction<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suture_materials_comparison_chart\" title=\"Suture materials comparison chart\" rel=\"external_link\" target=\"_blank\">Suture materials comparison chart<\/a><\/div>\n<p>Suture thread is made from numerous materials. The original sutures were made from biological materials, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a>. These absorbed bodily fluids and could be foci of infection. Founder of gynecology <a href=\"https:\/\/en.wikipedia.org\/wiki\/J._Marion_Sims\" title=\"J. Marion Sims\" rel=\"external_link\" target=\"_blank\">J. Marion Sims<\/a> invented the use of silver wire, which is anti-bacterial, for a suture. Most modern sutures are synthetic, including the absorbables <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monocryl\" title=\"Monocryl\" rel=\"external_link\" target=\"_blank\">Monocryl<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydioxanone\" title=\"Polydioxanone\" rel=\"external_link\" target=\"_blank\">polydioxanone<\/a> as well as the non-absorbables <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinylidene_fluoride\" title=\"Polyvinylidene fluoride\" rel=\"external_link\" target=\"_blank\">PVDF<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>.<sup id=\"rdp-ebb-cite_ref-SutureTypes_2-0\" class=\"reference\"><a href=\"#cite_note-SutureTypes-2\" rel=\"external_link\">[2]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> first approved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Triclosan\" title=\"Triclosan\" rel=\"external_link\" target=\"_blank\">triclosan<\/a>-coated sutures in 2002;<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> they have been shown to reduce the chances of wound infection.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Sutures come in very specific sizes and may be either absorbable (naturally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradation\" title=\"Biodegradation\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a> in the body) or non-absorbable. Sutures must be strong enough to hold tissue securely but flexible enough to be knotted. They must be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoallergenic\" title=\"Hypoallergenic\" rel=\"external_link\" target=\"_blank\">hypoallergenic<\/a> and avoid the \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Capillary_action\" title=\"Capillary action\" rel=\"external_link\" target=\"_blank\">wick<\/a> effect\" that would allow fluids and thus infection to penetrate the body along the suture tract.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Absorbability\">Absorbability<\/span><\/h3>\n<p>All sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. <i>Absorbable<\/i> suture materials include the original <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut<\/a> as well as the newer synthetics <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydioxanone\" title=\"Polydioxanone\" rel=\"external_link\" target=\"_blank\">polydioxanone<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caprolactone\" title=\"Caprolactone\" rel=\"external_link\" target=\"_blank\">caprolactone<\/a>. \nAbsorbable (or resorbable) medical devices such as sutures are made of polymers. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_material\" class=\"mw-redirect\" title=\"Polymer material\" rel=\"external_link\" target=\"_blank\">polymer materials<\/a> are based on one or more of five cyclic monomers: glycolide, l-lactide, p-dioxanone, trimethylene carbonate and \u03b5-caprolactone.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>They are broken down by various processes including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a> (polyglycolic acid) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proteolysis\" title=\"Proteolysis\" rel=\"external_link\" target=\"_blank\">proteolytic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enzyme\" title=\"Enzyme\" rel=\"external_link\" target=\"_blank\">enzymatic<\/a> degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> In both cases, they will hold the body tissues together long enough to allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Healing\" title=\"Healing\" rel=\"external_link\" target=\"_blank\">healing<\/a>, but will disintegrate so that they do not leave foreign material or require further procedures. Initially, there is a foreign body reaction to the material, which is transient. After complete resorption only connective tissue will remain.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12_Stitches.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/12_Stitches.jpg\/220px-12_Stitches.jpg\" width=\"220\" height=\"295\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12_Stitches.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Twelve nonabsorbable sutures in a person's lower back.<\/div><\/div><\/div>\n<p><i>Non-absorbable sutures<\/i> are made of special <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a> or the synthetics <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">Stainless steel<\/a> wires are commonly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedic surgery<\/a> and for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_sternum\" class=\"mw-redirect\" title=\"Human sternum\" rel=\"external_link\" target=\"_blank\">sternal<\/a> closure in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">cardiac surgery<\/a>. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> (with its constant pressure and movement) or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a> (with adverse chemical conditions). Non-absorbable sutures often cause less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scarring<\/a> because they provoke less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a>, and thus are used where cosmetic outcome is important. They may be removed after a certain time, or left permanently.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sizes\">Sizes<\/span><\/h3>\n\n<p>Suture sizes are defined by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Pharmacopeia\" title=\"United States Pharmacopeia\" rel=\"external_link\" target=\"_blank\">United States Pharmacopeia<\/a> (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2\/0) to #000000 (#6-0 or #6\/0).\n<\/p><p>Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.\n<\/p>\n<dl><dd><table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>USP<br \/>designation<\/th>\n<th>Collagen<br \/>diameter (mm)<\/th>\n<th>Synthetic absorbable<br \/>diameter (mm)<\/th>\n<th>Non-absorbable<br \/>diameter (mm)<\/th>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_wire_gauge\" title=\"American wire gauge\" rel=\"external_link\" target=\"_blank\">American <br \/>wire gauge<\/a>\n<\/th><\/tr>\n<tr>\n<td>11-0<\/td>\n<td><\/td>\n<td><\/td>\n<td>0.01<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>10-0<\/td>\n<td>0.02<\/td>\n<td>0.02<\/td>\n<td>0.02<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>9-0<\/td>\n<td>0.03<\/td>\n<td>0.03<\/td>\n<td>0.03<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>8-0<\/td>\n<td>0.05<\/td>\n<td>0.04<\/td>\n<td>0.04<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>7-0<\/td>\n<td>0.07<\/td>\n<td>0.05<\/td>\n<td>0.05<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>6-0<\/td>\n<td>0.1<\/td>\n<td>0.07<\/td>\n<td>0.07<\/td>\n<td>38\u201340\n<\/td><\/tr>\n<tr>\n<td>5-0<\/td>\n<td>0.15<\/td>\n<td>0.1<\/td>\n<td>0.1<\/td>\n<td>35\u201338\n<\/td><\/tr>\n<tr>\n<td>4-0<\/td>\n<td>0.2<\/td>\n<td>0.15<\/td>\n<td>0.15<\/td>\n<td>32\u201334\n<\/td><\/tr>\n<tr>\n<td>3-0<\/td>\n<td>0.3<\/td>\n<td>0.2<\/td>\n<td>0.2<\/td>\n<td>29\u201332\n<\/td><\/tr>\n<tr>\n<td>2-0<\/td>\n<td>0.35<\/td>\n<td>0.3<\/td>\n<td>0.3<\/td>\n<td>28\n<\/td><\/tr>\n<tr>\n<td>0<\/td>\n<td>0.4<\/td>\n<td>0.35<\/td>\n<td>0.35<\/td>\n<td>26\u201327\n<\/td><\/tr>\n<tr>\n<td>1<\/td>\n<td>0.5<\/td>\n<td>0.4<\/td>\n<td>0.4<\/td>\n<td>25\u201326\n<\/td><\/tr>\n<tr>\n<td>2<\/td>\n<td>0.6<\/td>\n<td>0.5<\/td>\n<td>0.5<\/td>\n<td>23\u201324\n<\/td><\/tr>\n<tr>\n<td>3<\/td>\n<td>0.7<\/td>\n<td>0.6<\/td>\n<td>0.6<\/td>\n<td>22\n<\/td><\/tr>\n<tr>\n<td>4<\/td>\n<td>0.8<\/td>\n<td>0.6<\/td>\n<td>0.6<\/td>\n<td>21\u201322\n<\/td><\/tr>\n<tr>\n<td>5<\/td>\n<td><\/td>\n<td>0.7<\/td>\n<td>0.7<\/td>\n<td>20\u201321\n<\/td><\/tr>\n<tr>\n<td>6<\/td>\n<td><\/td>\n<td><\/td>\n<td>0.8<\/td>\n<td>19\u201320\n<\/td><\/tr>\n<tr>\n<td>7<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td>18\n<\/td><\/tr>\n<\/tbody><\/table><\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Techniques\">Techniques<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_knot\" title=\"Surgical knot\" rel=\"external_link\" target=\"_blank\">Surgical knot<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture,_before_and_after,_RMO.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/07\/Suture%2C_before_and_after%2C_RMO.jpg\/220px-Suture%2C_before_and_after%2C_RMO.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture,_before_and_after,_RMO.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A wound before and after suture closure. The closure incorporates five <a href=\"https:\/\/en.wikipedia.org\/wiki\/Simple_interrupted_stitch\" title=\"Simple interrupted stitch\" rel=\"external_link\" target=\"_blank\">simple interrupted sutures<\/a> and one <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_mattress_stitch\" title=\"Vertical mattress stitch\" rel=\"external_link\" target=\"_blank\">vertical mattress suture<\/a> (center) at the apex of the wound.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara,_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\/lossy-page1-220px-ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara,_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Suturing two operation wounds with eleven simple stitches by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cuban_medical_internationalism\" title=\"Cuban medical internationalism\" rel=\"external_link\" target=\"_blank\">Cuban doctor<\/a>. Sara, Guinea-Bissau, 1974.<\/div><\/div><\/div>\n<p>Many different techniques exist. The most common is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Simple_interrupted_stitch\" title=\"Simple interrupted stitch\" rel=\"external_link\" target=\"_blank\">simple interrupted stitch<\/a>;<sup id=\"rdp-ebb-cite_ref-rh_11-0\" class=\"reference\"><a href=\"#cite_note-rh-11\" rel=\"external_link\">[11]<\/a><\/sup> it is indeed the simplest to perform and is called \"interrupted\" because the suture thread is cut between each individual stitch. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_mattress_stitch\" title=\"Vertical mattress stitch\" rel=\"external_link\" target=\"_blank\">vertical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Horizontal_mattress_stitch\" title=\"Horizontal mattress stitch\" rel=\"external_link\" target=\"_blank\">horizontal mattress stitch<\/a> are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Running_stitch\" title=\"Running stitch\" rel=\"external_link\" target=\"_blank\">continuous stitch<\/a> is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_drain_stitch\" class=\"mw-redirect\" title=\"Chest drain stitch\" rel=\"external_link\" target=\"_blank\">chest drain stitch<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corner_stitch\" title=\"Corner stitch\" rel=\"external_link\" target=\"_blank\">corner stitch<\/a> are variations of the horizontal mattress.\n<\/p><p>Other stitches or suturing techniques include:\n<\/p>\n<ul><li><i>Purse-string suture<\/i>, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Figure 8 stitch<\/li>\n<li>Subcuticular stitch.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Placement\">Placement<\/span><\/h3>\n<p>Sutures are placed by mounting a needle with attached suture into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_holder\" title=\"Needle holder\" rel=\"external_link\" target=\"_blank\">needle holder<\/a>. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reef_knot\" title=\"Reef knot\" rel=\"external_link\" target=\"_blank\">square knot<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon%27s_knot\" title=\"Surgeon's knot\" rel=\"external_link\" target=\"_blank\">surgeon's knot<\/a>. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> since the blood supply may be impeded and thus increase <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> and scarring.<sup id=\"rdp-ebb-cite_ref-macht_15-0\" class=\"reference\"><a href=\"#cite_note-macht-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-kirk_16-0\" class=\"reference\"><a href=\"#cite_note-kirk-16\" rel=\"external_link\">[16]<\/a><\/sup> Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal.<sup id=\"rdp-ebb-cite_ref-macht_15-1\" class=\"reference\"><a href=\"#cite_note-macht-15\" rel=\"external_link\">[15]<\/a><\/sup> Placement varies based on the location,\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Stitching_interval_and_spacing\">Stitching interval and spacing<\/span><\/h3>\n<p>Skin and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_tissue\" title=\"Soft tissue\" rel=\"external_link\" target=\"_blank\">soft tissue<\/a> can lengthen significantly under strain. To accommodate this lengthening, continuous stitches must have an adequate amount of slack. <b>Jenkin's rule<\/b> was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds.<sup id=\"rdp-ebb-cite_ref-kirk_16-1\" class=\"reference\"><a href=\"#cite_note-kirk-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> A later study suggested 6:1 as the optimal ratio in abdominal closure.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Layers\">Layers<\/span><\/h3>\n<p>In contrast to <i>single layer suturing<\/i>, <i>two layer suturing<\/i> generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cesarean_section\" class=\"mw-redirect\" title=\"Cesarean section\" rel=\"external_link\" target=\"_blank\">Cesarean section<\/a> can be performed with single or double layer suturing of the uterine incision.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Removal\">Removal<\/span><\/h3>\n<p>Whereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound.\n<\/p>\n<blockquote class=\"templatequote\"><p>Different parts of the body heal at different speeds. Common time to remove stitches will vary: facial wounds 3\u20135 days; scalp wound 7\u201310 days; limbs 10\u201314 days; joints 14 days; trunk of the body 7\u201310 days.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><\/blockquote>\n<p>Removal of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Expansions\">Expansions<\/span><\/h3>\n<p>A <i>pledgeted suture<\/i> is one that is supported by a <i>pledget<\/i>, that is, a small flat non-absorbent pad normally composed of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a>, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.<sup id=\"rdp-ebb-cite_ref-bard_21-0\" class=\"reference\"><a href=\"#cite_note-bard-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Tissue_adhesives\">Tissue adhesives<\/span><\/h2>\n<p>Topical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanoacrylate\" title=\"Cyanoacrylate\" rel=\"external_link\" target=\"_blank\">cyanoacrylate<\/a> adhesives (industrially used as super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances\/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds.\n<\/p><p>In surgical incisions it does not work as well as sutures as the wounds often break open.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Cyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:C._Stromayr;_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\/220px-C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" width=\"220\" height=\"246\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:C._Stromayr;_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sewing wound after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herniotomy\" class=\"mw-redirect\" title=\"Herniotomy\" rel=\"external_link\" target=\"_blank\">herniotomy<\/a>, 1559<\/div><\/div><\/div>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_thread_supplier_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Surgical_thread_supplier_1.jpg\/170px-Surgical_thread_supplier_1.jpg\" width=\"170\" height=\"255\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_thread_supplier_1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Old refillable surgical thread supplier (middle of 20th century)<\/div><\/div><\/div>\n<p>Through many millennia, various suture materials were used, debated, and remained largely unchanged. Needles were made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> or metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">silver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronze\" title=\"Bronze\" rel=\"external_link\" target=\"_blank\">bronze<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wire\" title=\"Wire\" rel=\"external_link\" target=\"_blank\">wire<\/a>. Sutures were made of plant materials (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Flax\" title=\"Flax\" rel=\"external_link\" target=\"_blank\">flax<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemp\" title=\"Hemp\" rel=\"external_link\" target=\"_blank\">hemp<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cotton\" title=\"Cotton\" rel=\"external_link\" target=\"_blank\">cotton<\/a>) or animal material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hair\" title=\"Hair\" rel=\"external_link\" target=\"_blank\">hair<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendons\" class=\"mw-redirect\" title=\"Tendons\" rel=\"external_link\" target=\"_blank\">tendons<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arteries\" class=\"mw-redirect\" title=\"Arteries\" rel=\"external_link\" target=\"_blank\">arteries<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a> strips and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerves\" class=\"mw-redirect\" title=\"Nerves\" rel=\"external_link\" target=\"_blank\">nerves<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut\" title=\"Catgut\" rel=\"external_link\" target=\"_blank\">catgut<\/a>).\n<\/p><p>The earliest reports of surgical suture date to 3000 BC in ancient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egypt\" title=\"Egypt\" rel=\"external_link\" target=\"_blank\">Egypt<\/a>, and the oldest known suture is in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mummy\" title=\"Mummy\" rel=\"external_link\" target=\"_blank\">mummy<\/a> from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sushruta_Samhita\" title=\"Sushruta Samhita\" rel=\"external_link\" target=\"_blank\">Sushruta<\/a>, written in 500 BC.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> The Greek father of medicine, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocrates\" title=\"Hippocrates\" rel=\"external_link\" target=\"_blank\">Hippocrates<\/a>, described suture techniques, as did the later Roman <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aulus_Cornelius_Celsus\" title=\"Aulus Cornelius Celsus\" rel=\"external_link\" target=\"_blank\">Aulus Cornelius Celsus<\/a>. The 2nd-century Roman physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Galen\" title=\"Galen\" rel=\"external_link\" target=\"_blank\">Galen<\/a> described gut sutures.<sup id=\"rdp-ebb-cite_ref-Nutton2005_24-0\" class=\"reference\"><a href=\"#cite_note-Nutton2005-24\" rel=\"external_link\">[24]<\/a><\/sup> In the 10th century, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> along with the surgery needle were developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abulcasis\" class=\"mw-redirect\" title=\"Abulcasis\" rel=\"external_link\" target=\"_blank\">Abulcasis<\/a><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> was similar to that of strings for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Violin\" title=\"Violin\" rel=\"external_link\" target=\"_blank\">violins<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Guitar\" title=\"Guitar\" rel=\"external_link\" target=\"_blank\">guitar<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tennis_racquet\" class=\"mw-redirect\" title=\"Tennis racquet\" rel=\"external_link\" target=\"_blank\">tennis racquet<\/a> and it involved harvesting sheep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intestine\" class=\"mw-redirect\" title=\"Intestine\" rel=\"external_link\" target=\"_blank\">intestines<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joseph_Lister,_1st_Baron_Lister\" class=\"mw-redirect\" title=\"Joseph Lister, 1st Baron Lister\" rel=\"external_link\" target=\"_blank\">Joseph Lister<\/a> endorsed the routine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> of all suture threads. He first attempted sterilization with the 1860s \"carbolic catgut,\" and chromic catgut followed two decades later. Sterile catgut was finally achieved in 1906 with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iodine\" title=\"Iodine\" rel=\"external_link\" target=\"_blank\">iodine<\/a> treatment.\n<\/p><p>The next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_alcohol\" title=\"Polyvinyl alcohol\" rel=\"external_link\" target=\"_blank\">polyvinyl alcohol<\/a> in 1931. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">Polyesters<\/a> were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">Polyglycolic acid<\/a> was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovine_Spongiform_Encephalopathy\" class=\"mw-redirect\" title=\"Bovine Spongiform Encephalopathy\" rel=\"external_link\" target=\"_blank\">Bovine Spongiform Encephalopathy<\/a>. Silk suture is still used, mainly to secure surgical drains.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alexis_Carrel\" title=\"Alexis Carrel\" rel=\"external_link\" target=\"_blank\">Alexis Carrel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barbed_suture\" title=\"Barbed suture\" rel=\"external_link\" target=\"_blank\">Barbed suture<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterfly_closure\" class=\"mw-redirect\" title=\"Butterfly closure\" rel=\"external_link\" target=\"_blank\">Butterfly closure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cheesewiring\" title=\"Cheesewiring\" rel=\"external_link\" target=\"_blank\">Cheesewiring<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chitin\" title=\"Chitin\" rel=\"external_link\" target=\"_blank\">Chitin<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanoacrylate\" title=\"Cyanoacrylate\" rel=\"external_link\" target=\"_blank\">Cyanoacrylate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knot\" title=\"Knot\" rel=\"external_link\" target=\"_blank\">Knots<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligature_(medicine)\" title=\"Ligature (medicine)\" rel=\"external_link\" target=\"_blank\">Ligature<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_medical_topics\" class=\"mw-redirect\" title=\"List of medical topics\" rel=\"external_link\" target=\"_blank\">List of medical topics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sewing\" title=\"Sewing\" rel=\"external_link\" target=\"_blank\">Sewing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_staple\" title=\"Surgical staple\" rel=\"external_link\" target=\"_blank\">Surgical staple<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound_closure_strip\" title=\"Wound closure strip\" rel=\"external_link\" target=\"_blank\">Wound closure strips<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ethicon.novartis.us\/pdf\/finalNeedleDetailer.pdf\" target=\"_blank\">Surgical Needle Guide<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Novartis\" title=\"Novartis\" rel=\"external_link\" target=\"_blank\">Novartis<\/a>. Copyright 2005.<\/span>\n<\/li>\n<li id=\"cite_note-SutureTypes-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SutureTypes_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dolphinsutures.com\/types-of-sutures\" target=\"_blank\">\"Types of Sutures\"<\/a>. Dolphin Sutures<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-01-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Types+of+Sutures&rft.pub=Dolphin+Sutures&rft_id=http%3A%2F%2Fwww.dolphinsutures.com%2Ftypes-of-sutures&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">ETHICON Products (20 December 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.prnewswire.com\/news-releases\/ethicon-receives-fda-clearance-to-market-vicryl-plus-first-ever-antibacterial-suture-77230792.html\" target=\"_blank\">\"ETHICON Receives FDA Clearance to Market VICRYL* Plus, First Ever Antibacterial Suture\"<\/a>. PRNewswire<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 January<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=ETHICON+Receives+FDA+Clearance+to+Market+VICRYL%2A+Plus%2C+First+Ever+Antibacterial+Suture&rft.date=2002-12-20&rft.au=ETHICON+Products&rft_id=http%3A%2F%2Fwww.prnewswire.com%2Fnews-releases%2Fethicon-receives-fda-clearance-to-market-vicryl-plus-first-ever-antibacterial-suture-77230792.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Daoud, FC; Edmiston CE, Jr; Leaper, D (June 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4063374\" target=\"_blank\">\"Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence\"<\/a>. <i>Surgical infections<\/i>. <b>15<\/b> (3): 165\u201381. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Fsur.2013.177\" target=\"_blank\">10.1089\/sur.2013.177<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4063374\" target=\"_blank\">4063374<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24738988\" target=\"_blank\">24738988<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+infections&rft.atitle=Meta-analysis+of+prevention+of+surgical+site+infections+following+incision+closure+with+triclosan-coated+sutures%3A+robustness+to+new+evidence.&rft.volume=15&rft.issue=3&rft.pages=165-81&rft.date=2014-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4063374&rft_id=info%3Apmid%2F24738988&rft_id=info%3Adoi%2F10.1089%2Fsur.2013.177&rft.aulast=Daoud&rft.aufirst=FC&rft.au=Edmiston+CE%2C+Jr&rft.au=Leaper%2C+D&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4063374&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">H\u00f6glund, Odd Viking (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pub.epsilon.slu.se\/8589\/1\/odd_v_hoglund_120210..pdf\" target=\"_blank\"><i>A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. pp. 17\u201319. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-91-576-7686-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+resorbable+device+for+ligation+of+blood+vessels+%3A+development%2C+assessment+of+surgical+procedures+and+clinical+evaluation&rft.pages=17-19&rft.date=2012&rft.isbn=978-91-576-7686-3&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+Viking&rft_id=http%3A%2F%2Fpub.epsilon.slu.se%2F8589%2F1%2Fodd_v_hoglund_120210..pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/teachmesurgery.com\/skills\/theatre-basics\/suture-materials\/\" target=\"_blank\">\"Suture Materials - Classification - Surgical Needles - TeachMeSurgery\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Suture+Materials+-+Classification+-+Surgical+Needles+-+TeachMeSurgery&rft_id=http%3A%2F%2Fteachmesurgery.com%2Fskills%2Ftheatre-basics%2Fsuture-materials%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">H\u00f6glund, Odd Viking (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pub.epsilon.slu.se\/8589\/1\/odd_v_hoglund_120210..pdf\" target=\"_blank\"><i>A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-91-576-7686-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+resorbable+device+for+ligation+of+blood+vessels+%3A+development%2C+assessment+of+surgical+procedures+and+clinical+evaluation&rft.date=2012&rft.isbn=978-91-576-7686-3&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+Viking&rft_id=http%3A%2F%2Fpub.epsilon.slu.se%2F8589%2F1%2Fodd_v_hoglund_120210..pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">H\u00f6glund, Odd V; Ingman, Jessica; S\u00f6dersten, Fredrik; Hansson, Kerstin; Borg, Niklas; Lagerstedt, Anne-Sofie (2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bmcresnotes.biomedcentral.com\/articles\/10.1186\/1756-0500-7-825\" target=\"_blank\">\"Ligation of the spermatic cord in dogs with a self-locking device of a resorbable polyglycolic based co-polymer \u2013 feasibility and long-term follow-up study\"<\/a>. <i>BMC Research Notes<\/i>. <b>7<\/b> (1): 825. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1756-0500-7-825\" target=\"_blank\">10.1186\/1756-0500-7-825<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Research+Notes&rft.atitle=Ligation+of+the+spermatic+cord+in+dogs+with+a+self-locking+device+of+a+resorbable+polyglycolic+based+co-polymer+%E2%80%93+feasibility+and+long-term+follow-up+study&rft.volume=7&rft.issue=1&rft.pages=825&rft.date=2014&rft_id=info%3Adoi%2F10.1186%2F1756-0500-7-825&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+V&rft.au=Ingman%2C+Jessica&rft.au=S%C3%B6dersten%2C+Fredrik&rft.au=Hansson%2C+Kerstin&rft.au=Borg%2C+Niklas&rft.au=Lagerstedt%2C+Anne-Sofie&rft_id=http%3A%2F%2Fbmcresnotes.biomedcentral.com%2Farticles%2F10.1186%2F1756-0500-7-825&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J. P. (5 October 2011). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". <i>Hernia<\/i>. <b>16<\/b> (2): 191\u2013197. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10029-011-0885-y\" target=\"_blank\">10.1007\/s10029-011-0885-y<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hernia&rft.atitle=Three-year+results+from+a+preclinical+implantation+study+of+a+long-term+resorbable+surgical+mesh+with+time-dependent+mechanical+characteristics&rft.volume=16&rft.issue=2&rft.pages=191-197&rft.date=2011-10-05&rft_id=info%3Adoi%2F10.1007%2Fs10029-011-0885-y&rft.aulast=Hjort&rft.aufirst=H.&rft.au=Mathisen%2C+T.&rft.au=Alves%2C+A.&rft.au=Clermont%2C+G.&rft.au=Boutrand%2C+J.+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anderson, James M.; Rodriguez, Analiz; Chang, David T. (April 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2327202\" target=\"_blank\">\"Foreign body reaction to biomaterials\"<\/a>. <i>Seminars in Immunology<\/i>. <b>20<\/b> (2): 86\u2013100. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.smim.2007.11.004\" target=\"_blank\">10.1016\/j.smim.2007.11.004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2327202\" target=\"_blank\">2327202<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Seminars+in+Immunology&rft.atitle=Foreign+body+reaction+to+biomaterials&rft.volume=20&rft.issue=2&rft.pages=86-100&rft.date=2008-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2327202&rft_id=info%3Adoi%2F10.1016%2Fj.smim.2007.11.004&rft.aulast=Anderson&rft.aufirst=James+M.&rft.au=Rodriguez%2C+Analiz&rft.au=Chang%2C+David+T.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2327202&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-rh-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-rh_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Lammers, Richard L; Trott, Alexander T (2004). \"Chapter 36: Methods of Wound Closure\". In Roberts, James R; Hedges, Jerris R. <i>Clinical Procedures in Emergency Medicine<\/i> (4th ed.). Philadelphia: Saunders. p. 671. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7216-9760-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+36%3A+Methods+of+Wound+Closure&rft.btitle=Clinical+Procedures+in+Emergency+Medicine&rft.place=Philadelphia&rft.pages=671&rft.edition=4th&rft.pub=Saunders&rft.date=2004&rft.isbn=0-7216-9760-7&rft.aulast=Lammers&rft.aufirst=Richard+L&rft.au=Trott%2C+Alexander+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dorland's Medical Dictionary for Health Consumers. Copyright 2007<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Miller-Keane_Encyclopedia_%26_Dictionary_of_Medicine,_Nursing,_and_Allied_Health\" title=\"Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health\" rel=\"external_link\" target=\"_blank\">Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health<\/a>, Seventh Edition.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Osterberg, B; Blomstedt, B (1979). \"Effect of suture materials on bacterial survival in infected wounds: An experimental study\". <i>Acta Chir Scand<\/i>. <b>145<\/b>: 431.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Chir+Scand&rft.atitle=Effect+of+suture+materials+on+bacterial+survival+in+infected+wounds%3A+An+experimental+study&rft.volume=145&rft.pages=431&rft.date=1979&rft.aulast=Osterberg&rft.aufirst=B&rft.au=Blomstedt%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-macht-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-macht_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-macht_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Macht, SD; Krizek, TJ (1978). \"Sutures and suturing - Current concepts\". <i>Journal of Oral Surgery<\/i>. <b>36<\/b>: 710.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Oral+Surgery&rft.atitle=Sutures+and+suturing+-+Current+concepts&rft.volume=36&rft.pages=710&rft.date=1978&rft.aulast=Macht&rft.aufirst=SD&rft.au=Krizek%2C+TJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-kirk-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kirk_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kirk_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kirk, RM (1978). <i>Basic Surgical Techniques<\/i>. Edinburgh: Churchill Livingstone.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Basic+Surgical+Techniques&rft.place=Edinburgh&rft.pub=Churchill+Livingstone&rft.date=1978&rft.aulast=Kirk&rft.aufirst=RM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Grossman, JA (1982). \"The repair of surface trauma\". <i>Emergency Medicine<\/i>. <b>14<\/b>: 220.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Emergency+Medicine&rft.atitle=The+repair+of+surface+trauma&rft.volume=14&rft.pages=220&rft.date=1982&rft.aulast=Grossman&rft.aufirst=JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Varshney, S; Manek, P; Johnson, CD (September 1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2503300\" target=\"_blank\">\"Six-fold suture:wound length ratio for abdominal closure\"<\/a>. <i>Annals of the Royal College of Surgeons of England<\/i>. <b>81<\/b> (5): 333\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2503300\" target=\"_blank\">2503300<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10645176\" target=\"_blank\">10645176<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+the+Royal+College+of+Surgeons+of+England&rft.atitle=Six-fold+suture%3Awound+length+ratio+for+abdominal+closure.&rft.volume=81&rft.issue=5&rft.pages=333-6&rft.date=1999-09&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2503300&rft_id=info%3Apmid%2F10645176&rft.aulast=Varshney&rft.aufirst=S&rft.au=Manek%2C+P&rft.au=Johnson%2C+CD&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2503300&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stark, M.; Chavkin, Y.; Kupfersztain, C.; Guedj, P.; Finkel, A. R. (1995). \"Evaluation of combinations of procedures in cesarean section\". <i>International Journal of Gynecology & Obstetrics<\/i>. <b>48<\/b> (3): 273\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0020-7292%2894%2902306-J\" target=\"_blank\">10.1016\/0020-7292(94)02306-J<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7781869\" target=\"_blank\">7781869<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Gynecology+%26+Obstetrics&rft.atitle=Evaluation+of+combinations+of+procedures+in+cesarean+section&rft.volume=48&rft.issue=3&rft.pages=273-6&rft.date=1995&rft_id=info%3Adoi%2F10.1016%2F0020-7292%2894%2902306-J&rft_id=info%3Apmid%2F7781869&rft.aulast=Stark&rft.aufirst=M.&rft.au=Chavkin%2C+Y.&rft.au=Kupfersztain%2C+C.&rft.au=Guedj%2C+P.&rft.au=Finkel%2C+A.+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.scribd.com\/doc\/127263916\/Bedah-Minor\" target=\"_blank\">\"www.scribd.com\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=www.scribd.com&rft_id=https%3A%2F%2Fwww.scribd.com%2Fdoc%2F127263916%2FBedah-Minor&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-bard-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-bard_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bardpv.com\/_vascular\/product.php?p=31\" target=\"_blank\">\"Polytetrafluoroethylene Pledget\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Polytetrafluoroethylene+Pledget&rft_id=http%3A%2F%2Fwww.bardpv.com%2F_vascular%2Fproduct.php%3Fp%3D31&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dumville, JC; Coulthard, P; Worthington, HV; Riley, P; Patel, N; Darcey, J; Esposito, M; van der Elst, M; van Waes, OJ (28 November 2014). \"Tissue adhesives for closure of surgical incisions\". <i>The Cochrane Database of Systematic Reviews<\/i>. <b>11<\/b>: CD004287. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004287.pub4\" target=\"_blank\">10.1002\/14651858.CD004287.pub4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25431843\" target=\"_blank\">25431843<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Tissue+adhesives+for+closure+of+surgical+incisions.&rft.volume=11&rft.pages=CD004287&rft.date=2014-11-28&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004287.pub4&rft_id=info%3Apmid%2F25431843&rft.aulast=Dumville&rft.aufirst=JC&rft.au=Coulthard%2C+P&rft.au=Worthington%2C+HV&rft.au=Riley%2C+P&rft.au=Patel%2C+N&rft.au=Darcey%2C+J&rft.au=Esposito%2C+M&rft.au=van+der+Elst%2C+M&rft.au=van+Waes%2C+OJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mysore, Venkataram. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=sushruta&f=false\"><i>Acs(I) Textbook on Cutaneous and Aesthetic Surgery<\/i><\/a>. Jaypee Brothers Medical Publishers Pvt. Ltd. pp. 125\u2013126. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789350905913<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 January<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Acs%28I%29+Textbook+on+Cutaneous+and+Aesthetic+Surgery&rft.pages=125-126&rft.pub=Jaypee+Brothers+Medical+Publishers+Pvt.+Ltd.&rft.isbn=9789350905913&rft.aulast=Mysore&rft.aufirst=Venkataram&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D47HGBAAAQBAJ%26lpg%3DPA125%26pg%3DPA126%23v%3Donepage%26q%3Dsushruta%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Nutton2005-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nutton2005_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Nutton, Dr Vivia (2005-07-30). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=PREr9_rojrQC\" target=\"_blank\"><i>Ancient Medicine<\/i><\/a>. Taylor & Francis US. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780415368483<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Ancient+Medicine&rft.pub=Taylor+%26+Francis+US&rft.date=2005-07-30&rft.isbn=9780415368483&rft.aulast=Nutton&rft.aufirst=Dr+Vivia&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPREr9_rojrQC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rooney, Anne (2009). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\"><i>The Story of Medicine<\/i><\/a>. Arcturus Publishing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781848580398.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Story+of+Medicine&rft.pub=Arcturus+Publishing&rft.date=2009&rft.isbn=9781848580398&rft.aulast=Rooney&rft.aufirst=Anne&rft_id=https%3A%2F%2Fbooks.google.com.sa%2Fbooks%3Fid%3DjBMEAwAAQBAJ%26pg%3DPT161%26dq%3DCatgut%2Bal-zahrawi%2BThe%2BStory%2Bof%2BMedicine%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwiFg53yt_XZAhWEPRQKHTkSB1AQ6AEIMzAC%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rakel, David; Rakel, Robert E. (2011). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Abulcasis%20%22surgical%20needle%22&f=false\"><i>Textbook of Family Medicine E-Book<\/i><\/a>. Elsevier Health Sciences. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1437735673.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Textbook+of+Family+Medicine+E-Book&rft.pub=Elsevier+Health+Sciences&rft.date=2011&rft.isbn=1437735673&rft.aulast=Rakel&rft.aufirst=David&rft.au=Rakel%2C+Robert+E.&rft_id=https%3A%2F%2Fbooks.google.com.sa%2Fbooks%3Fid%3DB3Hr25rgpZsC%26pg%3DPA550-IA11%26dq%3DAbulcasis%2B%2522plastic%2Bsurgery%2522%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwi_mJna5ffZAhWCtBQKHWJ_Cc4Q6AEILDAB%23v%3Donepage%26q%3DAbulcasis%2520%2522surgical%2520needle%2522%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Surgical_suture\" class=\"extiw\" title=\"commons:Category:Surgical suture\" rel=\"external_link\" target=\"_blank\">Surgical suture <\/a> at Wikimedia Commons\n<\/p>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/262529587_Sutured_tendon_repair_a_multi-scale_finite_element_model\" target=\"_blank\">Computer modelling of sutures<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181212170216\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.396 seconds\nReal time usage: 0.541 seconds\nPreprocessor visited node count: 1758\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 50735\/2097152 bytes\nTemplate argument size: 733\/2097152 bytes\nHighest expansion depth: 10\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 66925\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.197\/10.000 seconds\nLua memory usage: 5.82 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 463.253 1 -total\n<\/p>\n<pre>41.93% 194.264 1 Template:Reflist\n14.49% 67.112 4 Template:Cite_web\n14.46% 67.007 1 Template:Infobox_medical_intervention\n13.53% 62.685 1 Template:Infobox\n13.00% 60.200 10 Template:Cite_journal\n12.02% 55.704 1 Template:Commonscatinline\n10.43% 48.306 1 Template:Globalize\/US\n 9.12% 42.256 1 Template:Globalize\n 8.20% 37.983 1 Template:Ambox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:13896574-1!canonical and timestamp 20181212170216 and revision id 865977170\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214707\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.177 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 169.860 1 - wikipedia:Surgical_suture\n100.00% 169.860 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8264-0!*!*!*!*!*!* and timestamp 20181217214707 and revision id 24474\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques\">https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3014f54069aaa56a07a85b820a8b84f8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e9\/Atraumatisches_Nahtmaterial_17.JPG\/560px-Atraumatisches_Nahtmaterial_17.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/HechtnaaldenB.jpg\/240px-HechtnaaldenB.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/HechtnaaldenG.jpg\/240px-HechtnaaldenG.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9e\/Suture_micrograph.jpg\/440px-Suture_micrograph.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/12_Stitches.jpg\/440px-12_Stitches.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/07\/Suture%2C_before_and_after%2C_RMO.jpg\/440px-Suture%2C_before_and_after%2C_RMO.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\/lossy-page1-440px-ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\/440px-C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Surgical_thread_supplier_1.jpg\/340px-Surgical_thread_supplier_1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png"],"3014f54069aaa56a07a85b820a8b84f8_timestamp":1545083227,"7be8ae6a8cc61a682af74f5c8f893873_type":"article","7be8ae6a8cc61a682af74f5c8f893873_title":"Robot-assisted surgery","7be8ae6a8cc61a682af74f5c8f893873_url":"https:\/\/www.limswiki.org\/index.php\/Robot-assisted_surgery","7be8ae6a8cc61a682af74f5c8f893873_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRobot-assisted surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\n A robotically assisted surgical system used for prostatectomies, cardiac valve repair and gynecologic surgical procedures\nRobotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures. Robotically-assisted surgery was developed to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.\nIn the case of robotically-assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to control the instruments; either a direct telemanipulator or through computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the robotic arms carry out those movements using end-effectors and manipulators to perform the actual surgery on the patient. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerised method is that the surgeon does not have to be present, but can be anywhere in the world, leading to the possibility for remote surgery.\nIn the case of enhanced open surgery, autonomous instruments (in familiar configurations) replace traditional steel tools, performing certain actions (such as rib spreading) with much smoother, feedback-controlled motions than could be achieved by a human hand. The main object of such smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery without requiring more than a few minutes' training on the part of surgeons. This approach seeks to improve open surgeries, particularly cardio-thoracic, that have so far not benefited from minimally-invasive techniques.\nRobotic surgery has been criticized for its expense, by one estimate costing $1,500 to $2000 more per patient.[1]\n\nContents \n\n1 Comparison to traditional methods \n2 Uses \n\n2.1 Cardiology and electrophysiology \n2.2 Colon and rectal surgery \n2.3 Gastrointestinal surgery \n2.4 Gynecology \n2.5 Orthopedics \n2.6 Children \n2.7 Spine surgery \n2.8 Transplant surgery \n2.9 Urology \n\n\n3 History \n4 See also \n5 References \n6 External links \n\n\nComparison to traditional methods \nMajor advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification helps resulting in improved ergonomics. Due to these techniques there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.[2]\nThe existing open surgery technique has many flaws like limited access to surgical area, long recovery time, long hours of operation, blood loss, surgical scars and marks.[3]\nThe robot normally costs $1,390,000 and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher.[1] Additional surgical training is needed to operate the system.[4] Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain.[2] Higher expectations may explain higher rates of dissatisfaction and regret.[4]\nCompared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.[5]\nCritics of the system, including the American Congress of Obstetricians and Gynecologists,[6] say there is a steep learning curve for surgeons who adopt use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional laparoscopic surgery.[1] Articles in the newly created Journal of Robotic Surgery tend to report on one surgeon's experience.[1]\nA Medicare study found that some procedures that have traditionally been performed with large incisions can be converted to \"minimally invasive\" endoscopic procedures with the use of the Da Vinci Surgical System, shortening length-of-stay in the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement paid by the government or insurance companies when the system is used.[1]\nRobot-assisted pancreatectomies have been found to be associated with \"longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]\" than laparoscopic pancreatectomies; there was \"no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.\"[7] For surgical removal of the uterus and cervix for early cervical cancer robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer.[8]\n\nUses \nCardiology and electrophysiology \nAs of 2004, three types of heart surgery are being performed on a routine basis using robotic surgery systems.[9] These three surgery types were:\n\nAtrial septal defect repair \u2013 the repair of a hole between the two upper chambers of the heart,\nMitral valve repair \u2013 the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart,\nCoronary artery bypass \u2013 rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.\nColon and rectal surgery \nMany studies have been undertaken in order to examine the role of robotic procedures in the field of colorectal surgery.[10][11]\nResults to date indicate that robotic-assisted colorectal procedures outcomes are \"no worse\" than the results in the now \"traditional\" laparoscopic colorectal operations. Robotic-assisted colorectal surgery appears to be safe as well.[12] Most of the procedures have been performed for malignant colon and rectal lesions. However, surgeons are now moving into resections for diverticulitis and non-resective rectopexies (attaching the colon to the sacrum in order to treat rectal prolapse.)\nWhen evaluated for several variables, robotic-assisted procedures fare equally well when compared with laparoscopic, or open abdominal operations. Study parameters have looked at intraoperative patient preparation time, length of time to perform the operation, adequacy of the removed surgical specimen with respect to clear surgical margins and number of lymph nodes removed, blood loss, operative or postoperative complications and long-term results.\nMore difficult to evaluate are issues related to the view of the operative field, the types of procedures that should be performed using robotic assistance and the potential added cost for a robotic operation.\nMany surgeons feel that the optics of the 3-dimensional, two camera stereo optic robotic system are superior to the optical system used in laparoscopic procedures. The pelvic nerves are clearly visualized during robotic-assisted procedures. Less clear however is whether or not these supposedly improved optics and visualization improve patient outcomes with respect to postoperative impotence or incontinence, and whether long-term patient survival is improved by using the 3-dimensional optic system. Additionally, there is often a need for a wider, or \"larger\" view of the operative field than is routinely provided during robotic operations.,[13] The close-up view of the area under dissection may hamper visualization of the \"bigger view\", especially with respect to ureteral protection.\nQuestions remain unanswered, even after many years of experience with robotic-assisted colorectal operations. Ongoing studies may help clarify many of the issues of confusion associated with this novel surgical approach.\n\nGastrointestinal surgery \nMultiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems, including bariatric surgery and gastrectomy[14] for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.[15] Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux[16] and Heller myotomy for the treatment of achalasia.[17][18]\nOther gastrointestinal procedures including colon resection, pancreatectomy, esophagectomy and robotic approaches to pelvic disease have also been reported.\n\nGynecology \nRobotic surgery in gynecology is of uncertain benefit with it being unclear if it affects rates of complications. Gynecologic procedures may take longer with robot-assisted surgery but may be associated with a shorter hospital stay following hysterectomy.[19] In the United States, robotic-assisted hysterectomy for benign conditions has been shown to be more expensive than conventional laparoscopic hysterectomy, with no difference in overall rates of complications.[20]\nThis includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis, ovarian tumors, uterine prolapse, and female cancers. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies.\n\nOrthopedics \nRobots are used in orthopedic surgery.[21]\n\nChildren \nSurgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula repair, cholecystectomy, nissen fundoplication, morgagni's hernia repair, kasai portoenterostomy, congenital diaphragmatic hernia repair, and others.[citation needed ]\n\nSpine surgery \nRobotic devices started to be used in minimally invasive spine surgery starting in the mid-2000s.[22] As of 2014, there were too few randomized clinical trials to allow judgements as to whether robotic spine surgery is more or less safe than other approaches.[22]\n\nTransplant surgery \nTransplant surgery (organ transplantation) has been considered as highly technically demanding and virtually unobtainable by means of conventional laparoscopy. For many years, transplant patients were unable to benefit from the advantages of minimally invasive surgery. The development of robotic technology and its associated high resolution capabilities, three dimensional visual system, wrist type motion and fine instruments, gave opportunity for highly complex procedures to be completed in a minimally invasive fashion. Subsequently, the first fully robotic kidney transplantations were performed in the late 2000s. After the procedure was proven to be feasible and safe, the main emerging challenge was to determine which patients would benefit most from this robotic technique. As a result, recognition of the increasing prevalence of obesity amongst patients with kidney failure on hemodialysis posed a significant problem. Due to the abundantly higher risk of complications after traditional open kidney transplantation, obese patients were frequently denied access to transplantation, which is the premium treatment for end stage kidney disease.[citation needed ]\n\nUrology \nRobotic surgery in the field of urology has become very popular, especially in the United States.[23] It has been most extensively applied for excision of prostate cancer because of difficult anatomical access. It is also utilized for kidney cancer surgeries and to lesser extent surgeries of the bladder.\nAs of 2014, there is little evidence of increased benefits compared to standard surgery to justify the increased costs.[24] Some have found tentative evidence of more complete removal of cancer and less side effects from surgery for prostatectomy.[25]\nIn 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.[4]\nBreast Surgery\nRobotic breast surgery involves using the robot to assist in performing nipple-sparing mastectomy and breast reconstruction. In 2015, a group of surgeons led by Dr. Antonio Toesca, in Milan, Italy demonstrated the feasibility and safety of robotic nipple-sparing mastectomy and robotic breast reconstruction.[26] The Italian surgeons published their results in their first 29 consecutive patients. In this report, all patients had robotic mastectomy and reconstruction done through a 3 cm extra-mammary incision, hidden by the arm. Thereafter, a surgeon, Dr. Benjamin Sarfati, in Paris began performing robotic mastectomy and breast reconstruction.[27] On March 4, 2018, Dr. Neil Tanna and colleagues performed the first robotic nipple-sparing mastectomy and robotic breast reconstruction in North America.[28][29] \nTraditional (open) nipple-sparing mastectomy and breast reconstruction require incisions on the breast. Robotic nipple sparing mastectomy with robotic breast reconstruction is an innovative form of breast surgery that utilizes robotic technology to perform the surgery. By using the robot, the incisions can be much smaller and be placed off the breasts, far away near the armpit or the bra line.\n\nHistory \nThe first robot to assist in surgery was the Arthrobot, which was developed and used for the first time in Vancouver in 1983.[30] Intimately involved were biomedical engineer Dr. James McEwen, Geof Auchinleck, a UBC engineering physics grad, and Dr. Brian Day as well as a team of engineering students. The robot was used in an orthopaedic surgical procedure on 12 March 1984, at the UBC Hospital in Vancouver. Over 60 arthroscopic surgical procedures were performed in the first 12 months, and a 1985 National Geographic video on industrial robots, The Robotics Revolution, featured the device. Other related robotic devices developed at the same time included a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled Arthrobot illustrates some of these in operation.[citation needed ]\nIn 1985 a robot, the Unimation Puma 200, was used to place a needle for a brain biopsy using CT guidance.[31] PROBOT was then used to perform prostatic surgery and ROBODOC to assist with hip replacement surgeries. The latter was the first surgical robot that was approved by the FDA.[32] The ROBODOC from Integrated Surgical Systems (working closely with IBM) was introduced in 1992 to mill out precise fittings in the femur for hip replacement.[33] The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach\/rasp.\nFurther development of robotic systems was carried out by SRI International and Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system.[34] The first robotic surgery took place at The Ohio State University Medical Center in Columbus, Ohio under the direction of Robert E. Michler.[35] Examples of using ZEUS include a fallopian tube reconnection in July 1998,[36] a beating heart coronary artery bypass graft in October 1999,[37] and the Lindbergh Operation, which was a cholecystectomy performed remotely in September 2001.[38]\nThe original telesurgery robotic system that the da Vinci was based on was developed at SRI International in Menlo Park with grant support from DARPA and NASA.[39] Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Examples of using the da Vinci system include the first robotically assisted heart bypass (performed in Germany) in May 1998, and the first performed in the United States in September 1999;[citation needed ] and the first all-robotic-assisted kidney transplant, performed in January 2009.[40] The da Vinci Si was released in April 2009, and initially sold for $1.75 million.[41]\nIn May 2006 the first artificial intelligence doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct heart arrythmia. The results were rated as better than an above-average human surgeon. The machine had a database of 10,000 similar operations, and so, in the words of its designers, was \"more than qualified to operate on any patient\".[42][43] In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain.[44] In February 2008, Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction.[45]\nOn 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm.[46] In June 2008, the German Aerospace Centre (DLR) presented a robotic system for minimally invasive surgery, the MiroSurge.[47] In September 2010, the Eindhoven University of Technology announced the development of the Sofie surgical system, the first surgical robot to employ force feedback.[48] In September 2010, the first robotic operation at the femoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Ger\u0161ak.[49][50]\n\nSee also \n\nBone segment navigation\nComputer-assisted surgery\nComputer-integrated surgery\nMinimally invasive surgery\nPatient registration\nStereolithography (medicine)\nSurgical Segment Navigator\nTelemedicine\nReferences \n\n\n^ a b c d e Kolata, Gina (13 February 2010). \"Results Unproven, Robotic Surgery Wins Converts\". The New York Times. Retrieved 11 March 2010 . \n\n^ a b Estey, EP (2009). \"Robotic prostatectomy: The new standard of care or a marketing success?\". Canadian Urological Association Journal. 3 (6): 488\u201390. PMC 2792423 . PMID 20019980. \n\n^ O'Toole, M. D.; Bouazza-Marouf, K.; Kerr, D.; Gooroochurn, M.; Vloeberghs, M. (2009). \"A methodology for design and appraisal of surgical robotic systems\". Robotica. 28 (2): 297\u2013310. doi:10.1017\/S0263574709990658. \n\n^ a b c Finkelstein J; Eckersberger E; Sadri H; Taneja SS; Lepor H; Djavan B (2010). \"Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience\". Reviews in Urology. 12 (1): 35\u201343. PMC 2859140 . PMID 20428292. \n\n^ Gerhardus, D (July\u2013August 2003). \"Robot-assisted surgery: the future is here\". Journal of Healthcare Management. 48 (4): 242\u2013251. PMID 12908224. \n\n^ Breeden, James T., MD, President of ACOG, [1] Statement on Robotic Surgery, 14 March 2013 \n\n^ Zhou, JY; Xin, C; Mou, YP; Xu, XW; Zhang, MZ; Zhou, YC; Lu, C; Chen, RG (2016). \"Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes\". PLoS ONE. 11 (3): e0151189. Bibcode:2016PLoSO..1151189Z. doi:10.1371\/journal.pone.0151189. PMC 4790929 . PMID 26974961. \n\n^ Zanagnolo, V; Garbi, A; Achilarre, MT; Minig, L (16 January 2017). \"Robot-assisted surgery in Gynecologic cancers\". Journal of minimally invasive gynecology. 24: 379\u2013396. doi:10.1016\/j.jmig.2017.01.006. PMID 28104497. \n\n^ Kypson, Alan P; Chitwood Jr., W. Randolph (2004). \"Robotic Applications in Cardiac Surgery\". International Journal of Advanced Robotic Systems. 1 (2): 87\u201392. arXiv:cs\/0412055 . Bibcode:2004cs.......12055K. \n\n^ D'Annibale, A et al. Diseases of the Colon and Rectum. December 2004. Volume 47, issue 12, pp. 2162\u20132168 \n\n^ Spinoglio, G. Diseases of the Colon and Rectum. November 2008. Volume 51, issue 11, pp. 1627\u20131632 \n\n^ Delaney, C. et al. Diseases of the Colon and Rectum. December 2003. Volume 46, pp. 1633\u20131639 \n\n^ Braumann, C. et al. Diseases of the Colon and Rectum. December 2005. Volume 48, Number 9, pp1820-1827. \n\n^ Myung-Han, Hyun; Chung-Ho Lee; Hyun-Jung Kim; YiXin Tong; Sung-Soo Park (November 2013). \"Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resection for gastric carcinoma\". British Journal of Surgery. 100 (12): 1566\u201378. doi:10.1002\/bjs.9242. PMID 24264778. \n\n^ Talamini, M. A.; Chapman, S.; Horgan, S.; Melvin, W. S. (October 2003). \"A prospective analysis of 211 robotic-assisted surgical procedures\". Surgical Endoscopy. 17 (10): 1521\u20131524. doi:10.1007\/s00464-002-8853-3. PMID 12915974. \n\n^ Melvin, W. Scott; Needleman, Bradley J.; Krause, Kevin R.; Schneider, Carol; Ellison, E. Christopher (2002). \"Computer-Enhanced vs. Standard Laparoscopic Antireflux Surgery\". Journal of Gastrointestinal Surgery. 6 (1): 11\u201315, discussion 15\u20136. doi:10.1016\/S1091-255X(01)00032-4. PMID 11986012. \n\n^ Melvin, W. S.; Dundon, J. M.; Talamini, M.; Horgan, S. (October 2005). \"Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy\". Surgery. 138 (4): 553\u2013558, discussion 558\u20139. doi:10.1016\/j.surg.2005.07.025. PMID 16269282. \n\n^ Shaligram A; Unnirevi J; Simorov A; Kothari VM; Oleynikov D (April 2012). \"How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia\". Surgical Endoscopy. 26 (4): 1047\u201350. doi:10.1007\/s00464-011-1994-5. PMID 22038167. \n\n^ Liu, H; Lawrie, TA; Lu, D; Song, H; Wang, L; Shi, G (10 December 2014). \"Robot-assisted surgery in gynaecology\". The Cochrane Database of Systematic Reviews. 12 (12): CD011422. doi:10.1002\/14651858.CD011422. PMID 25493418. \n\n^ \"Committee Opinion: Robotic Surgery in Gynecolgy\". Obstetrics & Gynecology. 125 (3): 760\u2013767. March 2015. doi:10.1097\/01.AOG.0000461761.47981.07. \n\n^ DiGioia, Anthony M.; Jaramaz, Branislav; Picard, Frederic; Nolte, Lutz-Peter, eds. (30 December 2004). Computer and robotic assisted hip and knee surgery. Oxford University Press. pp. 127\u2013156. ISBN 0-19-850943-X. \n\n^ a b Shweikeh, Faris; Amadio, Jordan P.; Arnell, Monica; Barnard, Zachary R.; Kim, Terrence T.; Johnson, J. Patrick; Drazin, Doniel (2014-03-01). \"Robotics and the spine: a review of current and ongoing applications\". Neurosurgical Focus. 36 (3): E10. doi:10.3171\/2014.1.focus13526. PMID 24580002. \n\n^ Lee, DI (April 2009). \"Robotic prostatectomy: what we have learned and where we are going\". Yonsei Med J. 50 (2): 177\u201381. doi:10.3349\/ymj.2009.50.2.177. PMC 2678689 . PMID 19430547. \n\n^ Williams, SB; Prado, K; Hu, JC (November 2014). \"Economics of robotic surgery: does it make sense and for whom?\". The Urologic clinics of North America. 41 (4): 591\u20136. doi:10.1016\/j.ucl.2014.07.013. PMID 25306170. \n\n^ Ramsay, C; Pickard, R; Robertson, C; Close, A; Vale, L; Armstrong, N; Barocas, DA; Eden, CG; Fraser, C; Gurung, T; Jenkinson, D; Jia, X; Lam, TB; Mowatt, G; Neal, DE; Robinson, MC; Royle, J; Rushton, SP; Sharma, P; Shirley, MD; Soomro, N (2012). \"Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer\". Health technology assessment (Winchester, England). 16 (41): 1\u2013313. doi:10.3310\/hta16410. PMC 4780976 . PMID 23127367. \n\n^ Toesca, Antonio; Peradze, Nickolas; Galimberti, Viviana; Manconi, Andrea; Intra, Mattia; Gentilini, Oreste; Sances, Daniele; Negri, Debora; Veronesi, Giulia (August 2017). \"Robotic Nipple-sparing Mastectomy and Immediate Breast Reconstruction With Implant: First Report of Surgical Technique\". Annals of Surgery. 266 (2): e28\u2013e30. doi:10.1097\/SLA.0000000000001397. ISSN 1528-1140. PMID 28692558. \n\n^ Sarfati, Benjamin; Honart, Jean-Francois; Leymarie, Nicolas; Rimareix, Francoise; Al Khashnam, Heba; Kolb, Frederic (2017-12-18). \"Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report\". The Breast Journal. doi:10.1111\/tbj.12937. ISSN 1524-4741. PMID 29251382. \n\n^ city, joe torres, eyewitness news, wabc-tv, channel 7, abc 7, 7online, new york (2018-03-06). \"LI doctors perform 1st robotic mastectomy, breast reconstruction in US\". ABC7 New York. Retrieved 2018-04-14 . \n\n^ \"Double Mastectomy And Breast Reconstruction Performed Using A Robot\". 2018-03-06. Retrieved 2018-04-14 . \n\n^ \"Medical Post 23:1985\" (PDF) . \n\n^ Kwoh, Y. S.; Hou, J.; Jonckheere, E. A. & Hayall, S. (February 1988). \"A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery\". IEEE Transactions on Biomedical Engineering. 35 (2): 153\u2013161. doi:10.1109\/10.1354. \n\n^ Lanfranco, Anthony R.; Castellanos, Andres E.; Desai, Jaydev P.; Meyers, William C. (2004). \"Robotic Surgery\". Annals of Surgery. 239 (1): 14\u201321. doi:10.1097\/01.sla.0000103020.19595.7d. PMC 1356187 . PMID 14685095. \n\n^ \"ROBODOC: Surgical Robot Success Story\" (PDF) . Retrieved 25 June 2013 . \n\n^ Meadows, Michelle. \"Computer-Assisted Surgery: An Update\". FDA Consumer magazine. Food and Drug Administration. Archived from the original on 1 March 2009. \n\n^ McConnell, PI; Schneeberger, EW; Michler, RE (2003). \"History and development of robotic cardiac surgery\". Problems in General Surgery. 20 (2): 20\u201330. doi:10.1097\/01.sgs.0000081182.03671.6e. \n\n^ Leslie Versweyveld (29 September 1999). \"ZEUS robot system reverses sterilization to enable birth of baby boy\". Virtual Medical Worlds Monthly. \n\n^ \"Robotics: the Future of Minimally Invasive Heart Surgery\". Biomed.brown.edu. 6 October 1999. Retrieved 29 November 2011 . \n\n^ \"Linbergh Operation \u2013 IRCAD\/EITS Laparoscopic Center\". Retrieved 19 January 2011 . \n\n^ \"Telerobotic Surgery\". SRI International. Retrieved 30 September 2013 . \n\n^ \"New Robot Technology Eases Kidney Transplants\". CBS News. 22 June 2009. Retrieved 8 July 2009 . \n\n^ \"da Vinci Si Surgical System\". Intuitive Surgical. Retrieved 30 September 2013 . \n\n^ \"Autonomous Robotic Surgeon performs surgery on first live human\". Engadget. 19 May 2006. \n\n^ \"Robot surgeon carries out 9-hour operation by itself\". Phys.Org. \n\n^ Parekattil, Sijo. \"Robotic Infertility\". Retrieved 11 October 2012 . \n\n^ \"Surgeons perform world's first pediatric robotic bladder reconstruction\". Esciencenews.com. 20 November 2008. Retrieved 29 November 2011 . \n\n^ \"neuroArm : revolutionary procedure a world first\". ucalgary.ca. 16 May 2008. Retrieved 14 November 2012 . \n\n^ Hagn, U.; Nickl, M.; J\u00f6rg, S.; Tobergte, A.; K\u00fcbler, B.; Passig, G.; Gr\u00f6ger, M.; Fr\u00f6hlich, F.; Seibold, U.; Konietschke, R.; Le-Tien, L.; Albu-Sch\u00e4ffer, A.; Grebenstein, M.; Ortmaier, T. & Hirzinger, G. (2008). \"DLR MiroSurge \u2013 towards versatility in surgical robotics\". Jahrestagung der Deutschen Gesellschaft f\u00fcr Computer und Roboterassistierte Chirurgie; Proceedings of CURAC. 7: 143\u2013146. \n\n^ \"Beter opereren met nieuwe Nederlandse operatierobot Sofie\" (in Dutch). TU\/e. 27 September 2010. Archived from the original on 24 July 2011. Retrieved 10 October 2010 . \n\n^ \"V UKC Ljubljana prvi\u010d na svetu uporabili \u017eilnega robota za posege na femoralnem \u017eilju\" [The First Use of a Vascular Robot for Procedures on Femoral Vasculature] (in Slovenian). 8 November 2010. Retrieved 1 April 2011 . \n\n^ \"UKC Ljubljana kljub finan\u010dnim omejitvam uspe\u0161en v razvoju medicine\" [UMC Ljubljana Successfully Develops Medicine Despite Financial Limitations] (in Slovenian). 30 March 2011. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Surgical robots.\nvteEmerging technologiesFieldsAgriculture\nAgricultural robot\nClosed ecological systems\nCultured meat\nGenetically modified food\nPrecision agriculture\nVertical farming\nArchitecture\nArcology\nBuilding printing\nContour crafting\nDomed city\nBiomedical\nArtificial uterus\nAmpakine\nBrain transplant\nCryonics\nCryoprotectant\nCryopreservation\nVitrification\nSuspended animation\nDe-extinction\nGenetic engineering\nGene therapy\nHead transplant\nIsolated brain\nLife extension\nStrategies for Engineered Negligible Senescence\nNanomedicine\nNanosensors\nOrgan printing\nPersonalized medicine\nRegenerative medicine\nStem-cell therapy\nTissue engineering\nRobot-assisted surgery\nSynthetic 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,350 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7be8ae6a8cc61a682af74f5c8f893873_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Robot-assisted_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Robot-assisted surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/220px-Laproscopic_Surgery_Robot.jpg\" width=\"220\" height=\"320\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A robotically assisted surgical system used for prostatectomies, cardiac valve repair and gynecologic surgical procedures<\/div><\/div><\/div>\n<p><b>Robotic surgery<\/b>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">computer-assisted surgery<\/a>, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical procedures<\/a>. Robotically-assisted surgery was developed to overcome the limitations of pre-existing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally-invasive_procedures\" class=\"mw-redirect\" title=\"Minimally-invasive procedures\" rel=\"external_link\" target=\"_blank\">minimally-invasive surgical procedures<\/a> and to enhance the capabilities of surgeons performing open surgery.\n<\/p><p>In the case of robotically-assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to control the instruments; either a direct <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_manipulator\" title=\"Remote manipulator\" rel=\"external_link\" target=\"_blank\">telemanipulator<\/a> or through computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_arm\" title=\"Robotic arm\" rel=\"external_link\" target=\"_blank\">robotic arms<\/a> carry out those movements using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot_end_effector\" title=\"Robot end effector\" rel=\"external_link\" target=\"_blank\">end-effectors<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manipulator_(device)\" title=\"Manipulator (device)\" rel=\"external_link\" target=\"_blank\">manipulators<\/a> to perform the actual surgery on the patient. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerised method is that the surgeon does not have to be present, but can be anywhere in the world, leading to the possibility for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">remote surgery<\/a>.\n<\/p><p>In the case of enhanced open surgery, autonomous instruments (in familiar configurations) replace traditional steel tools, performing certain actions (such as rib spreading) with much smoother, feedback-controlled motions than could be achieved by a human hand. The main object of such smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery without requiring more than a few minutes' training on the part of surgeons. This approach seeks to improve open surgeries, particularly cardio-thoracic, that have so far not benefited from minimally-invasive techniques.\n<\/p><p>Robotic surgery has been criticized for its expense, by one estimate costing $1,500 to $2000 more per patient.<sup id=\"rdp-ebb-cite_ref-kolata_1-0\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Comparison_to_traditional_methods\">Comparison to traditional methods<\/span><\/h2>\n<p>Major advances aided by surgical robots have been <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">remote surgery<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_surgery\" class=\"mw-redirect\" title=\"Minimally invasive surgery\" rel=\"external_link\" target=\"_blank\">minimally invasive surgery<\/a> and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification helps resulting in improved ergonomics. Due to these techniques there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.<sup id=\"rdp-ebb-cite_ref-Estey_2-0\" class=\"reference\"><a href=\"#cite_note-Estey-2\" rel=\"external_link\">[2]<\/a><\/sup>\nThe existing open surgery technique has many flaws like limited access to surgical area, long recovery time, long hours of operation, blood loss, surgical scars and marks.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The robot normally costs $1,390,000 and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher.<sup id=\"rdp-ebb-cite_ref-kolata_1-1\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup> Additional surgical training is needed to operate the system.<sup id=\"rdp-ebb-cite_ref-ORPvsRALRP_4-0\" class=\"reference\"><a href=\"#cite_note-ORPvsRALRP-4\" rel=\"external_link\">[4]<\/a><\/sup> Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain.<sup id=\"rdp-ebb-cite_ref-Estey_2-1\" class=\"reference\"><a href=\"#cite_note-Estey-2\" rel=\"external_link\">[2]<\/a><\/sup> Higher expectations may explain higher rates of dissatisfaction and regret.<sup id=\"rdp-ebb-cite_ref-ORPvsRALRP_4-1\" class=\"reference\"><a href=\"#cite_note-ORPvsRALRP-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Critics of the system, including the American Congress of Obstetricians and Gynecologists,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> say there is a steep learning curve for surgeons who adopt use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-kolata_1-2\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup> Articles in the newly created <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Robotic_Surgery\" title=\"Journal of Robotic Surgery\" rel=\"external_link\" target=\"_blank\">Journal of Robotic Surgery<\/a><\/i> tend to report on one surgeon's experience.<sup id=\"rdp-ebb-cite_ref-kolata_1-3\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>A Medicare study found that some procedures that have traditionally been performed with large incisions can be converted to \"minimally invasive\" endoscopic procedures with the use of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">Da Vinci Surgical System<\/a>, shortening length-of-stay in the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement paid by the government or insurance companies when the system is used.<sup id=\"rdp-ebb-cite_ref-kolata_1-4\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Robot-assisted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatectomy\" title=\"Pancreatectomy\" rel=\"external_link\" target=\"_blank\">pancreatectomies<\/a> have been found to be associated with \"longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]\" than laparoscopic pancreatectomies; there was \"no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.\"<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> For surgical removal of the uterus and cervix for early <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_cancer\" title=\"Cervical cancer\" rel=\"external_link\" target=\"_blank\">cervical cancer<\/a> robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Cardiology_and_electrophysiology\">Cardiology and electrophysiology<\/span><\/h3>\n<p>As of 2004, three types of heart surgery are being performed on a routine basis using robotic surgery systems.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> These three surgery types were:\n<\/p>\n<ul><li>Atrial septal defect repair \u2013 the repair of a hole between the two upper chambers of the heart,<\/li>\n<li>Mitral valve repair \u2013 the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart,<\/li>\n<li>Coronary artery bypass \u2013 rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Colon_and_rectal_surgery\">Colon and rectal surgery<\/span><\/h3>\n<p>Many studies have been undertaken in order to examine the role of robotic procedures in the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colorectal_surgery\" title=\"Colorectal surgery\" rel=\"external_link\" target=\"_blank\">colorectal surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Results to date indicate that robotic-assisted colorectal procedures outcomes are \"no worse\" than the results in the now \"traditional\" laparoscopic colorectal operations. Robotic-assisted colorectal surgery appears to be safe as well.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Most of the procedures have been performed for malignant colon and rectal lesions. However, surgeons are now moving into resections for diverticulitis and non-resective rectopexies (attaching the colon to the sacrum in order to treat rectal prolapse.)\n<\/p><p>When evaluated for several variables, robotic-assisted procedures fare equally well when compared with laparoscopic, or open abdominal operations. Study parameters have looked at intraoperative patient preparation time, length of time to perform the operation, adequacy of the removed surgical specimen with respect to clear surgical margins and number of lymph nodes removed, blood loss, operative or postoperative complications and long-term results.\n<\/p><p>More difficult to evaluate are issues related to the view of the operative field, the types of procedures that should be performed using robotic assistance and the potential added cost for a robotic operation.\n<\/p><p>Many surgeons feel that the optics of the 3-dimensional, two camera stereo optic robotic system are superior to the optical system used in laparoscopic procedures. The pelvic nerves are clearly visualized during robotic-assisted procedures. Less clear however is whether or not these supposedly improved optics and visualization improve patient outcomes with respect to postoperative impotence or incontinence, and whether long-term patient survival is improved by using the 3-dimensional optic system. Additionally, there is often a need for a wider, or \"larger\" view of the operative field than is routinely provided during robotic operations.,<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> The close-up view of the area under dissection may hamper visualization of the \"bigger view\", especially with respect to ureteral protection.\n<\/p><p>Questions remain unanswered, even after many years of experience with robotic-assisted colorectal operations. Ongoing studies may help clarify many of the issues of confusion associated with this novel surgical approach.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gastrointestinal_surgery\">Gastrointestinal surgery<\/span><\/h3>\n<p>Multiple types of procedures have been performed with either the 'Zeus' or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci<\/a> robot systems, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">bariatric surgery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrectomy\" title=\"Gastrectomy\" rel=\"external_link\" target=\"_blank\">gastrectomy<\/a><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.<sup id=\"rdp-ebb-cite_ref-Talamini_M_1524_15-0\" class=\"reference\"><a href=\"#cite_note-Talamini_M_1524-15\" rel=\"external_link\">[15]<\/a><\/sup> Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> and Heller myotomy for the treatment of achalasia.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>Other gastrointestinal procedures including colon resection, pancreatectomy, esophagectomy and robotic approaches to pelvic disease have also been reported.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gynecology\">Gynecology<\/span><\/h3>\n<p>Robotic surgery in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gynecology\" class=\"mw-redirect\" title=\"Gynecology\" rel=\"external_link\" target=\"_blank\">gynecology<\/a> is of uncertain benefit with it being unclear if it affects rates of complications. Gynecologic procedures may take longer with robot-assisted surgery but may be associated with a shorter hospital stay following hysterectomy.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> In the United States, robotic-assisted hysterectomy for benign conditions has been shown to be more expensive than conventional laparoscopic hysterectomy, with no difference in overall rates of complications.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>This includes the use of the da Vinci surgical system in benign gynecology and gynecologic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oncology\" title=\"Oncology\" rel=\"external_link\" target=\"_blank\">oncology<\/a>. Robotic surgery can be used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibroma\" title=\"Fibroma\" rel=\"external_link\" target=\"_blank\">fibroids<\/a>, abnormal periods, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endometriosis\" title=\"Endometriosis\" rel=\"external_link\" target=\"_blank\">endometriosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovarian_tumor\" title=\"Ovarian tumor\" rel=\"external_link\" target=\"_blank\">ovarian tumors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterine_prolapse\" title=\"Uterine prolapse\" rel=\"external_link\" target=\"_blank\">uterine prolapse<\/a>, and female cancers. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Orthopedics\">Orthopedics<\/span><\/h3>\n<p>Robots are used in orthopedic surgery.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Children\">Children<\/span><\/h3>\n<p>Surgical robotics has been used in many types of pediatric surgical procedures including: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheoesophageal_fistula\" title=\"Tracheoesophageal fistula\" rel=\"external_link\" target=\"_blank\">tracheoesophageal fistula<\/a> repair, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nissen_fundoplication\" title=\"Nissen fundoplication\" rel=\"external_link\" target=\"_blank\">nissen fundoplication<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morgagni%27s_hernia\" class=\"mw-redirect\" title=\"Morgagni's hernia\" rel=\"external_link\" target=\"_blank\">morgagni's hernia<\/a> repair, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kasai_portoenterostomy\" class=\"mw-redirect\" title=\"Kasai portoenterostomy\" rel=\"external_link\" target=\"_blank\">kasai portoenterostomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_diaphragmatic_hernia\" title=\"Congenital diaphragmatic hernia\" rel=\"external_link\" target=\"_blank\">congenital diaphragmatic hernia<\/a> repair, and others.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Spine_surgery\">Spine surgery<\/span><\/h3>\n<p>Robotic devices started to be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_Invasive_Spine_Surgery\" class=\"mw-redirect\" title=\"Minimally Invasive Spine Surgery\" rel=\"external_link\" target=\"_blank\">minimally invasive spine surgery<\/a> starting in the mid-2000s.<sup id=\"rdp-ebb-cite_ref-Shweikeh2014rev_22-0\" class=\"reference\"><a href=\"#cite_note-Shweikeh2014rev-22\" rel=\"external_link\">[22]<\/a><\/sup> As of 2014, there were too few randomized clinical trials to allow judgements as to whether robotic spine surgery is more or less safe than other approaches.<sup id=\"rdp-ebb-cite_ref-Shweikeh2014rev_22-1\" class=\"reference\"><a href=\"#cite_note-Shweikeh2014rev-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Transplant_surgery\">Transplant surgery<\/span><\/h3>\n<p>Transplant surgery (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_transplantation\" title=\"Organ transplantation\" rel=\"external_link\" target=\"_blank\">organ transplantation<\/a>) has been considered as highly technically demanding and virtually unobtainable by means of conventional laparoscopy. For many years, transplant patients were unable to benefit from the advantages of minimally invasive surgery. The development of robotic technology and its associated high resolution capabilities, three dimensional visual system, wrist type motion and fine instruments, gave opportunity for highly complex procedures to be completed in a minimally invasive fashion. Subsequently, the first fully robotic kidney transplantations were performed in the late 2000s. After the procedure was proven to be feasible and safe, the main emerging challenge was to determine which patients would benefit most from this robotic technique. As a result, recognition of the increasing prevalence of obesity amongst patients with kidney failure on hemodialysis posed a significant problem. Due to the abundantly higher risk of complications after traditional open kidney transplantation, obese patients were frequently denied access to transplantation, which is the premium treatment for end stage kidney disease.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Urology\">Urology<\/span><\/h3>\n<p>Robotic surgery in the field of urology has become very popular, especially in the United States.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> It has been most extensively applied for excision of prostate cancer because of difficult anatomical access. It is also utilized for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidney<\/a> cancer surgeries and to lesser extent surgeries of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a>.\n<\/p><p>As of 2014, there is little evidence of increased benefits compared to standard surgery to justify the increased costs.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> Some have found tentative evidence of more complete removal of cancer and less side effects from surgery for prostatectomy.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.<sup id=\"rdp-ebb-cite_ref-ORPvsRALRP_4-2\" class=\"reference\"><a href=\"#cite_note-ORPvsRALRP-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p><b>Breast Surgery<\/b>\n<\/p><p>Robotic breast surgery involves using the robot to assist in performing nipple-sparing mastectomy and breast reconstruction. In 2015, a group of surgeons led by Dr. Antonio Toesca, in Milan, Italy demonstrated the feasibility and safety of robotic nipple-sparing mastectomy and robotic breast reconstruction.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> The Italian surgeons published their results in their first 29 consecutive patients. In this report, all patients had robotic mastectomy and reconstruction done through a 3 cm extra-mammary incision, hidden by the arm. Thereafter, a surgeon, Dr. Benjamin Sarfati, in Paris began performing robotic mastectomy and breast reconstruction.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> On March 4, 2018, Dr. Neil Tanna and colleagues performed the first robotic nipple-sparing mastectomy and robotic breast reconstruction in North America.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><b> <\/b>\n<\/p><p>Traditional (open) nipple-sparing mastectomy and breast reconstruction require incisions on the breast. Robotic nipple sparing mastectomy with robotic breast reconstruction is an innovative form of breast surgery that utilizes robotic technology to perform the surgery. By using the robot, the incisions can be much smaller and be placed off the breasts, far away near the armpit or the bra line.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first robot to assist in surgery was the <i>Arthrobot<\/i>, which was developed and used for the first time in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vancouver\" title=\"Vancouver\" rel=\"external_link\" target=\"_blank\">Vancouver<\/a> in 1983.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Intimately involved were <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_engineering\" title=\"Biomedical engineering\" rel=\"external_link\" target=\"_blank\">biomedical engineer<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/James_McEwen_(engineer)\" title=\"James McEwen (engineer)\" rel=\"external_link\" target=\"_blank\">Dr. James McEwen<\/a>, Geof Auchinleck, a UBC <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering_physics\" title=\"Engineering physics\" rel=\"external_link\" target=\"_blank\">engineering physics<\/a> grad, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brian_Day\" title=\"Brian Day\" rel=\"external_link\" target=\"_blank\">Dr. Brian Day<\/a> as well as a team of engineering students. The robot was used in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopaedy\" class=\"mw-redirect\" title=\"Orthopaedy\" rel=\"external_link\" target=\"_blank\">orthopaedic<\/a> surgical procedure on 12 March 1984, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/UBC_Hospital\" title=\"UBC Hospital\" rel=\"external_link\" target=\"_blank\">UBC Hospital<\/a> in Vancouver. Over 60 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopy\" title=\"Arthroscopy\" rel=\"external_link\" target=\"_blank\">arthroscopic<\/a> surgical procedures were performed in the first 12 months, and a 1985 <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Geographic_Society\" title=\"National Geographic Society\" rel=\"external_link\" target=\"_blank\">National Geographic<\/a> video on industrial robots, <i>The Robotics Revolution<\/i>, featured the device. Other related robotic devices developed at the same time included a surgical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scrub_nurse\" class=\"mw-redirect\" title=\"Scrub nurse\" rel=\"external_link\" target=\"_blank\">scrub nurse<\/a> robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled <i>Arthrobot<\/i> illustrates some of these in operation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In 1985 a robot, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Programmable_Universal_Machine_for_Assembly\" title=\"Programmable Universal Machine for Assembly\" rel=\"external_link\" target=\"_blank\">Unimation Puma 200<\/a>, was used to place a needle for a brain biopsy using CT guidance.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> PROBOT was then used to perform prostatic surgery and ROBODOC to assist with hip replacement surgeries. The latter was the first surgical robot that was approved by the FDA.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> The ROBODOC from Integrated Surgical Systems (working closely with <a href=\"https:\/\/en.wikipedia.org\/wiki\/IBM\" title=\"IBM\" rel=\"external_link\" target=\"_blank\">IBM<\/a>) was introduced in 1992 to mill out precise fittings in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> for hip replacement.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach\/rasp.\n<\/p><p>Further development of robotic systems was carried out by <a href=\"https:\/\/en.wikipedia.org\/wiki\/SRI_International\" title=\"SRI International\" rel=\"external_link\" target=\"_blank\">SRI International<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intuitive_Surgical\" title=\"Intuitive Surgical\" rel=\"external_link\" target=\"_blank\">Intuitive Surgical<\/a> with the introduction of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci Surgical System<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_Motion\" class=\"mw-redirect\" title=\"Computer Motion\" rel=\"external_link\" target=\"_blank\">Computer Motion<\/a> with the <i>AESOP<\/i> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ZEUS_robotic_surgical_system\" title=\"ZEUS robotic surgical system\" rel=\"external_link\" target=\"_blank\">ZEUS robotic surgical system<\/a>.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> The first robotic surgery took place at <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Ohio_State_University_Medical_Center\" class=\"mw-redirect\" title=\"The Ohio State University Medical Center\" rel=\"external_link\" target=\"_blank\">The Ohio State University Medical Center<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbus,_Ohio\" title=\"Columbus, Ohio\" rel=\"external_link\" target=\"_blank\">Columbus<\/a>, Ohio under the direction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_E._Michler\" title=\"Robert E. Michler\" rel=\"external_link\" target=\"_blank\">Robert E. Michler<\/a>.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> Examples of using ZEUS include a fallopian tube reconnection in July 1998,<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> a <i>beating heart<\/i> coronary artery bypass graft in October 1999,<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_Operation\" class=\"mw-redirect\" title=\"Lindbergh Operation\" rel=\"external_link\" target=\"_blank\">Lindbergh Operation<\/a>, which was a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a> performed remotely in September 2001.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p><p>The original telesurgery robotic system that the da Vinci was based on was developed at SRI International in Menlo Park with grant support from DARPA and NASA.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Examples of using the da Vinci system include the first robotically assisted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_bypass\" class=\"mw-redirect\" title=\"Heart bypass\" rel=\"external_link\" target=\"_blank\">heart bypass<\/a> (performed in Germany) in May 1998, and the first performed in the United States in September 1999;<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> and the first all-robotic-assisted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_transplant\" class=\"mw-redirect\" title=\"Kidney transplant\" rel=\"external_link\" target=\"_blank\">kidney transplant<\/a>, performed in January 2009.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup> The da Vinci Si was released in April 2009, and initially sold for $1.75 million.<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p><p>In May 2006 the first <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_intelligence\" title=\"Artificial intelligence\" rel=\"external_link\" target=\"_blank\">artificial intelligence<\/a> doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_arrythmia\" class=\"mw-redirect\" title=\"Heart arrythmia\" rel=\"external_link\" target=\"_blank\">heart arrythmia<\/a>. The results were rated as better than an above-average human surgeon. The machine had a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Database\" title=\"Database\" rel=\"external_link\" target=\"_blank\">database<\/a> of 10,000 similar operations, and so, in the words of its designers, was \"more than qualified to operate on any patient\".<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> In February 2008, Dr. Mohan S. Gundeti of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Chicago_Comer_Children%27s_Hospital\" class=\"mw-redirect\" title=\"University of Chicago Comer Children's Hospital\" rel=\"external_link\" target=\"_blank\">University of Chicago Comer Children's Hospital<\/a> performed the first robotic pediatric neurogenic bladder reconstruction.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p><p>On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Calgary\" title=\"University of Calgary\" rel=\"external_link\" target=\"_blank\">University of Calgary<\/a> by Dr. Garnette Sutherland using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/NeuroArm\" title=\"NeuroArm\" rel=\"external_link\" target=\"_blank\">NeuroArm<\/a>.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> In June 2008, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/German_Aerospace_Centre\" class=\"mw-redirect\" title=\"German Aerospace Centre\" rel=\"external_link\" target=\"_blank\">German Aerospace Centre<\/a> (DLR) presented a robotic system for minimally invasive surgery, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/MiroSurge\" title=\"MiroSurge\" rel=\"external_link\" target=\"_blank\">MiroSurge<\/a>.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> In September 2010, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eindhoven_University_of_Technology\" title=\"Eindhoven University of Technology\" rel=\"external_link\" target=\"_blank\">Eindhoven University of Technology<\/a> announced the development of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sofie_(surgical_robot)\" title=\"Sofie (surgical robot)\" rel=\"external_link\" target=\"_blank\">Sofie<\/a> surgical system, the first surgical robot to employ <a href=\"https:\/\/en.wikipedia.org\/wiki\/Force_feedback\" class=\"mw-redirect\" title=\"Force feedback\" rel=\"external_link\" target=\"_blank\">force feedback<\/a>.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> In September 2010, the first robotic operation at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_vasculature\" class=\"mw-redirect\" title=\"Femoral vasculature\" rel=\"external_link\" target=\"_blank\">femoral vasculature<\/a> was performed at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_Medical_Centre_Ljubljana\" class=\"mw-redirect\" title=\"University Medical Centre Ljubljana\" rel=\"external_link\" target=\"_blank\">University Medical Centre Ljubljana<\/a> by a team led by .<sup id=\"rdp-ebb-cite_ref-FV_robo1_49-0\" class=\"reference\"><a href=\"#cite_note-FV_robo1-49\" rel=\"external_link\">[49]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FV_robo2_50-0\" class=\"reference\"><a href=\"#cite_note-FV_robo2-50\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">Bone segment navigation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer-assisted surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-integrated_surgery\" class=\"mw-redirect\" title=\"Computer-integrated surgery\" rel=\"external_link\" target=\"_blank\">Computer-integrated surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_surgery\" class=\"mw-redirect\" title=\"Minimally invasive surgery\" rel=\"external_link\" target=\"_blank\">Minimally invasive surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">Patient registration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereolithography_(medicine)\" class=\"mw-redirect\" title=\"Stereolithography (medicine)\" rel=\"external_link\" target=\"_blank\">Stereolithography (medicine)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_Segment_Navigator\" class=\"mw-redirect\" title=\"Surgical Segment Navigator\" rel=\"external_link\" target=\"_blank\">Surgical Segment Navigator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Telemedicine\" title=\"Telemedicine\" rel=\"external_link\" target=\"_blank\">Telemedicine<\/a><\/li><\/ul><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-kolata-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kolata_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Kolata, Gina (13 February 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2010\/02\/14\/health\/14robot.html\" target=\"_blank\">\"Results Unproven, Robotic Surgery Wins Converts\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times\" title=\"The New York Times\" rel=\"external_link\" target=\"_blank\">The New York Times<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Results+Unproven%2C+Robotic+Surgery+Wins+Converts&rft.date=2010-02-13&rft.aulast=Kolata&rft.aufirst=Gina&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2010%2F02%2F14%2Fhealth%2F14robot.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Estey-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Estey_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Estey_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Estey, EP (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2792423\" target=\"_blank\">\"Robotic prostatectomy: The new standard of care or a marketing success?\"<\/a>. <i>Canadian Urological Association Journal<\/i>. <b>3<\/b> (6): 488\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2792423\" target=\"_blank\">2792423<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20019980\" target=\"_blank\">20019980<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Canadian+Urological+Association+Journal&rft.atitle=Robotic+prostatectomy%3A+The+new+standard+of+care+or+a+marketing+success%3F&rft.volume=3&rft.issue=6&rft.pages=488-90&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2792423&rft_id=info%3Apmid%2F20019980&rft.aulast=Estey&rft.aufirst=EP&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2792423&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">O'Toole, M. D.; Bouazza-Marouf, K.; Kerr, D.; Gooroochurn, M.; Vloeberghs, M. 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top: -2px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paywall\" title=\"closed access publication \u2013 behind paywall\" rel=\"external_link\" target=\"_blank\"><img alt=\"closed access publication \u2013 behind paywall\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c1\/Closed_Access_logo_alternative.svg\/9px-Closed_Access_logo_alternative.svg.png\" width=\"9\" height=\"14\" \/><\/a><\/span><\/span>\n<\/li>\n<li id=\"cite_note-ORPvsRALRP-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ORPvsRALRP_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ORPvsRALRP_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ORPvsRALRP_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Finkelstein J; Eckersberger E; Sadri H; Taneja SS; Lepor H; Djavan B (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2859140\" target=\"_blank\">\"Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience\"<\/a>. <i>Reviews in Urology<\/i>. <b>12<\/b> (1): 35\u201343. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2859140\" target=\"_blank\">2859140<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20428292\" target=\"_blank\">20428292<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Reviews+in+Urology&rft.atitle=Open+Versus+Laparoscopic+Versus+Robot-Assisted+Laparoscopic+Prostatectomy%3A+The+European+and+US+Experience&rft.volume=12&rft.issue=1&rft.pages=35-43&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2859140&rft_id=info%3Apmid%2F20428292&rft.au=Finkelstein+J&rft.au=Eckersberger+E&rft.au=Sadri+H&rft.au=Taneja+SS&rft.au=Lepor+H&rft.au=Djavan+B&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2859140&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gerhardus, D (July\u2013August 2003). \"Robot-assisted surgery: the future is here\". <i>Journal of Healthcare Management<\/i>. <b>48<\/b> (4): 242\u2013251. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12908224\" target=\"_blank\">12908224<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Healthcare+Management&rft.atitle=Robot-assisted+surgery%3A+the+future+is+here&rft.volume=48&rft.issue=4&rft.pages=242-251&rft.date=2003-07%2F2003-08&rft_id=info%3Apmid%2F12908224&rft.aulast=Gerhardus&rft.aufirst=D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Breeden, James T., MD, President of ACOG, <a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.acog.org\/About-ACOG\/News-Room\/News-Releases\/2013\/Statement-on-Robotic-Surgery\" target=\"_blank\">[1]<\/a> Statement on Robotic Surgery, 14 March 2013<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhou, JY; 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TU\/e. 27 September 2010. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/w3.wtb.tue.nl\/nl\/nieuws\/artikel\/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff\" target=\"_blank\">the original<\/a> on 24 July 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 October<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Beter+opereren+met+nieuwe+Nederlandse+operatierobot+Sofie&rft.pub=TU%2Fe&rft.date=2010-09-27&rft_id=http%3A%2F%2Fw3.wtb.tue.nl%2Fnl%2Fnieuws%2Fartikel%2F%3Ftx_ttnews%255Btt_news%255D%3D10041%26tx_ttnews%255BbackPid%255D%3D465%26cHash%3Debb243e7ff&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FV_robo1-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FV_robo1_49-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/med.over.net\/index.php?full=1&id=25545&title=V_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju\" target=\"_blank\">\"V UKC Ljubljana prvi\u010d na svetu uporabili \u017eilnega robota za posege na femoralnem \u017eilju\"<\/a> [The First Use of a Vascular Robot for Procedures on Femoral Vasculature] (in Slovenian). 8 November 2010<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">1 April<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=V+UKC+Ljubljana+prvi%C4%8D+na+svetu+uporabili+%C5%BEilnega+robota+za+posege+na+femoralnem+%C5%BEilju&rft.date=2010-11-08&rft_id=http%3A%2F%2Fmed.over.net%2Findex.php%3Ffull%3D1%26id%3D25545%26title%3DV_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FV_robo2-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FV_robo2_50-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dnevnik.si\/novice\/zdravje\/1042434634\" target=\"_blank\">\"UKC Ljubljana kljub finan\u010dnim omejitvam uspe\u0161en v razvoju medicine\"<\/a> [UMC Ljubljana Successfully Develops Medicine Despite Financial Limitations] (in Slovenian). 30 March 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=UKC+Ljubljana+kljub+finan%C4%8Dnim+omejitvam+uspe%C5%A1en+v+razvoju+medicine&rft.date=2011-03-30&rft_id=http%3A%2F%2Fwww.dnevnik.si%2Fnovice%2Fzdravje%2F1042434634&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1238\nCached time: 20181207063720\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.068 seconds\nReal time usage: 1.219 seconds\nPreprocessor visited node count: 3463\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 200452\/2097152 bytes\nTemplate argument size: 3623\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 10\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 134007\/5000000 bytes\nNumber of Wikibase entities loaded: 6\/400\nLua time usage: 0.627\/10.000 seconds\nLua memory usage: 5.58 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 996.491 1 -total\n<\/p>\n<pre>67.47% 672.299 1 Template:Reflist\n32.46% 323.433 24 Template:Cite_journal\n14.23% 141.787 8 Template:Cite_news\n 9.83% 97.985 12 Template:Cite_web\n 9.60% 95.657 4 Template:Citation_needed\n 8.79% 87.597 4 Template:Fix\n 8.11% 80.861 6 Template:Navbox\n 7.59% 75.681 1 Template:Commons_category\n 5.58% 55.585 1 Template:Emerging_technologies\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2629669-1!canonical and timestamp 20181207063719 and revision id 871820311\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Robot-assisted_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214706\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 155.035 1 - wikipedia:Robot-assisted_surgery\n100.00% 155.035 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8308-0!*!*!*!*!*!* and timestamp 20181217214706 and revision id 27028\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Robot-assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Robot-assisted_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7be8ae6a8cc61a682af74f5c8f893873_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/440px-Laproscopic_Surgery_Robot.jpg"],"7be8ae6a8cc61a682af74f5c8f893873_timestamp":1545083226,"030820c81ed47c2bd6404f897e7a000a_type":"article","030820c81ed47c2bd6404f897e7a000a_title":"Remote surgery","030820c81ed47c2bd6404f897e7a000a_url":"https:\/\/www.limswiki.org\/index.php\/Remote_surgery","030820c81ed47c2bd6404f897e7a000a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRemote surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tRemote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or more arms (controlled by the surgeon), a master controller (console), and a sensory system giving feedback to the user.[1][2] Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced telecommuting for surgeons, where the physical distance between the surgeon and the patient is less relevant. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.\n\nContents \n\n1 Surgical systems \n2 Costs \n3 The Lindbergh Operation \n4 Technology \n5 Applications \n6 Unassisted robotic surgery \n7 Force-feedback and time delay \n8 Depth perception \n9 Possible uses \n10 Limitations \n11 See also \n12 References \n13 External links \n\n\nSurgical systems \nSurgical robot systems have been developed from the first functional telesurgery system-ZEUS-to the da Vinci Surgical System, which is currently the only commercially available surgical robotic system. In Israel a company was established by Professor Moshe Schoham, from the faculty of Mechanical Engeenering at the Technion. Used mainly for \u201con-site\u201d surgery, these robots assist the surgeon visually, with better precision and less invasiveness to patients.[1][2] The Da Vinci Surgical System has also been combined to form a Dual Da Vinci system which allows two surgeons to work together on a patient at the same time. The system gives the surgeons the ability to control different arms, switch command of arms at any point and communicate through headsets during the operation.[3]\n\nCosts \nMarketed for $975,000, the ZEUS Robot Surgical System was less expensive than the da Vinci Surgical System, which cost $1 million. The cost of an operation through telesurgery is not precise but must pay for the surgical system, the surgeon, and contribute to paying for a year\u2019s worth of ATM technology which runs between $100,000-$200,000.[citation needed ][4]\n\nThe Lindbergh Operation \nMain article: Lindbergh Operation\nThe first true and complete remote surgery was conducted on 7 September 2001 across the Atlantic Ocean, with French surgeon (Dr. Jacques Marescaux) in New York City performing a cholecystectomy on a 68-year-old female patient 6,230 km away in Strasbourg, France. It was named Operation Lindbergh.[5] after Charles Lindbergh\u2019s pioneering transatlantic flight from New York to Paris. France Telecom provided the redundant fiberoptic ATM lines to minimize latency and optimize connectivity, and Computer Motion provided a modified Zeus robotic system. After clinical evaluation of the complete solution in July 2001, the human operation was successfully completed on 9\/7\/2001.[6]\nThe success and exposure of the procedure led the robotic team to use the same technology within Canada, this time using Bell Canada's public internet between Hamilton, Ontario and North Bay, Ontario (a distance of about 400 kilometers). While operation Lindbergh used the most expensive ATM fiber optics communication to ensure reliability and success of the first telesurgery, the follow on procedures in Canada used standard public internet which was provisioned with QOS using MPLS QOS-MPLS. A series of complex laparoscopic procedures were performed where in this case, the expert clinician would support the surgeon who was less experienced, operating on his patient. This resulted in patient receiving the best care possible while remaining in their hometown, the less experienced surgeon gaining valuable experience, and the expert surgeon providing their expertise without travel. The robotic team's goal was to go from Lindbergh's proof of concept to a real-life solution. This was achieved with over 20 complex laparoscopic operations between Hamilton and North Bay.\n\nTechnology \nThe speed of remote surgery is made possible through ATM technology, or Asynchronous Transfer Mode. \u201cAsynchronous Transfer Mode is a technology designed for the high-speed transfer of voice, video, and data through public and private networks using cell relay technology\u201d. Cell relay technology is the method of using small fixed length packets or cells to transfer data between computers or network equipment and determines the speed at which information is transferred. ATM technology has a maximum speed of 10 Gbit\/s (Gigabits per second). This developed technology provides opportunities for more transatlantic surgeries similar to the Operation Lindbergh.[7] During a surgery, the robot arm can use a different angle during a laparoscopic surgery than a tool in the surgeon\u2019s hand, providing easier movement. The da Vinci Surgical System, using \"Endowrist\" instruments, allows the surgeon seven degrees of rotation and a range of motion far greater than the human hand while filtering out the hand\u2019s natural tremor.[2][8]\n\nApplications \nSince Operation Lindbergh, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a laparoscopic surgeon in Hamilton, Canada, has conducted numerous remote surgeries on patients in North Bay, a city 400 kilometres from Hamilton.[9] Even though he uses a VPN over a non-dedicated fiberoptic connection that shares bandwidth with regular telecommunications data, Dr. Anvari has not had any connection problems during his procedures.[citation needed ]\nRapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Centre at Mt. Sinai Hospital in Toronto, Canada, the surgical room responds to the surgeon\u2019s voice commands in order to control a variety of equipment at the surgical site, including the lighting in the operating room, the position of the operating table and the surgical tools themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly.\nThe possibility of being able to project the knowledge and the physical skill of a surgeon over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and telerobotics can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres.\nAnother potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy\u2019s Hospital in London, England compared the success of kidney surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting kidney stones.[10]\nIn 2015, another test was conducted on the lag time involved in the robotic surgery. A Florida hospital successfully tested lag time created by the Internet for a simulated robotic surgery in Ft. Worth, Texas, more than 1,200 miles away from the surgeon who was at the virtual controls. The team found out that the lag time in robotic surgeries, were insignificant. Roger Smith, CTO at the Florida Hospital Nicholson Center said that the team had concluded that, telesurgery is something that is possible and generally safe for large areas within the United States.[11][12]\n\nUnassisted robotic surgery \nAs the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. Carlo Pappone, an Italian surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention.[13][unreliable source? ] This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.\n\nForce-feedback and time delay \nThe ability to carry out delicate manipulations relies greatly upon feedback. For example, it is easy to learn how much pressure is required to handle an egg. In robotic surgery, surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. Systems known as force-feedback, or haptic technology, have been developed to simulate this. Haptics is the science of touch. Any type of Haptic feedback provides a responsive force in opposition to the touch of the hand. Haptic technology in telesurgery, making a virtual image of a patient or incision, would allow a surgeon to see what they are working on as well as feel it. This technology is designed to give a surgeon the ability to feel tendons and muscles as if it were actually the patient's body.[8][14] However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.\n\nDepth perception \nBeing able to gauge the depth of an incision is crucial. Humans' binocular vision makes this easy in a three-dimensional environment. However this can be much more difficult when the view is presented on a flat computer screen.\n\nPossible uses \nOne possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel.\nAnother future possibility could be the use of remote surgery during long space exploration missions.\n\nLimitations \nFor now, remote surgery is not a widespread technology in part because it does not have sponsorship by the governments.[15] Before its acceptance on a broader scale, many issues will need to be resolved. For example, established clinical protocols, training, and global compatibility of equipment must be developed. Also, there is still the need for an anesthesiologist and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Nevertheless, Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe.\n\nSee also \nWaldo (short story) by Robert A. Heinlein.\nReferences \n\n^ a b Sandor, Jozsef; Haidegger, Tamas; Benyo, Zoltan (2012). \"Surgery in Space: The Future of Robotic Telesurgery\". Surgical Endoscopy. 26 (1): 681\u2013690. \n\n^ a b c Intuitive Surgical. 2012. \"The Da Vinci Surgical System.\" Intuitive Surgical. http:\/\/www.intuitivesurgical.com\/products\/davinci_surgical_system\/. \n\n^ Hanly, Miller; Kumar, Coste-Maniere; Talamini, Aurora; Schenkman (2006). \"Mentoring Console Improves\". J Laparoendosc Adv Surg Tech A. 5: 445\u2013451. \n\n^ Morris, B (2005). \"Robotic surgery: applications, limitations, and impact on surgical education\". MedGenMed. 7: 72. PMC 1681689 . PMID 16369298. \n\n^ http:\/\/www.intersurgtech.com\/media.html \n\n^ Event videos: http:\/\/www.intersurgtech.com\/media.html \n\n^ Cisco. 1992. \"Guide to ATM Technology - ATM Technology Fundamentals [Cisco Catalyst 8500 Series Multiservice Switch Routers] - Cisco Systems.\" http:\/\/www.cisco.com\/en\/US\/products\/hw\/switches\/ps718\/products_technical_reference_chapter09186a00800eb6fb.html#wp1019851. Archived 28 April 2012 at the Wayback Machine. \n\n^ a b Murphy, Challacombe; Khan; Dasgupta (2006). \"Robotic Technology in Urology\". Postgraduate Medical Journal. 82 (973): 743\u2013747. doi:10.1136\/pgmj.2006.048140. PMC 2660512 . \n\n^ \"Dr. Mehran Anvari\". Centre for Surgical Invention & Innovation. Retrieved 19 August 2016 . \n\n^ Revill, Jo (5 October 2002). \"' Remote' surgery turning point\". The Guardian. \n\n^ \"Hospital Tests Lag Time for Remote Surgery 12,000 Miles Away\". Raw Science. 2015-07-15. Retrieved 2017-09-20 . \n\n^ Mearian, Lucas. \"Hospital tests lag time for robotic surgery 1,200 miles away from doctor\". Computerworld. Retrieved 2017-09-20 . \n\n^ Robot Successfully Completes Unassisted Heart Surgery Digital Lifestyle Magazine @ dlmag.com \n\n^ Immersion Corporation. 2012. \"Haptic Technology\". \n\n^ Rosen, Jacob, Blake Hannaford, and Richard M. Satava. 2010. Surgical Robotics: Systems Applications and Visions. Springer. \n\n\nExternal links \n\n\n\nLook up telesurgery in Wiktionary, the free dictionary.\nArticle and Media Gallery for telesurgery\nPBS article on telesurgery\nUsing remote surgery as a teaching tool\nHow robotic surgery works\nArticle in Pulse of the Planet about remote surgery\nBBC News SCI\/TECH -- First transatlantic surgery\nHigh Performance Network Video in support of Telesurgery \/ NEEMO7 Mission - Revolutionary Telemedicine Techniques\nRobot Successfully Completes Unassisted Heart Surgery\nvteTelemedicineBackground concepts\nHealth informatics\nIn absentia health care\nTelecommunication\nMedical record\nAdmission note\nBlue Button\nDe-identification\nElectronic health record\nHealth Insurance Portability and Accountability Act\nPersonal health record\nPatient participation\nDecision aids\nDoctor\u2013patient relationship\nE-patient\nHealth 2.0\nHealth education\nKnowledge translation\nmHealth\nParticipative decision-making\nPatient Activation Measure\nShared decision-making\nHealth information on the Internet\nHealth information on Wikipedia\nOnline patient education\nPubMed\nTelemedicine subspecialties\neHealth\nRemote surgery\nRemote therapy\nTele-audiology\nTele-epidemiology\nTeledentistry\nTeledermatology\nTelehealth\nTelemental health\nTelenursing\nTeleophthalmology\nTelepathology\nTelepharmacy\nTelepsychiatry\nTeleradiology\nTelerehabilitation\nRoles to play\nOpen-source healthcare software\nPatient opinion leader\nResearch participant\nVirtual patient\n\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_surgery\">https:\/\/www.limswiki.org\/index.php\/Remote_surgery<\/a>\n\t\t\t\t\tCategories: Computer-assisted surgeryHealth informaticsMedical and surgical techniquesMedical roboticsHidden category: Articles 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","030820c81ed47c2bd6404f897e7a000a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Remote_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Remote surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Remote surgery<\/b> (also known as <b>telesurgery<\/b>) is the ability for a doctor to perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> on a patient even though they are not physically in the same location. It is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telepresence\" title=\"Telepresence\" rel=\"external_link\" target=\"_blank\">telepresence<\/a>. A robot surgical system generally consists of one or more arms (controlled by the surgeon), a master controller (console), and a sensory system giving feedback to the user.<sup id=\"rdp-ebb-cite_ref-sandor_1-0\" class=\"reference\"><a href=\"#cite_note-sandor-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_2-0\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-2\" rel=\"external_link\">[2]<\/a><\/sup> Remote surgery combines elements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot\" title=\"Robot\" rel=\"external_link\" target=\"_blank\">robotics<\/a>, cutting edge <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecommunication\" title=\"Telecommunication\" rel=\"external_link\" target=\"_blank\">communication technology<\/a> such as high-speed data connections and elements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Management_information_system\" title=\"Management information system\" rel=\"external_link\" target=\"_blank\">management information systems<\/a>. While the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">robotic surgery<\/a> is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecommuting\" title=\"Telecommuting\" rel=\"external_link\" target=\"_blank\">telecommuting<\/a> for surgeons, where the physical distance between the surgeon and the patient is less relevant. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Surgical_systems\">Surgical systems<\/span><\/h2>\n<p>Surgical robot systems have been developed from the first functional telesurgery system-ZEUS-to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci Surgical System<\/a>, which is currently the only commercially available surgical robotic system. In Israel a company was established by Professor Moshe Schoham, from the faculty of Mechanical Engeenering at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technion\" class=\"mw-redirect\" title=\"Technion\" rel=\"external_link\" target=\"_blank\">Technion<\/a>. Used mainly for \u201con-site\u201d surgery, these robots assist the surgeon visually, with better precision and less invasiveness to patients.<sup id=\"rdp-ebb-cite_ref-sandor_1-1\" class=\"reference\"><a href=\"#cite_note-sandor-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_2-1\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-2\" rel=\"external_link\">[2]<\/a><\/sup> The Da Vinci Surgical System has also been combined to form a Dual Da Vinci system which allows two surgeons to work together on a patient at the same time. The system gives the surgeons the ability to control different arms, switch command of arms at any point and communicate through headsets during the operation.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Costs\">Costs<\/span><\/h2>\n<p>Marketed for $975,000, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ZEUS_robotic_surgical_system\" title=\"ZEUS robotic surgical system\" rel=\"external_link\" target=\"_blank\">ZEUS Robot Surgical System<\/a> was less expensive than the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci Surgical System<\/a>, which cost $1 million. The cost of an operation through telesurgery is not precise but must pay for the surgical system, the surgeon, and contribute to paying for a year\u2019s worth of ATM technology which runs between $100,000-$200,000.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2018)\">citation needed<\/span><\/a><\/i>]<\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"The_Lindbergh_Operation\">The Lindbergh Operation<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_Operation\" class=\"mw-redirect\" title=\"Lindbergh Operation\" rel=\"external_link\" target=\"_blank\">Lindbergh Operation<\/a><\/div>\n<p>The first true and complete remote surgery was conducted on 7 September 2001 across the Atlantic Ocean, with French surgeon (Dr. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jacques_Marescaux\" title=\"Jacques Marescaux\" rel=\"external_link\" target=\"_blank\">Jacques Marescaux<\/a>) in <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_City\" title=\"New York City\" rel=\"external_link\" target=\"_blank\">New York City<\/a> performing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a> on a 68-year-old female patient 6,230 km away in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strasbourg\" title=\"Strasbourg\" rel=\"external_link\" target=\"_blank\">Strasbourg<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/France\" title=\"France\" rel=\"external_link\" target=\"_blank\">France<\/a>. It was named Operation Lindbergh.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Lindbergh\" title=\"Charles Lindbergh\" rel=\"external_link\" target=\"_blank\">Charles Lindbergh<\/a>\u2019s pioneering <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transatlantic_flight\" title=\"Transatlantic flight\" rel=\"external_link\" target=\"_blank\">transatlantic flight<\/a> from New York to Paris. France Telecom provided the redundant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_fiber\" title=\"Optical fiber\" rel=\"external_link\" target=\"_blank\">fiberoptic<\/a> ATM lines to minimize latency and optimize connectivity, and Computer Motion provided a modified Zeus robotic system. After clinical evaluation of the complete solution in July 2001, the human operation was successfully completed on 9\/7\/2001.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The success and exposure of the procedure led the robotic team to use the same technology within Canada, this time using Bell Canada's public internet between Hamilton, Ontario and North Bay, Ontario (a distance of about 400 kilometers). While operation Lindbergh used the most expensive ATM fiber optics communication to ensure reliability and success of the first telesurgery, the follow on procedures in Canada used standard public internet which was provisioned with QOS using MPLS <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_service\" title=\"Quality of service\" rel=\"external_link\" target=\"_blank\">QOS-MPLS<\/a>. A series of complex laparoscopic procedures were performed where in this case, the expert clinician would support the surgeon who was less experienced, operating on his patient. This resulted in patient receiving the best care possible while remaining in their hometown, the less experienced surgeon gaining valuable experience, and the expert surgeon providing their expertise without travel. The robotic team's goal was to go from Lindbergh's proof of concept to a real-life solution. This was achieved with over <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.intersurgtech.com\/media.html\" target=\"_blank\">20 complex laparoscopic operations<\/a> between Hamilton and North Bay.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technology\">Technology<\/span><\/h2>\n<p>The speed of remote surgery is made possible through ATM technology, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asynchronous_Transfer_Mode\" class=\"mw-redirect\" title=\"Asynchronous Transfer Mode\" rel=\"external_link\" target=\"_blank\">Asynchronous Transfer Mode<\/a>. \u201cAsynchronous Transfer Mode is a technology designed for the high-speed transfer of voice, video, and data through public and private networks using cell relay technology\u201d. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_relay\" title=\"Cell relay\" rel=\"external_link\" target=\"_blank\">Cell relay<\/a> technology is the method of using small fixed length packets or cells to transfer data between computers or network equipment and determines the speed at which information is transferred. ATM technology has a maximum speed of 10 Gbit\/s (Gigabits per second). This developed technology provides opportunities for more transatlantic surgeries similar to the Operation Lindbergh.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> During a surgery, the robot arm can use a different angle during a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a> than a tool in the surgeon\u2019s hand, providing easier movement. The da Vinci Surgical System, using \"Endowrist\" instruments, allows the surgeon seven degrees of rotation and a range of motion far greater than the human hand while filtering out the hand\u2019s natural tremor.<sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_2-2\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-murphy_8-0\" class=\"reference\"><a href=\"#cite_note-murphy-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Since Operation Lindbergh, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic<\/a> surgeon in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hamilton,_Ontario\" title=\"Hamilton, Ontario\" rel=\"external_link\" target=\"_blank\">Hamilton<\/a>, Canada, has conducted numerous remote surgeries on patients in <a href=\"https:\/\/en.wikipedia.org\/wiki\/North_Bay,_Ontario\" title=\"North Bay, Ontario\" rel=\"external_link\" target=\"_blank\">North Bay<\/a>, a city 400 kilometres from Hamilton.<sup id=\"rdp-ebb-cite_ref-CSIIAnvari_9-0\" class=\"reference\"><a href=\"#cite_note-CSIIAnvari-9\" rel=\"external_link\">[9]<\/a><\/sup> Even though he uses a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_private_network\" title=\"Virtual private network\" rel=\"external_link\" target=\"_blank\">VPN<\/a> over a non-dedicated fiberoptic connection that shares <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandwidth_(computing)\" title=\"Bandwidth (computing)\" rel=\"external_link\" target=\"_blank\">bandwidth<\/a> with regular telecommunications data, Dr. Anvari has not had any connection problems during his procedures.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Rapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Centre at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mount_Sinai_Hospital_(Toronto)\" title=\"Mount Sinai Hospital (Toronto)\" rel=\"external_link\" target=\"_blank\">Mt. Sinai Hospital<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toronto\" title=\"Toronto\" rel=\"external_link\" target=\"_blank\">Toronto<\/a>, Canada, the surgical room <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_recognition\" title=\"Speech recognition\" rel=\"external_link\" target=\"_blank\">responds to the surgeon\u2019s voice commands<\/a> in order to control a variety of equipment at the surgical site, including the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lighting\" title=\"Lighting\" rel=\"external_link\" target=\"_blank\">lighting<\/a> in the operating room, the position of the operating table and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instruments\" class=\"mw-redirect\" title=\"Surgical instruments\" rel=\"external_link\" target=\"_blank\">surgical tools<\/a> themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly.\n<\/p><p>The possibility of being able to project the knowledge and the physical skill of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgeon<\/a> over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telerobotics\" title=\"Telerobotics\" rel=\"external_link\" target=\"_blank\">telerobotics<\/a> can potentially save the lives of battle casualties by providing them with prompt attention in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Field_hospital\" title=\"Field hospital\" rel=\"external_link\" target=\"_blank\">mobile operating theatres<\/a>.\n<\/p><p>Another potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy\u2019s Hospital in <a href=\"https:\/\/en.wikipedia.org\/wiki\/London\" title=\"London\" rel=\"external_link\" target=\"_blank\">London<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/England\" title=\"England\" rel=\"external_link\" target=\"_blank\">England<\/a> compared the success of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidney<\/a> surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\" class=\"mw-redirect\" title=\"Kidney stone\" rel=\"external_link\" target=\"_blank\">kidney stones<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>In 2015, another test was conducted on the lag time involved in the robotic surgery. A Florida hospital successfully tested lag time created by the Internet for a simulated robotic surgery in Ft. Worth, Texas, more than 1,200 miles away from the surgeon who was at the virtual controls. The team found out that the lag time in robotic surgeries, were insignificant. Roger Smith, CTO at the Florida Hospital Nicholson Center said that the team had concluded that, telesurgery is something that is possible and generally safe for large areas within the United States.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Unassisted_robotic_surgery\">Unassisted robotic surgery<\/span><\/h2>\n<p>As the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. Carlo Pappone, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Italy\" title=\"Italy\" rel=\"external_link\" target=\"_blank\">Italian<\/a> surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources\" title=\"Wikipedia:Identifying reliable sources\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag may rely on an unreliable source. Could have sworn that my research turned up an article on how the original info on this had been garbled and propagated by the news media, and that the robot actually still had some human assistance. (December 2015)\">unreliable source?<\/span><\/a><\/i>]<\/sup> This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Force-feedback_and_time_delay\">Force-feedback and time delay<\/span><\/h2>\n<p>The ability to carry out delicate manipulations relies greatly upon feedback. For example, it is easy to learn how much pressure is required to handle an egg. In robotic surgery, surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. Systems known as force-feedback, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Haptic_technology\" title=\"Haptic technology\" rel=\"external_link\" target=\"_blank\">haptic technology<\/a>, have been developed to simulate this. Haptics is the science of touch. Any type of Haptic feedback provides a responsive force in opposition to the touch of the hand. Haptic technology in telesurgery, making a virtual image of a patient or incision, would allow a surgeon to see what they are working on as well as feel it. This technology is designed to give a surgeon the ability to feel tendons and muscles as if it were actually the patient's body.<sup id=\"rdp-ebb-cite_ref-murphy_8-1\" class=\"reference\"><a href=\"#cite_note-murphy-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Depth_perception\">Depth perception<\/span><\/h2>\n<p>Being able to gauge the depth of an incision is crucial. Humans' <a href=\"https:\/\/en.wikipedia.org\/wiki\/Binocular_vision\" title=\"Binocular vision\" rel=\"external_link\" target=\"_blank\">binocular vision<\/a> makes this easy in a three-dimensional environment. However this can be much more difficult when the view is presented on a flat computer screen.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Possible_uses\">Possible uses<\/span><\/h2>\n<p>One possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel.\n<\/p><p>Another future possibility could be the use of remote surgery during long space exploration missions.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Limitations\">Limitations<\/span><\/h2>\n<p>For now, remote surgery is not a widespread technology in part because it does not have sponsorship by the governments.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Before its acceptance on a broader scale, many issues will need to be resolved. For example, established clinical protocols, training, and global compatibility of equipment must be developed. Also, there is still the need for an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesiologist\" class=\"mw-redirect\" title=\"Anesthesiologist\" rel=\"external_link\" target=\"_blank\">anesthesiologist<\/a> and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Nevertheless, Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Waldo_(short_story)\" title=\"Waldo (short story)\" rel=\"external_link\" target=\"_blank\">Waldo (short story)<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_A._Heinlein\" title=\"Robert A. Heinlein\" rel=\"external_link\" target=\"_blank\">Robert A. Heinlein<\/a>.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-sandor-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-sandor_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-sandor_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sandor, Jozsef; Haidegger, Tamas; Benyo, Zoltan (2012). \"Surgery in Space: The Future of Robotic Telesurgery\". <i>Surgical Endoscopy<\/i>. <b>26<\/b> (1): 681\u2013690.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+Endoscopy&rft.atitle=Surgery+in+Space%3A+The+Future+of+Robotic+Telesurgery&rft.volume=26&rft.issue=1&rft.pages=681-690&rft.date=2012&rft.aulast=Sandor&rft.aufirst=Jozsef&rft.au=Haidegger%2C+Tamas&rft.au=Benyo%2C+Zoltan&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-intuitivesurgical.com-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-intuitivesurgical.com_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-intuitivesurgical.com_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-intuitivesurgical.com_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Intuitive Surgical. 2012. \"The Da Vinci Surgical System.\" Intuitive Surgical. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.intuitivesurgical.com\/products\/davinci_surgical_system\/\" target=\"_blank\">http:\/\/www.intuitivesurgical.com\/products\/davinci_surgical_system\/<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hanly, Miller; Kumar, Coste-Maniere; Talamini, Aurora; Schenkman (2006). \"Mentoring Console Improves\". <i>J Laparoendosc Adv Surg Tech A<\/i>. <b>5<\/b>: 445\u2013451.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Laparoendosc+Adv+Surg+Tech+A.&rft.atitle=Mentoring+Console+Improves&rft.volume=5&rft.pages=445-451&rft.date=2006&rft.aulast=Hanly&rft.aufirst=Miller&rft.au=Kumar%2C+Coste-Maniere&rft.au=Talamini%2C+Aurora&rft.au=Schenkman&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Morris, B (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1681689\" target=\"_blank\">\"Robotic surgery: applications, limitations, and impact on surgical education\"<\/a>. <i>MedGenMed<\/i>. <b>7<\/b>: 72. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1681689\" target=\"_blank\">1681689<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16369298\" target=\"_blank\">16369298<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=MedGenMed&rft.atitle=Robotic+surgery%3A+applications%2C+limitations%2C+and+impact+on+surgical+education&rft.volume=7&rft.pages=72&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1681689&rft_id=info%3Apmid%2F16369298&rft.aulast=Morris&rft.aufirst=B&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1681689&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.intersurgtech.com\/media.html\" target=\"_blank\">http:\/\/www.intersurgtech.com\/media.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Event videos: <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.intersurgtech.com\/media.html\" target=\"_blank\">http:\/\/www.intersurgtech.com\/media.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Cisco. 1992. \"Guide to ATM Technology - ATM Technology Fundamentals [Cisco Catalyst 8500 Series Multiservice Switch Routers] - Cisco Systems.\" <a rel=\"external_link\" class=\"external free\" href=\"#wp1019851\">http:\/\/www.cisco.com\/en\/US\/products\/hw\/switches\/ps718\/products_technical_reference_chapter09186a00800eb6fb.html#wp1019851<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"#wp1019851\">Archived<\/a> 28 April 2012 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-murphy-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-murphy_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-murphy_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Murphy, Challacombe; Khan; Dasgupta (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2660512\" target=\"_blank\">\"Robotic Technology in Urology\"<\/a>. <i>Postgraduate Medical Journal<\/i>. <b>82<\/b> (973): 743\u2013747. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fpgmj.2006.048140\" target=\"_blank\">10.1136\/pgmj.2006.048140<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2660512\" target=\"_blank\">2660512<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Postgraduate+Medical+Journal&rft.atitle=Robotic+Technology+in+Urology&rft.volume=82&rft.issue=973&rft.pages=743-747&rft.date=2006&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2660512&rft_id=info%3Adoi%2F10.1136%2Fpgmj.2006.048140&rft.aulast=Murphy&rft.aufirst=Challacombe&rft.au=Khan&rft.au=Dasgupta&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2660512&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CSIIAnvari-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CSIIAnvari_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.csii.ca\/about_csii\/leadership\/dr_mehran_anvari\" target=\"_blank\">\"Dr. Mehran Anvari\"<\/a>. Centre for Surgical Invention & Innovation<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 August<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Dr.+Mehran+Anvari&rft.pub=Centre+for+Surgical+Invention+%26+Innovation&rft_id=http%3A%2F%2Fwww.csii.ca%2Fabout_csii%2Fleadership%2Fdr_mehran_anvari&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Revill, Jo (5 October 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theguardian.com\/society\/2002\/oct\/06\/health.medicineandhealth\" target=\"_blank\">\"<span class=\"cs1-kern-left\">'<\/span>Remote' surgery turning point\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Guardian\" title=\"The Guardian\" rel=\"external_link\" target=\"_blank\">The Guardian<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Guardian&rft.atitle=%27Remote%27+surgery+turning+point&rft.date=2002-10-05&rft.aulast=Revill&rft.aufirst=Jo&rft_id=https%3A%2F%2Fwww.theguardian.com%2Fsociety%2F2002%2Foct%2F06%2Fhealth.medicineandhealth&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rawscience.tv\/hospital-tests-lag-time-for-remote-surgery-12000-miles-away\/\" target=\"_blank\">\"Hospital Tests Lag Time for Remote Surgery 12,000 Miles Away\"<\/a>. <i>Raw Science<\/i>. 2015-07-15<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-09-20<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Raw+Science&rft.atitle=Hospital+Tests+Lag+Time+for+Remote+Surgery+12%2C000+Miles+Away&rft.date=2015-07-15&rft_id=http%3A%2F%2Fwww.rawscience.tv%2Fhospital-tests-lag-time-for-remote-surgery-12000-miles-away%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Mearian, Lucas. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.computerworld.com\/article\/2927471\/healthcare-it\/robot-performs-test-surgery-1200-miles-away-from-doctor.html\" target=\"_blank\">\"Hospital tests lag time for robotic surgery 1,200 miles away from doctor\"<\/a>. <i>Computerworld<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-09-20<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Computerworld&rft.atitle=Hospital+tests+lag+time+for+robotic+surgery+1%2C200+miles+away+from+doctor&rft.aulast=Mearian&rft.aufirst=Lucas&rft_id=https%3A%2F%2Fwww.computerworld.com%2Farticle%2F2927471%2Fhealthcare-it%2Frobot-performs-test-surgery-1200-miles-away-from-doctor.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060820022121\/http:\/\/www.dlmag.com\/1653\/robot-successfully-completes-unassisted-heart-surgery.html\" target=\"_blank\">Robot Successfully Completes Unassisted Heart Surgery Digital Lifestyle Magazine @ dlmag.com<\/a><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Immersion Corporation. 2012. \"Haptic Technology\".<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rosen, Jacob, Blake Hannaford, and Richard M. Satava. 2010. Surgical Robotics: Systems Applications and Visions. Springer.<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.intersurgtech.com\/tele-medicine.html\" target=\"_blank\">Article and Media Gallery for telesurgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.pbs.org\/wnet\/innovation\/episode7_essay1.html\" target=\"_blank\">PBS article on telesurgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mtsinai.on.ca\/Publications\/YHRFall2001\/Hospital\/virtualreality.htm\" target=\"_blank\">Using remote surgery as a teaching tool<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/electronics.howstuffworks.com\/robotic-surgery.htm\" target=\"_blank\">How robotic surgery works<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pulseplanet.com\/archive\/Aug96\/1290.html\" target=\"_blank\">Article in Pulse of the Planet about remote surgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/sci\/tech\/1552211.stm\" target=\"_blank\">BBC News SCI\/TECH -- First transatlantic surgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.haivision.com\/download-center\/case-studies\/telesurgery-cmas\" target=\"_blank\">High Performance Network Video in support of Telesurgery \/ NEEMO7 Mission - Revolutionary Telemedicine Techniques<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061106000002\/http:\/\/www.dlmag.com\/1653\/robot-successfully-completes-unassisted-heart-surgery.html\" target=\"_blank\">Robot Successfully Completes Unassisted Heart Surgery<\/a><\/li><\/ul>\n\n<p class=\"mw-empty-elt\">\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181204023733\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.320 seconds\nReal time usage: 0.412 seconds\nPreprocessor visited node count: 1129\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 33965\/2097152 bytes\nTemplate argument size: 2115\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 25619\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.169\/10.000 seconds\nLua memory usage: 3.77 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 344.451 1 -total\n<\/p>\n<pre>31.43% 108.251 4 Template:Cite_journal\n26.62% 91.688 2 Template:Citation_needed\n26.16% 90.104 3 Template:Fix\n13.39% 46.114 5 Template:Category_handler\n11.04% 38.013 3 Template:Delink\n 7.71% 26.562 1 Template:Unreliable_source?\n 5.66% 19.501 1 Template:Use_dmy_dates\n 4.79% 16.492 1 Template:Telemedicine_navbox\n 4.59% 15.824 3 Template:Cite_news\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:586307-1!canonical and timestamp 20181204023732 and revision id 871819876\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214706\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.137 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 131.048 1 - wikipedia:Remote_surgery\n100.00% 131.048 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8216-0!*!*!*!*!*!* and timestamp 20181217214706 and revision id 27027\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_surgery\">https:\/\/www.limswiki.org\/index.php\/Remote_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","030820c81ed47c2bd6404f897e7a000a_images":[],"030820c81ed47c2bd6404f897e7a000a_timestamp":1545083226,"03e059abf77d6db7236b223c1f58f951_type":"article","03e059abf77d6db7236b223c1f58f951_title":"Politzerization","03e059abf77d6db7236b223c1f58f951_url":"https:\/\/www.limswiki.org\/index.php\/Politzerization","03e059abf77d6db7236b223c1f58f951_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolitzerization\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t The Politzer maneuver, original illustration of 1863\nPolitzerization, also called the Politzer maneuver or method, is a medical procedure that involves inflating the middle ear by blowing air up the nose during the act of swallowing. It is often performed to reopen the Eustachian tube and equalise pressure in the sinuses. \nThe procedure was derived from a medical experiment first performed by \u00c1d\u00e1m Politzer of Vienna that involved studying the air movement through the Eustachian tube by connecting a manometer to the external auditory canal meatus and another manometer in the pharynx. His first results on the technique were published in 1861 and he introduced a pear-shaped rubber air-bag for performing the procedure in 1863, which came to be known as a Politzer bag. This system was far more practical and less difficult for the patient than catheterizing the Eustachian tube and brought fame to Politzer.\n\nUse in clinical devices \nOne device that utilizes Politzeration is the EarPopper, developed by Shlomo Silman, Ph.D., professor of hearing sciences and audiology at Brooklyn College, CUNY, and otolaryngologist Daniel Arick, M.D. The EarPopper is a hand-held, battery-operated device that delivers controlled air flow through the nostril and can be used by the patient without medical supervision. Clinical studies have demonstrated the device's efficacy in the treatment of ear blockage caused by Eustachian tube dysfunction[1] and otitis media with effusion.[2]\n\nReferences \n\n\n^ Silman & Arick: \"Efficacy of a Modified Politzer Apparatus in Management of Eustachian Tube Dysfunction in Adults\", Journal of the American Academy of Audiology, October 1999; Volume 10, No. 9 \n\n^ Daniel S. Arick, MD, FACS; Shlomo Silman, PhD: \"Nonsurgical home treatment of middle ear effusion and associated hearing loss in children. Part I: Clinical trial and Part II: Validation study\", ENT-Ear, Nose & Throat Journal, September 2005 \u2022 Volume 84, Number 9 \n\n\n\"Adam Politzer\". American Academy of Otolaryngology\u2212Head and Neck Surgery. Retrieved February 2, 2005 . \n\"Politzerization\". Dorlands Medical Dictionary. Retrieved February 2, 2005 . \n\"Politzer' Method\". Dorlands Medical Dictionary. Retrieved February 2, 2005 . \nExternal links \nAdam Politzer. ENTLink.\nMudry, A. The Role of Adam Politzer in the History of Otology. Am. J. Otol. 21:753-763, 2000.\nWebsite of the EarPopper medical device, www.earpopper.com\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Politzerization\">https:\/\/www.limswiki.org\/index.php\/Politzerization<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:45.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 476 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","03e059abf77d6db7236b223c1f58f951_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Politzerization skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Politzerization<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Politzerization2.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/c\/c7\/Politzerization2.JPG\/250px-Politzerization2.JPG\" width=\"250\" height=\"176\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Politzerization2.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The Politzer maneuver, original illustration of 1863<\/div><\/div><\/div>\n<p><b>Politzerization<\/b>, also called the <b>Politzer maneuver<\/b> or <b>method<\/b>, is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_procedure\" title=\"Medical procedure\" rel=\"external_link\" target=\"_blank\">medical procedure<\/a> that involves inflating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_ear\" title=\"Middle ear\" rel=\"external_link\" target=\"_blank\">middle ear<\/a> by blowing air up the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_nose\" title=\"Human nose\" rel=\"external_link\" target=\"_blank\">nose<\/a> during the act of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swallowing\" title=\"Swallowing\" rel=\"external_link\" target=\"_blank\">swallowing<\/a>. It is often performed to reopen the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eustachian_tube\" title=\"Eustachian tube\" rel=\"external_link\" target=\"_blank\">Eustachian tube<\/a> and equalise pressure in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paranasal_sinus\" class=\"mw-redirect\" title=\"Paranasal sinus\" rel=\"external_link\" target=\"_blank\">sinuses<\/a>. \n<\/p><p>The procedure was derived from a medical experiment first performed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/%C3%81d%C3%A1m_Politzer\" title=\"\u00c1d\u00e1m Politzer\" rel=\"external_link\" target=\"_blank\">\u00c1d\u00e1m Politzer<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vienna\" title=\"Vienna\" rel=\"external_link\" target=\"_blank\">Vienna<\/a> that involved studying the air movement through the Eustachian tube by connecting a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manometer\" class=\"mw-redirect\" title=\"Manometer\" rel=\"external_link\" target=\"_blank\">manometer<\/a> to the external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">auditory canal meatus<\/a> and another manometer in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_pharynx\" class=\"mw-redirect\" title=\"Human pharynx\" rel=\"external_link\" target=\"_blank\">pharynx<\/a>. His first results on the technique were published in 1861 and he introduced a pear-shaped rubber air-bag for performing the procedure in 1863, which came to be known as a Politzer bag. This system was far more practical and less difficult for the patient than catheterizing the Eustachian tube and brought fame to Politzer.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use_in_clinical_devices\">Use in clinical devices<\/span><\/h2>\n<p>One device that utilizes Politzeration is the EarPopper, developed by Shlomo Silman, Ph.D., professor of hearing sciences and audiology at Brooklyn College, CUNY, and otolaryngologist Daniel Arick, M.D. The EarPopper is a hand-held, battery-operated device that delivers controlled air flow through the nostril and can be used by the patient without medical supervision. Clinical studies have demonstrated the device's efficacy in the treatment of ear blockage caused by Eustachian tube dysfunction<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otitis media with effusion<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Silman & Arick: \"Efficacy of a Modified Politzer Apparatus in Management of Eustachian Tube Dysfunction in Adults\", <i>Journal of the American Academy of Audiology<\/i>, October 1999; Volume 10, No. 9<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Daniel S. Arick, MD, FACS; Shlomo Silman, PhD: \"Nonsurgical home treatment of middle ear effusion and associated hearing loss in children. Part I: Clinical trial and Part II: Validation study\", <i>ENT-Ear, Nose & Throat Journal<\/i>, September 2005 \u2022 Volume 84, Number 9<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<ul><li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/entnet.org\/museum\/politzer.cfm\" target=\"_blank\">\"Adam Politzer\"<\/a>. <i>American Academy of Otolaryngology\u2212Head and Neck Surgery<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 2,<\/span> 2005<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=American+Academy+of+Otolaryngology%E2%88%92Head+and+Neck+Surgery&rft.atitle=Adam+Politzer&rft_id=http%3A%2F%2Fentnet.org%2Fmuseum%2Fpolitzer.cfm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolitzerization\" class=\"Z3988\"><\/span><\/li>\n<li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/merckmedicus.com\/ppdocs\/us\/common\/dorlands\/dorland\/dmd-p-055.htm#1081192\" target=\"_blank\">\"Politzerization\"<\/a>. <i>Dorlands Medical Dictionary<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 2,<\/span> 2005<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dorlands+Medical+Dictionary&rft.atitle=Politzerization&rft_id=http%3A%2F%2Fmerckmedicus.com%2Fppdocs%2Fus%2Fcommon%2Fdorlands%2Fdorland%2Fdmd-p-055.htm%231081192&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolitzerization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/merckmedicus.com\/ppdocs\/us\/common\/dorlands\/dorland\/dmd-m-026.htm#10017969\" target=\"_blank\">\"Politzer' Method\"<\/a>. <i>Dorlands Medical Dictionary<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 2,<\/span> 2005<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dorlands+Medical+Dictionary&rft.atitle=Politzer%27+Method&rft_id=http%3A%2F%2Fmerckmedicus.com%2Fppdocs%2Fus%2Fcommon%2Fdorlands%2Fdorland%2Fdmd-m-026.htm%2310017969&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolitzerization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060301005455\/http:\/\/entlink.net\/museum\/politzer.cfm?renderforprint=1\" target=\"_blank\">Adam Politzer<\/a>. ENTLink.<\/li>\n<li>Mudry, A. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060108173810\/http:\/\/www.politzersociety.org\/Adam\/Adam2.htm\" target=\"_blank\">The Role of Adam Politzer in the History of Otology<\/a>. Am. J. Otol. 21:753-763, 2000.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.earpopper.com\" target=\"_blank\">Website of the EarPopper medical device, www.earpopper.com<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1250\nCached time: 20181126082857\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.084 seconds\nReal time usage: 0.110 seconds\nPreprocessor visited node count: 176\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 4235\/2097152 bytes\nTemplate argument size: 79\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 5624\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.049\/10.000 seconds\nLua memory usage: 1.74 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 90.531 1 -total\n<\/p>\n<pre>77.70% 70.345 3 Template:Cite_web\n22.05% 19.961 1 Template:Reflist\n 3.16% 2.865 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1459634-1!canonical and timestamp 20181126082857 and revision id 832749065\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Politzerization\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214705\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.008 seconds\nReal time usage: 0.135 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 130.150 1 - wikipedia:Politzerization\n100.00% 130.150 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8570-0!*!*!*!*!*!* and timestamp 20181217214705 and revision id 24998\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Politzerization\">https:\/\/www.limswiki.org\/index.php\/Politzerization<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","03e059abf77d6db7236b223c1f58f951_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/c\/c7\/Politzerization2.JPG"],"03e059abf77d6db7236b223c1f58f951_timestamp":1545083225,"91138ae233fb9e17b5a681bfec9b3c6a_type":"article","91138ae233fb9e17b5a681bfec9b3c6a_title":"Osseointegration","91138ae233fb9e17b5a681bfec9b3c6a_url":"https:\/\/www.limswiki.org\/index.php\/Osseointegration","91138ae233fb9e17b5a681bfec9b3c6a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOsseointegration\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCompare osseoincorporation and osteosynthesis.\nOsseointegration (from Latin ossum \"bone\" and integrare \"to make whole\") is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant (\"load-bearing\" as defined by Albrektsson et al. in 1981). A more recent definition (by Schroeder et al.) defines osseointegration as \"functional ankylosis (bone adherence)\", where new bone is laid down directly on the implant surface and the implant exhibits mechanical stability (also known as primary stability \u2013 i.e., resistance to destabilization by mechanical agitation or shear forces). Osseointegration has enhanced the science of medical bone and joint replacement techniques as well as dental implants and improving prosthetics for amputees.\n\nContents \n\n1 Definition \n2 History \n3 Mechanism \n4 Technique \n\n4.1 Advances in materials engineering: metal foams \n\n\n5 Testing procedures \n6 Applications \n7 See also \n8 Notes and references \n9 Further reading \n10 External links \n\n\nDefinition \nOsseointegration is also defined as: \"the formation of a direct interface between an implant and bone, without intervening soft tissue\".[1] Osseointegrated implant is a type of implant defined as \"an endosteal implant containing pores into which osteoblasts and supporting connective tissue can migrate\".[2] Applied to oral implantology, this thus refers to bone grown right up to the implant surface without interposed soft tissue layer. No scar tissue, cartilage or ligament fibers are present between the bone and implant surface. The direct contact of bone and implant surface can be verified microscopically.\nOsseointegration may also be defined as :\n\nOsseous integration, the apparent direct attachment or connection of osseous tissue to an inert alloplastic material without intervening connective tissue.\nThe process and resultant apparent direct connection of the endogenous material surface and the host bone tissues without intervening connective tissue.\nThe interface between alloplastic material and bone.\nHistory \n Titanium implant (black) integrated into bone (red): Histologic section\nOsseointegration was first observed\u2014albeit not explicitly stated\u2014by Bothe, Beaton, and Davenport in 1940.[3][4] Bothe et al. were the first researchers to implant titanium in an animal and remarked how it had the tendency to fuse with bone.[3][4] Bothe et al. reported that due to the elemental nature of the titanium, its strength, and its hardness, it had great potential to be used as future prosthesis material.[3][4] Osseointegration was later described by Gottlieb Leventhal in 1951.[3][5] Leventhal placed titanium screws in rat femurs and remarked how \"At the end of 6 weeks, the screws were slightly tighter than when originally put in; at 12 weeks, the screws were more difficult to remove; and at the end of 16 weeks, the screws were so tight that in one specimen the femur was fractured when an attempt was made to remove the screw. Microscopic examinations of the bone structure revealed no reaction to the implants. The trabeculation appeared to be perfectly normal.\"[3][5] The reactions described by Leventhal and Bothe et al. would later be coined into the term \"osseointegration\" by Per-Ingvar Br\u00e5nemark of Sweden. In 1952, Br\u00e5nemark conducted an experiment where he utilized a titanium implant chamber to study blood flow in rabbit bone. At the conclusion of the experiment, when it became time to remove the titanium chambers from the bone, he discovered that the bone had integrated so completely with the implant that the chamber could not be removed. Br\u00e5nemark called this \"osseointegration\", and, like Bothe et al. and Leventhal before him, saw the possibilities for human use.[3][4][5]\nIn dental medicine the implementation of osseointegration started in the mid-1960s as a result of Br\u00e5nemark's work.[6][7][8][9] In 1965 Br\u00e5nemark, who was at the time Professor of Anatomy at the University of Gothenburg, placed dental implants into the first human patient \u2013 G\u00f6sta Larsson. This patient had a cleft palate defect and required implants to support a palatal obturator. G\u00f6sta Larsson died in 2005, with the original implants still in place after 40 years of function.[10]\nIn the mid-1970s Br\u00e5nemark entered into a commercial partnership with the Swedish defense company Bofors to manufacture dental implants and the instrumentation required for their placement. Eventually an offshoot of Bofors, Nobel Pharma, was created to concentrate on this product line. Nobel Pharma subsequently became Nobel Biocare.[10]\nBr\u00e5nemark spent almost 30 years fighting the scientific community for acceptance of osseointegration as a viable treatment. In Sweden he was often openly ridiculed at scientific conferences. His university stopped funding for his research, forcing him to open a private clinic to continue the treatment of patients. Eventually an emerging breed of young academics started to notice the work being performed in Sweden. Toronto's George Zarb, a Maltese-born Canadian prosthodontist, was instrumental in bringing the concept of osseointegration to the wider world. The 1983 Toronto Conference is generally considered to be the turning point, when finally the worldwide scientific community accepted Br\u00e5nemark's work. Today osseointegration is a highly predictable and commonplace treatment modality.[10]\nMore recently since 2010 Al Muderis in Sydney Australia utilised a high tensile strength titanium implant with high prose plasma sprayed surface as an intramedullary prosthesis that is inserted into the bone residuum of amputees and then connect through an opening in the skin to a robotic limb prosthesis. This allows amputees to mobilise with more comfort and less energy consumption. Al Muderis also published the first series of combining osseointegration prosthesis with Joint replacement enabling below knee amputees with knee arthritis or short residual bone to mobilise without the need of a socket prosthesis.[11]\n\n<\/p>\nOn December 7, 2015, two Operation Iraqi Freedom\/Operation Enduring Freedom veterans, Bryant Jacobs and Ed Salau, will be the first in America to get a percutaneous osseointegrated prosthesis.[12] During the first stage, doctors at Salt Lake Veterans Affairs Hospital will embed a titanium stud in the femur of each patient. About six weeks later, they will go back and attach the docking mechanism for the prosthesis.This article needs to be updated. Please update this article to reflect recent events or newly available information. (November 2018)\nMechanism \nSee also: Titanium biocompatibility\nOsseointegration is a dynamic process in which characteristics of the implant (i.e. macrogeometry, surface properties, etc.) play a role in modulating molecular and cellular behavior. While osseointegration has been observed using different materials, it is most often used to describe the reaction of bone tissues to titanium, or titanium coated with calcium phosphate derivatives.[13] It was previously thought that titanium implants were retained in bone through the action of mechanical stabilization or interfacial bonding. Alternatively, calcium phosphate coated implants were thought to be stabilized via chemical bonding. It is now known that both calcium phosphate coated implants and titanium implants are stabilized chemically with bone, either through direct contact between calcium and titanium atoms, or by the bonding to a cement line-like layer at the implant\/bone interface.[14][15] While there are some differences (e.g. like the lack of chondrogenic progenitors), osseointegration occurs through the same mechanisms as bone fracture healing.[16][17]\n\nTechnique \nFor osseointegrated dental implants, metallic, ceramic, and polymeric materials have been used,[2] in particular titanium.[18] To be termed osseointegration the connection between the bone and the implant need not be 100 percent, and the essence of osseointegration derives more from the stability of the fixation than the degree of contact in histologic terms. In short it represents a process whereby clinically asymptomatic rigid fixation of alloplastic materials is achieved, and maintained, in bone during functional loading.[19] Implant healing times and initial stability are a function of implant characteristics. For example, implants utilizing a screw-root form design achieve high initial mechanical stability through the action of their screws against the bone. Following placement of the implant, healing typically takes several weeks or months before the implant is fully integrated into the surrounding bone. First evidence of integration occurs after a few weeks, while more robust connection is progressively effected over the next months or years.[20] Implants that possess a screw-root form design result in bone resorption followed by interfacial bone remodeling and growth around the implant.[21]\nImplants utilizing a plateau-root form design (or screw-root form implants with a wide enough gap between the pitch of the screws) undergo a different mode of peri-implant ossification. Unlike the aforementioned screw-root form implants, plateau-root form implants exhibit de novo bone formation on the implant surface.[22] The type of bone healing exhibited by plateau-root form implants is known as intramembranous-like healing.[21]\nThough the osseointegrated interface becomes resistant to external shocks over time, it may be damaged by prolonged adverse stimuli and overload, which may result in implant failure.[23][24] In studies performed using \"Mini dental implants,\" it was noted that the absence of micromotion at the bone-implant interface was necessary to enable proper osseointegration.[25] Further, it was noted that there is a critical threshold of micromotion above which a fibrous encapsulation process occurs, rather than osseointegration.[26]\nOther complications may arise even in the absence of external impact. One issue is the growing of cement.[27] In normal cases, the absence of cementum on the implant surface prevents the attachment of collagen fibers. This is normally the case due to the absence of cementum progenitor cells in the area receiving the implant. However, when such cells are present, cement may form on or around the implant surface, and a functional collagen attachment may attach to it.[28]\n\nAdvances in materials engineering: metal foams \nSince 2005, a number of orthopedic device manufacturers have introduced products that feature porous metal construction.[29][30][31] Clinical studies on mammals have shown that porous metals, such as titanium foam, may allow the formation of vascular systems within the porous area.[32] For orthopedic uses, metals such as tantalum or titanium are often used, as these metals exhibit high tensile strength and corrosion resistance with excellent biocompatibility.\nThe process of osseointegration in metal foams is similar to that in bone grafts. The porous bone-like properties of the metal foam contribute to extensive bone infiltration, allowing osteoblast activity to take place. In addition, the porous structure allows for soft tissue adherence and vascularization within the implant. These materials are currently deployed in hip replacement, knee replacement and dental implant surgeries.\n\nTesting procedures \nThere are a number of methods used to gauge the level of osseointegration and the subsequent stability of an implant. One widely used diagnostic procedure is percussion analysis, where a dental instrument is tapped against the implant carrier.[33] The nature of the ringing that results is used as a qualitative measure of the implant\u2019s stability. An integrated implant will elicit a higher pitched \"crystal\" sound, whereas a non-integrated implant will elicit a dull, low-pitched sound.[34]\nAnother method is a reverse torque test, in which the implant carrier is unscrewed. If it fails to unscrew under the reverse torque pressure, the implant is stable. If the implant rotates under the pressure it is deemed a failure and removed.[35] This method comes at the risk of fracturing bone that is mid-way in the process of osseointegration.[33] It is also unreliable in determining the osseointegration potential of a bone region, as tests have yielded that a rotating implant can go on to be successfully integrated.[36]\nA non-invasive and increasingly implemented diagnostic method is resonance frequency analysis (RFA).[33] A resonance frequency analyzer device prompts vibrations in a small metal rod temporarily attached to the implant. As the rod vibrates, the probe reads its resonance frequency and translates it into an implant stability quotient (ISQ), which ranges from 1\u2013100, with 100 indicating the highest stability state. Values ranging between 57 and 82 are generally considered stable, though each case must be considered independently.[33]\n\nApplications \nDental implants are by far the main field of application\nRetention of a craniofacial prosthesis such as an artificial ear (ear prosthesis), maxillofacial reconstruction, eye (orbital prosthesis), or nose (nose prosthesis)\nBone anchored limb prostheses[37]\nBone anchored hearing conduction amplification (Bone anchored hearing aid)\nEyeborg perceive color through sound waves (sound conduction through bone)\nKnee and joint replacement\nSee also \n\n\n Medicine portal \n\nAbutment (dentistry)\nBritish Society of Oral Implantology\nEuropean Association for Osseointegration\nOral and maxillofacial surgery\nOsteosynthesis, reduction and internal fixation, which may use wires or implants\nPeriodontology\nProsthodontics\n\nNotes and references \n\n\n^ Miller, Benjamin F.; Keane, Claire B. (1992). Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health. Philadelphia: Saunders. ISBN 0-7216-3456-7. [page needed ] \n\n^ a b Mosby's Medical, Nursing & Allied Health Dictionary. St. Louis: Mosby. 2002. p. 1240. ISBN 0-323-01430-5. \n\n^ a b c d e f Rudy, Robert; Levi, Paul A; Bonacci, Fred J; Weisgold, Arnold S; Engler-Hamm, Daniel (2008). \"Intraosseous anchorage of dental prostheses: an early 20th century contribution\". Compend Contin Educ Dent. 29 (4): 220\u2013229. PMID 18524206. \n\n^ a b c d Bothe, RT; Beaton, KE; Davenport, HA (1940). \"Reaction of bone to multiple metallic implants\". Surg Gynecol Obstet. 71: 598\u2013602. \n\n^ a b c Leventhal, Gottlieb (1951). \"Titanium, a metal for surgery\". J Bone Joint Surg Am. 33-A (2): 473\u2013474. PMID 14824196. \n\n^ Br\u00e5nemark PI (September 1983). \"Osseointegration and its experimental background\". The Journal of Prosthetic Dentistry. 50 (3): 399\u2013410. doi:10.1016\/S0022-3913(83)80101-2. PMID 6352924. \n\n^ Br\u00e5nemark, Per-Ingvar; Zarb, George Albert; Albrektsson, Tomas (1985). Tissue-integrated prostheses: osseointegration in clinical dentistry. Chicago: Quintessence. ISBN 978-0-86715-129-9. [page needed ] \n\n^ Albrektsson, Tomas; Zarb, George A. (1989). The Branemark osseointegrated implant. Chicago: Quintessence Pub. Co. ISBN 978-0-86715-208-1. [page needed ] \n\n^ Beumer, John; Lewis, Steven (1989). The Branemark implant system: clinical and laboratory procedures. St. Louis: Ishiyaku EuroAmerica. ISBN 0-912791-62-4. [page needed ] \n\n^ a b c \nClose to the Edge - Br\u00e5nemark and the Development of Osseointegration, edited by Elaine McClarence, Quintessence 2003. \n\n^ Khemka A, Frossard L, Lord SJ, Bosley B, Al Muderis M (Jul 2015). \"Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases\". Acta Orthop. 86 (6): 740\u20134. doi:10.3109\/17453674.2015.1068635. PMC 4750776 . PMID 26145721. \n\n^ \"Veteran amputees to undergo first ever prosthetic implants | KSL.com\". www.ksl.com. Retrieved 2015-12-04 . \n\n^ Albrektsson, T; Johansson, C (2001). \"Osteoinduction, osteoconduction and osseointegration\". Eur Spine J. 10 (2): S96\u2013S101. doi:10.1007\/s005860100282. PMC 3611551 . \n\n^ Davies, J (2003). \"Understanding peri-implant endosseous healing\". J Dent Ed. 67 (8): 932\u2013949. \n\n^ Thuvander, M; Andersson, M (2014). \"Atomically resolved tissue integration\". Nano Lett. 14 (8): 4220\u20134223. doi:10.1021\/nl501564f. PMID 24989063. \n\n^ Colnot, C; Romero, DM; Huang, S; Rahman, J; Currey, JA; Nanci, A; Brunski, JB; Helms, JA (2007). \"Molecular analysis of healing at a bone-implant interface\". J Dent Res. 86 (9): 109\u2013118. PMID 17720856. \n\n^ Albrektsson, T; Branemark, PI; Hansson, HA; Lindstrom, J (1981). \"Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to- implant anchorage in man\". Acta Orthop Scand. 52 (2): 155\u2013170. doi:10.3109\/17453678108991776. PMID 7246093. \n\n^ Natali, Arturo N., ed. (2003). Dental biomechanics. Washington, DC: Taylor & Francis. pp. 69\u201387. ISBN 978-0-415-30666-9. \n\n^ Zarb, George A.; Albrektsson, Tomas (1991). \"Osseointegration: A requiem for the periodontal ligament?\". International Journal of Periodontology and Restorative Dentistry (11): 88\u201391. \n\n^ Albrektsson, Tomas; Berglundh, Tord; Lindhe, Jan (2003). \"Osseointegration: Historic Background and Current Concepts\". In Lindhe, Jan; Karring, Thorkild; Lang, Niklaus P. Clinical Periodontology and Implant Dentistry. Oxford: Blackwell Munksgaard. p. 815. ISBN 1-4051-0236-5. \n\n^ a b Coelho, P; Jimbo, R (2014). \"Osseointegration of metallic devices: current trends based on implant hardware design\". Arch Biochem Biophys. 561: 99\u2013108. doi:10.1016\/j.abb.2014.06.033. PMID 25010447. \n\n^ Berglundh, T; Abrahamsson, I; Lang, N; Lindhe, J (2003). \"De novo alveolar bone formation adjacent to endosseous implants\". Clin. Oral Impl. Res. 14 (3): 251\u2013262. doi:10.1034\/j.1600-0501.2003.00972.x. PMID 12755774. \n\n^ Albrektsson, Tomas; Berglundh, Tord; Lindhe, Jan (2003). \"Osseointegration: Historic Background and Current Concepts\". In Lindhe, Jan; Karring, Thorkild; Lang, Niklaus P. Clinical Periodontology and Implant Dentistry. Oxford: Blackwell Munksgaard. p. 816. ISBN 1-4051-0236-5. \n\n^ Isidor F (June 1996). \"Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys\". Clinical Oral Implants Research. 7 (2): 143\u201352. doi:10.1034\/j.1600-0501.1996.070208.x. PMID 9002833. \n\n^ Brunski JB (June 1999). \"In vivo bone response to biomechanical loading at the bone\/dental-implant interface\". Advances in Dental Research. 13: 99\u2013119. doi:10.1177\/08959374990130012301. PMID 11276755. \n\n^ Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH (1998). \"Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature\". Journal of Biomedical Materials Research. 43 (2): 192\u2013203. doi:10.1002\/(SICI)1097-4636(199822)43:2<192::AID-JBM14>3.0.CO;2-K. PMID 9619438. \n\n^ Pauletto N, Lahiffe BJ, Walton JN (1999). \"Complications associated with excess cement around crowns on osseointegrated implants: a clinical report\". The International Journal of Oral & Maxillofacial Implants. 14 (6): 865\u20138. PMID 10612925. \n\n^ Bernard, George W.; Carranza, Ferritin A.; Jovanovic, Sascha A. (1996). \"Biologic Aspects of Dental Implants\". In Carranza, Ferm\u00edn A.; Newman, Michael G. Clinical Periodontology. pp. 685\u20139. ISBN 978-0-7216-6728-7. \n\n^ Biomet Orthopedics, Regenerex\u00ae Porous Titanium Construct, http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231 \n\n^ Zimmer Orthopedics, Trabeluar Metal Technology, http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33 \n\n^ Zimmer Cancellous-Structured Titanium Porous Coating, http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP \n\n^ Osseointegration with Titanium Foam in Rabbit Femur, YouTube: https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q \n\n^ a b c d Implant Dentistry - A Rapidly Evolving Practice. 2011. pp. 111\u2013126. \n\n^ \"Current trends to measure implant stability\". Journal of the Indian Prosthodontic Society. 16: 124\u2013130. 2016. doi:10.4103\/0972-4052.176539. \n\n^ \"Methods Used to Assess Implant Stability: Current Status\" (PDF) . International Journal of Oral and Maxillofacial Implants. 22: 742\u2013754. 2007. \n\n^ Ivanoff, C. J.; Sennerby, L.; Lekholm, U. (1997-08-01). \"Reintegration of mobilized titanium implants. An experimental study in rabbit tibia\". International Journal of Oral and Maxillofacial Surgery. 26 (4): 310\u2013315. doi:10.1016\/s0901-5027(97)80878-8. ISSN 0901-5027. PMID 9258729. \n\n^ Hagberg K, Br\u00e5nemark R (2009). \"One hundred patients treated with osseointegrated transfemoral amputation prostheses--rehabilitation perspective\". Journal of Rehabilitation Research and Development. 46 (3): 331\u201344. PMID 19675986. \n\n \nTrabecular Metal Material: The Next Best Thing to BoneTM: http:\/\/www.trabecularmetal.zimmerdental.com\/Implant\/imp_home.aspx\nFurther reading \nZarb GA, Schmitt A (July 1990). \"The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto Study. Part II: The prosthetic results\". The Journal of Prosthetic Dentistry. 64 (1): 53\u201361. doi:10.1016\/0022-3913(90)90153-4. PMID 2200880. \nApse P, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: peri-implant mucosal response\". The International Journal of Periodontics & Restorative Dentistry. 11 (2): 94\u2013111. PMID 1718917. \nChaytor DV, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: bone level changes\". The International Journal of Periodontics & Restorative Dentistry. 11 (2): 112\u201325. PMID 1938184. \nBarber AJ, Butterworth CJ, Rogers SN (January 2010). \"Systematic review of primary osseointegrated dental implants in head and neck oncology\". The British Journal of Oral & Maxillofacial Surgery. 49 (1): 29\u201336. doi:10.1016\/j.bjoms.2009.12.007. PMID 20079957. \nHultin M, Gustafsson A, Klinge B (February 2000). \"Long-term evaluation of osseointegrated dental implants in the treatment of partly edentulous patients\". Journal of Clinical Periodontology. 27 (2): 128\u201333. doi:10.1034\/j.1600-051x.2000.027002128.x. PMID 10703659. \nOliv\u00e9, Jordi; Aparicio, Carlos (1990). \"The periotest implant as a measure of osseointegrated oral implant stability\". The International Journal of Oral & Maxillofacial Implants. 5 (4): 390\u2013400. \nHolmgren EP, Seckinger RJ, Kilgren LM, Mante F (1998). \"Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction\". The Journal of Oral Implantology. 24 (2): 80\u20138. doi:10.1563\/1548-1336(1998)024<0080:EPOODI>2.3.CO;2. PMID 9835834. \nExternal links \nClinical research on osseointegrated dental implants\nvteDentistrySpecialties\nEndodontics\nOral and maxillofacial pathology\nOral and maxillofacial radiology\nOral and maxillofacial surgery\nOrthodontics and dentofacial orthopedics\nPediatric dentistry\nPeriodontics\nProsthodontics\nDental public health\nCosmetic dentistry\nDental implantology\nGeriatric dentistry\nRestorative dentistry\nForensic odontology\nDental traumatology\nHolistic dentistry\nDental surgery\nDental extraction\nTooth filling\nRoot canal therapy\nRoot end surgery\nScaling and root planing\nTeeth cleaning\nDental bonding\nTooth polishing\nTooth bleaching\nSocket preservation\nDental implant\nOrganisations\nAmerican Association of Orthodontists\nBritish Dental Association\nBritish Dental Health Foundation\nBritish Orthodontic Society\nCanadian Association of Orthodontists\nDental Technologists Association\nIndian Dental Association\nNational Health Service\nOrthodontic National Group\nOrthodontic Technicians Association\nGeneral Dental Council\nSee also\nIndex of oral health and dental articles\nOutline of dentistry and oral health\nOral hygiene\nDental fear\nDental instruments\nDental material\nInfant oral mutilation\nMouth assessment\n\nvtePhysiology of bone and cartilageBone\nBone density\nBone remodeling\nBone healing\nBone resorption\nOsseointegration\nOssification\nOsteolysis\nBone age\nPeriosteal reaction\nCartilage\nChondrogenesis\nJoint\nRange of motion\nTeeth\nChewing\nCementogenesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Osseointegration\">https:\/\/www.limswiki.org\/index.php\/Osseointegration<\/a>\n\t\t\t\t\tCategories: BiomaterialsHealthcare termsImplants (medicine)Hidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","91138ae233fb9e17b5a681bfec9b3c6a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Osseointegration skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Osseointegration<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">Compare <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseoincorporation\" title=\"Osseoincorporation\" rel=\"external_link\" target=\"_blank\">osseoincorporation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosynthesis\" title=\"Osteosynthesis\" rel=\"external_link\" target=\"_blank\">osteosynthesis<\/a>.<\/div>\n<p><b>Osseointegration<\/b> (from Latin <i>ossum<\/i> \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a>\" and <i>integrare<\/i> \"to make whole\") is the direct structural and functional connection between living <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> and the surface of a load-bearing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">artificial implant<\/a> (\"load-bearing\" as defined by Albrektsson et al. in 1981). A more recent definition (by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schroeder\" title=\"Schroeder\" rel=\"external_link\" target=\"_blank\">Schroeder<\/a> et al.) defines osseointegration as \"functional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankylosis\" title=\"Ankylosis\" rel=\"external_link\" target=\"_blank\">ankylosis<\/a> (bone adherence)\", where new bone is laid down directly on the implant surface and the implant exhibits <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_properties_of_biomaterials\" title=\"Mechanical properties of biomaterials\" rel=\"external_link\" target=\"_blank\">mechanical stability<\/a> (also known as <i>primary stability<\/i> \u2013 i.e., resistance to destabilization by or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shear_force\" title=\"Shear force\" rel=\"external_link\" target=\"_blank\">shear forces<\/a>). Osseointegration has enhanced the science of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medical<\/a> bone and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Replacement_joint\" class=\"mw-redirect\" title=\"Replacement joint\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a> techniques as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> and improving <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthetics<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amputee\" class=\"mw-redirect\" title=\"Amputee\" rel=\"external_link\" target=\"_blank\">amputees<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Definition\">Definition<\/span><\/h2>\n<p>Osseointegration is also defined as: \"the formation of a direct interface between an implant and bone, without intervening soft tissue\".<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> <b>Osseointegrated implant<\/b> is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implant<\/a> defined as \"an endosteal implant containing pores into which osteoblasts and supporting connective tissue can migrate\".<sup id=\"rdp-ebb-cite_ref-mosby2002_2-0\" class=\"reference\"><a href=\"#cite_note-mosby2002-2\" rel=\"external_link\">[2]<\/a><\/sup> Applied to oral implantology, this thus refers to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> grown right up to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">implant<\/a> surface without interposed soft tissue layer. No <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar tissue<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">cartilage<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligament\" title=\"Ligament\" rel=\"external_link\" target=\"_blank\">ligament<\/a> fibers are present between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> and implant surface. The direct contact of bone and implant surface can be verified <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microscope\" title=\"Microscope\" rel=\"external_link\" target=\"_blank\">microscopically<\/a>.\n<\/p><p>Osseointegration may also be defined as :\n<\/p>\n<ol><li>Osseous integration, the apparent direct attachment or connection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseous_tissue\" class=\"mw-redirect\" title=\"Osseous tissue\" rel=\"external_link\" target=\"_blank\">osseous tissue<\/a> to an inert alloplastic material without intervening connective tissue.<\/li>\n<li>The process and resultant apparent direct connection of the endogenous material surface and the host bone tissues without intervening connective tissue.<\/li>\n<li>The interface between alloplastic material and bone.<\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osseointegration_Histology.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Osseointegration_Histology.jpg\/220px-Osseointegration_Histology.jpg\" width=\"220\" height=\"143\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osseointegration_Histology.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Titanium implant (black) integrated into bone (red): Histologic section<\/div><\/div><\/div>\n<p>Osseointegration was first observed\u2014albeit not explicitly stated\u2014by Bothe, Beaton, and Davenport in 1940.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-0\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-0\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup> Bothe et al. were the first researchers to implant titanium in an animal and remarked how it had the tendency to fuse with bone.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-1\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-1\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup> Bothe et al. reported that due to the elemental nature of the titanium, its strength, and its hardness, it had great potential to be used as future prosthesis material.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-2\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-2\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup> Osseointegration was later described by Gottlieb Leventhal in 1951.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-3\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Leventhal_5-0\" class=\"reference\"><a href=\"#cite_note-Leventhal-5\" rel=\"external_link\">[5]<\/a><\/sup> Leventhal placed titanium screws in rat femurs and remarked how \"At the end of 6 weeks, the screws were slightly tighter than when originally put in; at 12 weeks, the screws were more difficult to remove; and at the end of 16 weeks, the screws were so tight that in one specimen the femur was fractured when an attempt was made to remove the screw. Microscopic examinations of the bone structure revealed no reaction to the implants. The trabeculation appeared to be perfectly normal.\"<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-4\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Leventhal_5-1\" class=\"reference\"><a href=\"#cite_note-Leventhal-5\" rel=\"external_link\">[5]<\/a><\/sup> The reactions described by Leventhal and Bothe et al. would later be coined into the term \"osseointegration\" by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Per-Ingvar_Br%C3%A5nemark\" title=\"Per-Ingvar Br\u00e5nemark\" rel=\"external_link\" target=\"_blank\">Per-Ingvar Br\u00e5nemark<\/a> of Sweden. In 1952, Br\u00e5nemark conducted an experiment where he utilized a titanium implant chamber to study blood flow in rabbit bone. At the conclusion of the experiment, when it became time to remove the titanium chambers from the bone, he discovered that the bone had integrated so completely with the implant that the chamber could not be removed. Br\u00e5nemark called this \"osseointegration\", and, like Bothe et al. and Leventhal before him, saw the possibilities for human use.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-5\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-3\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Leventhal_5-2\" class=\"reference\"><a href=\"#cite_note-Leventhal-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentistry\" title=\"Dentistry\" rel=\"external_link\" target=\"_blank\">dental medicine<\/a> the implementation of osseointegration started in the mid-1960s as a result of Br\u00e5nemark's work.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> In 1965 Br\u00e5nemark, who was at the time Professor of Anatomy at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Gothenburg\" title=\"University of Gothenburg\" rel=\"external_link\" target=\"_blank\">University of Gothenburg<\/a>, placed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implants\" class=\"mw-redirect\" title=\"Dental implants\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> into the first human patient \u2013 G\u00f6sta Larsson. This patient had a cleft palate defect and required implants to support a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palatal_obturator\" title=\"Palatal obturator\" rel=\"external_link\" target=\"_blank\">palatal obturator<\/a>. G\u00f6sta Larsson died in 2005, with the original implants still in place after 40 years of function.<sup id=\"rdp-ebb-cite_ref-mcclarence_10-0\" class=\"reference\"><a href=\"#cite_note-mcclarence-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>In the mid-1970s Br\u00e5nemark entered into a commercial partnership with the Swedish defense company <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bofors\" title=\"Bofors\" rel=\"external_link\" target=\"_blank\">Bofors<\/a> to manufacture dental implants and the instrumentation required for their placement. Eventually an offshoot of Bofors, Nobel Pharma, was created to concentrate on this product line. Nobel Pharma subsequently became Nobel Biocare.<sup id=\"rdp-ebb-cite_ref-mcclarence_10-1\" class=\"reference\"><a href=\"#cite_note-mcclarence-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Br\u00e5nemark spent almost 30 years fighting the scientific community for acceptance of osseointegration as a viable treatment. In Sweden he was often openly ridiculed at scientific conferences. His university stopped funding for his research, forcing him to open a private clinic to continue the treatment of patients. Eventually an emerging breed of young academics started to notice the work being performed in Sweden. Toronto's George Zarb, a Maltese-born Canadian prosthodontist, was instrumental in bringing the concept of osseointegration to the wider world. The 1983 Toronto Conference is generally considered to be the turning point, when finally the worldwide scientific community accepted Br\u00e5nemark's work. Today osseointegration is a highly predictable and commonplace treatment modality.<sup id=\"rdp-ebb-cite_ref-mcclarence_10-2\" class=\"reference\"><a href=\"#cite_note-mcclarence-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<p>More recently since 2010 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Munjed_Al_Muderis\" title=\"Munjed Al Muderis\" rel=\"external_link\" target=\"_blank\">Al Muderis<\/a> in Sydney Australia utilised a high tensile strength titanium implant with high prose plasma sprayed surface as an intramedullary prosthesis that is inserted into the bone residuum of amputees and then connect through an opening in the skin to a robotic limb prosthesis. This allows amputees to mobilise with more comfort and less energy consumption. Al Muderis also published the first series of combining osseointegration prosthesis with Joint replacement enabling below knee amputees with knee arthritis or short residual bone to mobilise without the need of a socket prosthesis.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<\/p><p>\nOn December 7, 2015, two Operation Iraqi Freedom\/Operation Enduring Freedom veterans, Bryant Jacobs and Ed Salau, will be the first in America to get a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">percutaneous<\/a> osseointegrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> During the first stage, doctors at Salt Lake Veterans Affairs Hospital will embed a titanium stud in the femur of each patient. About six weeks later, they will go back and attach the docking mechanism for the prosthesis.<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_biocompatibility\" title=\"Titanium biocompatibility\" rel=\"external_link\" target=\"_blank\">Titanium biocompatibility<\/a><\/div>\n<p>Osseointegration is a dynamic process in which characteristics of the implant (i.e. macrogeometry, surface properties, etc.) play a role in modulating molecular and cellular behavior. While osseointegration has been observed using different materials, it is most often used to describe the reaction of bone tissues to titanium, or titanium coated with calcium phosphate derivatives.<sup id=\"rdp-ebb-cite_ref-Albr_2001_13-0\" class=\"reference\"><a href=\"#cite_note-Albr_2001-13\" rel=\"external_link\">[13]<\/a><\/sup> It was previously thought that titanium implants were retained in bone through the action of mechanical stabilization or interfacial bonding. Alternatively, calcium phosphate coated implants were thought to be stabilized via chemical bonding. It is now known that both calcium phosphate coated implants and titanium implants are stabilized chemically with bone, either through direct contact between calcium and titanium atoms, or by the bonding to a cement line-like layer at the implant\/bone interface.<sup id=\"rdp-ebb-cite_ref-davies_14-0\" class=\"reference\"><a href=\"#cite_note-davies-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-atoms_15-0\" class=\"reference\"><a href=\"#cite_note-atoms-15\" rel=\"external_link\">[15]<\/a><\/sup> While there are some differences (e.g. like the lack of chondrogenic progenitors), osseointegration occurs through the same mechanisms as bone fracture healing.<sup id=\"rdp-ebb-cite_ref-Colnot_2007_16-0\" class=\"reference\"><a href=\"#cite_note-Colnot_2007-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Albrek_osseo_1981_17-0\" class=\"reference\"><a href=\"#cite_note-Albrek_osseo_1981-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technique\">Technique<\/span><\/h2>\n<p>For osseointegrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>, metallic, ceramic, and polymeric materials have been used,<sup id=\"rdp-ebb-cite_ref-mosby2002_2-1\" class=\"reference\"><a href=\"#cite_note-mosby2002-2\" rel=\"external_link\">[2]<\/a><\/sup> in particular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> To be termed osseointegration the connection between the bone and the implant need not be 100 percent, and the essence of osseointegration derives more from the stability of the fixation than the degree of contact in histologic terms. In short it represents a process whereby clinically asymptomatic rigid fixation of alloplastic materials is achieved, and maintained, in bone during functional loading.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> Implant healing times and initial stability are a function of implant characteristics. For example, implants utilizing a screw-root form design achieve high initial mechanical stability through the action of their screws against the bone. Following placement of the implant, healing typically takes several weeks or months before the implant is fully integrated into the surrounding bone. First evidence of integration occurs after a few weeks, while more robust connection is progressively effected over the next months or years.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Implants that possess a screw-root form design result in bone resorption followed by interfacial bone remodeling and growth around the implant.<sup id=\"rdp-ebb-cite_ref-Coelho_2014_21-0\" class=\"reference\"><a href=\"#cite_note-Coelho_2014-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Implants utilizing a plateau-root form design (or screw-root form implants with a wide enough gap between the pitch of the screws) undergo a different mode of peri-implant ossification. Unlike the aforementioned screw-root form implants, plateau-root form implants exhibit de novo bone formation on the implant surface.<sup id=\"rdp-ebb-cite_ref-Berglundh_2003_22-0\" class=\"reference\"><a href=\"#cite_note-Berglundh_2003-22\" rel=\"external_link\">[22]<\/a><\/sup> The type of bone healing exhibited by plateau-root form implants is known as intramembranous-like healing.<sup id=\"rdp-ebb-cite_ref-Coelho_2014_21-1\" class=\"reference\"><a href=\"#cite_note-Coelho_2014-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Though the osseointegrated interface becomes resistant to external shocks over time, it may be damaged by prolonged adverse stimuli and overload, which may result in implant failure.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> In studies performed using \"Mini dental implants,\" it was noted that the absence of micromotion at the bone-implant interface was necessary to enable proper osseointegration.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Further, it was noted that there is a critical threshold of micromotion above which a fibrous encapsulation process occurs, rather than osseointegration.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>Other complications may arise even in the absence of external impact. One issue is the growing of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cementum\" title=\"Cementum\" rel=\"external_link\" target=\"_blank\">cement<\/a>.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> In normal cases, the absence of cementum on the implant surface prevents the attachment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> fibers. This is normally the case due to the absence of cementum progenitor cells in the area receiving the implant. However, when such cells are present, cement may form on or around the implant surface, and a functional collagen attachment may attach to it.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Advances_in_materials_engineering:_metal_foams\">Advances in materials engineering: metal foams<\/span><\/h3>\n<p>Since 2005, a number of orthopedic device manufacturers have introduced products that feature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_foam\" title=\"Metal foam\" rel=\"external_link\" target=\"_blank\">porous metal construction<\/a>.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> Clinical studies on mammals have shown that porous metals, such as titanium foam, may allow the formation of vascular systems within the porous area.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> For orthopedic uses, metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum\" title=\"Tantalum\" rel=\"external_link\" target=\"_blank\">tantalum<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> are often used, as these metals exhibit high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a> and corrosion resistance with excellent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>.\n<\/p><p>The process of osseointegration in metal foams is similar to that in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_grafts\" class=\"mw-redirect\" title=\"Bone grafts\" rel=\"external_link\" target=\"_blank\">bone grafts<\/a>. The porous bone-like properties of the metal foam contribute to extensive bone infiltration, allowing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoblast\" title=\"Osteoblast\" rel=\"external_link\" target=\"_blank\">osteoblast<\/a> activity to take place. In addition, the porous structure allows for soft tissue adherence and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascularization\" class=\"mw-redirect\" title=\"Vascularization\" rel=\"external_link\" target=\"_blank\">vascularization<\/a> within the implant. These materials are currently deployed in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">knee replacement<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implant<\/a> surgeries.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Testing_procedures\">Testing procedures<\/span><\/h2>\n<p>There are a number of methods used to gauge the level of osseointegration and the subsequent stability of an implant. One widely used diagnostic procedure is percussion analysis, where a dental instrument is tapped against the implant carrier.<sup id=\"rdp-ebb-cite_ref-:0_33-0\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> The nature of the ringing that results is used as a qualitative measure of the implant\u2019s stability. An integrated implant will elicit a higher pitched \"crystal\" sound, whereas a non-integrated implant will elicit a dull, low-pitched sound.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>Another method is a reverse torque test, in which the implant carrier is unscrewed. If it fails to unscrew under the reverse torque pressure, the implant is stable. If the implant rotates under the pressure it is deemed a failure and removed.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> This method comes at the risk of fracturing bone that is mid-way in the process of osseointegration.<sup id=\"rdp-ebb-cite_ref-:0_33-1\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> It is also unreliable in determining the osseointegration potential of a bone region, as tests have yielded that a rotating implant can go on to be successfully integrated.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p><p>A non-invasive and increasingly implemented diagnostic method is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resonance_frequency_analysis\" title=\"Resonance frequency analysis\" rel=\"external_link\" target=\"_blank\">resonance frequency analysis<\/a> (RFA).<sup id=\"rdp-ebb-cite_ref-:0_33-2\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> A resonance frequency analyzer device prompts vibrations in a small metal rod temporarily attached to the implant. As the rod vibrates, the probe reads its resonance frequency and translates it into an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_stability_quotient\" title=\"Implant stability quotient\" rel=\"external_link\" target=\"_blank\">implant stability quotient<\/a> (ISQ), which ranges from 1\u2013100, with 100 indicating the highest stability state. Values ranging between 57 and 82 are generally considered stable, though each case must be considered independently.<sup id=\"rdp-ebb-cite_ref-:0_33-3\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">Dental implants<\/a> are by far the main field of application<\/li>\n<li>Retention of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniofacial_prosthesis\" title=\"Craniofacial prosthesis\" rel=\"external_link\" target=\"_blank\">craniofacial prosthesis<\/a> such as an artificial ear (ear prosthesis), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_and_maxillofacial_surgery\" title=\"Oral and maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">maxillofacial<\/a> reconstruction, eye (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbital_prosthesis\" class=\"mw-redirect\" title=\"Orbital prosthesis\" rel=\"external_link\" target=\"_blank\">orbital prosthesis<\/a>), or nose (nose prosthesis)<\/li>\n<li>Bone anchored limb prostheses<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><\/li>\n<li>Bone anchored hearing conduction amplification (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_anchored_hearing_aid\" class=\"mw-redirect\" title=\"Bone anchored hearing aid\" rel=\"external_link\" target=\"_blank\">Bone anchored hearing aid<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Eyeborg\" class=\"mw-redirect\" title=\"Eyeborg\" rel=\"external_link\" target=\"_blank\">Eyeborg<\/a> perceive color through sound waves (sound conduction through bone)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">Knee<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/12px-WHO_Rod.svg.png\" width=\"12\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine\" title=\"Portal:Medicine\" rel=\"external_link\" target=\"_blank\">Medicine portal<\/a><\/span><\/li><\/ul><\/div>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Abutment_(dentistry)\" title=\"Abutment (dentistry)\" rel=\"external_link\" target=\"_blank\">Abutment (dentistry)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/British_Society_of_Oral_Implantology\" title=\"British Society of Oral Implantology\" rel=\"external_link\" target=\"_blank\">British Society of Oral Implantology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Association_for_Osseointegration\" title=\"European Association for Osseointegration\" rel=\"external_link\" target=\"_blank\">European Association for Osseointegration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_and_maxillofacial_surgery\" title=\"Oral and maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">Oral and maxillofacial surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosynthesis\" title=\"Osteosynthesis\" rel=\"external_link\" target=\"_blank\">Osteosynthesis<\/a>, reduction and internal fixation, which may use wires or implants<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Periodontology\" title=\"Periodontology\" rel=\"external_link\" target=\"_blank\">Periodontology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthodontics\" title=\"Prosthodontics\" rel=\"external_link\" target=\"_blank\">Prosthodontics<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes_and_references\">Notes and references<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Miller, Benjamin F.; Keane, Claire B. (1992). <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Miller-Keane_Encyclopedia_%26_Dictionary_of_Medicine,_Nursing,_and_Allied_Health\" title=\"Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health\" rel=\"external_link\" target=\"_blank\">Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health<\/a><\/i>. Philadelphia: Saunders. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7216-3456-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Miller-Keane+Encyclopedia+%26+Dictionary+of+Medicine%2C+Nursing%2C+and+Allied+Health&rft.place=Philadelphia&rft.pub=Saunders&rft.date=1992&rft.isbn=0-7216-3456-7&rft.aulast=Miller&rft.aufirst=Benjamin+F.&rft.au=Keane%2C+Claire+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (August 2010)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-mosby2002-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-mosby2002_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mosby2002_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mosby%27s_Medical,_Nursing_%26_Allied_Health_Dictionary\" class=\"mw-redirect\" title=\"Mosby's Medical, Nursing & Allied Health Dictionary\" rel=\"external_link\" target=\"_blank\">Mosby's Medical, Nursing & Allied Health Dictionary<\/a><\/i>. St. Louis: Mosby. 2002. p. 1240. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-323-01430-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mosby%27s+Medical%2C+Nursing+%26+Allied+Health+Dictionary&rft.place=St.+Louis&rft.pages=1240&rft.pub=Mosby&rft.date=2002&rft.isbn=0-323-01430-5&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Rudy_et_al.-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Rudy_et_al._3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rudy, Robert; Levi, Paul A; Bonacci, Fred J; Weisgold, Arnold S; Engler-Hamm, Daniel (2008). \"Intraosseous anchorage of dental prostheses: an early 20th century contribution\". <i>Compend Contin Educ Dent<\/i>. <b>29<\/b> (4): 220\u2013229. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18524206\" target=\"_blank\">18524206<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Compend+Contin+Educ+Dent&rft.atitle=Intraosseous+anchorage+of+dental+prostheses%3A+an+early+20th+century+contribution.&rft.volume=29&rft.issue=4&rft.pages=220-229&rft.date=2008&rft_id=info%3Apmid%2F18524206&rft.aulast=Rudy&rft.aufirst=Robert&rft.au=Levi%2C+Paul+A&rft.au=Bonacci%2C+Fred+J&rft.au=Weisgold%2C+Arnold+S&rft.au=Engler-Hamm%2C+Daniel&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Bothe_et_al.-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Bothe_et_al._4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bothe_et_al._4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bothe_et_al._4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bothe_et_al._4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bothe, RT; Beaton, KE; Davenport, HA (1940). \"Reaction of bone to multiple metallic implants\". <i>Surg Gynecol Obstet<\/i>. <b>71<\/b>: 598\u2013602.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surg+Gynecol+Obstet&rft.atitle=Reaction+of+bone+to+multiple+metallic+implants.&rft.volume=71&rft.pages=598-602&rft.date=1940&rft.aulast=Bothe&rft.aufirst=RT&rft.au=Beaton%2C+KE&rft.au=Davenport%2C+HA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Leventhal-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Leventhal_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Leventhal_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Leventhal_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Leventhal, Gottlieb (1951). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/eutils.ncbi.nlm.nih.gov\/entrez\/eutils\/elink.fcgi?dbfrom=pubmed&id=14824196&retmode=ref&cmd=prlinks\" target=\"_blank\">\"Titanium, a metal for surgery\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>33-A<\/b> (2): 473\u2013474. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14824196\" target=\"_blank\">14824196<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Titanium%2C+a+metal+for+surgery&rft.volume=33-A&rft.issue=2&rft.pages=473-474&rft.date=1951&rft_id=info%3Apmid%2F14824196&rft.aulast=Leventhal&rft.aufirst=Gottlieb&rft_id=http%3A%2F%2Feutils.ncbi.nlm.nih.gov%2Fentrez%2Feutils%2Felink.fcgi%3Fdbfrom%3Dpubmed%26id%3D14824196%26retmode%3Dref%26cmd%3Dprlinks&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Br\u00e5nemark PI (September 1983). \"Osseointegration and its experimental background\". <i>The Journal of Prosthetic Dentistry<\/i>. <b>50<\/b> (3): 399\u2013410. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0022-3913%2883%2980101-2\" target=\"_blank\">10.1016\/S0022-3913(83)80101-2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6352924\" target=\"_blank\">6352924<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Prosthetic+Dentistry&rft.atitle=Osseointegration+and+its+experimental+background&rft.volume=50&rft.issue=3&rft.pages=399-410&rft.date=1983-09&rft_id=info%3Adoi%2F10.1016%2FS0022-3913%2883%2980101-2&rft_id=info%3Apmid%2F6352924&rft.au=Br%C3%A5nemark+PI&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Br\u00e5nemark, Per-Ingvar; Zarb, George Albert; Albrektsson, Tomas (1985). <i>Tissue-integrated prostheses: osseointegration in clinical dentistry<\/i>. Chicago: Quintessence. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-86715-129-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Tissue-integrated+prostheses%3A+osseointegration+in+clinical+dentistry&rft.place=Chicago&rft.pub=Quintessence&rft.date=1985&rft.isbn=978-0-86715-129-9&rft.aulast=Br%C3%A5nemark&rft.aufirst=Per-Ingvar&rft.au=Zarb%2C+George+Albert&rft.au=Albrektsson%2C+Tomas&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (August 2010)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Albrektsson, Tomas; Zarb, George A. (1989). <i>The Branemark osseointegrated implant<\/i>. Chicago: Quintessence Pub. Co. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-86715-208-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Branemark+osseointegrated+implant&rft.place=Chicago&rft.pub=Quintessence+Pub.+Co&rft.date=1989&rft.isbn=978-0-86715-208-1&rft.aulast=Albrektsson&rft.aufirst=Tomas&rft.au=Zarb%2C+George+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (August 2010)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Beumer, John; Lewis, Steven (1989). <i>The Branemark implant system: clinical and laboratory procedures<\/i>. St. Louis: Ishiyaku EuroAmerica. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-912791-62-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Branemark+implant+system%3A+clinical+and+laboratory+procedures&rft.place=St.+Louis&rft.pub=Ishiyaku+EuroAmerica&rft.date=1989&rft.isbn=0-912791-62-4&rft.aulast=Beumer&rft.aufirst=John&rft.au=Lewis%2C+Steven&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. 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Res<\/i>. <b>14<\/b> (3): 251\u2013262. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.2003.00972.x\" target=\"_blank\">10.1034\/j.1600-0501.2003.00972.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12755774\" target=\"_blank\">12755774<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin.+Oral+Impl.+Res.&rft.atitle=De+novo+alveolar+bone+formation+adjacent+to+endosseous+implants.&rft.volume=14&rft.issue=3&rft.pages=251-262&rft.date=2003&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.2003.00972.x&rft_id=info%3Apmid%2F12755774&rft.aulast=Berglundh&rft.aufirst=T&rft.au=Abrahamsson%2C+I&rft.au=Lang%2C+N&rft.au=Lindhe%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Albrektsson, Tomas; Berglundh, Tord; Lindhe, Jan (2003). \"Osseointegration: Historic Background and Current Concepts\". In Lindhe, Jan; Karring, Thorkild; Lang, Niklaus P. <i>Clinical Periodontology and Implant Dentistry<\/i>. Oxford: Blackwell Munksgaard. p. 816. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-4051-0236-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Osseointegration%3A+Historic+Background+and+Current+Concepts&rft.btitle=Clinical+Periodontology+and+Implant+Dentistry&rft.place=Oxford&rft.pages=816&rft.pub=Blackwell+Munksgaard&rft.date=2003&rft.isbn=1-4051-0236-5&rft.aulast=Albrektsson&rft.aufirst=Tomas&rft.au=Berglundh%2C+Tord&rft.au=Lindhe%2C+Jan&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Isidor F (June 1996). \"Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys\". <i>Clinical Oral Implants Research<\/i>. <b>7<\/b> (2): 143\u201352. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.1996.070208.x\" target=\"_blank\">10.1034\/j.1600-0501.1996.070208.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9002833\" target=\"_blank\">9002833<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Implants+Research&rft.atitle=Loss+of+osseointegration+caused+by+occlusal+load+of+oral+implants.+A+clinical+and+radiographic+study+in+monkeys&rft.volume=7&rft.issue=2&rft.pages=143-52&rft.date=1996-06&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.1996.070208.x&rft_id=info%3Apmid%2F9002833&rft.au=Isidor+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brunski JB (June 1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adr.sagepub.com\/cgi\/pmidlookup?view=long&pmid=11276755\" target=\"_blank\">\"In vivo bone response to biomechanical loading at the bone\/dental-implant interface\"<\/a>. <i>Advances in Dental Research<\/i>. <b>13<\/b>: 99\u2013119. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F08959374990130012301\" target=\"_blank\">10.1177\/08959374990130012301<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11276755\" target=\"_blank\">11276755<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Dental+Research&rft.atitle=In+vivo+bone+response+to+biomechanical+loading+at+the+bone%2Fdental-implant+interface&rft.volume=13&rft.pages=99-119&rft.date=1999-06&rft_id=info%3Adoi%2F10.1177%2F08959374990130012301&rft_id=info%3Apmid%2F11276755&rft.au=Brunski+JB&rft_id=http%3A%2F%2Fadr.sagepub.com%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D11276755&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH (1998). \"Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature\". <i>Journal of Biomedical Materials Research<\/i>. <b>43<\/b> (2): 192\u2013203. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F%28SICI%291097-4636%28199822%2943%3A2%3C192%3A%3AAID-JBM14%3E3.0.CO%3B2-K\" target=\"_blank\">10.1002\/(SICI)1097-4636(199822)43:2<192::AID-JBM14>3.0.CO;2-K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9619438\" target=\"_blank\">9619438<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Materials+Research&rft.atitle=Timing+of+loading+and+effect+of+micromotion+on+bone-dental+implant+interface%3A+review+of+experimental+literature&rft.volume=43&rft.issue=2&rft.pages=192-203&rft.date=1998&rft_id=info%3Adoi%2F10.1002%2F%28SICI%291097-4636%28199822%2943%3A2%3C192%3A%3AAID-JBM14%3E3.0.CO%3B2-K&rft_id=info%3Apmid%2F9619438&rft.aulast=Szmukler-Moncler&rft.aufirst=S&rft.au=Salama%2C+H&rft.au=Reingewirtz%2C+Y&rft.au=Dubruille%2C+JH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pauletto N, Lahiffe BJ, Walton JN (1999). \"Complications associated with excess cement around crowns on osseointegrated implants: a clinical report\". <i>The International Journal of Oral & Maxillofacial Implants<\/i>. <b>14<\/b> (6): 865\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10612925\" target=\"_blank\">10612925<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Oral+%26+Maxillofacial+Implants&rft.atitle=Complications+associated+with+excess+cement+around+crowns+on+osseointegrated+implants%3A+a+clinical+report&rft.volume=14&rft.issue=6&rft.pages=865-8&rft.date=1999&rft_id=info%3Apmid%2F10612925&rft.aulast=Pauletto&rft.aufirst=N&rft.au=Lahiffe%2C+BJ&rft.au=Walton%2C+JN&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bernard, George W.; Carranza, Ferritin A.; Jovanovic, Sascha A. (1996). \"Biologic Aspects of Dental Implants\". In Carranza, Ferm\u00edn A.; Newman, Michael G. <i>Clinical Periodontology<\/i>. pp. 685\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7216-6728-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Biologic+Aspects+of+Dental+Implants&rft.btitle=Clinical+Periodontology&rft.pages=685-9&rft.date=1996&rft.isbn=978-0-7216-6728-7&rft.aulast=Bernard&rft.aufirst=George+W.&rft.au=Carranza%2C+Ferritin+A.&rft.au=Jovanovic%2C+Sascha+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Biomet Orthopedics, Regenerex\u00ae Porous Titanium Construct, <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231\" target=\"_blank\">http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231<\/a><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zimmer Orthopedics, Trabeluar Metal Technology, <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33\" target=\"_blank\">http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33<\/a><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zimmer Cancellous-Structured Titanium Porous Coating, <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP\" target=\"_blank\">http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP<\/a><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Osseointegration with Titanium Foam in Rabbit Femur, YouTube: <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q\" target=\"_blank\">https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q<\/a><\/span>\n<\/li>\n<li id=\"cite_note-:0-33\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_33-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_33-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_33-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_33-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i>Implant Dentistry - A Rapidly Evolving Practice<\/i>. 2011. pp. 111\u2013126.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Implant+Dentistry+-+A+Rapidly+Evolving+Practice&rft.pages=111-126&rft.date=2011&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Current trends to measure implant stability\". <i>Journal of the Indian Prosthodontic Society<\/i>. <b>16<\/b>: 124\u2013130. 2016. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0972-4052.176539\" target=\"_blank\">10.4103\/0972-4052.176539<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Indian+Prosthodontic+Society&rft.atitle=Current+trends+to+measure+implant+stability&rft.volume=16&rft.pages=124-130&rft.date=2016&rft_id=info%3Adoi%2F10.4103%2F0972-4052.176539&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sld.cu\/galerias\/pdf\/sitios\/protesis\/methods_used_to_assess_implant_stability.pdf\" target=\"_blank\">\"Methods Used to Assess Implant Stability: Current Status\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>International Journal of Oral and Maxillofacial Implants<\/i>. <b>22<\/b>: 742\u2013754. 2007.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Oral+and+Maxillofacial+Implants&rft.atitle=Methods+Used+to+Assess+Implant+Stability%3A+Current+Status&rft.volume=22&rft.pages=742-754&rft.date=2007&rft_id=http%3A%2F%2Fwww.sld.cu%2Fgalerias%2Fpdf%2Fsitios%2Fprotesis%2Fmethods_used_to_assess_implant_stability.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ivanoff, C. J.; Sennerby, L.; Lekholm, U. (1997-08-01). \"Reintegration of mobilized titanium implants. An experimental study in rabbit tibia\". <i>International Journal of Oral and Maxillofacial Surgery<\/i>. <b>26<\/b> (4): 310\u2013315. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0901-5027%2897%2980878-8\" target=\"_blank\">10.1016\/s0901-5027(97)80878-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0901-5027\" target=\"_blank\">0901-5027<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9258729\" target=\"_blank\">9258729<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Oral+and+Maxillofacial+Surgery&rft.atitle=Reintegration+of+mobilized+titanium+implants.+An+experimental+study+in+rabbit+tibia&rft.volume=26&rft.issue=4&rft.pages=310-315&rft.date=1997-08-01&rft.issn=0901-5027&rft_id=info%3Apmid%2F9258729&rft_id=info%3Adoi%2F10.1016%2Fs0901-5027%2897%2980878-8&rft.aulast=Ivanoff&rft.aufirst=C.+J.&rft.au=Sennerby%2C+L.&rft.au=Lekholm%2C+U.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hagberg K, Br\u00e5nemark R (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rehab.research.va.gov\/jour\/09\/46\/3\/Hagberg.html\" target=\"_blank\">\"One hundred patients treated with osseointegrated transfemoral amputation prostheses--rehabilitation perspective\"<\/a>. <i>Journal of Rehabilitation Research and Development<\/i>. <b>46<\/b> (3): 331\u201344. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19675986\" target=\"_blank\">19675986<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Rehabilitation+Research+and+Development&rft.atitle=One+hundred+patients+treated+with+osseointegrated+transfemoral+amputation+prostheses--rehabilitation+perspective&rft.volume=46&rft.issue=3&rft.pages=331-44&rft.date=2009&rft_id=info%3Apmid%2F19675986&rft.aulast=Hagberg&rft.aufirst=K&rft.au=Br%C3%A5nemark%2C+R&rft_id=http%3A%2F%2Fwww.rehab.research.va.gov%2Fjour%2F09%2F46%2F3%2FHagberg.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div> \n<ul><li>Trabecular Metal Material: The Next Best Thing to BoneTM: <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.trabecularmetal.zimmerdental.com\/Implant\/imp_home.aspx\" target=\"_blank\">http:\/\/www.trabecularmetal.zimmerdental.com\/Implant\/imp_home.aspx<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Zarb GA, Schmitt A (July 1990). \"The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto Study. Part II: The prosthetic results\". <i>The Journal of Prosthetic Dentistry<\/i>. <b>64<\/b> (1): 53\u201361. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0022-3913%2890%2990153-4\" target=\"_blank\">10.1016\/0022-3913(90)90153-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2200880\" target=\"_blank\">2200880<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Prosthetic+Dentistry&rft.atitle=The+longitudinal+clinical+effectiveness+of+osseointegrated+dental+implants%3A+the+Toronto+Study.+Part+II%3A+The+prosthetic+results&rft.volume=64&rft.issue=1&rft.pages=53-61&rft.date=1990-07&rft_id=info%3Adoi%2F10.1016%2F0022-3913%2890%2990153-4&rft_id=info%3Apmid%2F2200880&rft.aulast=Zarb&rft.aufirst=GA&rft.au=Schmitt%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Apse P, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: peri-implant mucosal response\". <i>The International Journal of Periodontics & Restorative Dentistry<\/i>. <b>11<\/b> (2): 94\u2013111. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1718917\" target=\"_blank\">1718917<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Periodontics+%26+Restorative+Dentistry&rft.atitle=The+longitudinal+effectiveness+of+osseointegrated+dental+implants.+The+Toronto+Study%3A+peri-implant+mucosal+response&rft.volume=11&rft.issue=2&rft.pages=94-111&rft.date=1991&rft_id=info%3Apmid%2F1718917&rft.aulast=Apse&rft.aufirst=P&rft.au=Zarb%2C+GA&rft.au=Schmitt%2C+A&rft.au=Lewis%2C+DW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Chaytor DV, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: bone level changes\". <i>The International Journal of Periodontics & Restorative Dentistry<\/i>. <b>11<\/b> (2): 112\u201325. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1938184\" target=\"_blank\">1938184<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Periodontics+%26+Restorative+Dentistry&rft.atitle=The+longitudinal+effectiveness+of+osseointegrated+dental+implants.+The+Toronto+Study%3A+bone+level+changes&rft.volume=11&rft.issue=2&rft.pages=112-25&rft.date=1991&rft_id=info%3Apmid%2F1938184&rft.aulast=Chaytor&rft.aufirst=DV&rft.au=Zarb%2C+GA&rft.au=Schmitt%2C+A&rft.au=Lewis%2C+DW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Barber AJ, Butterworth CJ, Rogers SN (January 2010). \"Systematic review of primary osseointegrated dental implants in head and neck oncology\". <i>The British Journal of Oral & Maxillofacial Surgery<\/i>. <b>49<\/b> (1): 29\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bjoms.2009.12.007\" target=\"_blank\">10.1016\/j.bjoms.2009.12.007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20079957\" target=\"_blank\">20079957<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+British+Journal+of+Oral+%26+Maxillofacial+Surgery&rft.atitle=Systematic+review+of+primary+osseointegrated+dental+implants+in+head+and+neck+oncology&rft.volume=49&rft.issue=1&rft.pages=29-36&rft.date=2010-01&rft_id=info%3Adoi%2F10.1016%2Fj.bjoms.2009.12.007&rft_id=info%3Apmid%2F20079957&rft.aulast=Barber&rft.aufirst=AJ&rft.au=Butterworth%2C+CJ&rft.au=Rogers%2C+SN&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Hultin M, Gustafsson A, Klinge B (February 2000). \"Long-term evaluation of osseointegrated dental implants in the treatment of partly edentulous patients\". <i>Journal of Clinical Periodontology<\/i>. <b>27<\/b> (2): 128\u201333. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-051x.2000.027002128.x\" target=\"_blank\">10.1034\/j.1600-051x.2000.027002128.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10703659\" target=\"_blank\">10703659<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Periodontology&rft.atitle=Long-term+evaluation+of+osseointegrated+dental+implants+in+the+treatment+of+partly+edentulous+patients&rft.volume=27&rft.issue=2&rft.pages=128-33&rft.date=2000-02&rft_id=info%3Adoi%2F10.1034%2Fj.1600-051x.2000.027002128.x&rft_id=info%3Apmid%2F10703659&rft.aulast=Hultin&rft.aufirst=M&rft.au=Gustafsson%2C+A&rft.au=Klinge%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Oliv\u00e9, Jordi; Aparicio, Carlos (1990). \"The periotest implant as a measure of osseointegrated oral implant stability\". <i>The International Journal of Oral & Maxillofacial Implants<\/i>. <b>5<\/b> (4): 390\u2013400.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Oral+%26+Maxillofacial+Implants&rft.atitle=The+periotest+implant+as+a+measure+of+osseointegrated+oral+implant+stability&rft.volume=5&rft.issue=4&rft.pages=390-400&rft.date=1990&rft.aulast=Oliv%C3%A9&rft.aufirst=Jordi&rft.au=Aparicio%2C+Carlos&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Holmgren EP, Seckinger RJ, Kilgren LM, Mante F (1998). \"Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction\". <i>The Journal of Oral Implantology<\/i>. <b>24<\/b> (2): 80\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1563%2F1548-1336%281998%29024%3C0080%3AEPOODI%3E2.3.CO%3B2\" target=\"_blank\">10.1563\/1548-1336(1998)024<0080:EPOODI>2.3.CO;2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9835834\" target=\"_blank\">9835834<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Oral+Implantology&rft.atitle=Evaluating+parameters+of+osseointegrated+dental+implants+using+finite+element+analysis--a+two-dimensional+comparative+study+examining+the+effects+of+implant+diameter%2C+implant+shape%2C+and+load+direction&rft.volume=24&rft.issue=2&rft.pages=80-8&rft.date=1998&rft_id=info%3Adoi%2F10.1563%2F1548-1336%281998%29024%3C0080%3AEPOODI%3E2.3.CO%3B2&rft_id=info%3Apmid%2F9835834&rft.aulast=Holmgren&rft.aufirst=EP&rft.au=Seckinger%2C+RJ&rft.au=Kilgren%2C+LM&rft.au=Mante%2C+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nidcr.nih.gov\/grantsandfunding\/see_funding_opportunities_sorted_by\/conceptclearance\/currentcc\/osseointegrated.htm\" target=\"_blank\">Clinical research on osseointegrated dental implants<\/a><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1263\nCached time: 20181217092740\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.628 seconds\nReal time usage: 0.747 seconds\nPreprocessor visited node count: 2707\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 102323\/2097152 bytes\nTemplate argument size: 2731\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 105126\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.352\/10.000 seconds\nLua memory usage: 5.27 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 647.644 1 -total\n<\/p>\n<pre>60.23% 390.061 1 Template:Reflist\n32.13% 208.084 28 Template:Cite_journal\n16.37% 105.998 10 Template:Cite_book\n 9.69% 62.788 4 Template:Page_needed\n 8.64% 55.949 4 Template:Fix\n 8.49% 55.012 1 Template:Update\n 7.07% 45.782 3 Template:Main_other\n 6.40% 41.447 1 Template:Ambox\n 5.01% 32.416 4 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1176900-1!canonical and timestamp 20181217092740 and revision id 870831881\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214705\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.182 seconds\nReal time usage: 0.295 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 284.677 1 - wikipedia:Osseointegration\n100.00% 284.677 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8046-0!*!*!*!*!*!* and timestamp 20181217214705 and revision id 24535\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Osseointegration\">https:\/\/www.limswiki.org\/index.php\/Osseointegration<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","91138ae233fb9e17b5a681bfec9b3c6a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Osseointegration_Histology.jpg\/440px-Osseointegration_Histology.jpg"],"91138ae233fb9e17b5a681bfec9b3c6a_timestamp":1545083225,"ecf92fce38dc6c6fbe9e6feac471ffd2_type":"article","ecf92fce38dc6c6fbe9e6feac471ffd2_title":"Magnetic resonance imaging","ecf92fce38dc6c6fbe9e6feac471ffd2_url":"https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging","ecf92fce38dc6c6fbe9e6feac471ffd2_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMagnetic resonance imaging\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"MRI\" redirects here. For other uses, see MRI (disambiguation).\nMagnetic resonance imagingMedical diagnosticsPlay media Para-sagittal MRI of the head, with aliasing artifacts (nose and forehead appear at the back of the head)Synonymsnuclear magnetic resonance imaging (NMRI), magnetic resonance tomography (MRT)ICD-9-CM88.91MeSHD008279 MedlinePlus003335 \nMagnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body in both health and disease. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body. MRI does not involve X-rays or the use of ionizing radiation, which distinguishes it from CT or CAT scans and PET scans. Magnetic resonance imaging is a medical application of nuclear magnetic resonance (NMR). NMR can also be used for imaging in other NMR applications such as NMR spectroscopy.\nWhile the hazards of X-rays are now well-controlled in most medical contexts, an MRI scan may still be seen as a better choice than a CT scan. MRI is widely used in hospitals and clinics for medical diagnosis, staging of disease and follow-up without exposing the body to radiation. However, MRI may often yield different diagnostic information compared with CT. There may be risks and discomfort associated with MRI scans. Compared with CT scans, MRI scans typically take longer and are louder, and they usually need the subject to enter a narrow, confining tube. In addition, people with some medical implants or other non-removable metal inside the body may be unable to undergo an MRI examination safely.\nMRI was originally called NMRI (nuclear magnetic resonance imaging), but the use of 'nuclear' in the acronym was dropped to avoid negative associations with the word.[1] Certain atomic nuclei are able to absorb and emit radio frequency energy when placed in an external magnetic field. In clinical and research MRI, hydrogen atoms are most often used to generate a detectable radio-frequency signal that is received by antennas in close proximity to the anatomy being examined. Hydrogen atoms are naturally abundant in people and other biological organisms, particularly in water and fat. For this reason, most MRI scans essentially map the location of water and fat in the body. Pulses of radio waves excite the nuclear spin energy transition, and magnetic field gradients localize the signal in space. By varying the parameters of the pulse sequence, different contrasts may be generated between tissues based on the relaxation properties of the hydrogen atoms therein.\nSince its development in the 1970s and 1980s, MRI has proven to be a highly versatile imaging technique. While MRI is most prominently used in diagnostic medicine and biomedical research, it also may be used to form images of non-living objects. MRI scans are capable of producing a variety of chemical and physical data, in addition to detailed spatial images. The sustained increase in demand for MRI within health systems has led to concerns about cost effectiveness and overdiagnosis.[2][3]\n\nContents \n\n1 Mechanism \n\n1.1 Construction and physics \n1.2 T1 and T2 \n\n\n2 Diagnostics \n\n2.1 Usage by organ or system \n\n2.1.1 Neuroimaging \n2.1.2 Cardiovascular \n2.1.3 Musculoskeletal \n2.1.4 Liver and gastrointestinal \n2.1.5 Angiography \n\n\n2.2 Contrast agents \n2.3 Sequences \n\n2.3.1 Overview table \n\n\n2.4 Other specialized configurations \n\n2.4.1 Magnetic resonance spectroscopy \n2.4.2 Real-time MRI \n2.4.3 Interventional MRI \n2.4.4 Magnetic resonance guided focused ultrasound \n2.4.5 Multinuclear imaging \n2.4.6 Molecular imaging by MRI \n\n\n\n\n3 Economics \n\n3.1 Clinical MRI installation in a general hospital \n\n\n4 Safety \n\n4.1 Overuse \n\n\n5 Artifacts \n6 Non-medical use \n7 History \n8 See also \n9 References \n10 Further reading \n11 External links \n\n\nMechanism \nConstruction and physics \nMain article: Physics of magnetic resonance imaging\n Schematic of construction of a cylindrical superconducting MR scanner.\nTo perform a study, the person is positioned within an MRI scanner that forms a strong magnetic field around the area to be imaged. In most medical applications, protons (hydrogen atoms) in tissues containing water molecules create a signal that is processed to form an image of the body. First, energy from an oscillating magnetic field temporarily is applied to the patient at the appropriate resonance frequency. The excited hydrogen atoms emit a radio frequency signal, which is measured by a receiving coil. The radio signal may be made to encode position information by varying the main magnetic field using gradient coils. As these coils are rapidly switched on and off they create the characteristic repetitive noise of an MRI scan. The contrast between different tissues is determined by the rate at which excited atoms return to the equilibrium state. Exogenous contrast agents may be given to the person to make the image clearer.[4]\nThe major components of an MRI scanner are the main magnet, which polarizes the sample, the shim coils for correcting shifts in the homogeneity of the main magnetic field, the gradient system which is used to localize the MR signal and the RF system, which excites the sample and detects the resulting NMR signal. The whole system is controlled by one or more computers.\nMRI requires a magnetic field that is both strong and uniform. The field strength of the magnet is measured in teslas \u2013 and while the majority of systems operate at 1.5 T, commercial systems are available between 0.2 and 7 T. Most clinical magnets are superconducting magnets, which require liquid helium. Lower field strengths can be achieved with permanent magnets, which are often used in \"open\" MRI scanners for claustrophobic patients.[5] Recently, MRI has been demonstrated also at ultra-low fields, i.e., in the microtesla-to-millitesla range, where sufficient signal quality is made possible by prepolarization (on the order of 10-100 mT) and by measuring the Larmor precession fields at about 100 microtesla with highly sensitive superconducting quantum interference devices (SQUIDs).[6][7][8]\n\nT1 and T2 \nFurther information: Relaxation (NMR)\n Effects of TR and TE on MR signal\n Examples of T1 weighted, T2 weighted and PD weighted MRI scans\nEach tissue returns to its equilibrium state after excitation by the independent relaxation processes of T1 (spin-lattice; that is, magnetization in the same direction as the static magnetic field) and T2 (spin-spin; transverse to the static magnetic field).\n \nTo create a T1-weighted image, magnetization is allowed to recover before measuring the MR signal by changing the repetition time (TR). This image weighting is useful for assessing the cerebral cortex, identifying fatty tissue, characterizing focal liver lesions and in general for obtaining morphological information, as well as for post-contrast imaging.\n \nTo create a T2-weighted image, magnetization is allowed to decay before measuring the MR signal by changing the echo time (TE). This image weighting is useful for detecting edema and inflammation, revealing white matter lesions and assessing zonal anatomy in the prostate and uterus.\nThe standard display of MRI images is to represent fluid characteristics in black and white images, where different tissues turn out as follows:\n\n\n\nSignal\nT1-weighted\nT2-weighted\n\n\nHigh\n\n\nFat[9][10]\nSubacute hemorrhage[10]\nMelanin[10]\nProtein-rich fluid[10]\nSlowly flowing blood[10]\nParamagnetic substances, such as gadolinium, manganese, copper[10]\nCortical pseudolaminar necrosis[10]\n\n\nMore water content,[9] as in edema, tumor, infarction, inflammation and infection[10]\nExtracellularly located methemoglobin in subacute hemorrhage[10]\n\n\nInter- mediate\n\nGray matter darker than white matter[11]\n\nWhite matter darker than grey matter[11]\n\n\nLow\n\n\nBone[9]\nUrine\nCSF\nAir[9]\nMore water content,[9] as in edema, tumor, infarction, inflammation, infection, hyperacute or chronic hemorrhage[10]\nLow proton density as in calcification[10]\n\n\nBone[9]\nAir[9]\nFat[9]\nLow proton density, as in calcification and fibrosis[10]\nParamagnetic material, such as deoxyhemoglobin, intracelullar methemoglobin, iron, ferritin, hemosiderin, melanin[10]\nProtein-rich fluid[10]\n\nDiagnostics \nUsage by organ or system \n Patient being positioned for MR study of the head and abdomen.\nMRI has a wide range of applications in medical diagnosis and more than 25,000 scanners are estimated to be in use worldwide.[12] MRI affects diagnosis and treatment in many specialties although the effect on improved health outcomes is uncertain.[13]\nMRI is the investigation of choice in the preoperative staging of rectal and prostate cancer and, has a role in the diagnosis, staging, and follow-up of other tumors.[14]\n\nNeuroimaging \nMain article: MRI of brain and brain stem\nSee also: Neuroimaging\n MRI image of white matter tracts\nMRI is the investigative tool of choice for neurological cancers, as it has better resolution than CT and offers better visualization of the posterior cranial fossa, containing the brainstem and the cerebellum. The contrast provided between grey and white matter makes MRI the best choice for many conditions of the central nervous system, including demyelinating diseases, dementia, cerebrovascular disease, infectious diseases, Alzheimer's disease and epilepsy.[15][16][17] Since many images are taken milliseconds apart, it shows how the brain responds to different stimuli, enabling researchers to study both the functional and structural brain abnormalities in psychological disorders.[18] MRI also is used in guided stereotactic surgery and radiosurgery for treatment of intracranial tumors, arteriovenous malformations, and other surgically treatable conditions using a device known as the N-localizer.[19][20][21]\n\nCardiovascular \nMain article: Cardiac magnetic resonance imaging\n MR angiogram in congenital heart disease\nCardiac MRI is complementary to other imaging techniques, such as echocardiography, cardiac CT, and nuclear medicine. Its applications include assessment of myocardial ischemia and viability, cardiomyopathies, myocarditis, iron overload, vascular diseases, and congenital heart disease.[22]\n\nMusculoskeletal \nApplications in the musculoskeletal system include spinal imaging, assessment of joint disease, and soft tissue tumors.[23]\n\nLiver and gastrointestinal \nHepatobiliary MR is used to detect and characterize lesions of the liver, pancreas, and bile ducts. Focal or diffuse disorders of the liver may be evaluated using diffusion-weighted, opposed-phase imaging, and dynamic contrast enhancement sequences. Extracellular contrast agents are used widely in liver MRI and newer hepatobiliary contrast agents also provide the opportunity to perform functional biliary imaging. Anatomical imaging of the bile ducts is achieved by using a heavily T2-weighted sequence in magnetic resonance cholangiopancreatography (MRCP). Functional imaging of the pancreas is performed following administration of secretin. MR enterography provides non-invasive assessment of inflammatory bowel disease and small bowel tumors. MR-colonography may play a role in the detection of large polyps in patients at increased risk of colorectal cancer.[24][25][26][27]\n\nAngiography \n Magnetic resonance angiography\nMain article: Magnetic resonance angiography\nMagnetic resonance angiography (MRA) generates pictures of the arteries to evaluate them for stenosis (abnormal narrowing) or aneurysms (vessel wall dilatations, at risk of rupture). MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs (called a \"run-off\"). A variety of techniques can be used to generate the pictures, such as administration of a paramagnetic contrast agent (gadolinium) or using a technique known as \"flow-related enhancement\" (e.g., 2D and 3D time-of-flight sequences), where most of the signal on an image is due to blood that recently moved into that plane (see also FLASH MRI).\nTechniques involving phase accumulation (known as phase contrast angiography) can also be used to generate flow velocity maps easily and accurately. Magnetic resonance venography (MRV) is a similar procedure that is used to image veins. In this method, the tissue is now excited inferiorly, while the signal is gathered in the plane immediately superior to the excitation plane\u2014thus imaging the venous blood that recently moved from the excited plane.[28]\n\nContrast agents \nMain article: MRI contrast agent\nMRI for imaging anatomical structures or blood flow do not require contrast agents as the varying properties of the tissues or blood provide natural contrasts. However, for more specific types of imaging, exogenous contrast agents may be given intravenously, orally, or intra-articularly.[4] The most commonly used intravenous contrast agents are based on chelates of gadolinium.[29] In general, these agents have proved safer than the iodinated contrast agents used in X-ray radiography or CT. Anaphylactoid reactions are rare, occurring in approx. 0.03\u20130.1%.[30] Of particular interest is the lower incidence of nephrotoxicity, compared with iodinated agents, when given at usual doses\u2014this has made contrast-enhanced MRI scanning an option for patients with renal impairment, who would otherwise not be able to undergo contrast-enhanced CT.[31]\nAlthough gadolinium agents have proved useful for patients with renal impairment, in patients with severe renal failure requiring dialysis there is a risk of a rare but serious illness, nephrogenic systemic fibrosis, which may be linked to the use of certain gadolinium-containing agents. The most frequently linked is gadodiamide, but other agents have been linked too.[32] Although a causal link has not been definitively established, current guidelines in the United States are that dialysis patients should only receive gadolinium agents where essential, and that dialysis should be performed as soon as possible after the scan to remove the agent from the body promptly.[33][34]\nIn Europe, where more gadolinium-containing agents are available, a classification of agents according to potential risks has been released.[35][36] Recently, a new contrast agent named gadoxetate, brand name Eovist (US) or Primovist (EU), was approved for diagnostic use: this has the theoretical benefit of a dual excretion path.[37]\n\nSequences \nMain article: MRI sequences\nAn MRI sequence is a particular setting of radiofrequency pulses and gradients, resulting in a particular image appearance.[38] The T1 and T2 weighting can also be described as MRI sequences.\n\nOverview table \nedit \r\nThis table does not include uncommon and experimental sequences.\n\n\n\n\nGroup\nSequence\nAbbr.\nPhysics\nMain clinical distinctions\nExample\n\n\nSpin echo\nT1 weighted\nT1\nMeasuring spin\u2013lattice relaxation by using a short repetition time (TR) and echo time (TE)\n\n\nLower signal for more water content, [39]as in edema, tumor, infarction, inflammation, infection, hyperacute or chronic hemorrhage [40]\nHigh signal for fat[39][40]\nHigh signal for paramagnetic substances, such as MRI contrast agents[40]\nStandard foundation and comparison for other sequences\n\n\n\n\n\nT2 weighted\nT2\nMeasuring spin\u2013spin relaxation by using long TR and TE times\n\n\nHigher signal for more water content[39]\nLow signal for fat[39]\nLow signal for paramagnetic substances[40]\nStandard foundation and comparison for other sequences\n\n\n\n\n\nProton density weighted\nPD\nLong TR (to reduce T1) and short TE (to minimize T2)[41]\n\nJoint disease and injury.[42]\nHigh signal from meniscus tears[43] (pictured)\n\n\n\n\nGradient echo (GRE)\nSteady-state free precession\nSSFP\nMaintenance of a steady, residual transverse magnetisation over successive cycles.[44]\nCreation of cardiac MRI videos (pictured).[44]\n\n\n\nEffective T2 \r\nor \"T2-star\"\nT2*\nPostexcitation refocused GRE with small flip angle.[45]\nLow signal from hemosiderin deposits (pictured) and hemorrhages.[45]\n\n\n\nInversion recovery\n\nShort tau inversion recovery\nSTIR\nFat suppression by setting an inversion time where the signal of fat is zero[46]\n\nHigh signal in edema, such as in more severe stress fracture[47] Shin splints pictured:\n\n\n\nFluid-attenuated inversion recovery\nFLAIR\nFluid suppression by setting an inversion time that nulls fluids\nHigh signal in lacunar infarction, multiple sclerosis (MS) plaques, subarachnoid haemorrhage and meningitis (pictured).[48]\n\n\n\nDouble inversion recovery\nDIR\nSimultaneous suppression of cerebrospinal fluid and white matter by two inversion times[49]\n\nHigh signal of multiple sclerosis plaques (pictured)[49]\n\n\n\n\nDiffusion weighted (DWI)\nConventional\nDWI\nMeasure of Brownian motion of water molecules[50]\n\nHigh signal within minutes of cerebral infarction (pictured).[51]\n\n\n\n\nApparent diffusion coefficient\nADC\nReduced T2 weighting by taking multiple conventional DWI images with different DWI weighting, and the change corresponds to diffusion[52]\n\nLow signal minutes after cerebral infarction (pictured)[53]\n\n\n\n\nDiffusion tensor\nDTI\nMainly tractography (pictured) by an overall greater Brownian motion of water molecules in the directions of nerve fibers[54]\n\n\nEvaluating white matter deformation by tumors[54]\nReduced fractional anisotropy may indicate dementia[55]\n\n\n\n\nPerfusion weighted (PWI)\n\nDynamic susceptibility contrast\nDSC\nGadolinium contrast is injected, and rapid repeated imaging (generally gradient-echo echo-planar T2 weighted) quantifies susceptibility-induced signal loss[56]\n\nIn cerebral infarction, the infarcted core and the penumbra have decreased perfusion (pictured).[57]\n\n\n\n\nDynamic contrast enhanced\nDCE\nMeasuring shortening of the spin\u2013lattice relaxation (T1) induced by a gadolinium contrast bolus[58]\n\n\nArterial spin labelling\nASL\nMagnetic labeling of arterial blood below the imaging slab, which subsequently enters the region of interest[59] It does not need gadolinium contrast.[60]\n\n\nFunctional MRI (fMRI)\nBlood-oxygen-level dependent imaging\nBOLD\nChanges in oxygen saturation-dependent magnetism of hemoglobin reflects tissue activity.[61]\n\nLocalizing highly active brain areas before surgery[62]\n\n\n\n\nMagnetic resonance angiography (MRA) and venography\nTime-of-flight\nTOF\nBlood entering the imaged area is not yet magnetically saturated, giving it a much higher signal when using short echo time and flow compensation.\n\nDetection of aneurysm, stenosis, or dissection[63]\n\n\n\n\nPhase-contrast magnetic resonance imaging\nPC-MRA\nTwo gradients with equal magnitude, but opposite direction, are used to encode a phase shift, which is proportional to the velocity of spins.[64]\n\nDetection of aneurysm, stenosis, or dissection (pictured)[63]\n\n\r\n(VIPR)\n\n\nSusceptibility-weighted\nSWI\nSensitive for blood and calcium, by a fully flow compensated, long echo, gradient recalled echo (GRE) pulse sequence to exploit magnetic susceptibility differences between tissues\n\nDetecting small amounts of hemorrhage (diffuse axonal injury pictured) or calcium[65]\n\n\n\nOther specialized configurations \nMagnetic resonance spectroscopy \nMain articles: In vivo magnetic resonance spectroscopy and Nuclear magnetic resonance spectroscopy\nMagnetic resonance spectroscopy (MRS) is used to measure the levels of different metabolites in body tissues. The MR signal produces a spectrum of resonances that corresponds to different molecular arrangements of the isotope being \"excited\". This signature is used to diagnose certain metabolic disorders, especially those affecting the brain,[66] and to provide information on tumor metabolism.[67]\nMagnetic resonance spectroscopic imaging (MRSI) combines both spectroscopic and imaging methods to produce spatially localized spectra from within the sample or patient. The spatial resolution is much lower (limited by the available SNR), but the spectra in each voxel contains information about many metabolites. Because the available signal is used to encode spatial and spectral information, MRSI requires high SNR achievable only at higher field strengths (3 T and above).[68] The high procurement and maintenance costs of MRI with extremely high field strengths[69] inhibit their popularity. However, recent compressed sensing-based software algorithms (e.g., SAMV[70]) have been proposed to achieve super-resolution without requiring such high field strengths.\n\nReal-time MRI \nPlay media Real-time MRI of a human heart at a resolution of 50 ms\nMain article: Real-time MRI\nReal-time MRI refers to the continuous imaging of moving objects (such as the heart) in real time. One of the many different strategies developed since the early 2000s is based on radial FLASH MRI, and iterative reconstruction. This gives a temporal resolution of 20\u201330 ms for images with an in-plane resolution of 1.5\u20132.0 mm.[71] Balanced steady-state free precession (bSSFP) imaging has a better image contrast between the blood pool and myocardium than the FLASH MRI, yet it will produce severe banding artifact when the B0 inhomogeneity is strong. Real-time MRI is likely to add important information on diseases of the heart and the joints, and in many cases may make MRI examinations easier and more comfortable for patients, especially for the patients who cannot hold their breathings or who have arrhythmia.[72]\n\nInterventional MRI \nMain article: Interventional magnetic resonance imaging\nThe lack of harmful effects on the patient and the operator make MRI well-suited for interventional radiology, where the images produced by an MRI scanner guide minimally invasive procedures. Such procedures use no ferromagnetic instruments.[citation needed ]\nA specialized growing subset of interventional MRI is intraoperative MRI, in which an MRI is used in surgery. Some specialized MRI systems allow imaging concurrent with the surgical procedure. More typically, the surgical procedure is temporarily interrupted so that MRI can assess the success of the procedure or guide subsequent surgical work.[citation needed ]\n\nMagnetic resonance guided focused ultrasound \nIn guided therapy, high-intensity focused ultrasound (HIFU) beams are focused on a tissue, that are controlled using MR thermal imaging. Due to the high energy at the focus, the temperature rises to above 65 \u00b0C (150 \u00b0F) which completely destroys the tissue. This technology can achieve precise ablation of diseased tissue. MR imaging provides a three-dimensional view of the target tissue, allowing for the precise focusing of ultrasound energy. The MR imaging provides quantitative, real-time, thermal images of the treated area. This allows the physician to ensure that the temperature generated during each cycle of ultrasound energy is sufficient to cause thermal ablation within the desired tissue and if not, to adapt the parameters to ensure effective treatment.[73]\n\nMultinuclear imaging \nHydrogen has the most frequently imaged nucleus in MRI because it is present in biological tissues in great abundance, and because its high gyromagnetic ratio gives a strong signal. However, any nucleus with a net nuclear spin could potentially be imaged with MRI. Such nuclei include helium-3, lithium-7, carbon-13, fluorine-19, oxygen-17, sodium-23, phosphorus-31 and xenon-129. 23Na and 31P are naturally abundant in the body, so can be imaged directly. Gaseous isotopes such as 3He or 129Xe must be hyperpolarized and then inhaled as their nuclear density is too low to yield a useful signal under normal conditions. 17O and 19F can be administered in sufficient quantities in liquid form (e.g. 17O-water) that hyperpolarization is not a necessity.[citation needed ] Using helium or xenon has the advantage of reduced background noise, and therefore increased contrast for the image itself, because these elements are not normally present in biological tissues.[74]\nMoreover, the nucleus of any atom that has a net nuclear spin and that is bonded to a hydrogen atom could potentially be imaged via heteronuclear magnetization transfer MRI that would image the high-gyromagnetic-ratio hydrogen nucleus instead of the low-gyromagnetic-ratio nucleus that is bonded to the hydrogen atom.[75] In principle, hetereonuclear magnetization transfer MRI could be used to detect the presence or absence of specific chemical bonds.[76][77]\nMultinuclear imaging is primarily a research technique at present. However, potential applications include functional imaging and imaging of organs poorly seen on 1H MRI (e.g., lungs and bones) or as alternative contrast agents. Inhaled hyperpolarized 3He can be used to image the distribution of air spaces within the lungs. Injectable solutions containing 13C or stabilized bubbles of hyperpolarized 129Xe have been studied as contrast agents for angiography and perfusion imaging. 31P can potentially provide information on bone density and structure, as well as functional imaging of the brain. Multinuclear imaging holds the potential to chart the distribution of lithium in the human brain, this element finding use as an important drug for those with conditions such as bipolar disorder.[citation needed ]\n\nMolecular imaging by MRI \nMain article: Molecular imaging\nMRI has the advantages of having very high spatial resolution and is very adept at morphological imaging and functional imaging. MRI does have several disadvantages though. First, MRI has a sensitivity of around 10\u22123 mol\/L to 10\u22125 mol\/L, which, compared to other types of imaging, can be very limiting. This problem stems from the fact that the population difference between the nuclear spin states is very small at room temperature. For example, at 1.5 teslas, a typical field strength for clinical MRI, the difference between high and low energy states is approximately 9 molecules per 2 million. Improvements to increase MR sensitivity include increasing magnetic field strength, and hyperpolarization via optical pumping or dynamic nuclear polarization. There are also a variety of signal amplification schemes based on chemical exchange that increase sensitivity.[citation needed ]\nTo achieve molecular imaging of disease biomarkers using MRI, targeted MRI contrast agents with high specificity and high relaxivity (sensitivity) are required. To date, many studies have been devoted to developing targeted-MRI contrast agents to achieve molecular imaging by MRI. Commonly, peptides, antibodies, or small ligands, and small protein domains, such as HER-2 affibodies, have been applied to achieve targeting. To enhance the sensitivity of the contrast agents, these targeting moieties are usually linked to high payload MRI contrast agents or MRI contrast agents with high relaxivities.[78] A new class of gene targeting MR contrast agents (CA) has been introduced to show gene action of unique mRNA and gene transcription factor proteins.[79][80] This new CA can trace cells with unique mRNA, microRNA and virus; tissue response to inflammation in living brains.[81] The MR reports change in gene expression with positive correlation to TaqMan analysis, optical and electron microscopy.[82]\n\nEconomics \nIn the UK, the price of a clinical 1.5-tesla MRI scanner is around \u00a3920,000\/US$1.4 million , with the lifetime maintenance cost broadly similar to the purchase cost.[83] In the Netherlands, the average MRI scanner costs around \u20ac1 million,[84] with a 7-T MRI having been taken in use by the UMC Utrecht in December 2007, costing \u20ac7 million.[85] Construction of MRI suites could cost up to US$500,000 \/\u20ac370.000 or more, depending on project scope. Pre-polarizing MRI (PMRI) systems using resistive electromagnets have shown promise as a low-cost alternative and have specific advantages for joint imaging near metal implants, however they are likely unsuitable for routine whole-body or neuroimaging applications.[86][87]\n\n A 3 tesla clinical MRI scanner.\nMRI scanners have become significant sources of revenue for healthcare providers in the US. This is because of favorable reimbursement rates from insurers and federal government programs. Insurance reimbursement is provided in two components, an equipment charge for the actual performance and operation of the MRI scan and a professional charge for the radiologist's review of the images and\/or data. In the US Northeast, an equipment charge might be $3,500\/\u20ac2,600 and a professional charge might be $350\/\u20ac260,[88] although the actual fees received by the equipment owner and interpreting physician are often significantly less and depend on the rates negotiated with insurance companies or determined by the Medicare fee schedule. For example, an orthopedic surgery group in Illinois billed a charge of $1,116\/\u20ac825 for a knee MRI in 2007, but the Medicare reimbursement in 2007 was only $470.91\/\u20ac350.[89] Many insurance companies require advance approval of an MRI procedure as a condition for coverage.\nIn the US, the Deficit Reduction Act of 2005 significantly reduced reimbursement rates paid by federal insurance programs for the equipment component of many scans, shifting the economic landscape. Many private insurers have followed suit.[citation needed ]\nIn the United States, an MRI of the brain with and without contrast billed to Medicare Part B entails, on average, a technical payment of US$403 \/\u20ac300 and a separate payment to the radiologist of US$93 \/\u20ac70.[90] In France, the cost of an MRI exam is approximately \u20ac150\/US$205 . This covers three basic scans including one with an intravenous contrast agent as well as a consultation with the technician and a written report to the patient's physician.[91] In Japan, the cost of an MRI examination (excluding the cost of contrast material and films) ranges from US$155 \/\u20ac115 to US$180 \/\u20ac133, with an additional radiologist professional fee of US$17 \/\u20ac12.50.[92] In India, the cost of an MRI examination including the fee for the radiologist's opinion comes to around Rs 3000\u20134000 (\u20ac37\u201349\/US$50\u201360 ), excluding the cost of contrast material. In the UK the retail price for an MRI scan privately ranges between \u00a3350 and \u00a3700 (\u20ac405\u2013810).[93]\n\nClinical MRI installation in a general hospital \n\n\t\t\n\t\t\t\n\t\t\t\nControl console\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBore camera\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nOperator performing a scan\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nTechnical area\n\n\t\t\t\n\t\t\n\nSafety \nMain article: Safety of magnetic resonance imaging\nMRI is in general a safe technique, although injuries may occur as a result of failed safety procedures or human error.[94] Contraindications to MRI include most cochlear implants and cardiac pacemakers, shrapnel, and metallic foreign bodies in the eyes. The safety of MRI during the first trimester of pregnancy is uncertain, but it may be preferable to other options.[95] Since MRI does not use any ionizing radiation, its use is generally favored in preference to CT when either modality could yield the same information.[96] In certain cases, MRI is not preferred as it may be more expensive, time-consuming, and claustrophobia-exacerbating.\nMRI uses powerful magnets and can therefore cause magnetic materials to move at great speeds posing risk. Deaths have occurred.[97] However, as millions of MRIs are performed globally each year.,[98] fatalities are extremely rare.\n\nOveruse \nSee also: Overdiagnosis\nMedical societies issue guidelines for when physicians should use MRI on patients and recommend against overuse. MRI can detect health problems or confirm a diagnosis, but medical societies often recommend that MRI not be the first procedure for creating a plan to diagnose or manage a patient's complaint. A common case is to use MRI to seek a cause of low back pain; the American College of Physicians, for example, recommends against this procedure as unlikely to result in a positive outcome for the patient.[99][100]\n\nArtifacts \n Motion artifact (T1 coronal study of cervical vertebrae).[101]\nMain article: MRI artifact\nAn MRI artifact is a visual artifact, that is, an anomaly during visual representation. Many different artifacts can occur\nduring magnetic resonance imaging (MRI), some affecting the diagnostic quality, while others may be confused with pathology. Artifacts can be classified as patient-related, signal processing-dependent and hardware (machine)-related.[101]\n\nNon-medical use \nMain article: Nuclear magnetic resonance \u00a7 Applications\nMRI is used industrially mainly for routine analysis of chemicals. The nuclear magnetic resonance technique is also used, for example, to measure the ratio between water and fat in foods, monitoring of flow of corrosive fluids in pipes, or to study molecular structures such as catalysts.[102]\n\nHistory \nMain article: History of magnetic resonance imaging\nIn 1971, Paul Lauterbur applied magnetic field gradients in all three dimensions and a back-projection technique to create NMR images. He published the first images of two tubes of water in 1973 in the journal Nature, followed by the picture of a living animal, a clam, and in 1974 by the image of the thoracic cavity of a mouse. Lauterbur called his imaging method zeugmatography, a term which was later replaced by (N)MR imaging.[103] In the late 1970s, physicists Peter Mansfield and Paul Lauterbur, developed MRI-related techniques, like the echo-planar imaging (EPI) technique.[104] Mansfield and Lauterbur were awarded the 2003 Nobel Prize in Physiology or Medicine for their \"discoveries concerning magnetic resonance imaging\".\n\nSee also \n\n\n Medicine portal \n\nEarth's field NMR\nElectron paramagnetic resonance\nHigh-definition fiber tracking\nHistory of neuroimaging\nInternational Society of Magnetic Resonance in Medicine\nJemris\nList of neuroimaging software\nMagnetic immunoassay\nMagnetic particle imaging\nMagnetic resonance elastography\nMagnetic Resonance Imaging (journal)\nMagnetic resonance microscopy\nNobel Prize controversies\nRabi cycle\nRobinson oscillator\nSodium MRI\nVirtopsy\nHigh-resolution computed tomography\nSuper-resolution imaging\nCompressed sensing\n\nReferences \n\n\n^ McRobbie DW, Moore EA, Graves MJ, Prince MR (2007). 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Physical Review B. 12 (9): 3618\u20133634. doi:10.1103\/physrevb.12.3618. \n\n\nFurther reading \n\nRinck PA (ed.). \"The history of MRI\". TRTF\/EMRF. \nEustace SJ, Nelson E (June 2004). \"Whole body magnetic resonance imaging\". BMJ. 328 (7453): 1387\u20138. doi:10.1136\/bmj.328.7453.1387. PMC 421763 . PMID 15191954. \nPykett IL (May 1982). \"NMR imaging in medicine\". Scientific American. 246 (5): 78\u201388. doi:10.1038\/scientificamerican0582-78. PMID 7079720. \nSimon M, Mattson JS (1996). The pioneers of NMR and magnetic resonance in medicine: The story of MRI. Ramat Gan, Israel: Bar-Ilan University Press. ISBN 978-0-9619243-1-7. \nHaacke EM, Brown RF, Thompson M, Venkatesan R (1999). Magnetic resonance imaging: Physical principles and sequence design. New York: J. Wiley & Sons. ISBN 978-0-471-35128-3. \nLee SC, Kim K, Kim J, Lee S, Han Yi J, Kim SW, Ha KS, Cheong C (June 2001). \"One micrometer resolution NMR microscopy\". Journal of Magnetic Resonance. 150 (2): 207\u201313. doi:10.1006\/jmre.2001.2319. PMID 11384182. \nSprawls P (2000). Magnetic Resonance Imaging Principles, Methods, and Techniques. Medical Physics Publishing. ISBN 978-0-944838-97-6. \nMansfield P (1982). NMR Imaging in Biomedicine: Supplement 2 Advances in Magnetic Resonance. Elsevier. ISBN 978-0-323-15406-2. \nFukushima E (1989). NMR in Biomedicine: The Physical Basis. Springer Science & Business Media. ISBN 978-0-88318-609-1. \nBl\u00fcmich B, Kuhn W (1992). Magnetic Resonance Microscopy: Methods and Applications in Materials Science, Agriculture and Biomedicine. Wiley. ISBN 978-3-527-28403-0. \nBl\u00fcmer P (1998). Bl\u00fcmler P, Bl\u00fcmich B, Botto RE, Fukushima E, eds. Spatially Resolved Magnetic Resonance: Methods, Materials, Medicine, Biology, Rheology, Geology, Ecology, Hardware. Wiley-VCH. ISBN 978-3-527-29637-8. \nLiang Z, Lauterbur PC (1999). Principles of Magnetic Resonance Imaging: A Signal Processing Perspective. Wiley. ISBN 978-0-7803-4723-6. \nSchmitt F, Stehling MK, Turner R (1998). Echo-Planar Imaging: Theory, Technique and Application. Springer Berlin Heidelberg. ISBN 978-3-540-63194-1. \nKuperman V (2000). Magnetic Resonance Imaging: Physical Principles and Applications. Academic Press. ISBN 978-0-08-053570-8. \nBl\u00fcmich B (2000). NMR Imaging of Materials. Clarendon Press. ISBN 978-0-19-850683-6. \nJin J (1998). Electromagnetic Analysis and Design in Magnetic Resonance Imaging. CRC Press. ISBN 978-0-8493-9693-9. \nFarhat IA, Belton PS, Webb GA (2007). Magnetic Resonance in Food Science: From Molecules to Man. Royal Society of Chemistry. ISBN 978-0-85404-340-8. \n\nExternal links \n\n\n\nWikimedia Commons has media related to Magnetic resonance imaging.\nLibrary resources about \r\n Magnetic resonance imaging \nResources in your library\n\nRinck PA (ed.). \"MRI: A Peer-Reviewed, Critical Introduction\". European Magnetic Resonance Forum (EMRF)\/The Round Table Foundation (TRTF). \nA Guided Tour of MRI: An introduction for laypeople National High Magnetic Field Laboratory\nThe Basics of MRI. Underlying physics and technical aspects.\nVideo: What to Expect During Your MRI Exam from the Institute for Magnetic Resonance Safety, Education, and Research (IMRSER)\nRoyal Institution Lecture \u2013 MRI: A Window on the Human Body\nA SHORT HISTORY OF MAGNETIC RESONANCE IMAGING FROM A EUROPEAN POINT OF VIEW\n[ permanent dead link ] Animal Imaging Database (AIDB)\nHow MRI works explained simply using diagrams\nReal-time MRI videos: Biomedizinische NMR Forschungs GmbH.\nvteMedical imaging (ICD-9-CM V3 87\u201388, ICD-10-PCS B, CPT 70010\u201379999)X-ray\/\r\nRadiography2DMedical:\nPneumoencephalography\nDental radiography\nSialography\nMyelography\nCXR\nBronchography\nAXR\nKUB\nDXA\/DXR\nUpper gastrointestinal series\/Small-bowel follow-through\/Lower gastrointestinal series\nCholangiography\/Cholecystography\nMammography\nPyelogram\nCystography\nArthrogram\nHysterosalpingography\nSkeletal survey\nAngiography\nAngiocardiography\nAortography\nVenography\nLymphogram\nIndustrial:\nRadiographic testing\nCT scanTechniques:\nGeneral operation of CT\nQuantitative CT\nHigh resolution CT\nX-ray microtomography\nElectron beam tomography\nTargets\nCoronary\nCalcium scan\nCT angiography\nAbdominal and pelvic CT\nVirtual colonoscopy\nCT angiography\nCoronary CT\nPulmonary CT\nHead CT\nThyroid CT\nWhole body imaging\nFull-body CT scan\nOther\nFluoroscopy\nDental panoramic radiography\nX-ray motion analysis\nMRI\nMRI of the brain\nMR neurography\nCardiac MRI\/Cardiac MRI perfusion\nMR angiography\nMR cholangiopancreatography\nBreast MRI\nFunctional MRI\nSequences\nDiffusion MRI\nPerfusion MRI\nTractography\nSynthetic MRI\nUltrasound\nEchocardiography\nDoppler ultrasonography\nDoppler echocardiography\nTTE\nTEE\nTranscranial Doppler\nIntravascular\nGynecologic\nObstetric\nEchoencephalography\nAbdominal ultrasonography\nTransrectal\nBreast ultrasound\nTransscrotal ultrasound\nCarotid ultrasonography\nContrast-enhanced\n3D ultrasound\nEndoscopic ultrasound\nEmergency ultrasound\nFAST\nPre-hospital ultrasound\nDuplex\nRadionuclide2D \/ scintigraphy\nCholescintigraphy\nScintimammography\nVentilation\/perfusion scan\nRadionuclide ventriculography\nRadionuclide angiography\nRadioisotope renography\nSestamibi parathyroid scintigraphy\nRadioactive iodine uptake test\nBone scintigraphy\nImmunoscintigraphy\nDacryoscintigraphy\nDMSA scan\nGastric emptying scan\nFull body:\nOctreotide scan\nGallium 67 scan\nIndium-111 WBC scan\n3D \/ ECTSPECT (gamma ray):\nMyocardial perfusion imaging\nPET (positron):\nBrain PET\nCardiac PET\nPET mammography\nPET-CT\nPET-MRI\nOptical\/Laser\nOptical tomography\nOptical coherence tomography\nConfocal microscopy\nEndomicroscopy\nOrthogonal polarization spectral imaging\nThermography\nnon-contact thermography\ncontact thermography\ndynamic angiothermography\n\nAuthority control \nBNF: cb120656832 (data) \nGND: 4120806-7 \nLCCN: sh85079741 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging\">https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:43.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,455 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ecf92fce38dc6c6fbe9e6feac471ffd2_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Magnetic_resonance_imaging skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Magnetic resonance imaging<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"MRI\" redirects here. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_(disambiguation)\" class=\"mw-disambig\" title=\"MRI (disambiguation)\" rel=\"external_link\" target=\"_blank\">MRI (disambiguation)<\/a>.<\/div>\n\n<p><b>Magnetic resonance imaging<\/b> (<b>MRI<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">medical imaging<\/a> technique used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiology\" title=\"Radiology\" rel=\"external_link\" target=\"_blank\">radiology<\/a> to form pictures of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomy\" title=\"Anatomy\" rel=\"external_link\" target=\"_blank\">anatomy<\/a> and the physiological processes of the body in both health and disease. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging#MRI_scanner\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI scanners<\/a> use strong <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic fields<\/a>, magnetic field gradients, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_wave\" title=\"Radio wave\" rel=\"external_link\" target=\"_blank\">radio waves<\/a> to generate images of the organs in the body. MRI does not involve <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-rays\" class=\"mw-redirect\" title=\"X-rays\" rel=\"external_link\" target=\"_blank\">X-rays<\/a> or the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionizing_radiation\" title=\"Ionizing radiation\" rel=\"external_link\" target=\"_blank\">ionizing radiation<\/a>, which distinguishes it from <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT or CAT scans<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_scans\" class=\"mw-redirect\" title=\"PET scans\" rel=\"external_link\" target=\"_blank\">PET scans<\/a>. Magnetic resonance imaging is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance#Medicine\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">medical application<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">nuclear magnetic resonance<\/a> (NMR). NMR can also be used for <i>imaging<\/i> in other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance#Applications\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">NMR applications<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance_spectroscopy\" title=\"Nuclear magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">NMR spectroscopy<\/a>.\n<\/p><p>While the hazards of X-rays are now well-controlled in most medical contexts, an MRI scan may still be seen as a better choice than a <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a>. MRI is widely used in hospitals and clinics for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">medical diagnosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer_staging\" title=\"Cancer staging\" rel=\"external_link\" target=\"_blank\">staging<\/a> of disease and follow-up without exposing the body to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionizing_radiation\" title=\"Ionizing radiation\" rel=\"external_link\" target=\"_blank\">radiation<\/a>. However, MRI may often yield different diagnostic information compared with CT. There may be risks and discomfort associated with MRI scans. Compared with CT scans, MRI scans typically take longer and are louder, and they usually need the subject to enter a narrow, confining tube. In addition, people with some medical implants or other non-removable metal inside the body may be unable to undergo an MRI examination safely.\n<\/p><p>MRI was originally called NMRI (nuclear magnetic resonance imaging), but the use of 'nuclear' in the acronym was dropped to avoid negative associations with the word.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_nucleus\" title=\"Atomic nucleus\" rel=\"external_link\" target=\"_blank\">atomic nuclei<\/a> are able to absorb and emit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_frequency\" title=\"Radio frequency\" rel=\"external_link\" target=\"_blank\">radio frequency<\/a> energy when placed in an external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic field<\/a>. In clinical and research MRI, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen\" title=\"Hydrogen\" rel=\"external_link\" target=\"_blank\">hydrogen atoms<\/a> are most often used to generate a detectable radio-frequency signal that is received by antennas in close proximity to the anatomy being examined. Hydrogen atoms are naturally abundant in people and other biological organisms, particularly in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Properties_of_water\" title=\"Properties of water\" rel=\"external_link\" target=\"_blank\">water<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lipid\" title=\"Lipid\" rel=\"external_link\" target=\"_blank\">fat<\/a>. For this reason, most MRI scans essentially map the location of water and fat in the body. Pulses of radio waves excite the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_(physics)\" title=\"Spin (physics)\" rel=\"external_link\" target=\"_blank\">nuclear spin<\/a> energy transition, and magnetic field gradients localize the signal in space. By varying the parameters of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_sequence\" class=\"mw-redirect\" title=\"Pulse sequence\" rel=\"external_link\" target=\"_blank\">pulse sequence<\/a>, different contrasts may be generated between tissues based on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relaxation_(NMR)\" title=\"Relaxation (NMR)\" rel=\"external_link\" target=\"_blank\">relaxation<\/a> properties of the hydrogen atoms therein.\n<\/p><p>Since its development in the 1970s and 1980s, MRI has proven to be a highly versatile imaging technique. While MRI is most prominently used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">diagnostic medicine<\/a> and biomedical research, it also may be used to form images of non-living objects. MRI scans are capable of producing a variety of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_MRI\" title=\"Diffusion MRI\" rel=\"external_link\" target=\"_blank\">chemical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_magnetic_resonance_imaging\" title=\"Functional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">physical<\/a> data, in addition to detailed spatial images. The sustained increase in demand for MRI within <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_system\" title=\"Health system\" rel=\"external_link\" target=\"_blank\">health systems<\/a> has led to concerns about <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cost-effectiveness_analysis\" title=\"Cost-effectiveness analysis\" rel=\"external_link\" target=\"_blank\">cost effectiveness<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Overdiagnosis\" title=\"Overdiagnosis\" rel=\"external_link\" target=\"_blank\">overdiagnosis<\/a>.<sup id=\"rdp-ebb-cite_ref-Smith-Bindman2012_2-0\" class=\"reference\"><a href=\"#cite_note-Smith-Bindman2012-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Construction_and_physics\">Construction and physics<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Physics of magnetic resonance imaging<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:332px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mri_scanner_schematic_labelled.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/62\/Mri_scanner_schematic_labelled.svg\/330px-Mri_scanner_schematic_labelled.svg.png\" width=\"330\" height=\"313\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mri_scanner_schematic_labelled.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Schematic of construction of a cylindrical superconducting MR scanner.<\/div><\/div><\/div>\n<p>To perform a study, the person is positioned within an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging#MRI_scanner\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI scanner<\/a> that forms a strong <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic field<\/a> around the area to be imaged. In most medical applications, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proton\" title=\"Proton\" rel=\"external_link\" target=\"_blank\">protons<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen\" title=\"Hydrogen\" rel=\"external_link\" target=\"_blank\">hydrogen<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atom\" title=\"Atom\" rel=\"external_link\" target=\"_blank\">atoms<\/a>) in tissues containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Properties_of_water\" title=\"Properties of water\" rel=\"external_link\" target=\"_blank\">water molecules<\/a> create a signal that is processed to form an image of the body. First, energy from an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oscillation\" title=\"Oscillation\" rel=\"external_link\" target=\"_blank\">oscillating<\/a> magnetic field temporarily is applied to the patient at the appropriate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resonance\" title=\"Resonance\" rel=\"external_link\" target=\"_blank\">resonance<\/a> frequency. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Excited_state\" title=\"Excited state\" rel=\"external_link\" target=\"_blank\">excited<\/a> hydrogen atoms emit a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_frequency\" title=\"Radio frequency\" rel=\"external_link\" target=\"_blank\">radio frequency<\/a> signal, which is measured by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiofrequency_coil\" title=\"Radiofrequency coil\" rel=\"external_link\" target=\"_blank\">receiving coil<\/a>. The radio signal may be made to encode position information by varying the main magnetic field using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging#Gradients\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">gradient coils<\/a>. As these coils are rapidly switched on and off they create the characteristic repetitive noise of an MRI scan. The contrast between different tissues is determined by the rate at which excited atoms return to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermodynamic_equilibrium\" title=\"Thermodynamic equilibrium\" rel=\"external_link\" target=\"_blank\">equilibrium state<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exogeny\" title=\"Exogeny\" rel=\"external_link\" target=\"_blank\">Exogenous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contrast_agent\" title=\"Contrast agent\" rel=\"external_link\" target=\"_blank\">contrast agents<\/a> may be given to the person to make the image clearer.<sup id=\"rdp-ebb-cite_ref-McRobbie_4-0\" class=\"reference\"><a href=\"#cite_note-McRobbie-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>The major components of an MRI scanner are the main <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnet\" title=\"Magnet\" rel=\"external_link\" target=\"_blank\">magnet<\/a>, which polarizes the sample, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shim_(magnetism)\" title=\"Shim (magnetism)\" rel=\"external_link\" target=\"_blank\">shim coils<\/a> for correcting shifts in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homogeneity_(physics)\" title=\"Homogeneity (physics)\" rel=\"external_link\" target=\"_blank\">homogeneity<\/a> of the main magnetic field, the gradient system which is used to localize the MR signal and the RF system, which excites the sample and detects the resulting NMR signal. The whole system is controlled by one or more computers.\n<\/p><p>MRI requires a magnetic field that is both strong and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homogeneity_(physics)\" title=\"Homogeneity (physics)\" rel=\"external_link\" target=\"_blank\">uniform<\/a>. The field strength of the magnet is measured in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">teslas<\/a> \u2013 and while the majority of systems operate at 1.5 T, commercial systems are available between 0.2 and 7 T. Most clinical magnets are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superconductivity\" title=\"Superconductivity\" rel=\"external_link\" target=\"_blank\">superconducting<\/a> magnets, which require liquid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Helium\" title=\"Helium\" rel=\"external_link\" target=\"_blank\">helium<\/a>. Lower field strengths can be achieved with permanent magnets, which are often used in \"open\" MRI scanners for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Claustrophobia\" title=\"Claustrophobia\" rel=\"external_link\" target=\"_blank\">claustrophobic<\/a> patients.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Recently, MRI has been demonstrated also at ultra-low fields, i.e., in the microtesla-to-millitesla range, where sufficient signal quality is made possible by prepolarization (on the order of 10-100 mT) and by measuring the Larmor precession fields at about 100 microtesla with highly sensitive superconducting quantum interference devices (<a href=\"https:\/\/en.wikipedia.org\/wiki\/SQUID\" title=\"SQUID\" rel=\"external_link\" target=\"_blank\">SQUID<\/a>s).<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"T1_and_T2\">T1 and T2<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relaxation_(NMR)\" title=\"Relaxation (NMR)\" rel=\"external_link\" target=\"_blank\">Relaxation (NMR)<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TR_TE.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4d\/TR_TE.jpg\/220px-TR_TE.jpg\" width=\"220\" height=\"122\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TR_TE.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Effects of TR and TE on MR signal<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:T1t2PD.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1t2PD.jpg\/220px-T1t2PD.jpg\" width=\"220\" height=\"97\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:T1t2PD.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Examples of T1 weighted, T2 weighted and <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequence#Proton_density\" title=\"MRI sequence\" rel=\"external_link\" target=\"_blank\">PD<\/a> weighted MRI scans<\/div><\/div><\/div>\n<p>Each tissue returns to its equilibrium state after excitation by the independent relaxation processes of T1 (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93lattice_relaxation\" title=\"Spin\u2013lattice relaxation\" rel=\"external_link\" target=\"_blank\">spin-lattice<\/a>; that is, magnetization in the same direction as the static magnetic field) and T2 (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin-spin_relaxation_time\" class=\"mw-redirect\" title=\"Spin-spin relaxation time\" rel=\"external_link\" target=\"_blank\">spin-spin<\/a>; transverse to the static magnetic field).\n<span id=\"rdp-ebb-T1-weighted_MRI\"><\/span>\nTo create a T1-weighted image, magnetization is allowed to recover before measuring the MR signal by changing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repetition_time\" class=\"mw-redirect\" title=\"Repetition time\" rel=\"external_link\" target=\"_blank\">repetition time<\/a> (TR). This image weighting is useful for assessing the cerebral cortex, identifying fatty tissue, characterizing focal liver lesions and in general for obtaining morphological information, as well as for <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_contrast_agent\" title=\"MRI contrast agent\" rel=\"external_link\" target=\"_blank\">post-contrast<\/a> imaging.\n<span id=\"rdp-ebb-T2-weighted_MRI\"><\/span>\nTo create a T2-weighted image, magnetization is allowed to decay before measuring the MR signal by changing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo_time\" class=\"mw-redirect\" title=\"Echo time\" rel=\"external_link\" target=\"_blank\">echo time<\/a> (TE). This image weighting is useful for detecting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a> and inflammation, revealing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperintensity\" title=\"Hyperintensity\" rel=\"external_link\" target=\"_blank\">white matter lesions<\/a> and assessing zonal anatomy in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate\" title=\"Prostate\" rel=\"external_link\" target=\"_blank\">prostate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a>.\n<\/p><p>The standard display of MRI images is to represent fluid characteristics in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Black_and_white\" title=\"Black and white\" rel=\"external_link\" target=\"_blank\">black and white<\/a> images, where different tissues turn out as follows:\n<\/p>\n<table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>Signal<\/th>\n<th>T1-weighted<\/th>\n<th>T2-weighted\n<\/th><\/tr>\n<tr>\n<td style=\"background: silver\"><b>High<\/b>\n<\/td>\n<td>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fat\" title=\"Fat\" rel=\"external_link\" target=\"_blank\">Fat<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-0\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-johnson2_10-0\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Subacute hemorrhage<sup id=\"rdp-ebb-cite_ref-johnson2_10-1\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Melanin\" title=\"Melanin\" rel=\"external_link\" target=\"_blank\">Melanin<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-2\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Protein-rich fluid<sup id=\"rdp-ebb-cite_ref-johnson2_10-3\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Slowly flowing blood<sup id=\"rdp-ebb-cite_ref-johnson2_10-4\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">Paramagnetic<\/a> substances, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium\" title=\"Gadolinium\" rel=\"external_link\" target=\"_blank\">gadolinium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">manganese<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-5\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cortical_pseudolaminar_necrosis\" title=\"Cortical pseudolaminar necrosis\" rel=\"external_link\" target=\"_blank\">Cortical pseudolaminar necrosis<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-6\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td>\n<td>\n<ul><li>More water content,<sup id=\"rdp-ebb-cite_ref-wisconsin_9-1\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup> as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infarction\" title=\"Infarction\" rel=\"external_link\" target=\"_blank\">infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-7\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracellular\" title=\"Extracellular\" rel=\"external_link\" target=\"_blank\">Extracellularly<\/a> located <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methemoglobin\" title=\"Methemoglobin\" rel=\"external_link\" target=\"_blank\">methemoglobin<\/a> in subacute hemorrhage<sup id=\"rdp-ebb-cite_ref-johnson2_10-8\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td><\/tr>\n<tr>\n<td style=\"background: grey\"><b>Inter- mediate<\/b>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gray_matter\" class=\"mw-redirect\" title=\"Gray matter\" rel=\"external_link\" target=\"_blank\">Gray matter<\/a> darker than <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a><sup id=\"rdp-ebb-cite_ref-patil_11-0\" class=\"reference\"><a href=\"#cite_note-patil-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">White matter<\/a> darker than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grey_matter\" title=\"Grey matter\" rel=\"external_link\" target=\"_blank\">grey matter<\/a><sup id=\"rdp-ebb-cite_ref-patil_11-1\" class=\"reference\"><a href=\"#cite_note-patil-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td style=\"background: black; color:white;\"><b>Low<\/b>\n<\/td>\n<td>\n<ul><li>Bone<sup id=\"rdp-ebb-cite_ref-wisconsin_9-2\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>Urine<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">CSF<\/a><\/li>\n<li>Air<sup id=\"rdp-ebb-cite_ref-wisconsin_9-3\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>More water content,<sup id=\"rdp-ebb-cite_ref-wisconsin_9-4\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup> as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infarction\" title=\"Infarction\" rel=\"external_link\" target=\"_blank\">infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, hyperacute or chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhage\" class=\"mw-redirect\" title=\"Hemorrhage\" rel=\"external_link\" target=\"_blank\">hemorrhage<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-9\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proton\" title=\"Proton\" rel=\"external_link\" target=\"_blank\">proton<\/a> density as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcification\" title=\"Calcification\" rel=\"external_link\" target=\"_blank\">calcification<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-10\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td>\n<td>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">Bone<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-5\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Air\" class=\"mw-redirect\" title=\"Air\" rel=\"external_link\" target=\"_blank\">Air<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-6\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fat\" title=\"Fat\" rel=\"external_link\" target=\"_blank\">Fat<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-7\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>Low proton density, as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcification\" title=\"Calcification\" rel=\"external_link\" target=\"_blank\">calcification<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibrosis\" title=\"Fibrosis\" rel=\"external_link\" target=\"_blank\">fibrosis<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-11\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">Paramagnetic<\/a> material, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deoxyhemoglobin\" class=\"mw-redirect\" title=\"Deoxyhemoglobin\" rel=\"external_link\" target=\"_blank\">deoxyhemoglobin<\/a>, intracelullar <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methemoglobin\" title=\"Methemoglobin\" rel=\"external_link\" target=\"_blank\">methemoglobin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferritin\" title=\"Ferritin\" rel=\"external_link\" target=\"_blank\">ferritin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemosiderin\" title=\"Hemosiderin\" rel=\"external_link\" target=\"_blank\">hemosiderin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melanin\" title=\"Melanin\" rel=\"external_link\" target=\"_blank\">melanin<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-12\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Protein-rich fluid<sup id=\"rdp-ebb-cite_ref-johnson2_10-13\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Diagnostics\">Diagnostics<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Usage_by_organ_or_system\">Usage by organ or system<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Siemens_Magnetom_Aera_MRI_scanner.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Siemens_Magnetom_Aera_MRI_scanner.jpg\/220px-Siemens_Magnetom_Aera_MRI_scanner.jpg\" width=\"220\" height=\"136\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Siemens_Magnetom_Aera_MRI_scanner.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Patient being positioned for MR study of the head and abdomen.<\/div><\/div><\/div>\n<p>MRI has a wide range of applications in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">medical diagnosis<\/a> and more than 25,000 scanners are estimated to be in use worldwide.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> MRI affects diagnosis and treatment in many specialties although the effect on improved health outcomes is uncertain.<sup id=\"rdp-ebb-cite_ref-HollingworthTodd2000_13-0\" class=\"reference\"><a href=\"#cite_note-HollingworthTodd2000-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>MRI is the investigation of choice in the preoperative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer_staging\" title=\"Cancer staging\" rel=\"external_link\" target=\"_blank\">staging<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colorectal_cancer\" title=\"Colorectal cancer\" rel=\"external_link\" target=\"_blank\">rectal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate_cancer\" title=\"Prostate cancer\" rel=\"external_link\" target=\"_blank\">prostate cancer<\/a> and, has a role in the diagnosis, staging, and follow-up of other tumors.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Neuroimaging\">Neuroimaging<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_of_brain_and_brain_stem\" class=\"mw-redirect\" title=\"MRI of brain and brain stem\" rel=\"external_link\" target=\"_blank\">MRI of brain and brain stem<\/a><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroimaging\" title=\"Neuroimaging\" rel=\"external_link\" target=\"_blank\">Neuroimaging<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:White_Matter_Connections_Obtained_with_MRI_Tractography.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png\/220px-White_Matter_Connections_Obtained_with_MRI_Tractography.png\" width=\"220\" height=\"303\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:White_Matter_Connections_Obtained_with_MRI_Tractography.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>MRI image of <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a> tracts<\/div><\/div><\/div>\n<p>MRI is the investigative tool of choice for neurological cancers, as it has better resolution than CT and offers better visualization of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_cranial_fossa\" title=\"Posterior cranial fossa\" rel=\"external_link\" target=\"_blank\">posterior cranial fossa<\/a>, containing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brainstem\" title=\"Brainstem\" rel=\"external_link\" target=\"_blank\">brainstem<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebellum\" title=\"Cerebellum\" rel=\"external_link\" target=\"_blank\">cerebellum<\/a>. The contrast provided between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grey_matter\" title=\"Grey matter\" rel=\"external_link\" target=\"_blank\">grey<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a> makes MRI the best choice for many conditions of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a>, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Demyelinating_disease\" title=\"Demyelinating disease\" rel=\"external_link\" target=\"_blank\">demyelinating diseases<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrovascular_disease\" title=\"Cerebrovascular disease\" rel=\"external_link\" target=\"_blank\">cerebrovascular disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_infections_of_the_central_nervous_system\" title=\"List of infections of the central nervous system\" rel=\"external_link\" target=\"_blank\">infectious diseases<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alzheimer%27s_disease\" title=\"Alzheimer's disease\" rel=\"external_link\" target=\"_blank\">Alzheimer's disease<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a>.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Since many images are taken milliseconds apart, it shows how the brain responds to different stimuli, enabling researchers to study both the functional and structural brain abnormalities in psychological disorders.<sup id=\"rdp-ebb-cite_ref-Abnormal_Psychology_18-0\" class=\"reference\"><a href=\"#cite_note-Abnormal_Psychology-18\" rel=\"external_link\">[18]<\/a><\/sup> MRI also is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image_guided_surgery\" class=\"mw-redirect\" title=\"Image guided surgery\" rel=\"external_link\" target=\"_blank\">guided<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">stereotactic surgery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiosurgery\" title=\"Radiosurgery\" rel=\"external_link\" target=\"_blank\">radiosurgery<\/a> for treatment of intracranial tumors, arteriovenous malformations, and other surgically treatable conditions using a device known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/N-localizer\" title=\"N-localizer\" rel=\"external_link\" target=\"_blank\">N-localizer<\/a>.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Cardiovascular\">Cardiovascular<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_magnetic_resonance_imaging\" title=\"Cardiac magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Cardiac magnetic resonance imaging<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAPVR.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ad\/PAPVR.gif\/220px-PAPVR.gif\" width=\"220\" height=\"161\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAPVR.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>MR angiogram in congenital heart disease<\/div><\/div><\/div>\n<p>Cardiac MRI is complementary to other imaging techniques, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echocardiography\" title=\"Echocardiography\" rel=\"external_link\" target=\"_blank\">echocardiography<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography_of_the_heart\" class=\"mw-redirect\" title=\"Computed tomography of the heart\" rel=\"external_link\" target=\"_blank\">cardiac CT<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_medicine\" title=\"Nuclear medicine\" rel=\"external_link\" target=\"_blank\">nuclear medicine<\/a>. Its applications include assessment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_disease\" title=\"Coronary artery disease\" rel=\"external_link\" target=\"_blank\">myocardial ischemia and viability<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiomyopathy\" title=\"Cardiomyopathy\" rel=\"external_link\" target=\"_blank\">cardiomyopathies<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocarditis\" title=\"Myocarditis\" rel=\"external_link\" target=\"_blank\">myocarditis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron_overload\" title=\"Iron overload\" rel=\"external_link\" target=\"_blank\">iron overload<\/a>, vascular diseases, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_heart_defect\" title=\"Congenital heart defect\" rel=\"external_link\" target=\"_blank\">congenital heart disease<\/a>.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Musculoskeletal\">Musculoskeletal<\/span><\/h4>\n<p>Applications in the musculoskeletal system include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal imaging<\/a>, assessment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint\" title=\"Joint\" rel=\"external_link\" target=\"_blank\">joint<\/a> disease, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_tissue_pathology\" title=\"Soft tissue pathology\" rel=\"external_link\" target=\"_blank\">soft tissue tumors<\/a>.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Liver_and_gastrointestinal\">Liver and gastrointestinal<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatobiliary_system\" class=\"mw-redirect\" title=\"Hepatobiliary system\" rel=\"external_link\" target=\"_blank\">Hepatobiliary<\/a> MR is used to detect and characterize lesions of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreas\" title=\"Pancreas\" rel=\"external_link\" target=\"_blank\">pancreas<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bile_duct\" title=\"Bile duct\" rel=\"external_link\" target=\"_blank\">bile ducts<\/a>. Focal or diffuse disorders of the liver may be evaluated using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_MRI\" title=\"Diffusion MRI\" rel=\"external_link\" target=\"_blank\">diffusion-weighted<\/a>, opposed-phase imaging, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_Contrast_Enhanced_MRI\" class=\"mw-redirect\" title=\"Dynamic Contrast Enhanced MRI\" rel=\"external_link\" target=\"_blank\">dynamic contrast enhancement<\/a> sequences. Extracellular contrast agents are used widely in liver MRI and newer hepatobiliary contrast agents also provide the opportunity to perform functional biliary imaging. Anatomical imaging of the bile ducts is achieved by using a heavily T2-weighted sequence in magnetic resonance cholangiopancreatography (MRCP). Functional imaging of the pancreas is performed following administration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Secretin\" title=\"Secretin\" rel=\"external_link\" target=\"_blank\">secretin<\/a>. MR enterography provides non-invasive assessment of inflammatory bowel disease and small bowel tumors. MR-colonography may play a role in the detection of large polyps in patients at increased risk of colorectal cancer.<sup id=\"rdp-ebb-cite_ref-FrydrychowiczLubner2012_24-0\" class=\"reference\"><a href=\"#cite_note-FrydrychowiczLubner2012-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SandrasegaranLin2010_25-0\" class=\"reference\"><a href=\"#cite_note-SandrasegaranLin2010-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MasselliGualdi2012_26-0\" class=\"reference\"><a href=\"#cite_note-MasselliGualdi2012-26\" rel=\"external_link\">[26]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ZijtaBipat2009_27-0\" class=\"reference\"><a href=\"#cite_note-ZijtaBipat2009-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Angiography\">Angiography<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mra1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/38\/Mra1.jpg\/220px-Mra1.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mra1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Magnetic resonance angiography<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_angiography\" title=\"Magnetic resonance angiography\" rel=\"external_link\" target=\"_blank\">Magnetic resonance angiography<\/a><\/div>\n<p>Magnetic resonance <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angiography\" title=\"Angiography\" rel=\"external_link\" target=\"_blank\">angiography<\/a> (MRA) generates pictures of the arteries to evaluate them for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a> (abnormal narrowing) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysms<\/a> (vessel wall dilatations, at risk of rupture). MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs (called a \"run-off\"). A variety of techniques can be used to generate the pictures, such as administration of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetic\" class=\"mw-redirect\" title=\"Paramagnetic\" rel=\"external_link\" target=\"_blank\">paramagnetic<\/a> contrast agent (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium\" title=\"Gadolinium\" rel=\"external_link\" target=\"_blank\">gadolinium<\/a>) or using a technique known as \"flow-related enhancement\" (e.g., 2D and 3D time-of-flight sequences), where most of the signal on an image is due to blood that recently moved into that plane (see also <a href=\"https:\/\/en.wikipedia.org\/wiki\/FLASH_MRI\" class=\"mw-redirect\" title=\"FLASH MRI\" rel=\"external_link\" target=\"_blank\">FLASH MRI<\/a>).\n<\/p><p>Techniques involving phase accumulation (known as phase contrast angiography) can also be used to generate flow velocity maps easily and accurately. Magnetic resonance venography (MRV) is a similar procedure that is used to image veins. In this method, the tissue is now excited inferiorly, while the signal is gathered in the plane immediately superior to the excitation plane\u2014thus imaging the venous blood that recently moved from the excited plane.<sup id=\"rdp-ebb-cite_ref-haacke_28-0\" class=\"reference\"><a href=\"#cite_note-haacke-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Contrast_agents\">Contrast agents<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_contrast_agent\" title=\"MRI contrast agent\" rel=\"external_link\" target=\"_blank\">MRI contrast agent<\/a><\/div>\n<p>MRI for imaging anatomical structures or blood flow do not require contrast agents as the varying properties of the tissues or blood provide natural contrasts. However, for more specific types of imaging, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exogeny\" title=\"Exogeny\" rel=\"external_link\" target=\"_blank\">exogenous<\/a> contrast agents may be given <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">intravenously<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_administration\" title=\"Oral administration\" rel=\"external_link\" target=\"_blank\">orally<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_injection\" title=\"Joint injection\" rel=\"external_link\" target=\"_blank\">intra-articularly<\/a>.<sup id=\"rdp-ebb-cite_ref-McRobbie_4-1\" class=\"reference\"><a href=\"#cite_note-McRobbie-4\" rel=\"external_link\">[4]<\/a><\/sup> The most commonly used intravenous contrast agents are based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chelate\" class=\"mw-redirect\" title=\"Chelate\" rel=\"external_link\" target=\"_blank\">chelates<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium\" title=\"Gadolinium\" rel=\"external_link\" target=\"_blank\">gadolinium<\/a>.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> In general, these agents have proved safer than the iodinated contrast agents used in X-ray radiography or CT. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis\" title=\"Anaphylaxis\" rel=\"external_link\" target=\"_blank\">Anaphylactoid reactions<\/a> are rare, occurring in approx. 0.03\u20130.1%.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Of particular interest is the lower incidence of nephrotoxicity, compared with iodinated agents, when given at usual doses\u2014this has made contrast-enhanced MRI scanning an option for patients with renal impairment, who would otherwise not be able to undergo <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiocontrast\" class=\"mw-redirect\" title=\"Radiocontrast\" rel=\"external_link\" target=\"_blank\">contrast-enhanced CT<\/a>.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>Although gadolinium agents have proved useful for patients with renal impairment, in patients with severe renal failure requiring dialysis there is a risk of a rare but serious illness, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrogenic_systemic_fibrosis\" title=\"Nephrogenic systemic fibrosis\" rel=\"external_link\" target=\"_blank\">nephrogenic systemic fibrosis<\/a>, which may be linked to the use of certain gadolinium-containing agents. The most frequently linked is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadodiamide\" title=\"Gadodiamide\" rel=\"external_link\" target=\"_blank\">gadodiamide<\/a>, but other agents have been linked too.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> Although a causal link has not been definitively established, current guidelines in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> are that dialysis patients should only receive gadolinium agents where essential, and that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" title=\"Dialysis\" rel=\"external_link\" target=\"_blank\">dialysis<\/a> should be performed as soon as possible after the scan to remove the agent from the body promptly.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>In Europe, where more gadolinium-containing agents are available, a classification of agents according to potential risks has been released.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> Recently, a new contrast agent named <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadoxetic_acid\" title=\"Gadoxetic acid\" rel=\"external_link\" target=\"_blank\">gadoxetate<\/a>, brand name Eovist (US) or Primovist (EU), was approved for diagnostic use: this has the theoretical benefit of a dual excretion path.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sequences\">Sequences<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequences\" class=\"mw-redirect\" title=\"MRI sequences\" rel=\"external_link\" target=\"_blank\">MRI sequences<\/a><\/div>\n<p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequences\" class=\"mw-redirect\" title=\"MRI sequences\" rel=\"external_link\" target=\"_blank\">MRI sequence<\/a> is a particular setting of radiofrequency pulses and gradients, resulting in a particular image appearance.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup> The <a href=\"#T1_and_T2\" rel=\"external_link\">T1 and T2<\/a> weighting can also be described as MRI sequences.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Overview_table\">Overview table<\/span><\/h4>\n<p><span class=\"noprint plainlinks\"><\/span><br \/>This table does not include <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequences#Uncommon_and_experimental_sequences\" class=\"mw-redirect\" title=\"MRI sequences\" rel=\"external_link\" target=\"_blank\">uncommon and experimental sequences<\/a>.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Group<\/th>\n<th>Sequence<\/th>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Abbreviation\" title=\"Abbreviation\" rel=\"external_link\" target=\"_blank\">Abbr.<\/a><\/th>\n<th>Physics<\/th>\n<th>Main clinical distinctions<\/th>\n<th>Example\n<\/th><\/tr>\n<tr>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_echo\" title=\"Spin echo\" rel=\"external_link\" target=\"_blank\">Spin echo<\/a><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging#T1_and_T2\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">T1 weighted<\/a><\/td>\n<td><b>T1<\/b><\/td>\n<td>Measuring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93lattice_relaxation\" title=\"Spin\u2013lattice relaxation\" rel=\"external_link\" target=\"_blank\">spin\u2013lattice relaxation<\/a> by using a short <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repetition_time\" class=\"mw-redirect\" title=\"Repetition time\" rel=\"external_link\" target=\"_blank\">repetition time<\/a> (TR) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo_time\" class=\"mw-redirect\" title=\"Echo time\" rel=\"external_link\" target=\"_blank\">echo time<\/a> (TE)\n<\/td>\n<td>\n<ul><li>Lower signal for more water content, <sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-0\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup>as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infarction\" title=\"Infarction\" rel=\"external_link\" target=\"_blank\">infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, hyperacute or chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhage\" class=\"mw-redirect\" title=\"Hemorrhage\" rel=\"external_link\" target=\"_blank\">hemorrhage<\/a> <sup id=\"rdp-ebb-cite_ref-johnson_40-0\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li>High signal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fat\" title=\"Fat\" rel=\"external_link\" target=\"_blank\">fat<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-1\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-johnson_40-1\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li>High signal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">paramagnetic<\/a> substances, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_contrast_agent\" title=\"MRI contrast agent\" rel=\"external_link\" target=\"_blank\">MRI contrast agents<\/a><sup id=\"rdp-ebb-cite_ref-johnson_40-2\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li><\/ul>\n<p>Standard foundation and comparison for other sequences\n<\/p>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:T1-weighted-MRI.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"T1-weighted-MRI.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1-weighted-MRI.png\/100px-T1-weighted-MRI.png\" width=\"100\" height=\"116\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging#T1_and_T2\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">T2 weighted<\/a><\/td>\n<td><b>T2<\/b><\/td>\n<td>Measuring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93spin_relaxation\" title=\"Spin\u2013spin relaxation\" rel=\"external_link\" target=\"_blank\">spin\u2013spin relaxation<\/a> by using long TR and TE times\n<\/td>\n<td>\n<ul><li>Higher signal for more water content<sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-2\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li>Low signal for fat<sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-3\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li>Low signal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">paramagnetic<\/a> substances<sup id=\"rdp-ebb-cite_ref-johnson_40-3\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li><\/ul>\n<p>Standard foundation and comparison for other sequences\n<\/p>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Normal axial T2-weighted MR image of the brain.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\/100px-Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\" width=\"100\" height=\"125\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequence#PD\" title=\"MRI sequence\" rel=\"external_link\" target=\"_blank\">Proton density weighted<\/a><\/td>\n<td><b>PD<\/b><\/td>\n<td>Long <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repetition_time\" class=\"mw-redirect\" title=\"Repetition time\" rel=\"external_link\" target=\"_blank\">TR<\/a> (to reduce T1) and short <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo_time\" class=\"mw-redirect\" title=\"Echo time\" rel=\"external_link\" target=\"_blank\">TE<\/a> (to minimize T2)<sup id=\"rdp-ebb-cite_ref-Graham2011_41-0\" class=\"reference\"><a href=\"#cite_note-Graham2011-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthropathy\" title=\"Arthropathy\" rel=\"external_link\" target=\"_blank\">Joint disease<\/a> and injury.<sup id=\"rdp-ebb-cite_ref-Overview_42-0\" class=\"reference\"><a href=\"#cite_note-Overview-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<ul><li>High signal from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tear_of_meniscus\" title=\"Tear of meniscus\" rel=\"external_link\" target=\"_blank\">meniscus tears<\/a><sup id=\"rdp-ebb-cite_ref-LefevreNaouri2016_43-0\" class=\"reference\"><a href=\"#cite_note-LefevreNaouri2016-43\" rel=\"external_link\">[43]<\/a><\/sup> (pictured)<\/li><\/ul>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Proton density MRI of a grade 2 medial meniscal tear.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\/100px-Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\" width=\"100\" height=\"101\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"2\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gradient_echo\" class=\"mw-redirect\" title=\"Gradient echo\" rel=\"external_link\" target=\"_blank\">Gradient echo<\/a> (GRE)<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Steady-state_free_precession_imaging\" title=\"Steady-state free precession imaging\" rel=\"external_link\" target=\"_blank\">Steady-state free precession<\/a><\/td>\n<td><b>SSFP<\/b><\/td>\n<td>Maintenance of a steady, residual transverse magnetisation over successive cycles.<sup id=\"rdp-ebb-cite_ref-Luijkx_44-0\" class=\"reference\"><a href=\"#cite_note-Luijkx-44\" rel=\"external_link\">[44]<\/a><\/sup><\/td>\n<td>Creation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_magnetic_resonance_imaging\" title=\"Cardiac magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">cardiac MRI<\/a> videos (pictured).<sup id=\"rdp-ebb-cite_ref-Luijkx_44-1\" class=\"reference\"><a href=\"#cite_note-Luijkx-44\" rel=\"external_link\">[44]<\/a><\/sup><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Four_chamber_cardiovascular_magnetic_resonance_imaging.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Four chamber cardiovascular magnetic resonance imaging.gif\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Four_chamber_cardiovascular_magnetic_resonance_imaging.gif\/100px-Four_chamber_cardiovascular_magnetic_resonance_imaging.gif\" width=\"100\" height=\"100\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/T2*-weighted_imaging\" title=\"T2*-weighted imaging\" rel=\"external_link\" target=\"_blank\">Effective T2 <br \/>or \"T2-star\"<\/a><\/td>\n<td><b>T2*<\/b><\/td>\n<td>Postexcitation refocused GRE with small flip angle.<sup id=\"rdp-ebb-cite_ref-ChavhanBabyn2009_45-0\" class=\"reference\"><a href=\"#cite_note-ChavhanBabyn2009-45\" rel=\"external_link\">[45]<\/a><\/sup><\/td>\n<td>Low signal from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemosiderin\" title=\"Hemosiderin\" rel=\"external_link\" target=\"_blank\">hemosiderin<\/a> deposits (pictured) and hemorrhages.<sup id=\"rdp-ebb-cite_ref-ChavhanBabyn2009_45-1\" class=\"reference\"><a href=\"#cite_note-ChavhanBabyn2009-45\" rel=\"external_link\">[45]<\/a><\/sup><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Effective T2-weighted MRI of hemosiderin deposits after subarachnoid hemorrhage.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\/100px-Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\" width=\"100\" height=\"100\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"3\">Inversion recovery\n<\/td>\n<td>Short tau inversion recovery<\/td>\n<td><b>STIR<\/b><\/td>\n<td>Fat suppression by setting an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inversion_time\" class=\"mw-redirect\" title=\"Inversion time\" rel=\"external_link\" target=\"_blank\">inversion time<\/a> where the signal of fat is zero<sup id=\"rdp-ebb-cite_ref-Shorttau_46-0\" class=\"reference\"><a href=\"#cite_note-Shorttau-46\" rel=\"external_link\">[46]<\/a><\/sup>\n<\/td>\n<td>High signal in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, such as in more severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_fracture\" title=\"Stress fracture\" rel=\"external_link\" target=\"_blank\">stress fracture<\/a><sup id=\"rdp-ebb-cite_ref-Stress_47-0\" class=\"reference\"><a href=\"#cite_note-Stress-47\" rel=\"external_link\">[47]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shin_splints\" title=\"Shin splints\" rel=\"external_link\" target=\"_blank\">Shin splints<\/a> pictured:<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Shinsplint-mri_(crop).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Shinsplint-mri (crop).jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Shinsplint-mri_%28crop%29.jpg\/70px-Shinsplint-mri_%28crop%29.jpg\" width=\"70\" height=\"121\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluid-attenuated_inversion_recovery\" title=\"Fluid-attenuated inversion recovery\" rel=\"external_link\" target=\"_blank\">Fluid-attenuated inversion recovery<\/a><\/td>\n<td><b>FLAIR<\/b><\/td>\n<td>Fluid suppression by setting an inversion time that nulls fluids<\/td>\n<td>High signal in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lacunar_stroke\" title=\"Lacunar stroke\" rel=\"external_link\" target=\"_blank\">lacunar infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis (MS) plaques<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subarachnoid_hemorrhage\" title=\"Subarachnoid hemorrhage\" rel=\"external_link\" target=\"_blank\">subarachnoid haemorrhage<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Meningitis\" title=\"Meningitis\" rel=\"external_link\" target=\"_blank\">meningitis<\/a> (pictured).<sup id=\"rdp-ebb-cite_ref-:0_48-0\" class=\"reference\"><a href=\"#cite_note-:0-48\" rel=\"external_link\">[48]<\/a><\/sup><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:FLAIR_MRI_of_meningitis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"FLAIR MRI of meningitis.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/FLAIR_MRI_of_meningitis.jpg\/100px-FLAIR_MRI_of_meningitis.jpg\" width=\"100\" height=\"87\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td>Double inversion recovery<\/td>\n<td><b>DIR<\/b><\/td>\n<td>Simultaneous suppression of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">cerebrospinal fluid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a> by two inversion times<sup id=\"rdp-ebb-cite_ref-muzio_49-0\" class=\"reference\"><a href=\"#cite_note-muzio-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/td>\n<td>High signal of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a> plaques (pictured)<sup id=\"rdp-ebb-cite_ref-muzio_49-1\" class=\"reference\"><a href=\"#cite_note-muzio-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Axial DIR MRI of a brain with multiple sclerosis lesions.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\/100px-Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\" width=\"100\" height=\"116\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_weighted_imaging\" class=\"mw-redirect\" title=\"Diffusion weighted imaging\" rel=\"external_link\" target=\"_blank\">Diffusion weighted<\/a> (<b>DWI<\/b>)<\/td>\n<td>Conventional<\/td>\n<td><b>DWI<\/b><\/td>\n<td>Measure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brownian_motion\" title=\"Brownian motion\" rel=\"external_link\" target=\"_blank\">Brownian motion<\/a> of water molecules<sup id=\"rdp-ebb-cite_ref-dwi_50-0\" class=\"reference\"><a href=\"#cite_note-dwi-50\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/td>\n<td>High signal within minutes of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_infarction\" title=\"Cerebral infarction\" rel=\"external_link\" target=\"_blank\">cerebral infarction<\/a> (pictured).<sup id=\"rdp-ebb-cite_ref-IschaemicStroke_51-0\" class=\"reference\"><a href=\"#cite_note-IschaemicStroke-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Cerebral infarction after 4 hours on DWI MRI.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\/100px-Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\" width=\"100\" height=\"108\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apparent_diffusion_coefficient\" class=\"mw-redirect\" title=\"Apparent diffusion coefficient\" rel=\"external_link\" target=\"_blank\">Apparent diffusion coefficient<\/a><\/td>\n<td><b>ADC<\/b><\/td>\n<td>Reduced T2 weighting by taking multiple conventional DWI images with different DWI weighting, and the change corresponds to diffusion<sup id=\"rdp-ebb-cite_ref-hammer_52-0\" class=\"reference\"><a href=\"#cite_note-hammer-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/td>\n<td>Low signal minutes after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_infarction\" title=\"Cerebral infarction\" rel=\"external_link\" target=\"_blank\">cerebral infarction<\/a> (pictured)<sup id=\"rdp-ebb-cite_ref-AnFord2011_53-0\" class=\"reference\"><a href=\"#cite_note-AnFord2011-53\" rel=\"external_link\">[53]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Cerebral infarction after 4 hours on ADC MRI.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f3\/Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg\/100px-Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg\" width=\"100\" height=\"119\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td>Diffusion tensor<\/td>\n<td><b>DTI<\/b><\/td>\n<td>Mainly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tractography\" title=\"Tractography\" rel=\"external_link\" target=\"_blank\">tractography<\/a> (pictured) by an overall greater <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brownian_motion\" title=\"Brownian motion\" rel=\"external_link\" target=\"_blank\">Brownian motion<\/a> of water molecules in the directions of nerve fibers<sup id=\"rdp-ebb-cite_ref-radiopaedia-dti_54-0\" class=\"reference\"><a href=\"#cite_note-radiopaedia-dti-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/td>\n<td>\n<ul><li>Evaluating white matter deformation by tumors<sup id=\"rdp-ebb-cite_ref-radiopaedia-dti_54-1\" class=\"reference\"><a href=\"#cite_note-radiopaedia-dti-54\" rel=\"external_link\">[54]<\/a><\/sup><\/li>\n<li>Reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractional_anisotropy\" title=\"Fractional anisotropy\" rel=\"external_link\" target=\"_blank\">fractional anisotropy<\/a> may indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a><sup id=\"rdp-ebb-cite_ref-ChuaWen2008_55-0\" class=\"reference\"><a href=\"#cite_note-ChuaWen2008-55\" rel=\"external_link\">[55]<\/a><\/sup><\/li><\/ul>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:White_Matter_Connections_Obtained_with_MRI_Tractography.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"White Matter Connections Obtained with MRI Tractography.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png\/100px-White_Matter_Connections_Obtained_with_MRI_Tractography.png\" width=\"100\" height=\"138\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfusion_MRI\" title=\"Perfusion MRI\" rel=\"external_link\" target=\"_blank\">Perfusion weighted<\/a> (<b>PWI<\/b>)\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_susceptibility_contrast\" class=\"mw-redirect\" title=\"Dynamic susceptibility contrast\" rel=\"external_link\" target=\"_blank\">Dynamic susceptibility contrast<\/a><\/td>\n<td><b>DSC<\/b><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium_contrast\" class=\"mw-redirect\" title=\"Gadolinium contrast\" rel=\"external_link\" target=\"_blank\">Gadolinium contrast<\/a> is injected, and rapid repeated imaging (generally gradient-echo echo-planar <a href=\"https:\/\/en.wikipedia.org\/wiki\/T2_weighted\" class=\"mw-redirect\" title=\"T2 weighted\" rel=\"external_link\" target=\"_blank\">T2 weighted<\/a>) quantifies susceptibility-induced signal loss<sup id=\"rdp-ebb-cite_ref-DSC_56-0\" class=\"reference\"><a href=\"#cite_note-DSC-56\" rel=\"external_link\">[56]<\/a><\/sup>\n<\/td>\n<td rowspan=\"3\">In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_infarction\" title=\"Cerebral infarction\" rel=\"external_link\" target=\"_blank\">cerebral infarction<\/a>, the infarcted core and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penumbra_(medicine)\" title=\"Penumbra (medicine)\" rel=\"external_link\" target=\"_blank\">penumbra<\/a> have decreased perfusion (pictured).<sup id=\"rdp-ebb-cite_ref-Chen2012_57-0\" class=\"reference\"><a href=\"#cite_note-Chen2012-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/td>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Tmax by MRI perfusion in cerebral artery occlusion.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg\/100px-Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg\" width=\"100\" height=\"118\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_contrast_enhanced\" class=\"mw-redirect\" title=\"Dynamic contrast enhanced\" rel=\"external_link\" target=\"_blank\">Dynamic contrast enhanced<\/a><\/td>\n<td><b>DCE<\/b><\/td>\n<td>Measuring shortening of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93lattice_relaxation\" title=\"Spin\u2013lattice relaxation\" rel=\"external_link\" target=\"_blank\">spin\u2013lattice relaxation<\/a> (T1) induced by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium_contrast\" class=\"mw-redirect\" title=\"Gadolinium contrast\" rel=\"external_link\" target=\"_blank\">gadolinium contrast<\/a> bolus<sup id=\"rdp-ebb-cite_ref-DCE_58-0\" class=\"reference\"><a href=\"#cite_note-DCE-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_spin_labelling\" title=\"Arterial spin labelling\" rel=\"external_link\" target=\"_blank\">Arterial spin labelling<\/a><\/td>\n<td><b>ASL<\/b><\/td>\n<td>Magnetic labeling of arterial blood below the imaging slab, which subsequently enters the region of interest<sup id=\"rdp-ebb-cite_ref-UOM_59-0\" class=\"reference\"><a href=\"#cite_note-UOM-59\" rel=\"external_link\">[59]<\/a><\/sup> It does not need gadolinium contrast.<sup id=\"rdp-ebb-cite_ref-ASL_60-0\" class=\"reference\"><a href=\"#cite_note-ASL-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_magnetic_resonance_imaging\" title=\"Functional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Functional MRI<\/a> (<b>fMRI<\/b>)<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood-oxygen-level_dependent\" class=\"mw-redirect\" title=\"Blood-oxygen-level dependent\" rel=\"external_link\" target=\"_blank\">Blood-oxygen-level dependent<\/a> imaging<\/td>\n<td><b>BOLD<\/b><\/td>\n<td>Changes in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_saturation_(medicine)\" title=\"Oxygen saturation (medicine)\" rel=\"external_link\" target=\"_blank\">oxygen saturation<\/a>-dependent magnetism of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemoglobin\" title=\"Hemoglobin\" rel=\"external_link\" target=\"_blank\">hemoglobin<\/a> reflects tissue activity.<sup id=\"rdp-ebb-cite_ref-nature1990_61-0\" class=\"reference\"><a href=\"#cite_note-nature1990-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/td>\n<td>Localizing highly active brain areas before surgery<sup id=\"rdp-ebb-cite_ref-Fmri_62-0\" class=\"reference\"><a href=\"#cite_note-Fmri-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:1206_FMRI.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"1206 FMRI.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/1206_FMRI.jpg\/100px-1206_FMRI.jpg\" width=\"100\" height=\"120\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"2\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_angiography\" title=\"Magnetic resonance angiography\" rel=\"external_link\" target=\"_blank\">Magnetic resonance angiography<\/a> (<b>MRA<\/b>) and venography<\/td>\n<td>Time-of-flight<\/td>\n<td><b>TOF<\/b><\/td>\n<td>Blood entering the imaged area is not yet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saturation_(magnetic)\" title=\"Saturation (magnetic)\" rel=\"external_link\" target=\"_blank\">magnetically saturated<\/a>, giving it a much higher signal when using short echo time and flow compensation.\n<\/td>\n<td>Detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysm<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dissection_(medical)\" title=\"Dissection (medical)\" rel=\"external_link\" target=\"_blank\">dissection<\/a><sup id=\"rdp-ebb-cite_ref-hopkins_63-0\" class=\"reference\"><a href=\"#cite_note-hopkins-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mra-mip.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Mra-mip.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/Mra-mip.jpg\/100px-Mra-mip.jpg\" width=\"100\" height=\"117\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phase_contrast_magnetic_resonance_imaging\" title=\"Phase contrast magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Phase-contrast magnetic resonance imaging<\/a><\/td>\n<td><b>PC-MRA<\/b><\/td>\n<td>Two gradients with equal magnitude, but opposite direction, are used to encode a phase shift, which is proportional to the velocity of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_(physics)\" title=\"Spin (physics)\" rel=\"external_link\" target=\"_blank\">spins<\/a>.<sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup>\n<\/td>\n<td>Detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysm<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dissection_(medical)\" title=\"Dissection (medical)\" rel=\"external_link\" target=\"_blank\">dissection<\/a> (pictured)<sup id=\"rdp-ebb-cite_ref-hopkins_63-1\" class=\"reference\"><a href=\"#cite_note-hopkins-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vastly_undersampled_Isotropic_Projection_Reconstruction_(VIPR)_Phase_Contrast_(PC)_sequence_MRI_of_arterial_dissections.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Vastly undersampled Isotropic Projection Reconstruction (VIPR) Phase Contrast (PC) sequence MRI of arterial dissections.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/26\/Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg\/100px-Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg\" width=\"100\" height=\"95\" \/><\/a><br \/>(<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vastly_undersampled_Isotropic_Projection_Reconstruction\" class=\"mw-redirect\" title=\"Vastly undersampled Isotropic Projection Reconstruction\" rel=\"external_link\" target=\"_blank\">VIPR<\/a>)\n<\/td><\/tr>\n<tr>\n<td colspan=\"2\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Susceptibility_weighted_imaging\" title=\"Susceptibility weighted imaging\" rel=\"external_link\" target=\"_blank\">Susceptibility-weighted<\/a><\/td>\n<td><b>SWI<\/b><\/td>\n<td>Sensitive for blood and calcium, by a fully flow compensated, long echo, gradient recalled echo (GRE) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_sequence\" class=\"mw-redirect\" title=\"Pulse sequence\" rel=\"external_link\" target=\"_blank\">pulse sequence<\/a> to exploit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_susceptibility\" title=\"Magnetic susceptibility\" rel=\"external_link\" target=\"_blank\">magnetic susceptibility<\/a> differences between tissues\n<\/td>\n<td>Detecting small amounts of hemorrhage (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffuse_axonal_injury\" title=\"Diffuse axonal injury\" rel=\"external_link\" target=\"_blank\">diffuse axonal injury<\/a> pictured) or calcium<sup id=\"rdp-ebb-cite_ref-swi_65-0\" class=\"reference\"><a href=\"#cite_note-swi-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Susceptibility_weighted_imaging_(SWI)_in_diffuse_axonal_injury.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Susceptibility weighted imaging (SWI) in diffuse axonal injury.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Susceptibility_weighted_imaging_%28SWI%29_in_diffuse_axonal_injury.jpg\/100px-Susceptibility_weighted_imaging_%28SWI%29_in_diffuse_axonal_injury.jpg\" width=\"100\" height=\"116\" \/><\/a>\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Other_specialized_configurations\">Other specialized configurations<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Magnetic_resonance_spectroscopy\">Magnetic resonance spectroscopy<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main articles: <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo_magnetic_resonance_spectroscopy\" title=\"In vivo magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">In vivo magnetic resonance spectroscopy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance_spectroscopy\" title=\"Nuclear magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">Nuclear magnetic resonance spectroscopy<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo_magnetic_resonance_spectroscopy\" title=\"In vivo magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">Magnetic resonance spectroscopy<\/a> (MRS) is used to measure the levels of different <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolites\" class=\"mw-redirect\" title=\"Metabolites\" rel=\"external_link\" target=\"_blank\">metabolites<\/a> in body tissues. The MR signal produces a spectrum of resonances that corresponds to different molecular arrangements of the isotope being \"excited\". This signature is used to diagnose certain metabolic disorders, especially those affecting the brain,<sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup> and to provide information on tumor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolism\" title=\"Metabolism\" rel=\"external_link\" target=\"_blank\">metabolism<\/a>.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup>\n<\/p><p>Magnetic resonance spectroscopic imaging (MRSI) combines both spectroscopic and imaging methods to produce spatially localized spectra from within the sample or patient. The spatial resolution is much lower (limited by the available <a href=\"https:\/\/en.wikipedia.org\/wiki\/Signal-to-noise_ratio\" title=\"Signal-to-noise ratio\" rel=\"external_link\" target=\"_blank\">SNR<\/a>), but the spectra in each voxel contains information about many metabolites. Because the available signal is used to encode spatial and spectral information, MRSI requires high SNR achievable only at higher field strengths (3 T and above).<sup id=\"rdp-ebb-cite_ref-DW_Al._2018_68-0\" class=\"reference\"><a href=\"#cite_note-DW_Al._2018-68\" rel=\"external_link\">[68]<\/a><\/sup> The high procurement and maintenance costs of MRI with extremely high field strengths<sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup> inhibit their popularity. However, recent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressed_sensing\" title=\"Compressed sensing\" rel=\"external_link\" target=\"_blank\">compressed sensing<\/a>-based software algorithms (<i>e.g.<\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/SAMV_(algorithm)\" title=\"SAMV (algorithm)\" rel=\"external_link\" target=\"_blank\">SAMV<\/a><sup id=\"rdp-ebb-cite_ref-AbeidaZhang_70-0\" class=\"reference\"><a href=\"#cite_note-AbeidaZhang-70\" rel=\"external_link\">[70]<\/a><\/sup>) have been proposed to achieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Super-resolution_imaging\" title=\"Super-resolution imaging\" rel=\"external_link\" target=\"_blank\">super-resolution<\/a> without requiring such high field strengths.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Real-time_MRI\">Real-time MRI<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_2\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:384px"><video id="mwe_player_3" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/384px--Real-time_MRI_-_Thorax.ogv.jpg" controls="" preload="none" autoplay="" style="width:384px;height:384px" class="kskin" data-durationhint="15.75" data-startoffset="0" data-mwtitle="Real-time_MRI_-_Thorax.ogv" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/d\/dd\/Real-time_MRI_-_Thorax.ogv" type="video\/ogg; codecs=&quot;theora&quot;" data-title="Original Ogg file, 384 \u00d7 384 (819 kbps)" data-shorttitle="Ogg source" data-width="384" data-height="384" data-bandwidth="818502" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="120" data-height="120" data-bandwidth="63112" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="160" data-height="160" data-bandwidth="126952" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="180" data-height="180" data-bandwidth="102768" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="240" data-height="240" data-bandwidth="132512" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="240" data-height="240" data-bandwidth="253424" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.360p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="360" data-height="360" data-bandwidth="221152" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="360" data-height="360" data-bandwidth="503040" data-framerate="20"\/><\/video><\/div>\"><img alt=\"File:Real-time MRI - Thorax.ogv\" style=\"width:220px;height:220px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/220px--Real-time_MRI_-_Thorax.ogv.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/d\/dd\/Real-time_MRI_-_Thorax.ogv\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Real-time_MRI_-_Thorax.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Real-time MRI of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_heart\" class=\"mw-redirect\" title=\"Human heart\" rel=\"external_link\" target=\"_blank\">human heart<\/a> at a resolution of 50 ms<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Real-time_MRI\" title=\"Real-time MRI\" rel=\"external_link\" target=\"_blank\">Real-time MRI<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Real-time_MRI\" title=\"Real-time MRI\" rel=\"external_link\" target=\"_blank\">Real-time MRI<\/a> refers to the continuous imaging of moving objects (such as the heart) in real time. One of the many different strategies developed since the early 2000s is based on radial <a href=\"https:\/\/en.wikipedia.org\/wiki\/FLASH_MRI\" class=\"mw-redirect\" title=\"FLASH MRI\" rel=\"external_link\" target=\"_blank\">FLASH MRI<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iterative_reconstruction\" title=\"Iterative reconstruction\" rel=\"external_link\" target=\"_blank\">iterative reconstruction<\/a>. This gives a temporal resolution of 20\u201330 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Millisecond\" title=\"Millisecond\" rel=\"external_link\" target=\"_blank\">ms<\/a> for images with an in-plane resolution of 1.5\u20132.0 mm.<sup id=\"rdp-ebb-cite_ref-Uecker_71-0\" class=\"reference\"><a href=\"#cite_note-Uecker-71\" rel=\"external_link\">[71]<\/a><\/sup> Balanced has a better image contrast between the blood pool and myocardium than the <a href=\"https:\/\/en.wikipedia.org\/wiki\/FLASH_MRI\" class=\"mw-redirect\" title=\"FLASH MRI\" rel=\"external_link\" target=\"_blank\">FLASH MRI<\/a>, yet it will produce severe banding artifact when the B0 inhomogeneity is strong. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Real-time_MRI\" title=\"Real-time MRI\" rel=\"external_link\" target=\"_blank\">Real-time MRI<\/a> is likely to add important information on diseases of the heart and the joints, and in many cases may make MRI examinations easier and more comfortable for patients, especially for the patients who cannot hold their breathings or who have arrhythmia.<sup id=\"rdp-ebb-cite_ref-UyanikLindner2013_72-0\" class=\"reference\"><a href=\"#cite_note-UyanikLindner2013-72\" rel=\"external_link\">[72]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Interventional_MRI\">Interventional MRI<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_magnetic_resonance_imaging\" title=\"Interventional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Interventional magnetic resonance imaging<\/a><\/div>\n<p>The lack of harmful effects on the patient and the operator make MRI well-suited for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">interventional radiology<\/a>, where the images produced by an MRI scanner guide minimally invasive procedures. Such procedures use no <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferromagnetic\" class=\"mw-redirect\" title=\"Ferromagnetic\" rel=\"external_link\" target=\"_blank\">ferromagnetic<\/a> instruments.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>A specialized growing subset of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_magnetic_resonance_imaging\" title=\"Interventional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">interventional MRI<\/a> is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraoperative_MRI\" title=\"Intraoperative MRI\" rel=\"external_link\" target=\"_blank\">intraoperative MRI<\/a>, in which an MRI is used in surgery. Some specialized MRI systems allow imaging concurrent with the surgical procedure. More typically, the surgical procedure is temporarily interrupted so that MRI can assess the success of the procedure or guide subsequent surgical work.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Magnetic_resonance_guided_focused_ultrasound\">Magnetic resonance guided focused ultrasound<\/span><\/h4>\n<p>In guided therapy, <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-intensity_focused_ultrasound\" title=\"High-intensity focused ultrasound\" rel=\"external_link\" target=\"_blank\">high-intensity focused ultrasound<\/a> (HIFU) beams are focused on a tissue, that are controlled using MR thermal imaging. Due to the high energy at the focus, the temperature rises to above 65 <a href=\"https:\/\/en.wikipedia.org\/wiki\/%C2%B0C\" class=\"mw-redirect\" title=\"\u00b0C\" rel=\"external_link\" target=\"_blank\">\u00b0C<\/a> (150 \u00b0F) which completely destroys the tissue. This technology can achieve precise <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ablation\" title=\"Ablation\" rel=\"external_link\" target=\"_blank\">ablation<\/a> of diseased tissue. MR imaging provides a three-dimensional view of the target tissue, allowing for the precise focusing of ultrasound energy. The MR imaging provides quantitative, real-time, thermal images of the treated area. This allows the physician to ensure that the temperature generated during each cycle of ultrasound energy is sufficient to cause thermal ablation within the desired tissue and if not, to adapt the parameters to ensure effective treatment.<sup id=\"rdp-ebb-cite_ref-73\" class=\"reference\"><a href=\"#cite_note-73\" rel=\"external_link\">[73]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Multinuclear_imaging\">Multinuclear imaging<\/span><\/h4>\n<p>Hydrogen has the most frequently imaged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_nucleus\" title=\"Atomic nucleus\" rel=\"external_link\" target=\"_blank\">nucleus<\/a> in MRI because it is present in biological tissues in great abundance, and because its high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gyromagnetic_ratio\" title=\"Gyromagnetic ratio\" rel=\"external_link\" target=\"_blank\">gyromagnetic ratio<\/a> gives a strong signal. However, any nucleus with a net <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_(physics)\" title=\"Spin (physics)\" rel=\"external_link\" target=\"_blank\">nuclear spin<\/a> could potentially be imaged with MRI. Such nuclei include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Helium\" title=\"Helium\" rel=\"external_link\" target=\"_blank\">helium<\/a>-3, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium\" title=\"Lithium\" rel=\"external_link\" target=\"_blank\">lithium<\/a>-7, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a>-13, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorine\" title=\"Fluorine\" rel=\"external_link\" target=\"_blank\">fluorine<\/a>-19, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen-17\" title=\"Oxygen-17\" rel=\"external_link\" target=\"_blank\">oxygen-17<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium\" title=\"Sodium\" rel=\"external_link\" target=\"_blank\">sodium<\/a>-23, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus\" title=\"Phosphorus\" rel=\"external_link\" target=\"_blank\">phosphorus<\/a>-31 and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenon#Isotopes\" title=\"Xenon\" rel=\"external_link\" target=\"_blank\">xenon-129<\/a>. <sup>23<\/sup>Na and <sup>31<\/sup>P are naturally abundant in the body, so can be imaged directly. Gaseous isotopes such as <sup>3<\/sup>He or <sup>129<\/sup>Xe must be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperpolarization_(physics)\" title=\"Hyperpolarization (physics)\" rel=\"external_link\" target=\"_blank\">hyperpolarized<\/a> and then inhaled as their nuclear density is too low to yield a useful signal under normal conditions. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen-17\" title=\"Oxygen-17\" rel=\"external_link\" target=\"_blank\"><sup>17<\/sup>O<\/a> and <sup>19<\/sup>F can be administered in sufficient quantities in liquid form (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen-17\" title=\"Oxygen-17\" rel=\"external_link\" target=\"_blank\"><sup>17<\/sup>O<\/a>-water) that hyperpolarization is not a necessity.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> Using helium or xenon has the advantage of reduced background noise, and therefore increased contrast for the image itself, because these elements are not normally present in biological tissues.<sup id=\"rdp-ebb-cite_ref-74\" class=\"reference\"><a href=\"#cite_note-74\" rel=\"external_link\">[74]<\/a><\/sup>\n<\/p><p>Moreover, the nucleus of any atom that has a net nuclear spin and that is bonded to a hydrogen atom could potentially be imaged via heteronuclear magnetization transfer MRI that would image the high-gyromagnetic-ratio hydrogen nucleus instead of the low-gyromagnetic-ratio nucleus that is bonded to the hydrogen atom.<sup id=\"rdp-ebb-cite_ref-75\" class=\"reference\"><a href=\"#cite_note-75\" rel=\"external_link\">[75]<\/a><\/sup> In principle, hetereonuclear magnetization transfer MRI could be used to detect the presence or absence of specific chemical bonds.<sup id=\"rdp-ebb-cite_ref-76\" class=\"reference\"><a href=\"#cite_note-76\" rel=\"external_link\">[76]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-77\" class=\"reference\"><a href=\"#cite_note-77\" rel=\"external_link\">[77]<\/a><\/sup>\n<\/p><p>Multinuclear imaging is primarily a research technique at present. However, potential applications include functional imaging and imaging of organs poorly seen on <sup>1<\/sup>H MRI (e.g., lungs and bones) or as alternative contrast agents. Inhaled hyperpolarized <sup>3<\/sup>He can be used to image the distribution of air spaces within the lungs. Injectable solutions containing <sup>13<\/sup>C or stabilized bubbles of hyperpolarized <sup>129<\/sup>Xe have been studied as contrast agents for angiography and perfusion imaging. <sup>31<\/sup>P can potentially provide information on bone density and structure, as well as functional imaging of the brain. Multinuclear imaging holds the potential to chart the distribution of lithium in the human brain, this element finding use as an important drug for those with conditions such as bipolar disorder.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Molecular_imaging_by_MRI\">Molecular imaging by MRI<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_imaging\" title=\"Molecular imaging\" rel=\"external_link\" target=\"_blank\">Molecular imaging<\/a><\/div>\n<p>MRI has the advantages of having very high spatial resolution and is very adept at morphological imaging and functional imaging. MRI does have several disadvantages though. First, MRI has a sensitivity of around 10<sup>\u22123<\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Concentration#Molarity\" title=\"Concentration\" rel=\"external_link\" target=\"_blank\">mol\/L<\/a> to 10<sup>\u22125<\/sup> mol\/L, which, compared to other types of imaging, can be very limiting. This problem stems from the fact that the population difference between the nuclear spin states is very small at room temperature. For example, at 1.5 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">teslas<\/a>, a typical field strength for clinical MRI, the difference between high and low energy states is approximately 9 molecules per 2 million. Improvements to increase MR sensitivity include increasing magnetic field strength, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperpolarization_(physics)\" title=\"Hyperpolarization (physics)\" rel=\"external_link\" target=\"_blank\">hyperpolarization<\/a> via optical pumping or dynamic nuclear polarization. There are also a variety of signal amplification schemes based on chemical exchange that increase sensitivity.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>To achieve molecular imaging of disease biomarkers using MRI, targeted MRI contrast agents with high specificity and high relaxivity (sensitivity) are required. To date, many studies have been devoted to developing targeted-MRI contrast agents to achieve molecular imaging by MRI. Commonly, peptides, antibodies, or small ligands, and small protein domains, such as HER-2 affibodies, have been applied to achieve targeting. To enhance the sensitivity of the contrast agents, these targeting moieties are usually linked to high payload MRI contrast agents or MRI contrast agents with high relaxivities.<sup id=\"rdp-ebb-cite_ref-78\" class=\"reference\"><a href=\"#cite_note-78\" rel=\"external_link\">[78]<\/a><\/sup> A new class of gene targeting MR contrast agents (CA) has been introduced to show gene action of unique mRNA and gene transcription factor proteins.<sup id=\"rdp-ebb-cite_ref-pmid17234603_79-0\" class=\"reference\"><a href=\"#cite_note-pmid17234603-79\" rel=\"external_link\">[79]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid24115049_80-0\" class=\"reference\"><a href=\"#cite_note-pmid24115049-80\" rel=\"external_link\">[80]<\/a><\/sup> This new CA can trace cells with unique mRNA, microRNA and virus; tissue response to inflammation in living brains.<sup id=\"rdp-ebb-cite_ref-pmid19295156_81-0\" class=\"reference\"><a href=\"#cite_note-pmid19295156-81\" rel=\"external_link\">[81]<\/a><\/sup> The MR reports change in gene expression with positive correlation to TaqMan analysis, optical and electron microscopy.<sup id=\"rdp-ebb-cite_ref-pmid23150521_82-0\" class=\"reference\"><a href=\"#cite_note-pmid23150521-82\" rel=\"external_link\">[82]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Economics\">Economics<\/span><\/h2>\n<p>In the UK, the price of a clinical 1.5-tesla MRI scanner is around \u00a3920,000\/<span style=\"white-space: nowrap\">US$1.4 million<\/span>, with the lifetime maintenance cost broadly similar to the purchase cost.<sup id=\"rdp-ebb-cite_ref-83\" class=\"reference\"><a href=\"#cite_note-83\" rel=\"external_link\">[83]<\/a><\/sup> In the Netherlands, the average MRI scanner costs around \u20ac1 million,<sup id=\"rdp-ebb-cite_ref-84\" class=\"reference\"><a href=\"#cite_note-84\" rel=\"external_link\">[84]<\/a><\/sup> with a 7-T MRI having been taken in use by the UMC Utrecht in December 2007, costing \u20ac7 million.<sup id=\"rdp-ebb-cite_ref-85\" class=\"reference\"><a href=\"#cite_note-85\" rel=\"external_link\">[85]<\/a><\/sup> Construction of MRI suites could cost up to <span style=\"white-space: nowrap\">US$500,000<\/span>\/\u20ac370.000 or more, depending on project scope. Pre-polarizing MRI (PMRI) systems using resistive electromagnets have shown promise as a low-cost alternative and have specific advantages for joint imaging near metal implants, however they are likely unsuitable for routine whole-body or neuroimaging applications.<sup id=\"rdp-ebb-cite_ref-MorganConolly1996_86-0\" class=\"reference\"><a href=\"#cite_note-MorganConolly1996-86\" rel=\"external_link\">[86]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Blamire2008_87-0\" class=\"reference\"><a href=\"#cite_note-Blamire2008-87\" rel=\"external_link\">[87]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Modern_3T_MRI.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Modern_3T_MRI.JPG\/220px-Modern_3T_MRI.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Modern_3T_MRI.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A 3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">tesla<\/a> clinical MRI scanner.<\/div><\/div><\/div>\n<p>MRI scanners have become significant sources of revenue for healthcare providers in the US. This is because of favorable reimbursement rates from insurers and federal government programs. Insurance reimbursement is provided in two components, an equipment charge for the actual performance and operation of the MRI scan and a professional charge for the radiologist's review of the images and\/or data. In the US Northeast, an equipment charge might be $3,500\/\u20ac2,600 and a professional charge might be $350\/\u20ac260,<sup id=\"rdp-ebb-cite_ref-88\" class=\"reference\"><a href=\"#cite_note-88\" rel=\"external_link\">[88]<\/a><\/sup> although the actual fees received by the equipment owner and interpreting physician are often significantly less and depend on the rates negotiated with insurance companies or determined by the Medicare fee schedule. For example, an orthopedic surgery group in Illinois billed a charge of $1,116\/\u20ac825 for a knee MRI in 2007, but the Medicare reimbursement in 2007 was only $470.91\/\u20ac350.<sup id=\"rdp-ebb-cite_ref-89\" class=\"reference\"><a href=\"#cite_note-89\" rel=\"external_link\">[89]<\/a><\/sup> Many insurance companies require advance approval of an MRI procedure as a condition for coverage.\n<\/p><p>In the US, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deficit_Reduction_Act_of_2005\" title=\"Deficit Reduction Act of 2005\" rel=\"external_link\" target=\"_blank\">Deficit Reduction Act of 2005<\/a> significantly reduced reimbursement rates paid by federal insurance programs for the equipment component of many scans, shifting the economic landscape. Many private insurers have followed suit.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2008)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In the United States, an MRI of the brain with and without contrast billed to Medicare Part B entails, on average, a technical payment of <span style=\"white-space: nowrap\">US$403<\/span>\/\u20ac300 and a separate payment to the radiologist of <span style=\"white-space: nowrap\">US$93<\/span>\/\u20ac70.<sup id=\"rdp-ebb-cite_ref-90\" class=\"reference\"><a href=\"#cite_note-90\" rel=\"external_link\">[90]<\/a><\/sup> In France, the cost of an MRI exam is approximately \u20ac150\/<span style=\"white-space: nowrap\">US$205<\/span>. This covers three basic scans including one with an intravenous contrast agent as well as a consultation with the technician and a written report to the patient's physician.<sup id=\"rdp-ebb-cite_ref-91\" class=\"reference\"><a href=\"#cite_note-91\" rel=\"external_link\">[91]<\/a><\/sup> In Japan, the cost of an MRI examination (excluding the cost of contrast material and films) ranges from <span style=\"white-space: nowrap\">US$155<\/span>\/\u20ac115 to <span style=\"white-space: nowrap\">US$180<\/span>\/\u20ac133, with an additional radiologist professional fee of <span style=\"white-space: nowrap\">US$17<\/span>\/\u20ac12.50.<sup id=\"rdp-ebb-cite_ref-92\" class=\"reference\"><a href=\"#cite_note-92\" rel=\"external_link\">[92]<\/a><\/sup> In India, the cost of an MRI examination including the fee for the radiologist's opinion comes to around Rs 3000\u20134000 (\u20ac37\u201349\/<span style=\"white-space: nowrap\">US$50\u201360<\/span>), excluding the cost of contrast material. In the UK the retail price for an MRI scan privately ranges between \u00a3350 and \u00a3700 (\u20ac405\u2013810).<sup id=\"rdp-ebb-cite_ref-93\" class=\"reference\"><a href=\"#cite_note-93\" rel=\"external_link\">[93]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Clinical_MRI_installation_in_a_general_hospital\">Clinical MRI installation in a general hospital<\/span><\/h3>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507509040946.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Wx_camera_1507509040946.jpg\/120px-Wx_camera_1507509040946.jpg\" width=\"120\" height=\"68\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Control console\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507509050808.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Wx_camera_1507509050808.jpg\/67px-Wx_camera_1507509050808.jpg\" width=\"67\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Bore camera\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507512102648.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Wx_camera_1507512102648.jpg\/120px-Wx_camera_1507512102648.jpg\" width=\"120\" height=\"68\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Operator performing a scan\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507514479961.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1a\/Wx_camera_1507514479961.jpg\/67px-Wx_camera_1507514479961.jpg\" width=\"67\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Technical area\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Safety\">Safety<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Safety_of_magnetic_resonance_imaging\" title=\"Safety of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Safety of magnetic resonance imaging<\/a><\/div>\n<p>MRI is in general a safe technique, although injuries may occur as a result of failed safety procedures or human error.<sup id=\"rdp-ebb-cite_ref-94\" class=\"reference\"><a href=\"#cite_note-94\" rel=\"external_link\">[94]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contraindications\" class=\"mw-redirect\" title=\"Contraindications\" rel=\"external_link\" target=\"_blank\">Contraindications<\/a> to MRI include most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implants<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">cardiac pacemakers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fragmentation_(weaponry)\" title=\"Fragmentation (weaponry)\" rel=\"external_link\" target=\"_blank\">shrapnel<\/a>, and metallic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body\" title=\"Foreign body\" rel=\"external_link\" target=\"_blank\">foreign bodies<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbit_(anatomy)\" title=\"Orbit (anatomy)\" rel=\"external_link\" target=\"_blank\">eyes<\/a>. The safety of MRI during the first trimester of pregnancy is uncertain, but it may be preferable to other options.<sup id=\"rdp-ebb-cite_ref-WangChong2012_95-0\" class=\"reference\"><a href=\"#cite_note-WangChong2012-95\" rel=\"external_link\">[95]<\/a><\/sup> Since MRI does not use any ionizing radiation, its use is generally favored in preference to <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_computed_tomography\" class=\"mw-redirect\" title=\"X-ray computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> when either modality could yield the same information.<sup id=\"rdp-ebb-cite_ref-iRefer_96-0\" class=\"reference\"><a href=\"#cite_note-iRefer-96\" rel=\"external_link\">[96]<\/a><\/sup> In certain cases, MRI is not preferred as it may be more expensive, time-consuming, and claustrophobia-exacerbating.\n<\/p><p>MRI uses powerful magnets and can therefore cause <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferromagnetism\" title=\"Ferromagnetism\" rel=\"external_link\" target=\"_blank\">magnetic materials<\/a> to move at great speeds posing risk. Deaths have occurred.<sup id=\"rdp-ebb-cite_ref-97\" class=\"reference\"><a href=\"#cite_note-97\" rel=\"external_link\">[97]<\/a><\/sup> However, as millions of MRIs are performed globally each year.,<sup id=\"rdp-ebb-cite_ref-98\" class=\"reference\"><a href=\"#cite_note-98\" rel=\"external_link\">[98]<\/a><\/sup> fatalities are extremely rare.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Overuse\">Overuse<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Overdiagnosis\" title=\"Overdiagnosis\" rel=\"external_link\" target=\"_blank\">Overdiagnosis<\/a><\/div>\n<p>Medical societies issue guidelines for when physicians should use MRI on patients and recommend against overuse. MRI can detect health problems or confirm a diagnosis, but medical societies often recommend that MRI not be the first procedure for creating a plan to diagnose or manage a patient's complaint. A common case is to use MRI to seek a cause of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Low_back_pain\" title=\"Low back pain\" rel=\"external_link\" target=\"_blank\">low back pain<\/a>; the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_College_of_Physicians\" title=\"American College of Physicians\" rel=\"external_link\" target=\"_blank\">American College of Physicians<\/a>, for example, recommends against this procedure as unlikely to result in a positive outcome for the patient.<sup id=\"rdp-ebb-cite_ref-ACPfive_99-0\" class=\"reference\"><a href=\"#cite_note-ACPfive-99\" rel=\"external_link\">[99]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-backimage_100-0\" class=\"reference\"><a href=\"#cite_note-backimage-100\" rel=\"external_link\">[100]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Artifacts\">Artifacts<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MRI_with_motion_artifacts.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/MRI_with_motion_artifacts.jpg\/220px-MRI_with_motion_artifacts.jpg\" width=\"220\" height=\"194\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MRI_with_motion_artifacts.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Motion artifact (T1 coronal study of cervical vertebrae).<sup id=\"rdp-ebb-cite_ref-ErasmusHurter2004_101-0\" class=\"reference\"><a href=\"#cite_note-ErasmusHurter2004-101\" rel=\"external_link\">[101]<\/a><\/sup><\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_artifact\" title=\"MRI artifact\" rel=\"external_link\" target=\"_blank\">MRI artifact<\/a><\/div>\n<p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_artifact\" title=\"MRI artifact\" rel=\"external_link\" target=\"_blank\">MRI artifact<\/a> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_artifact\" title=\"Visual artifact\" rel=\"external_link\" target=\"_blank\">visual artifact<\/a>, that is, an anomaly during visual representation. Many different artifacts can occur\nduring magnetic resonance imaging (MRI), some affecting the diagnostic quality, while others may be confused with pathology. Artifacts can be classified as patient-related, signal processing-dependent and hardware (machine)-related.<sup id=\"rdp-ebb-cite_ref-ErasmusHurter2004_101-1\" class=\"reference\"><a href=\"#cite_note-ErasmusHurter2004-101\" rel=\"external_link\">[101]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Non-medical_use\">Non-medical use<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance#Applications\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">Nuclear magnetic resonance \u00a7 Applications<\/a><\/div>\n<p>MRI is used industrially mainly for routine analysis of chemicals. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">nuclear magnetic resonance<\/a> technique is also used, for example, to measure the ratio between water and fat in foods, monitoring of flow of corrosive fluids in pipes, or to study molecular structures such as catalysts.<sup id=\"rdp-ebb-cite_ref-non-medical_102-0\" class=\"reference\"><a href=\"#cite_note-non-medical-102\" rel=\"external_link\">[102]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_magnetic_resonance_imaging\" title=\"History of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">History of magnetic resonance imaging<\/a><\/div>\n<p>In 1971, Paul Lauterbur applied magnetic field gradients in all three dimensions and a back-projection technique to create NMR images. He published the first images of two tubes of water in 1973 in the journal <i>Nature<\/i>, followed by the picture of a living animal, a clam, and in 1974 by the image of the thoracic cavity of a mouse. Lauterbur called his imaging method zeugmatography, a term which was later replaced by (N)MR imaging.<sup id=\"rdp-ebb-cite_ref-103\" class=\"reference\"><a href=\"#cite_note-103\" rel=\"external_link\">[103]<\/a><\/sup> In the late 1970s, physicists <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peter_Mansfield\" title=\"Peter Mansfield\" rel=\"external_link\" target=\"_blank\">Peter Mansfield<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_Lauterbur\" title=\"Paul Lauterbur\" rel=\"external_link\" target=\"_blank\">Paul Lauterbur<\/a>, developed MRI-related techniques, like the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo-planar_imaging\" class=\"mw-redirect\" title=\"Echo-planar imaging\" rel=\"external_link\" target=\"_blank\">echo-planar imaging<\/a> (EPI) technique.<sup id=\"rdp-ebb-cite_ref-Mansfield-EPI_104-0\" class=\"reference\"><a href=\"#cite_note-Mansfield-EPI-104\" rel=\"external_link\">[104]<\/a><\/sup> Mansfield and Lauterbur were awarded the 2003 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nobel_Prize_in_Physiology_or_Medicine\" title=\"Nobel Prize in Physiology or Medicine\" rel=\"external_link\" target=\"_blank\">Nobel Prize in Physiology or Medicine<\/a> for their \"discoveries concerning magnetic resonance imaging\".\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/12px-WHO_Rod.svg.png\" width=\"12\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine\" title=\"Portal:Medicine\" rel=\"external_link\" target=\"_blank\">Medicine portal<\/a><\/span><\/li><\/ul><\/div>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 22em; -webkit-column-width: 22em; column-width: 22em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Earth%27s_field_NMR\" title=\"Earth's field NMR\" rel=\"external_link\" target=\"_blank\">Earth's field NMR<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron_paramagnetic_resonance\" title=\"Electron paramagnetic resonance\" rel=\"external_link\" target=\"_blank\">Electron paramagnetic resonance<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/High-definition_fiber_tracking\" title=\"High-definition fiber tracking\" rel=\"external_link\" target=\"_blank\">High-definition fiber tracking<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_neuroimaging\" title=\"History of neuroimaging\" rel=\"external_link\" target=\"_blank\">History of neuroimaging<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Society_of_Magnetic_Resonance_in_Medicine\" title=\"International Society of Magnetic Resonance in Medicine\" rel=\"external_link\" target=\"_blank\">International Society of Magnetic Resonance in Medicine<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jemris\" title=\"Jemris\" rel=\"external_link\" target=\"_blank\">Jemris<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_neuroimaging_software\" title=\"List of neuroimaging software\" rel=\"external_link\" target=\"_blank\">List of neuroimaging software<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_immunoassay\" title=\"Magnetic immunoassay\" rel=\"external_link\" target=\"_blank\">Magnetic immunoassay<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_particle_imaging\" title=\"Magnetic particle imaging\" rel=\"external_link\" target=\"_blank\">Magnetic particle imaging<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_elastography\" title=\"Magnetic resonance elastography\" rel=\"external_link\" target=\"_blank\">Magnetic resonance elastography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_Resonance_Imaging_(journal)\" title=\"Magnetic Resonance Imaging (journal)\" rel=\"external_link\" target=\"_blank\"><i>Magnetic Resonance Imaging<\/i> (journal)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_microscopy\" title=\"Magnetic resonance microscopy\" rel=\"external_link\" target=\"_blank\">Magnetic resonance microscopy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nobel_Prize_controversies\" title=\"Nobel Prize controversies\" rel=\"external_link\" target=\"_blank\">Nobel Prize controversies<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Rabi_cycle\" title=\"Rabi cycle\" rel=\"external_link\" target=\"_blank\">Rabi cycle<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robinson_oscillator\" title=\"Robinson oscillator\" rel=\"external_link\" target=\"_blank\">Robinson oscillator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_MRI\" title=\"Sodium MRI\" rel=\"external_link\" target=\"_blank\">Sodium MRI<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtopsy\" title=\"Virtopsy\" rel=\"external_link\" target=\"_blank\">Virtopsy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/High-resolution_computed_tomography\" title=\"High-resolution computed tomography\" rel=\"external_link\" target=\"_blank\">High-resolution computed tomography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Super-resolution_imaging\" title=\"Super-resolution imaging\" rel=\"external_link\" target=\"_blank\">Super-resolution imaging<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressed_sensing\" title=\"Compressed sensing\" rel=\"external_link\" target=\"_blank\">Compressed sensing<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">McRobbie DW, Moore EA, Graves MJ, Prince MR (2007). <i>MRI from Picture to Proton<\/i>. Cambridge University Press. p. 1. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-139-45719-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=MRI+from+Picture+to+Proton&rft.pages=1&rft.pub=Cambridge+University+Press&rft.date=2007&rft.isbn=978-1-139-45719-4&rft.aulast=McRobbie&rft.aufirst=Donald+W.&rft.au=Moore%2C+Elizabeth+A.&rft.au=Graves%2C+Martin+J.&rft.au=Prince%2C+Martin+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Smith-Bindman2012-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Smith-Bindman2012_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, et al. (June 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3859870\" target=\"_blank\">\"Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010\"<\/a>. <i>Jama<\/i>. <b>307<\/b> (22): 2400\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.2012.5960\" target=\"_blank\">10.1001\/jama.2012.5960<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3859870\" target=\"_blank\">3859870<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22692172\" target=\"_blank\">22692172<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Jama&rft.atitle=Use+of+diagnostic+imaging+studies+and+associated+radiation+exposure+for+patients+enrolled+in+large+integrated+health+care+systems%2C+1996-2010&rft.volume=307&rft.issue=22&rft.pages=2400-9&rft.date=2012-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3859870&rft_id=info%3Apmid%2F22692172&rft_id=info%3Adoi%2F10.1001%2Fjama.2012.5960&rft.aulast=Smith-Bindman&rft.aufirst=R&rft.au=Miglioretti%2C+DL&rft.au=Johnson%2C+E&rft.au=Lee%2C+C&rft.au=Feigelson%2C+HS&rft.au=Flynn%2C+M&rft.au=Greenlee%2C+RT&rft.au=Kruger%2C+RL&rft.au=Hornbrook%2C+MC&rft.au=Roblin%2C+D&rft.au=Solberg%2C+LI&rft.au=Vanneman%2C+N&rft.au=Weinmann%2C+S&rft.au=Williams%2C+AE&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3859870&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i>Health at a glance 2009 OECD indicators<\/i>. Health at a Glance. 2009. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1787%2Fhealth_glance-2009-en\" target=\"_blank\">10.1787\/health_glance-2009-en<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-92-64-07555-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Health+at+a+glance+2009+OECD+indicators&rft.series=Health+at+a+Glance&rft.date=2009&rft_id=info%3Adoi%2F10.1787%2Fhealth_glance-2009-en&rft.isbn=978-92-64-07555-9&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-McRobbie-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-McRobbie_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-McRobbie_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">McRobbie DW (2007). <i>MRI from picture to proton<\/i>. Cambridge, UK; New York: Cambridge University Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-521-68384-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=MRI+from+picture+to+proton&rft.place=Cambridge%2C+UK%3B+New+York&rft.pub=Cambridge+University+Press&rft.date=2007&rft.isbn=978-0-521-68384-5&rft.aulast=McRobbie&rft.aufirst=Donald+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sasaki M, Ehara S, Nakasato T, Tamakawa Y, Kuboya Y, Sugisawa M, Sato T (April 1990). \"MR of the shoulder with a 0.2-T permanent-magnet unit\". <i>AJR. American Journal of Roentgenology<\/i>. <b>154<\/b> (4): 777\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2Fajr.154.4.2107675\" target=\"_blank\">10.2214\/ajr.154.4.2107675<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2107675\" target=\"_blank\">2107675<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=MR+of+the+shoulder+with+a+0.2-T+permanent-magnet+unit&rft.volume=154&rft.issue=4&rft.pages=777-8&rft.date=1990-04&rft_id=info%3Adoi%2F10.2214%2Fajr.154.4.2107675&rft_id=info%3Apmid%2F2107675&rft.aulast=Sasaki&rft.aufirst=M&rft.au=Ehara%2C+S&rft.au=Nakasato%2C+T&rft.au=Tamakawa%2C+Y&rft.au=Kuboya%2C+Y&rft.au=Sugisawa%2C+M&rft.au=Sato%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">McDermott R, Lee S, ten Haken B, Trabesinger AH, Pines A, Clarke J (May 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC419521\" target=\"_blank\">\"Microtesla MRI with a superconducting quantum interference device\"<\/a>. <i>Proceedings of the National Academy of Sciences of the United States of America<\/i>. <b>101<\/b> (21): 7857\u201361. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.0402382101\" target=\"_blank\">10.1073\/pnas.0402382101<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC419521\" target=\"_blank\">419521<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15141077\" target=\"_blank\">15141077<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America&rft.atitle=Microtesla+MRI+with+a+superconducting+quantum+interference+device&rft.volume=101&rft.issue=21&rft.pages=7857-61&rft.date=2004-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC419521&rft_id=info%3Apmid%2F15141077&rft_id=info%3Adoi%2F10.1073%2Fpnas.0402382101&rft.aulast=McDermott&rft.aufirst=R&rft.au=Lee%2C+S&rft.au=ten+Haken%2C+B&rft.au=Trabesinger%2C+AH&rft.au=Pines%2C+A&rft.au=Clarke%2C+J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC419521&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zotev VS, Matlashov AN, Volegov PL, Urbaitis AV, Espy MA, Kraus Jr RH (2007). \"SQUID-based instrumentation for ultralow-field MRI\". <i>Superconductor Science and Technology<\/i>. <b>20<\/b> (11): S367\u2013S373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/0705.0661\" target=\"_blank\">0705.0661<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F0953-2048%2F20%2F11%2FS13\" target=\"_blank\">10.1088\/0953-2048\/20\/11\/S13<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Superconductor+Science+and+Technology&rft.atitle=SQUID-based+instrumentation+for+ultralow-field+MRI&rft.volume=20&rft.issue=11&rft.pages=S367-S373&rft.date=2007&rft_id=info%3Aarxiv%2F0705.0661&rft_id=info%3Adoi%2F10.1088%2F0953-2048%2F20%2F11%2FS13&rft.aulast=Zotev&rft.aufirst=Vadim+S&rft.au=Matlashov%2C+Andrei+N&rft.au=Volegov%2C+Petr+L&rft.au=Urbaitis%2C+Algis+V&rft.au=Espy%2C+Michelle+A&rft.au=Kraus+Jr%2C+Robert+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vesanen PT, Nieminen JO, Zevenhoven KC, Dabek J, Parkkonen LT, Zhdanov AV, Luomahaara J, Hassel J, Penttil\u00e4 J, Simola J, Ahonen AI, M\u00e4kel\u00e4 JP, Ilmoniemi RJ (June 2013). \"Hybrid ultra-low-field MRI and magnetoencephalography system based on a commercial whole-head neuromagnetometer\". <i>Magnetic Resonance in Medicine<\/i>. <b>69<\/b> (6): 1795\u2013804. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmrm.24413\" target=\"_blank\">10.1002\/mrm.24413<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22807201\" target=\"_blank\">22807201<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Magnetic+Resonance+in+Medicine&rft.atitle=Hybrid+ultra-low-field+MRI+and+magnetoencephalography+system+based+on+a+commercial+whole-head+neuromagnetometer&rft.volume=69&rft.issue=6&rft.pages=1795-804&rft.date=2013-06&rft_id=info%3Adoi%2F10.1002%2Fmrm.24413&rft_id=info%3Apmid%2F22807201&rft.aulast=Vesanen&rft.aufirst=PT&rft.au=Nieminen%2C+JO&rft.au=Zevenhoven%2C+KC&rft.au=Dabek%2C+J&rft.au=Parkkonen%2C+LT&rft.au=Zhdanov%2C+AV&rft.au=Luomahaara%2C+J&rft.au=Hassel%2C+J&rft.au=Penttil%C3%A4%2C+J&rft.au=Simola%2C+J&rft.au=Ahonen%2C+AI&rft.au=M%C3%A4kel%C3%A4%2C+JP&rft.au=Ilmoniemi%2C+RJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-wisconsin-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-wisconsin_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170510065614\/https:\/\/www.radiology.wisc.edu\/education\/med_students\/neuroradiology\/NeuroRad\/Intro\/MRIintro.htm\" target=\"_blank\">\"Magnetic Resonance Imaging\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Wisconsin\" class=\"mw-redirect\" title=\"University of Wisconsin\" rel=\"external_link\" target=\"_blank\">University of Wisconsin<\/a>. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Applied+Neurophysiology&rft.atitle=Brown-Roberts-Wells+stereotactic+frame+modifications+to+accomplish+magnetic+resonance+imaging+guidance+in+three+planes&rft.volume=50&rft.issue=1%E2%80%936&rft.pages=143-52&rft.date=1987&rft_id=info%3Adoi%2F10.1159%2F000100700&rft_id=info%3Apmid%2F3329837&rft.aulast=Heilbrun&rft.aufirst=MP&rft.au=Sunderland%2C+PM&rft.au=McDonald%2C+PR&rft.au=Wells%2C+TH&rft.au=Cosman%2C+E&rft.au=Ganz%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"ACCF\/ACR\/SCCT\/SCMR\/ASNC\/NASCI\/SCAI\/SIR 2006 appropriateness criteria 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A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group\". <i>Journal of the American College of Radiology<\/i>. <b>3<\/b> (10): 751\u201371. October 2006. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jacr.2006.08.008\" target=\"_blank\">10.1016\/j.jacr.2006.08.008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17412166\" target=\"_blank\">17412166<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+College+of+Radiology&rft.atitle=ACCF%2FACR%2FSCCT%2FSCMR%2FASNC%2FNASCI%2FSCAI%2FSIR+2006+appropriateness+criteria+for+cardiac+computed+tomography+and+cardiac+magnetic+resonance+imaging.+A+report+of+the+American+College+of+Cardiology+Foundation+Quality+Strategic+Directions+Committee+Appropriateness+Criteria+Working+Group&rft.volume=3&rft.issue=10&rft.pages=751-71&rft.date=2006-10&rft_id=info%3Adoi%2F10.1016%2Fj.jacr.2006.08.008&rft_id=info%3Apmid%2F17412166&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Helms C (2008). <i>Musculoskeletal MRI<\/i>. Saunders. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4160-5534-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Musculoskeletal+MRI&rft.pub=Saunders&rft.date=2008&rft.isbn=978-1-4160-5534-1&rft.aulast=Helms&rft.aufirst=C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FrydrychowiczLubner2012-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FrydrychowiczLubner2012_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Frydrychowicz A, Lubner MG, Brown JJ, Merkle EM, Nagle SK, Rofsky NM, Reeder SB (March 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3281562\" target=\"_blank\">\"Hepatobiliary MR imaging with gadolinium-based contrast agents\"<\/a>. <i>Journal of Magnetic Resonance Imaging<\/i>. <b>35<\/b> (3): 492\u2013511. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjmri.22833\" target=\"_blank\">10.1002\/jmri.22833<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3281562\" target=\"_blank\">3281562<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22334493\" target=\"_blank\">22334493<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Magnetic+Resonance+Imaging&rft.atitle=Hepatobiliary+MR+imaging+with+gadolinium-based+contrast+agents&rft.volume=35&rft.issue=3&rft.pages=492-511&rft.date=2012-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3281562&rft_id=info%3Apmid%2F22334493&rft_id=info%3Adoi%2F10.1002%2Fjmri.22833&rft.aulast=Frydrychowicz&rft.aufirst=A&rft.au=Lubner%2C+MG&rft.au=Brown%2C+JJ&rft.au=Merkle%2C+EM&rft.au=Nagle%2C+SK&rft.au=Rofsky%2C+NM&rft.au=Reeder%2C+SB&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3281562&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SandrasegaranLin2010-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SandrasegaranLin2010_25-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sandrasegaran K, Lin C, Akisik FM, Tann M (July 2010). \"State-of-the-art pancreatic MRI\". <i>AJR. American Journal of Roentgenology<\/i>. <b>195<\/b> (1): 42\u201353. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2Fajr.195.3_supplement.0s42\" target=\"_blank\">10.2214\/ajr.195.3_supplement.0s42<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20566796\" target=\"_blank\">20566796<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=State-of-the-art+pancreatic+MRI&rft.volume=195&rft.issue=1&rft.pages=42-53&rft.date=2010-07&rft_id=info%3Adoi%2F10.2214%2Fajr.195.3_supplement.0s42&rft_id=info%3Apmid%2F20566796&rft.aulast=Sandrasegaran&rft.aufirst=K&rft.au=Lin%2C+C&rft.au=Akisik%2C+FM&rft.au=Tann%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MasselliGualdi2012-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MasselliGualdi2012_26-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Masselli G, Gualdi G (August 2012). \"MR imaging of the small bowel\". <i>Radiology<\/i>. <b>264<\/b> (2): 333\u201348. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1148%2Fradiol.12111658\" target=\"_blank\">10.1148\/radiol.12111658<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22821694\" target=\"_blank\">22821694<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Radiology&rft.atitle=MR+imaging+of+the+small+bowel&rft.volume=264&rft.issue=2&rft.pages=333-48&rft.date=2012-08&rft_id=info%3Adoi%2F10.1148%2Fradiol.12111658&rft_id=info%3Apmid%2F22821694&rft.aulast=Masselli&rft.aufirst=G&rft.au=Gualdi%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ZijtaBipat2009-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ZijtaBipat2009_27-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zijta FM, Bipat S, Stoker J (May 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2850516\" target=\"_blank\">\"Magnetic resonance (MR) colonography in the detection of colorectal lesions: a systematic review of prospective studies\"<\/a>. <i>European Radiology<\/i>. <b>20<\/b> (5): 1031\u201346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00330-009-1663-4\" target=\"_blank\">10.1007\/s00330-009-1663-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2850516\" target=\"_blank\">2850516<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19936754\" target=\"_blank\">19936754<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Radiology&rft.atitle=Magnetic+resonance+%28MR%29+colonography+in+the+detection+of+colorectal+lesions%3A+a+systematic+review+of+prospective+studies&rft.volume=20&rft.issue=5&rft.pages=1031-46&rft.date=2010-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2850516&rft_id=info%3Apmid%2F19936754&rft_id=info%3Adoi%2F10.1007%2Fs00330-009-1663-4&rft.aulast=Zijta&rft.aufirst=FM&rft.au=Bipat%2C+S&rft.au=Stoker%2C+J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2850516&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-haacke-28\"><span class=\"mw-cite-backlink\"><b><a 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href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23335551\" target=\"_blank\">23335551<\/a>.<\/cite><span 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rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, Kim YR, Ren JQ, Eichler F, Rosen BR, Liu PK (January 2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2647966\" target=\"_blank\">\"Imaging cerebral gene transcripts in live animals\"<\/a>. <i>The Journal of Neuroscience<\/i>. <b>27<\/b> (3): 713\u201322. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2FJNEUROSCI.4660-06.2007\" target=\"_blank\">10.1523\/JNEUROSCI.4660-06.2007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2647966\" target=\"_blank\">2647966<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17234603\" target=\"_blank\">17234603<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Neuroscience&rft.atitle=Imaging+cerebral+gene+transcripts+in+live+animals&rft.volume=27&rft.issue=3&rft.pages=713-22&rft.date=2007-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2647966&rft_id=info%3Apmid%2F17234603&rft_id=info%3Adoi%2F10.1523%2FJNEUROSCI.4660-06.2007&rft.aulast=Liu&rft.aufirst=CH&rft.au=Kim%2C+YR&rft.au=Ren%2C+JQ&rft.au=Eichler%2C+F&rft.au=Rosen%2C+BR&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2647966&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid24115049-80\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid24115049_80-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, Ren J, Liu CM, Liu PK (January 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3868842\" target=\"_blank\">\"Intracellular gene transcription factor protein-guided MRI by DNA aptamers in vivo\"<\/a>. <i>FASEB Journal<\/i>. <b>28<\/b> (1): 464\u201373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1096%2Ffj.13-234229\" target=\"_blank\">10.1096\/fj.13-234229<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3868842\" target=\"_blank\">3868842<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24115049\" target=\"_blank\">24115049<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=FASEB+Journal&rft.atitle=Intracellular+gene+transcription+factor+protein-guided+MRI+by+DNA+aptamers+in+vivo&rft.volume=28&rft.issue=1&rft.pages=464-73&rft.date=2014-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3868842&rft_id=info%3Apmid%2F24115049&rft_id=info%3Adoi%2F10.1096%2Ffj.13-234229&rft.aulast=Liu&rft.aufirst=CH&rft.au=Ren%2C+J&rft.au=Liu%2C+CM&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3868842&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid19295156-81\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid19295156_81-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, You Z, Liu CM, Kim YR, Whalen MJ, Rosen BR, Liu PK (March 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2726707\" target=\"_blank\">\"Diffusion-weighted magnetic resonance imaging reversal by gene knockdown of matrix metalloproteinase-9 activities in live animal brains\"<\/a>. <i>The Journal of Neuroscience<\/i>. <b>29<\/b> (11): 3508\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2FJNEUROSCI.5332-08.2009\" target=\"_blank\">10.1523\/JNEUROSCI.5332-08.2009<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2726707\" target=\"_blank\">2726707<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19295156\" target=\"_blank\">19295156<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Neuroscience&rft.atitle=Diffusion-weighted+magnetic+resonance+imaging+reversal+by+gene+knockdown+of+matrix+metalloproteinase-9+activities+in+live+animal+brains&rft.volume=29&rft.issue=11&rft.pages=3508-17&rft.date=2009-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2726707&rft_id=info%3Apmid%2F19295156&rft_id=info%3Adoi%2F10.1523%2FJNEUROSCI.5332-08.2009&rft.aulast=Liu&rft.aufirst=CH&rft.au=You%2C+Z&rft.au=Liu%2C+CM&rft.au=Kim%2C+YR&rft.au=Whalen%2C+MJ&rft.au=Rosen%2C+BR&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2726707&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid23150521-82\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid23150521_82-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, Yang J, Ren JQ, Liu CM, You Z, Liu PK (February 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3545538\" target=\"_blank\">\"MRI reveals differential effects of amphetamine exposure on neuroglia in vivo\"<\/a>. <i>FASEB Journal<\/i>. <b>27<\/b> (2): 712\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1096%2Ffj.12-220061\" target=\"_blank\">10.1096\/fj.12-220061<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3545538\" target=\"_blank\">3545538<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23150521\" target=\"_blank\">23150521<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=FASEB+Journal&rft.atitle=MRI+reveals+differential+effects+of+amphetamine+exposure+on+neuroglia+in+vivo&rft.volume=27&rft.issue=2&rft.pages=712-24&rft.date=2013-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3545538&rft_id=info%3Apmid%2F23150521&rft_id=info%3Adoi%2F10.1096%2Ffj.12-220061&rft.aulast=Liu&rft.aufirst=CH&rft.au=Yang%2C+J&rft.au=Ren%2C+JQ&rft.au=Liu%2C+CM&rft.au=You%2C+Z&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3545538&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-83\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-83\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131203002732\/http:\/\/www.official-documents.gov.uk\/document\/hc1011\/hc08\/0822\/0822.pdf\" target=\"_blank\">\"Managing high value capital equipment in the NHS in England\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Audit_Office_(United_Kingdom)\" title=\"National Audit Office (United Kingdom)\" rel=\"external_link\" target=\"_blank\">National Audit Office (United Kingdom)<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.official-documents.gov.uk\/document\/hc1011\/hc08\/0822\/0822.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 3 December 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 November<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Managing+high+value+capital+equipment+in+the+NHS+in+England&rft.pub=National+Audit+Office+%28United+Kingdom%29&rft_id=http%3A%2F%2Fwww.official-documents.gov.uk%2Fdocument%2Fhc1011%2Fhc08%2F0822%2F0822.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-84\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-84\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ed.nl\/economie\/philips\/mri-scanner-kassucces-voor-philips-1.2172462\" target=\"_blank\">\"MRI-scanner big financial success for Philips (Dutch)\"<\/a>. Eindhovens Dagblad (ED)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=MRI-scanner+big+financial+success+for+Philips+%28Dutch%29&rft.pub=Eindhovens+Dagblad+%28ED%29&rft_id=http%3A%2F%2Fwww.ed.nl%2Feconomie%2Fphilips%2Fmri-scanner-kassucces-voor-philips-1.2172462&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-85\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-85\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150904002346\/http:\/\/medischcontact.artsennet.nl\/actueel\/nieuws\/nieuwsartikel\/21265\/mriscanner-van-7-miljoen-in-gebruik.htm\" target=\"_blank\">\"MRI scanner of \u20ac7 million in use(Dutch)\"<\/a>. Medisch Contact. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medischcontact.artsennet.nl\/actueel\/nieuws\/nieuwsartikel\/21265\/mriscanner-van-7-miljoen-in-gebruik.htm\" target=\"_blank\">the original<\/a> on 4 September 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 December<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=MRI+scanner+of+%E2%82%AC7+million+in+use%28Dutch%29&rft.pub=Medisch+Contact&rft_id=http%3A%2F%2Fmedischcontact.artsennet.nl%2Factueel%2Fnieuws%2Fnieuwsartikel%2F21265%2Fmriscanner-van-7-miljoen-in-gebruik.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MorganConolly1996-86\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MorganConolly1996_86-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Morgan P, Conolly S, Scott G, Macovski A (October 1996). \"A readout magnet for prepolarized MRI\". <i>Magnetic Resonance in Medicine<\/i>. <b>36<\/b> (4): 527\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmrm.1910360405\" target=\"_blank\">10.1002\/mrm.1910360405<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8892203\" target=\"_blank\">8892203<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Magnetic+Resonance+in+Medicine&rft.atitle=A+readout+magnet+for+prepolarized+MRI&rft.volume=36&rft.issue=4&rft.pages=527-36&rft.date=1996-10&rft_id=info%3Adoi%2F10.1002%2Fmrm.1910360405&rft_id=info%3Apmid%2F8892203&rft.aulast=Morgan&rft.aufirst=P&rft.au=Conolly%2C+S&rft.au=Scott%2C+G&rft.au=Macovski%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Blamire2008-87\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Blamire2008_87-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blamire AM (August 2008). \"The technology of MRI--the next 10 years?\". <i>The British Journal of Radiology<\/i>. <b>81<\/b> (968): 601\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1259%2Fbjr%2F96872829\" target=\"_blank\">10.1259\/bjr\/96872829<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18628329\" target=\"_blank\">18628329<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+British+Journal+of+Radiology&rft.atitle=The+technology+of+MRI--the+next+10+years%3F&rft.volume=81&rft.issue=968&rft.pages=601-17&rft.date=2008-08&rft_id=info%3Adoi%2F10.1259%2Fbjr%2F96872829&rft_id=info%3Apmid%2F18628329&rft.aulast=Blamire&rft.aufirst=AM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-88\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-88\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Stamford Hospital price quotation October 2008, Stamford CT US<\/span>\n<\/li>\n<li id=\"cite_note-89\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-89\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation conference\">Goldstein WM, Gordon AC, Branson JJ, Simmons C, Berland K, Willsey DS, Andrews AL (March 5\u20139, 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150904002346\/http:\/\/www.ibji.com\/images\/lyftenbloggie\/poster_goldstein_2008aaos.pdf\" target=\"_blank\"><i>Over-Utilization of MRI in the Osteoarthritis Patient<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. Annual Meeting AAOS. San Francisco. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ibji.com\/images\/lyftenbloggie\/poster_goldstein_2008aaos.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2015-09-04<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-07-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=conference&rft.btitle=Over-Utilization+of+MRI+in+the+Osteoarthritis+Patient&rft.place=San+Francisco&rft.date=2008-03-05%2F2008-03-09&rft.aulast=Goldstein&rft.aufirst=Wayne+M.&rft.au=Gordon%2C+Alexander+C.&rft.au=Branson%2C+Jill+Jasperson&rft.au=Simmons%2C+Christopher&rft.au=Berland%2C+Kimberly&rft.au=Willsey%2C+Daniel+S.&rft.au=Andrews%2C+Amanda+L.&rft_id=http%3A%2F%2Fwww.ibji.com%2Fimages%2Flyftenbloggie%2Fposter_goldstein_2008aaos.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-90\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-90\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Current_Procedural_Terminology\" title=\"Current Procedural Terminology\" rel=\"external_link\" target=\"_blank\">Current Procedural Terminology<\/a> code #70553 <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/explore.data.gov\/Health-and-Nutrition\/Part-B-National-Summary-Data-File-CY2010\/5vgw-8z3q\" target=\"_blank\">\"2010 Medicare Part B National Summary Data File\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120214030717\/http:\/\/explore.data.gov\/Health-and-Nutrition\/Part-B-National-Summary-Data-File-CY2010\/5vgw-8z3q\" target=\"_blank\">Archived<\/a> 2012-02-14 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Data.gov, An Official Website of the United States Government.<\/span>\n<\/li>\n<li id=\"cite_note-91\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-91\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webmd.com\/multiple-sclerosis\/qa\/how-long-does-an-mri-take\" target=\"_blank\">\"How long does an MRI take?\"<\/a>. <i>WebMD.com<\/i>. 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American Journal of Roentgenology<\/i>. <b>191<\/b> (2): 328\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2FAJR.07.3940\" target=\"_blank\">10.2214\/AJR.07.3940<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18647897\" target=\"_blank\">18647897<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=Radiology+in+Japan+in+2008&rft.volume=191&rft.issue=2&rft.pages=328-9&rft.date=2008-08&rft_id=info%3Adoi%2F10.2214%2FAJR.07.3940&rft_id=info%3Apmid%2F18647897&rft.aulast=Ehara&rft.aufirst=S&rft.au=Nakajima%2C+Y&rft.au=Matsui%2C+O&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-93\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-93\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fairfield.org.uk\/tests\/private-mri-scan\/\" target=\"_blank\">\"Private MRI Scan\"<\/a>. <i>Fairfield.org.uk<\/i>. 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American Journal of Roentgenology<\/i>. <b>198<\/b> (4): 778\u201384. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2FAJR.11.7405\" target=\"_blank\">10.2214\/AJR.11.7405<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22451541\" target=\"_blank\">22451541<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=Imaging+of+pregnant+and+lactating+patients%3A+part+1%2C+evidence-based+review+and+recommendations&rft.volume=198&rft.issue=4&rft.pages=778-84&rft.date=2012-04&rft_id=info%3Adoi%2F10.2214%2FAJR.11.7405&rft_id=info%3Apmid%2F22451541&rft.aulast=Wang&rft.aufirst=PI&rft.au=Chong%2C+ST&rft.au=Kielar%2C+AZ&rft.au=Kelly%2C+AM&rft.au=Knoepp%2C+UD&rft.au=Mazza%2C+MB&rft.au=Goodsitt%2C+MM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-iRefer-96\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-iRefer_96-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rcr.ac.uk\/content.aspx?PageID=995\" target=\"_blank\">\"iRefer\"<\/a>. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/consumerhealthchoices.org\/wp-content\/uploads\/2012\/04\/High-Value-Care-Back-Pain-ACP.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 15 January 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 14,<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=High+Value+Care&rft.atitle=Imaging+tests+for+lower-back+pain%3A+Why+you+probably+don%27t+need+them&rft.date=2012-04&rft.au=Consumer+Reports&rft.au=American+College+of+Physicians&rft_id=http%3A%2F%2Fconsumerhealthchoices.org%2Fwp-content%2Fuploads%2F2012%2F04%2FHigh-Value-Care-Back-Pain-ACP.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ErasmusHurter2004-101\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ErasmusHurter2004_101-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ErasmusHurter2004_101-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Erasmus LJ, Hurter D, Naude M, Kritzinger HG, Acho S (2004). \"A short overview of MRI artefacts\". <i>South African Journal of Radiology<\/i>. <b>8<\/b> (2): 13. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4102%2Fsajr.v8i2.127\" target=\"_blank\">10.4102\/sajr.v8i2.127<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=South+African+Journal+of+Radiology&rft.atitle=A+short+overview+of+MRI+artefacts&rft.volume=8&rft.issue=2&rft.pages=13&rft.date=2004&rft_id=info%3Adoi%2F10.4102%2Fsajr.v8i2.127&rft.aulast=Erasmus&rft.aufirst=LJ&rft.au=Hurter%2C+D&rft.au=Naude%2C+M&rft.au=Kritzinger%2C+HG&rft.au=Acho%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-non-medical-102\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-non-medical_102-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rinck PA (2017). \"Chapter Nineteen Non-Medical Applications of NMR and MRI\". <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.magnetic-resonance.org\/ch\/19-01.html\" target=\"_blank\"><i>Magnetic Resonance<\/i><\/a> (11th ed.)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-12-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+Nineteen+Non-Medical+Applications+of+NMR+and+MRI&rft.btitle=Magnetic+Resonance&rft.edition=11th&rft.date=2017&rft.aulast=Rinck&rft.aufirst=PA&rft_id=http%3A%2F%2Fwww.magnetic-resonance.org%2Fch%2F19-01.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-103\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-103\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rinck PA (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.spectroscopyeurope.com\/article\/short-history-magnetic-resonance-imaging\" target=\"_blank\">\"A short history of magnetic resonance imaging\"<\/a>. <i>Spectroscopy Europe<\/i>. <b>20<\/b> (1): 7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Spectroscopy+Europe&rft.atitle=A+short+history+of+magnetic+resonance+imaging&rft.volume=20&rft.issue=1&rft.pages=7&rft.date=2008&rft.aulast=Rinck&rft.aufirst=PA&rft_id=https%3A%2F%2Fwww.spectroscopyeurope.com%2Farticle%2Fshort-history-magnetic-resonance-imaging&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mansfield-EPI-104\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mansfield-EPI_104-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mansfield P, Grannell PK (1975). \"<span class=\"cs1-kern-left\">\"<\/span>Diffraction\" and microscopy in solids and liquids by NMR\". <i>Physical Review B<\/i>. <b>12<\/b> (9): 3618\u20133634. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1103%2Fphysrevb.12.3618\" target=\"_blank\">10.1103\/physrevb.12.3618<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+Review+B&rft.atitle=%22Diffraction%22+and+microscopy+in+solids+and+liquids+by+NMR&rft.volume=12&rft.issue=9&rft.pages=3618-3634&rft.date=1975&rft_id=info%3Adoi%2F10.1103%2Fphysrevb.12.3618&rft.aulast=Mansfield&rft.aufirst=P&rft.au=Grannell%2C+PK&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<div class=\"refbegin columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em;\">\n<ul><li><cite class=\"citation web\">Rinck PA (ed.). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.magnetic-resonance.org\/ch\/20-01.html\" target=\"_blank\">\"The history of MRI\"<\/a>. <i>TRTF\/EMRF<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TRTF%2FEMRF&rft.atitle=The+history+of+MRI&rft_id=http%3A%2F%2Fwww.magnetic-resonance.org%2Fch%2F20-01.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Eustace SJ, Nelson E (June 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC421763\" target=\"_blank\">\"Whole body magnetic resonance imaging\"<\/a>. <i>BMJ<\/i>. <b>328<\/b> (7453): 1387\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.328.7453.1387\" target=\"_blank\">10.1136\/bmj.328.7453.1387<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC421763\" target=\"_blank\">421763<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15191954\" target=\"_blank\">15191954<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ&rft.atitle=Whole+body+magnetic+resonance+imaging&rft.volume=328&rft.issue=7453&rft.pages=1387-8&rft.date=2004-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC421763&rft_id=info%3Apmid%2F15191954&rft_id=info%3Adoi%2F10.1136%2Fbmj.328.7453.1387&rft.aulast=Eustace&rft.aufirst=SJ&rft.au=Nelson%2C+E&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC421763&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Pykett IL (May 1982). \"NMR imaging in medicine\". <i>Scientific American<\/i>. <b>246<\/b> (5): 78\u201388. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fscientificamerican0582-78\" target=\"_blank\">10.1038\/scientificamerican0582-78<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7079720\" target=\"_blank\">7079720<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scientific+American&rft.atitle=NMR+imaging+in+medicine&rft.volume=246&rft.issue=5&rft.pages=78-88&rft.date=1982-05&rft_id=info%3Adoi%2F10.1038%2Fscientificamerican0582-78&rft_id=info%3Apmid%2F7079720&rft.aulast=Pykett&rft.aufirst=IL&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Simon M, Mattson JS (1996). <i>The pioneers of NMR and magnetic resonance in medicine: The story of MRI<\/i>. Ramat Gan, Israel: Bar-Ilan University Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-9619243-1-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+pioneers+of+NMR+and+magnetic+resonance+in+medicine%3A+The+story+of+MRI&rft.place=Ramat+Gan%2C+Israel&rft.pub=Bar-Ilan+University+Press&rft.date=1996&rft.isbn=978-0-9619243-1-7&rft.aulast=Simon&rft.aufirst=Merrill&rft.au=Mattson%2C+James+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Haacke EM, Brown RF, Thompson M, Venkatesan R (1999). <i>Magnetic resonance imaging: Physical principles and sequence design<\/i>. New York: J. Wiley & Sons. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-471-35128-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+resonance+imaging%3A+Physical+principles+and+sequence+design&rft.place=New+York&rft.pub=J.+Wiley+%26+Sons&rft.date=1999&rft.isbn=978-0-471-35128-3&rft.aulast=Haacke&rft.aufirst=E+Mark&rft.au=Brown%2C+Robert+F&rft.au=Thompson%2C+Michael&rft.au=Venkatesan%2C+Ramesh&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Lee SC, Kim K, Kim J, Lee S, Han Yi J, Kim SW, Ha KS, Cheong C (June 2001). \"One micrometer resolution NMR microscopy\". <i>Journal of Magnetic Resonance<\/i>. <b>150<\/b> (2): 207\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1006%2Fjmre.2001.2319\" target=\"_blank\">10.1006\/jmre.2001.2319<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11384182\" target=\"_blank\">11384182<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Magnetic+Resonance&rft.atitle=One+micrometer+resolution+NMR+microscopy&rft.volume=150&rft.issue=2&rft.pages=207-13&rft.date=2001-06&rft_id=info%3Adoi%2F10.1006%2Fjmre.2001.2319&rft_id=info%3Apmid%2F11384182&rft.aulast=Lee&rft.aufirst=SC&rft.au=Kim%2C+K&rft.au=Kim%2C+J&rft.au=Lee%2C+S&rft.au=Han+Yi%2C+J&rft.au=Kim%2C+SW&rft.au=Ha%2C+KS&rft.au=Cheong%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Sprawls P (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sprawls.org\/mripmt\/index.html\" target=\"_blank\"><i>Magnetic Resonance Imaging <sub>Principles, Methods, and Techniques<\/sub><\/i><\/a>. Medical Physics Publishing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-944838-97-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+Imaging+%3Csub%3EPrinciples%2C+Methods%2C+and+Techniques%3C%2Fsub%3E&rft.pub=Medical+Physics+Publishing&rft.date=2000&rft.isbn=978-0-944838-97-6&rft.aulast=Sprawls&rft.aufirst=Perry&rft_id=http%3A%2F%2Fwww.sprawls.org%2Fmripmt%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Mansfield P (1982). <i>NMR Imaging in Biomedicine: Supplement 2 Advances in Magnetic Resonance<\/i>. Elsevier. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-323-15406-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=NMR+Imaging+in+Biomedicine%3A+Supplement+2+Advances+in+Magnetic+Resonance&rft.pub=Elsevier&rft.date=1982&rft.isbn=978-0-323-15406-2&rft.aulast=Mansfield&rft.aufirst=P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Fukushima E (1989). <i>NMR in Biomedicine: The Physical Basis<\/i>. Springer Science & Business Media. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-88318-609-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=NMR+in+Biomedicine%3A+The+Physical+Basis&rft.pub=Springer+Science+%26+Business+Media&rft.date=1989&rft.isbn=978-0-88318-609-1&rft.aulast=Fukushima&rft.aufirst=Eiichi&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Bl\u00fcmich B, Kuhn W (1992). <i>Magnetic Resonance Microscopy: Methods and Applications in Materials Science, Agriculture and Biomedicine<\/i>. Wiley. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-527-28403-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+Microscopy%3A+Methods+and+Applications+in+Materials+Science%2C+Agriculture+and+Biomedicine&rft.pub=Wiley&rft.date=1992&rft.isbn=978-3-527-28403-0&rft.aulast=Bl%C3%BCmich&rft.aufirst=Bernhard&rft.au=Kuhn%2C+Winfried&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Bl\u00fcmer P (1998). Bl\u00fcmler P, Bl\u00fcmich B, Botto RE, Fukushima E, eds. <i>Spatially Resolved Magnetic Resonance: Methods, Materials, Medicine, Biology, Rheology, Geology, Ecology, Hardware<\/i>. Wiley-VCH. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-527-29637-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Spatially+Resolved+Magnetic+Resonance%3A+Methods%2C+Materials%2C+Medicine%2C+Biology%2C+Rheology%2C+Geology%2C+Ecology%2C+Hardware&rft.pub=Wiley-VCH&rft.date=1998&rft.isbn=978-3-527-29637-8&rft.aulast=Bl%C3%BCmer&rft.aufirst=Peter&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Liang Z, Lauterbur PC (1999). <i>Principles of Magnetic Resonance Imaging: A Signal Processing Perspective<\/i>. Wiley. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7803-4723-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+of+Magnetic+Resonance+Imaging%3A+A+Signal+Processing+Perspective&rft.pub=Wiley&rft.date=1999&rft.isbn=978-0-7803-4723-6&rft.aulast=Liang&rft.aufirst=Zhi-Pei&rft.au=Lauterbur%2C+Paul+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Schmitt F, Stehling MK, Turner R (1998). <i>Echo-Planar Imaging: Theory, Technique and Application<\/i>. Springer Berlin Heidelberg. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-63194-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Echo-Planar+Imaging%3A+Theory%2C+Technique+and+Application&rft.pub=Springer+Berlin+Heidelberg&rft.date=1998&rft.isbn=978-3-540-63194-1&rft.aulast=Schmitt&rft.aufirst=Franz&rft.au=Stehling%2C+Michael+K.&rft.au=Turner%2C+Robert&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Kuperman V (2000). <i>Magnetic Resonance Imaging: Physical Principles and Applications<\/i>. Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-08-053570-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+Imaging%3A+Physical+Principles+and+Applications&rft.pub=Academic+Press&rft.date=2000&rft.isbn=978-0-08-053570-8&rft.aulast=Kuperman&rft.aufirst=Vadim&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Bl\u00fcmich B (2000). <i>NMR Imaging of Materials<\/i>. Clarendon Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-19-850683-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=NMR+Imaging+of+Materials&rft.pub=Clarendon+Press&rft.date=2000&rft.isbn=978-0-19-850683-6&rft.aulast=Bl%C3%BCmich&rft.aufirst=Bernhard&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Jin J (1998). <i>Electromagnetic Analysis and Design in Magnetic Resonance Imaging<\/i>. CRC Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8493-9693-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Electromagnetic+Analysis+and+Design+in+Magnetic+Resonance+Imaging&rft.pub=CRC+Press&rft.date=1998&rft.isbn=978-0-8493-9693-9&rft.aulast=Jin&rft.aufirst=Jianming&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Farhat IA, Belton PS, Webb GA (2007). <i>Magnetic Resonance in Food Science: From Molecules to Man<\/i>. Royal Society of Chemistry. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-85404-340-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+in+Food+Science%3A+From+Molecules+to+Man&rft.pub=Royal+Society+of+Chemistry&rft.date=2007&rft.isbn=978-0-85404-340-8&rft.aulast=Farhat&rft.aufirst=Imad+Akil&rft.au=Belton%2C+P.+S.&rft.au=Webb%2C+Graham+Alan&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<ul><li><cite class=\"citation web\">Rinck PA (ed.). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.magnetic-resonance.org\" target=\"_blank\">\"MRI: A Peer-Reviewed, Critical Introduction\"<\/a>. <i>European Magnetic Resonance Forum (EMRF)\/The Round Table Foundation (TRTF)<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=European+Magnetic+Resonance+Forum+%28EMRF%29%2FThe+Round+Table+Foundation+%28TRTF%29&rft.atitle=MRI%3A+A+Peer-Reviewed%2C+Critical+Introduction&rft_id=http%3A%2F%2Fwww.magnetic-resonance.org&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/nationalmaglab.org\/education\/magnet-academy\/learn-the-basics\/stories\/mri-a-guided-tour\" target=\"_blank\">A Guided Tour of MRI: An introduction for laypeople<\/a> National High Magnetic Field Laboratory<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cis.rit.edu\/htbooks\/mri\/\" target=\"_blank\">The Basics of MRI<\/a>. <i>Underlying physics and technical aspects<\/i>.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.imrser.org\/PatientVideo.html\" target=\"_blank\">Video: What to Expect During Your MRI Exam<\/a> from the Institute for Magnetic Resonance Safety, Education, and Research (IMRSER)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.vega.org.uk\/video\/programme\/73\" target=\"_blank\">Royal Institution Lecture \u2013 MRI: A Window on the Human Body<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070413032705\/http:\/\/www.emrf.org\/FAQs%20MRI%20History.html\" target=\"_blank\">A SHORT HISTORY OF MAGNETIC RESONANCE IMAGING FROM A EUROPEAN POINT OF VIEW<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/aidb.crbs.ucsd.edu\/sand\/index.jsp\" target=\"_blank\"><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<\/span><\/sup><\/a><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since July 2018\">permanent dead link<\/span><\/a><\/i>] Animal Imaging Database (AIDB)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.howequipmentworks.com\/physics\/medical_imaging\/mri\/magnetic_resonance_imaging.html\" target=\"_blank\">How MRI works explained simply using diagrams<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biomednmr.mpg.de\/index.php?option=com_content&task=view&id=132&Itemid=39\" target=\"_blank\">Real-time MRI videos: Biomedizinische NMR Forschungs GmbH<\/a>.<\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1249\nCached time: 20181217050855\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.604 seconds\nReal time usage: 1.847 seconds\nPreprocessor visited node count: 7256\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 308864\/2097152 bytes\nTemplate argument size: 5772\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 15\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 322566\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.950\/10.000 seconds\nLua memory usage: 7.54 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1496.871 1 -total\n<\/p>\n<pre>58.50% 875.603 1 Template:Reflist\n28.17% 421.602 51 Template:Cite_journal\n13.93% 208.467 42 Template:Cite_web\n12.37% 185.148 24 Template:Cite_book\n 8.28% 123.960 9 Template:Fix\n 7.14% 106.924 6 Template:Citation_needed\n 4.63% 69.271 1 Template:Commons_category\n 4.01% 59.952 8 Template:Delink\n 3.87% 57.867 1 Template:Commons\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:19446-1!canonical and timestamp 20181217050853 and revision id 873528501\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214704\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.034 seconds\nReal time usage: 0.240 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 222.565 1 - wikipedia:Magnetic_resonance_imaging\n100.00% 222.565 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8569-0!*!*!*!*!*!* and timestamp 20181217214704 and revision id 24997\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging\">https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ecf92fce38dc6c6fbe9e6feac471ffd2_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/62\/Mri_scanner_schematic_labelled.svg\/660px-Mri_scanner_schematic_labelled.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/4d\/TR_TE.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1t2PD.jpg\/440px-T1t2PD.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Siemens_Magnetom_Aera_MRI_scanner.jpg\/440px-Siemens_Magnetom_Aera_MRI_scanner.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/ad\/PAPVR.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/38\/Mra1.jpg\/440px-Mra1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1-weighted-MRI.png\/200px-T1-weighted-MRI.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\/200px-Normal_axial_T2-weighted_MR_image_of_the_brain.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\/200px-Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/73\/Four_chamber_cardiovascular_magnetic_resonance_imaging.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\/200px-Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Shinsplint-mri_%28crop%29.jpg\/140px-Shinsplint-mri_%28crop%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/FLAIR_MRI_of_meningitis.jpg\/200px-FLAIR_MRI_of_meningitis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\/200px-Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\/200px-Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f3\/Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png\/200px-White_Matter_Connections_Obtained_with_MRI_Tractography.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/9\/9b\/Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/1206_FMRI.jpg\/200px-1206_FMRI.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/Mra-mip.jpg\/200px-Mra-mip.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/26\/Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg\/200px-Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a5\/Susceptibility_weighted_imaging_%28SWI%29_in_diffuse_axonal_injury.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Modern_3T_MRI.JPG\/440px-Modern_3T_MRI.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Wx_camera_1507509040946.jpg\/240px-Wx_camera_1507509040946.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Wx_camera_1507509050808.jpg\/135px-Wx_camera_1507509050808.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Wx_camera_1507512102648.jpg\/240px-Wx_camera_1507512102648.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1a\/Wx_camera_1507514479961.jpg\/135px-Wx_camera_1507514479961.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/MRI_with_motion_artifacts.jpg\/440px-MRI_with_motion_artifacts.jpg"],"ecf92fce38dc6c6fbe9e6feac471ffd2_timestamp":1545083224,"bc5b7003f9b6b64085881e0e1ffa3d21_type":"article","bc5b7003f9b6b64085881e0e1ffa3d21_title":"Laparoscopic surgery","bc5b7003f9b6b64085881e0e1ffa3d21_url":"https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery","bc5b7003f9b6b64085881e0e1ffa3d21_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tLaparoscopic surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tLaparoscopyIllustration of LaparoscopyICD-9-CM54.21MeSHD010535 OPS-301 code1-694[edit on Wikidata]\nLaparoscopy (from Ancient Greek  \u03bb\u03b1\u03c0\u03ac\u03c1\u03b1 (lapara), meaning 'flank, side', and  \u03c3\u03ba\u03bf\u03c0\u03ad\u03c9 (skopeo), meaning 'to see') is an operation performed in the abdomen or pelvis using small incisions (usually 0.5\u20131.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.[1]\nLaparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery, is a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. These include reduced pain due to smaller incisions, reduced hemorrhaging and shorter recovery time. The key element is the use of a laparoscope, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.\nLaparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in a laparoscopic surgery include forceps, scissors, probes, dissectors, hooks and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.\n\nContents \n\n1 Types \n2 Procedures \n\n2.1 Advantages \n2.2 Disadvantages \n2.3 Risks \n\n\n3 Robotic laparoscopic surgery \n4 Non-robotic hand guided assistance systems \n5 History \n6 Gynecological diagnosis \n7 See also \n8 References \n9 External links \n\n\nTypes \n Cholecystectomy as seen through a laparoscope\nThere are two types of laparoscope:[2]\n\na telescopic rod lens system, usually connected to a video camera (single chip or three chip)\na digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system\nThe mechanism mentioned in the second type is mainly used to improve the image quality of flexible endoscopes, replacing traditional fiberscopes. Nevertheless, laparoscopes are rigid endoscopes. The rigidity is required in clinical practice. The rod-lens based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 \u00b5m typically, dependant on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. The second type of laparoscope is very rare in the laparoscope market and in hospitals.\nAlso attached is a fiber optic cable system connected to a \"cold\" light source (halogen or xenon), to illuminate the operative field, which is inserted through a 5 mm or 10 mm cannula or trocar. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.[3]\n\nProcedures \n Surgeons perform laparoscopic stomach surgery.\nLaparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5\u201310 mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO\r\n2 from leaking). Over one million cholecystectomies are performed in the U.S. annually, with over 96% of those being performed laparoscopically.\nRather than a minimum 20 cm incision as in traditional (open) cholecystectomy, four incisions of 0.5\u20131.0 cm, or more recently a single incision of 1.5\u20132.0 cm,[4] will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gallbladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.\nIn certain advanced laparoscopic procedures, where the size of the specimen being removed would be too large to pull out through a trocar site (as would be done with a gallbladder), an incision larger than 10 mm must be made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons who choose this hand-assist technique feel it reduces operative time significantly versus the straight laparoscopic approach. It also gives them more options in dealing with unexpected adverse events (e.g., uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.[citation needed ]\nConceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties, including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery, and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.[citation needed ]\n\n Laparoscopic instruments.\nThe restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception, and the limited working area are factors adding to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery gain additional laparoscopic surgery training during one or two years of fellowship after completing their basic surgical residency. In OB-GYN residency programs, the average laparoscopy-to-laparotomy quotient (LPQ) is 0.55.\nThe first transatlantic surgery (Lindbergh operation) ever performed was a laparoscopic gallbladder removal.\nLaparoscopic techniques have also been developed in the field of veterinary medicine. Due to the relative high cost of the equipment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices. Many of the same surgeries performed in humans can be applied to animal cases \u2013 everything from an egg-bound tortoise to a German Shepherd can benefit from MIS. A paper published in JAVMA (Journal of the American Veterinary Medical Association) in 2005 showed that dogs spayed laparoscopically experienced significantly less pain (65%) than those that were spayed with traditional \"open\" methods. Arthroscopy, thoracoscopy, cystoscopy are all performed in veterinary medicine today. The University of Georgia School of Veterinary Medicine and Colorado State University's School of Veterinary Medicine are two of the main centers where veterinary laparoscopy got started and have excellent training programs for veterinarians interested in getting started in MIS.[citation needed ]\n\nAdvantages \nThere are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2018) (Learn how and when to remove this template message)\nReduced hemorrhaging, which reduces the chance of needing a blood transfusion.\nSmaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.\nLess pain, leading to less pain medication needed.\nAlthough procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.\nReduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.\nThere are more indications for laparoscopic surgery in gastrointestinal emergencies as the field develops.[5]\nAlthough laparoscopy in adult age group is widely accepted, its advantages in pediatric age group is questioned. Benefits of laparoscopy appears to recede with younger age. Efficacy of laparoscopy is inferior to open surgery in certain conditions such as pyloromyotomy for Infantile hypertrophic pyloric stenosis. Although laparoscopic appendectomy has lesser wound problems than open surgery, the former is associated with more intra-abdominal abscesses.[6]\n\nDisadvantages \nWhile laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult from the surgeon's perspective when compared to traditional, open surgery:\n\nThe surgeon has a limited range of motion at the surgical site, resulting in a loss of dexterity.\nPoor depth perception.\nSurgeons must use tools to interact with tissue rather than manipulate it directly with their hands. This results in an inability to accurately judge how much force is being applied to tissue as well as a risk of damaging tissue by applying more force than necessary. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.[7]\nThe tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn. This is called the fulcrum effect.[8]\nSome surgeries (carpal tunnel for instance) generally turn out better for the patient when the area can be opened up, allowing the surgeon to see \"the whole picture\" surrounding physiology, to better address the issue at hand. In this regard, keyhole surgery can be a disadvantage.[9]\nRisks \nSome of the risks are briefly described below:\n\nThe most significant risks are from trocar injuries during insertion into the abdominal cavity, as the trocar is typically inserted blindly. Injuries include abdominal wall hematoma, umbilical hernias, umbilical wound infection, and penetration of blood vessels or small or large bowel.[10]\nThe risk of such injuries is increased in patients who have a low body mass index[11] or have a history of prior abdominal surgery. While these injuries are rare, significant complications can occur, and they are primarily related to the umbilical insertion site. Vascular injuries can result in hemorrhage that may be life-threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible.[12]\n\nSome patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2018) (Learn how and when to remove this template message)\nThere may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, has been shown to reduce this risk.[13]\nMany patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.\nNot all of the CO\r\n2 introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the diaphragm (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient's shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration.[14]\nCoagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.\nIntra-abdominal adhesion formation is a risk associated with both laparoscopic and open surgery and remains a significant, unresolved problem.[15] Adhesions are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries,[15] with the risk of developing adhesions being the same for both procedures.[16][17] Complications of adhesions include chronic pelvic pain, bowel obstruction, and female infertility. In particular, small bowel obstruction poses the most significant problem.[16] The use of surgical humidification therapy during laparoscopic surgery may minimise the incidence of adhesion formation.[18] Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery.[16]\nRobotic laparoscopic surgery \nMain article: Robotic surgery\n A laparoscopic robotic surgery machine.\nIn recent years, electronic tools have been developed to aid surgeons. Some of the features include:\n\nVisual magnification \u2014 use of a large viewing screen improves visibility\nStabilization \u2014 Electromechanical damping of vibrations, due to machinery or shaky human hands\nSimulators \u2014 use of specialized virtual reality training tools to improve physicians' proficiency in surgery [19]\nReduced number of incisions\nThere has been a distinct lack of disclosure regarding nano-scale developments in keyhole surgery and remote medicine, a \"disparity of disclosure\" which does not correlate with the rapid advancements in both the medical and nanotechnology fields over the last two decades.[citation needed ]\nRobotic surgery has been touted as a solution to underdeveloped nations, whereby a single central hospital can operate several remote machines at distant locations. The potential for robotic surgery has had strong military interest as well, with the intention of providing mobile medical care while keeping trained doctors safe from battle.[citation needed ]\n\nNon-robotic hand guided assistance systems \nThere are also user-friendly non robotic assistance systems that are single hand guided devices with a high potential to save time and money. These assistance devices are not bound by the restrictions of common medical robotic systems. The systems enhance the manual possibilities of the surgeon and his\/her team, regarding the need of replacing static holding force during the intervention.[citation needed ]\nSome of the features are:[citation needed ]\n\nThe stabilisation of the camera picture because the whole static workload is conveyed by the assistance system.\nSome systems enable a fast repositioning and very short time for fixation of less than 0.02 seconds at the desired position. Some systems are lightweight constructions (18 kg) and can withstand a force of 20 N in any position and direction.\nThe benefit \u2013 a physically relaxed intervention team can work concentrated on the main goals during the intervention.\nThe potentials of these systems enhance the possibilities of the mobile medical care with those lightweight assistance systems. These assistance systems meet the demands of true solo surgery assistance systems and are robust, versatile, and easy to use.\nHistory \n Hans Christian Jacobaeus\nIt is difficult to credit one individual with the pioneering of the laparoscopic approach. In 1901, Georg Kelling of Dresden, Germany, performed the first laparoscopic procedure in dogs, and, in 1910, Hans Christian Jacobaeus of Sweden performed the first laparoscopic operation in humans.[20]\nIn the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The advent of computer chip-based television cameras was a seminal event in the field of laparoscopy. This technological innovation provided the means to project a magnified view of the operative field onto a monitor and, at the same time, freed both the operating surgeon's hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very few applications, mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.[citation needed ]\nThe first publication on modern diagnostic laparoscopy by Raoul Palmer appeared in 1947,[21] followed by the publication of Hans Frangenheim and Kurt Semm. Hans Lindermann and Kurt Semm practised CO\r\n2 hysteroscopy during the mid-1970s.[citation needed ]\nIn 1972, Clarke invented, published, patented, presented, and recorded on film laparoscopic surgery, with instruments marketed by the Ven Instrument Company of Buffalo, New York.[22]\nIn 1975, Tarasconi, from the Department of Ob-Gyn of the University of Passo Fundo Medical School (Passo Fundo, RS, Brazil), started his experience with organ resection by laparoscopy (Salpingectomy), first reported in the Third AAGL Meeting, Hyatt Regency Atlanta, November 1976 and later published in The Journal of Reproductive Medicine in 1981.[23]\nThis laparoscopic surgical procedure was the first laparoscopic organ resection reported in medical literature.\n\n<\/p>In 1981, Semm, from the gynecological clinic of Kiel University, Germany, performed the first laparoscopic appendectomy. Following his lecture on laparoscopic appendectomy, the president of the German Surgical Society wrote to the Board of Directors of the German Gynecological Society suggesting suspension of Semm from medical practice. Subsequently, Semm submitted a paper on laparoscopic appendectomy to the American Journal of Obstetrics and Gynecology, at first rejected as unacceptable for publication on the grounds that the technique reported on was \"unethical,\" but finally published in the journal Endoscopy.[24]\nThe abstract of his paper on endoscopic appendectomy can be found at here.\nSemm established several standard procedures that were regularly performed, such as ovarian cyst enucleation, myomectomy, treatment of ectopic pregnancy and finally laparoscopic-assisted vaginal hysterectomy (nowadays termed as cervical intra-fascial Semm hysterectomy). He also developed a medical instrument company Wisap in Munich, Germany, which still produces various endoscopic instruments of high quality. In 1985, he constructed the pelvi-trainer = laparo-trainer, a practical surgical model whereby colleagues could practice laparoscopic techniques. Semm published over 1000 papers in various journals.[4] He also produced over 30 endoscopic films and more than 20,000 colored slides to teach and inform interested colleagues about his technique. His first atlas, More Details on Pelviscopy and Hysteroscopy was published in 1976, a slide atlas on pelviscopy, hysteroscopy, and fetoscopy in 1979, and his books on gynecological endoscopic surgery in German, English, and many other languages in 1984, 1987, and 2002.\n\n<\/p>Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation. The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made general surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons continue to use the single clip appliers as they save as much as $200 per case for the patient, detract nothing from the quality of the clip ligation, and add only seconds to case lengths. It must be noted that both laparoscopy tubal ligations and cholecystectomies may be performed using suturing and tying, thus further reducing the expensive cost of single and multiclips (when compared to suture). Once again this may increase case lengths but costs are greatly reduced (ideal for developing countries) and widespread accidents of loose clips are eliminated.[citation needed ]\n\nGynecological diagnosis \nFurther information: Fertiloscope\nIn gynecology, diagnostic laparoscopy may be used to inspect the outside of the uterus, ovaries, and fallopian tubes, as, for example, in the diagnosis of female infertility. Usually, one incision is placed near the navel and a second near the pubic hairline. A special type of laparoscope called a fertiloscope, which is modified for transvaginal application, can be used. A dye test may be performed to detect any blockage in the reproductive tract, wherein a dark blue dye is passed up through the cervix and is followed with the laparoscope through its passage out into the fallopian tubes to the ovaries.[1]\n\nSee also \nArthroscopic surgery\nLaparotomy, an older open surgery technique for operations on the abdomen\nPercutaneous (surgery)\nInvasiveness of surgical procedures\nNatural orifice translumenal endoscopic surgery (NOTES)\nRevision weight loss surgery\nSingle port laparoscopy\nReferences \n\n\n^ a b MedlinePlus > Laparoscopy Archived 2011-07-26 at the Wayback Machine. Update Date: 8\/21\/2009. Updated by: James Lee, MD \/\/ No longer valid \n\n^ Mastery of Endoscopic and Laparoscopic Surgery W. Stephen, M.D. Eubanks; Steve Eubanks (Editor); Lee L., M.D. Swanstrom (Editor); Nathaniel J. Soper (Editor) Lippincott Williams & Wilkins 2nd Edition 2004 \n\n^ \"Training in diagnostic laparoscopy\". Gfmer.ch. Archived from the original on July 14, 2014. Retrieved October 10, 2013 . \n\n^ Bhandarkar, Deepraj; Mittal, Gaurav; Shah, Rasik; Katara, Avinash; Udwadia, Tehemton E (January 1, 2011). \"Single-incision laparoscopic cholecystectomy: How I do it?\". Journal of Minimal Access Surgery. 7 (1): 17\u201323. doi:10.4103\/0972-9941.72367. ISSN 0972-9941. PMC 3002000 . PMID 21197237. \n\n^ Jimenez-Rodr\u00edguez, RM; Segura-Sampedro, JJ (February 2016). \"Laparoscopic approach in gastrointestinal emergencies\". World Journal of Gastroenterology. 22 (9): 2701. doi:10.3748\/wjg.v22.i9.2701. \n\n^ Raveenthiran, V (October\u2013December 2010). \"Pediatric laparoscopy: Facts and factitious claims\". J Indian Assoc Pediatr Surg. 15 (4): 122\u2013126. doi:10.4103\/0971-9261.72434. PMC 2995935 . PMID 21170193. Archived from the original on 2017-09-03. \n\n^ Westebring-van der Putten EP; Goossens RHM; Jakimowicz JJ; Dankelman J (2008). \"Haptics in Minimally Invasive Surgery \u2013 A Review\". Minimally Invasive Therapy. 17 (1): 3\u201316. doi:10.1080\/13645700701820242. \n\n^ A. G. Gallagher; N. McClure; J. McGuigan; K. Ritchie; N. P. Sheehy (2007). \"An Ergonomic Analysis of the Fulcrum Effect in the Acquisition of Endoscopic Skills\". Endoscopy. 1 (7): 617\u2013620. doi:10.1055\/s-2007-1001366. \n\n^ Rodriguez, Anthony, Carpel Tunnel Surgery in Review, Beklind, 2009p.234 \n\n^ Mayol, Julio; Garcia-Aguilar, Julio; Ortiz-Oshiro, Elena; De-Diego Carmona, Jose A.; Fernandez-Represa, Jesus A. (1997). \"Risks of the Minimal Access Approach for Laparoscopic Surgery: Multivariate Analysis of Morbidity Related to Umbilical Trocar Insertion\". World Journal of Surgery. 21 (5): 529\u2013533. doi:10.1007\/PL00012281. ISSN 0364-2313. \n\n^ Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S (September 1998). \"Predicting risk of complications with gynecologic laparoscopic surgery\". Obstet Gynecol. 92 (3): 327\u201331. doi:10.1016\/S0029-7844(98)00209-9. PMID 9721764. \n\n^ Janie Fuller, DDS, (CAPT, USPHS), Walter Scott, Ph.D. (CAPT, USPHS), Binita Ashar, M.D., Julia Corrado, M.D. FDA, CDRH, \"Laparoscopic Trocar Injuries: A report from a U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee\" Archived 2007-08-23 at the Wayback Machine.\n Finalized: November 7, 2003 \n\n^ Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (January 2009). \"Heated and humidified CO\r\n2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\". J. Surg. Res. 151 (1): 40\u20137. doi:10.1016\/j.jss.2008.03.039. PMID 18639246. Archived from the original on 2018-04-27. \n\n^ Alexander JI, Hull MG (March 1987). \"Abdominal pain after laparoscopy: the value of a gas drain\". Br J Obstet Gynaecol. 94 (3): 267\u20139. doi:10.1111\/j.1471-0528.1987.tb02366.x. PMID 2952161. \n\n^ a b D\u00f6rthe, Br\u00fcggmann; Garri Tchartchian; Markus Wallwiener; Karsten M\u00fcnstedt; Hans-Rudolf Tinneberg; Andreas Hackethal (November 2010). \"Intra-abdominal Adhesions \u2013 Definition, Origin, Significance in Surgical Practice, and Treatment Options\". Dtsch Arztebl Int. 107 (44): 769\u2013775. doi:10.3238\/arztebl.2010.0769. PMC 2992017 . PMID 21116396. \n\n^ a b c DeWilde, Rudy Leon; Geoffrey Trew (September 2007). \"Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position\". Gynecological Surgery. 4 (3): 161\u2013168. doi:10.1007\/s10397-007-0338-x. Archived from the original on 2013-07-11. \n\n^ Lower, A.M.; R.J.S. Hawthorn; D. Clark; J.H. Boyd; A.R. Finlayson; A.D. Knight; A.M. Crowe (2004). \"Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24\u2009046 patients\". Human Reproduction. 19 (8): 1877\u20131885. doi:10.1093\/humrep\/deh321. PMID 15178659. Archived from the original on 2016-02-08. \n\n^ Peng, Y; Zheng M; Ye Q; Chen X; Yu B; Liu B (Jan 2009). \"Heated and Humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\". J Surg Res. 151 (1): 40\u20137. doi:10.1016\/j.jss.2008.03.039. PMID 18639246. \n\n^ Ahmed K, Keeling AN, Fakhry M, et al. (January 2010). \"Role of virtual reality simulation in teaching and assessing technical skills in endovascular intervention\". J Vasc Interv Radiol. 21 (1): 55\u201366. doi:10.1016\/j.jvir.2009.09.019. PMID 20123191. Archived from the original on 2017-12-22. \n\n^ Journal of Endourology Hans Christian Jacobaeus: Inventor of Human Laparoscopy and Thoracoscopy \n\n^ Palmer, R (1947). \"Instrumentation et technique de la coelioscopie gynecologique\". Gynecol Obstet (Paris). 46 (4): 420\u201331. PMID 18917806. \n\n^ Clarke HC (April 1972). \"Laparoscopy\u2014new instruments for suturing and ligation\". Fertil. Steril. 23 (4): 274\u20137. doi:10.1016\/S0015-0282(16)38886-0. PMID 4258561. \n\n^ Tarasconi JC (October 1981). \"Endoscopic salpingectomy\". J Reprod Med. 26 (10): 541\u20135. PMID 6458700. \n\n^ Semm K (March 1983). \"Endoscopic Appendectomy\". Endoscopy. 15 (2): 59\u201364. doi:10.1055\/s-2007-1021466. PMID 6221925. \n\n\nExternal links \nFeder, Barnaby J., \"Surgical Device Poses a Rare but Serious Peril\" The New York Times, March 17, 2006\nvteEndoscopyGastrointestinal tract\nUpper:\nEsophagogastroduodenoscopy\nLower: Enteroscopy\nColonoscopy\nSigmoidoscopy\nProctoscopy\nAnoscopy\nCapsule endoscopy\nAccessory: Endoscopic retrograde cholangiopancreatography\nRespiratory tract\nRhinoscopy\nLaryngoscopy\nBronchoscopy\nUrinary tract\nNephroscopy\nUreteroscopy\nCystoscopy\nFemale reproductive system\nColposcopy\nHysteroscopy\nFalloposcopy\nCuldoscopy\nClosed cavity via incision\nLaparoscopy\nLaparoscopic surgery\nArthroscopy\nThoracoscopy\nMediastinoscopy\nCoelioscopy\nOther\nFetoscopy\nAngioscopy\nOtoscopy\n\nvteSurgical procedures involving the digestive system (ICD-9-CM V3 42\u201354, ICD-10-PCS 0D)Digestive tractUpper GI tractSGs \/ Esophagus\nEsophagectomy\nHeller myotomy\nSialography\nImpedance\u2013pH monitoring\nEsophageal pH monitoring\nEsophageal motility study\nStomach\nBariatric surgery\nAdjustable gastric band\nEndoscopic sleeve gastroplasty\nGastric bypass surgery\nSleeve gastrectomy\nVertical banded gastroplasty surgery\nCollis gastroplasty\nGastrectomy\nBillroth I\nBillroth II\nRoux-en-Y\nGastroenterostomy\nGastropexy\nGastrostomy\nPercutaneous endoscopic gastrostomy\nEsophagogastric dissociation\nHill repair\nNissen fundoplication\nPyloromyotomy\nMedical imaging\nEndoscopy: Esophagogastroduodenoscopy\nBarium swallow\nUpper gastrointestinal series\nLower GI tractSmall bowel\nBariatric surgery\nDuodenal switch\nJejunoileal bypass\nBowel resection\nIleostomy\nIntestine transplantation\nJejunostomy\nPartial ileal bypass surgery\nStrictureplasty\nLarge bowel\nAppendicectomy\nColectomy\nColonic polypectomy\nColostomy\nHartmann's operation\nRectum\nAbdominoperineal resection \/ Miles operation\nLower anterior resection\nTotal mesorectal excision\nAnal canal\nAnal sphincterotomy\nAnorectal manometry\nLateral internal sphincterotomy\nRubber band ligation\nTransanal hemorrhoidal dearterialization\nMedical imaging\nEndoscopy: Colonoscopy\nAnoscopy\nCapsule endoscopy\nEnteroscopy\nProctoscopy\nSigmoidoscopy\nAbdominal ultrasonography\nDefecography\nDouble-contrast barium enema\nEndoanal ultrasound\nEnteroclysis\nLower gastrointestinal series\nSmall-bowel follow-through\nTransrectal ultrasonography\nVirtual colonoscopy\nStool tests\nFecal fat test\nFecal pH test\nStool guaiac test\nAccessoryLiver\nArtificial extracorporeal liver support\nBioartificial liver devices\nLiver dialysis\nHepatectomy\nLiver biopsy\nLiver transplantation\nPortal hypertension\nTransjugular intrahepatic portosystemic shunt [TIPS]\nDistal splenorenal shunt procedure\nGallbladder, bile duct\nCholecystectomy\nCholecystostomy\nERCP\nHepatoportoenterostomy\nMedical imaging: Cholangiography\nIV\nMRCP\nPTC\nCholecystography\nCholescintigraphy\nPancreas\nFrey's procedure\nPancreas transplantation\nPancreatectomy\nPancreaticoduodenectomy\nPuestow procedure\nAbdominopelvicPeritoneum\nDiagnostic peritoneal lavage\nIntraperitoneal injection\nLaparoscopy\nOmentopexy\nParacentesis\nPeritoneal dialysis\nHernia\nHernia repair: Inguinal hernia surgery\nFemoral hernia repair\nOther\nLaparotomy\nExploratory laparotomy\nRapid urease test \/ Urea breath test\nCPRs\nMELD\nPELD\nUKELD\nChild\u2013Pugh score\nRanson criteria\nMilan criteria\n\nAuthority control \nNDL: 00563624 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery\">https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","bc5b7003f9b6b64085881e0e1ffa3d21_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Laparoscopic_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Laparoscopic surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Laparoscopy<\/b> (from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greek_language\" class=\"mw-redirect\" title=\"Ancient Greek language\" rel=\"external_link\" target=\"_blank\">Ancient Greek<\/a> <i> <\/i>\u03bb\u03b1\u03c0\u03ac\u03c1\u03b1<i> (lapara)<\/i>, meaning 'flank, side', and <i> <\/i>\u03c3\u03ba\u03bf\u03c0\u03ad\u03c9<i> (skopeo)<\/i>, meaning 'to see') is an operation performed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_pelvis\" class=\"mw-redirect\" title=\"Human pelvis\" rel=\"external_link\" target=\"_blank\">pelvis<\/a> using small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_incision\" title=\"Surgical incision\" rel=\"external_link\" target=\"_blank\">incisions<\/a> (usually 0.5\u20131.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.<sup id=\"rdp-ebb-cite_ref-medlineplus_1-0\" class=\"reference\"><a href=\"#cite_note-medlineplus-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Laparoscopic surgery, also called <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive\" class=\"mw-redirect\" title=\"Minimally invasive\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a> surgery<\/i> (MIS), <i>bandaid surgery<\/i>, or <i>keyhole surgery<\/i>, is a modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> technique. There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. These include reduced pain due to smaller incisions, reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhaging\" class=\"mw-redirect\" title=\"Hemorrhaging\" rel=\"external_link\" target=\"_blank\">hemorrhaging<\/a> and shorter recovery time. The key element is the use of a <b>laparoscope<\/b>, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.\n<\/p><p>Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in a laparoscopic surgery include forceps, scissors, probes, dissectors, hooks and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">endoscopy<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/220px-Gallbladderop.jpg\" width=\"220\" height=\"204\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">Cholecystectomy<\/a> as seen through a laparoscope<\/div><\/div><\/div>\n<p>There are two types of laparoscope:<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<ol><li>a telescopic rod <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lens<\/a> system, usually connected to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Video_camera\" title=\"Video camera\" rel=\"external_link\" target=\"_blank\">video camera<\/a> (single <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charge-coupled_device\" title=\"Charge-coupled device\" rel=\"external_link\" target=\"_blank\">chip<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Three-CCD\" class=\"mw-redirect\" title=\"Three-CCD\" rel=\"external_link\" target=\"_blank\">three chip<\/a>)<\/li>\n<li>a digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system<\/li><\/ol>\n<p>The mechanism mentioned in the second type is mainly used to improve the image quality of flexible endoscopes, replacing traditional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberscope\" title=\"Fiberscope\" rel=\"external_link\" target=\"_blank\">fiberscopes<\/a>. Nevertheless, laparoscopes are rigid endoscopes. The rigidity is required in clinical practice. The rod-lens based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 \u00b5m typically, dependant on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. The second type of laparoscope is very rare in the laparoscope market and in hospitals.\n<\/p><p>Also attached is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber_optic\" class=\"mw-redirect\" title=\"Fiber optic\" rel=\"external_link\" target=\"_blank\">fiber optic<\/a> cable system connected to a \"cold\" light source (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Halogen_lamp\" title=\"Halogen lamp\" rel=\"external_link\" target=\"_blank\">halogen<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenon_arc_lamp\" title=\"Xenon arc lamp\" rel=\"external_link\" target=\"_blank\">xenon<\/a>), to illuminate the operative field, which is inserted through a 5 mm or 10 mm <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">cannula<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocar<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a> is usually <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insufflation_(medicine)\" title=\"Insufflation (medicine)\" rel=\"external_link\" target=\"_blank\">insufflated<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a> gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO<sub>2<\/sub> is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Procedures\">Procedures<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_stomach_surgery.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/Laparoscopic_stomach_surgery.jpg\/220px-Laparoscopic_stomach_surgery.jpg\" width=\"220\" height=\"161\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_stomach_surgery.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Surgeons perform laparoscopic stomach surgery.<\/div><\/div><\/div>\n<p>Laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a> is the most common laparoscopic procedure performed. In this procedure, 5\u201310 mm diameter instruments (graspers, scissors, clip applier) can be introduced by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgeon<\/a> into the abdomen through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocars<\/a> (hollow tubes with a seal to keep the <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> from leaking). Over one million cholecystectomies are performed in the U.S. annually, with over 96% of those being performed laparoscopically.\n<\/p><p>Rather than a minimum 20 cm incision as in traditional (open) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a>, four incisions of 0.5\u20131.0 cm, or more recently a single incision of 1.5\u20132.0 cm,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> will be sufficient to perform a laparoscopic removal of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallbladder\" title=\"Gallbladder\" rel=\"external_link\" target=\"_blank\">gallbladder<\/a>. Since the gallbladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.\n<\/p><p>In certain advanced laparoscopic procedures, where the size of the specimen being removed would be too large to pull out through a trocar site (as would be done with a gallbladder), an incision larger than 10 mm must be made. The most common of these procedures are removal of all or part of the colon (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colectomy\" title=\"Colectomy\" rel=\"external_link\" target=\"_blank\">colectomy<\/a>), or removal of the kidney (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrectomy\" title=\"Nephrectomy\" rel=\"external_link\" target=\"_blank\">nephrectomy<\/a>). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO<sub>2<\/sub> will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons who choose this hand-assist technique feel it reduces operative time significantly versus the straight laparoscopic approach. It also gives them more options in dealing with unexpected adverse events (e.g., uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Conceptually, the laparoscopic approach is intended to minimise post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a> and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties, including gastrointestinal surgery (including bariatric procedures for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obesity\" title=\"Obesity\" rel=\"external_link\" target=\"_blank\">morbid obesity<\/a>), gynecologic surgery, and urology. Based on numerous prospective <a href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial\" title=\"Randomized controlled trial\" rel=\"external_link\" target=\"_blank\">randomized controlled trials<\/a>, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hernia\" title=\"Hernia\" rel=\"external_link\" target=\"_blank\">hernias<\/a> (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_Hand_Instruments_001_JPN.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b4\/Laparoscopic_Hand_Instruments_001_JPN.jpg\/220px-Laparoscopic_Hand_Instruments_001_JPN.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_Hand_Instruments_001_JPN.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Laparoscopic instruments.<\/div><\/div><\/div>\n<p>The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception, and the limited working area are factors adding to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery gain additional laparoscopic surgery training during one or two years of fellowship after completing their basic surgical residency. In OB-GYN residency programs, the average laparoscopy-to-laparotomy quotient (LPQ) is 0.55.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_operation\" title=\"Lindbergh operation\" rel=\"external_link\" target=\"_blank\">first transatlantic surgery (Lindbergh operation)<\/a> ever performed was a laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallbladder\" title=\"Gallbladder\" rel=\"external_link\" target=\"_blank\">gallbladder<\/a> removal.\n<\/p><p>Laparoscopic techniques have also been developed in the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinary_medicine\" title=\"Veterinary medicine\" rel=\"external_link\" target=\"_blank\">veterinary medicine<\/a>. Due to the relative high cost of the equipment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices. Many of the same surgeries performed in humans can be applied to animal cases \u2013 everything from an egg-bound tortoise to a German Shepherd can benefit from MIS. A paper published in JAVMA (Journal of the American Veterinary Medical Association) in 2005 showed that dogs spayed laparoscopically experienced significantly less pain (65%) than those that were spayed with traditional \"open\" methods. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopy\" title=\"Arthroscopy\" rel=\"external_link\" target=\"_blank\">Arthroscopy<\/a>, thoracoscopy, cystoscopy are all performed in veterinary medicine today. The University of Georgia School of Veterinary Medicine and Colorado State University's School of Veterinary Medicine are two of the main centers where veterinary laparoscopy got started and have excellent training programs for veterinarians interested in getting started in MIS.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h3><p>\nThere are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:<\/p>\n<ul><li>Reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhaging\" class=\"mw-redirect\" title=\"Hemorrhaging\" rel=\"external_link\" target=\"_blank\">hemorrhaging<\/a>, which reduces the chance of needing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_transfusion\" title=\"Blood transfusion\" rel=\"external_link\" target=\"_blank\">blood transfusion<\/a>.<\/li>\n<li>Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.<\/li>\n<li>Less pain, leading to less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic\" title=\"Analgesic\" rel=\"external_link\" target=\"_blank\">pain medication<\/a> needed.<\/li>\n<li>Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.<\/li>\n<li>Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.<\/li>\n<li>There are more indications for laparoscopic surgery in gastrointestinal emergencies as the field develops.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><\/li><\/ul>\n<p>Although laparoscopy in adult age group is widely accepted, its advantages in pediatric age group is questioned. Benefits of laparoscopy appears to recede with younger age. Efficacy of laparoscopy is inferior to open surgery in certain conditions such as pyloromyotomy for Infantile hypertrophic pyloric stenosis. Although laparoscopic appendectomy has lesser wound problems than open surgery, the former is associated with more intra-abdominal abscesses.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Disadvantages\">Disadvantages<\/span><\/h3>\n<p>While laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult from the surgeon's perspective when compared to traditional, open surgery:\n<\/p>\n<ul><li>The surgeon has a limited range of motion at the surgical site, resulting in a loss of dexterity.<\/li>\n<li>Poor depth perception.<\/li>\n<li>Surgeons must use tools to interact with tissue rather than manipulate it directly with their hands. This results in an inability to accurately judge how much force is being applied to tissue as well as a risk of damaging tissue by applying more force than necessary. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><\/li>\n<li>The tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn. This is called the <i>fulcrum effect<\/i>.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li>Some surgeries (carpal tunnel for instance) generally turn out better for the patient when the area can be opened up, allowing the surgeon to see \"the whole picture\" surrounding physiology, to better address the issue at hand. In this regard, keyhole surgery can be a disadvantage.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h3>\n<p>Some of the risks are briefly described below:\n<\/p>\n<ul><li>The most significant risks are from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocar<\/a> injuries during insertion into the abdominal cavity, as the trocar is typically inserted blindly. Injuries include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_wall\" title=\"Abdominal wall\" rel=\"external_link\" target=\"_blank\">abdominal wall<\/a> hematoma, umbilical hernias, umbilical wound infection, and penetration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessel\" title=\"Blood vessel\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a> or small or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colon_(anatomy)\" class=\"mw-redirect\" title=\"Colon (anatomy)\" rel=\"external_link\" target=\"_blank\">large bowel<\/a>.<sup id=\"rdp-ebb-cite_ref-MayolGarcia-Aguilar1997_10-0\" class=\"reference\"><a href=\"#cite_note-MayolGarcia-Aguilar1997-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<p>The risk of such injuries is increased in patients who have a low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_mass_index\" title=\"Body mass index\" rel=\"external_link\" target=\"_blank\">body mass index<\/a><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> or have a history of prior <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_surgery\" title=\"Abdominal surgery\" rel=\"external_link\" target=\"_blank\">abdominal surgery<\/a>. While these injuries are rare, significant complications can occur, and they are primarily related to the umbilical insertion site. Vascular injuries can result in hemorrhage that may be life-threatening. Injuries to the bowel can cause a delayed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritonitis\" title=\"Peritonitis\" rel=\"external_link\" target=\"_blank\">peritonitis<\/a>. It is very important that these injuries be recognized as early as possible.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<ul><li>Some patients have sustained electrical burns unseen by surgeons who are working with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a> that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.<\/li>\n<li>There may be an increased risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypothermia\" title=\"Hypothermia\" rel=\"external_link\" target=\"_blank\">hypothermia<\/a> and peritoneal trauma due to increased exposure to cold, dry gases during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insufflation_(medicine)\" title=\"Insufflation (medicine)\" rel=\"external_link\" target=\"_blank\">insufflation<\/a>. The use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_humidification\" title=\"Surgical humidification\" rel=\"external_link\" target=\"_blank\">surgical humidification<\/a> therapy, which is the use of heated and humidified CO<sub>2<\/sub> for insufflation, has been shown to reduce this risk.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Many patients with existing pulmonary disorders may not tolerate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumoperitoneum\" title=\"Pneumoperitoneum\" rel=\"external_link\" target=\"_blank\">pneumoperitoneum<\/a> (gas in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_cavity\" title=\"Abdominal cavity\" rel=\"external_link\" target=\"_blank\">abdominal cavity<\/a>), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.<\/li>\n<li>Not all of the <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO<sub>2<\/sub> rises in the abdomen, it pushes against the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thoracic_diaphragm\" title=\"Thoracic diaphragm\" rel=\"external_link\" target=\"_blank\">diaphragm<\/a> (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phrenic_nerve\" title=\"Phrenic nerve\" rel=\"external_link\" target=\"_blank\">phrenic nerve<\/a>. This produces a sensation of pain that may extend to the patient's shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO<sub>2<\/sub> and eliminate it through respiration.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">Coagulation<\/a> disorders and dense <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesions\" class=\"mw-redirect\" title=\"Adhesions\" rel=\"external_link\" target=\"_blank\">adhesions<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar tissue<\/a>) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intra-abdominal_adhesion\" class=\"mw-redirect\" title=\"Intra-abdominal adhesion\" rel=\"external_link\" target=\"_blank\">Intra-abdominal adhesion<\/a> formation is a risk associated with both laparoscopic and open surgery and remains a significant, unresolved problem.<sup id=\"rdp-ebb-cite_ref-d\u00f6rthe769_15-0\" class=\"reference\"><a href=\"#cite_note-d\u00f6rthe769-15\" rel=\"external_link\">[15]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesion_(medicine)\" title=\"Adhesion (medicine)\" rel=\"external_link\" target=\"_blank\">Adhesions<\/a> are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries,<sup id=\"rdp-ebb-cite_ref-d\u00f6rthe769_15-1\" class=\"reference\"><a href=\"#cite_note-d\u00f6rthe769-15\" rel=\"external_link\">[15]<\/a><\/sup> with the risk of developing adhesions being the same for both procedures.<sup id=\"rdp-ebb-cite_ref-dewilde161_16-0\" class=\"reference\"><a href=\"#cite_note-dewilde161-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Complications of adhesions include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pelvic_pain\" class=\"mw-redirect\" title=\"Chronic pelvic pain\" rel=\"external_link\" target=\"_blank\">chronic pelvic pain<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel_obstruction\" title=\"Bowel obstruction\" rel=\"external_link\" target=\"_blank\">bowel obstruction<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Female_infertility\" title=\"Female infertility\" rel=\"external_link\" target=\"_blank\">female infertility<\/a>. In particular, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Small_bowel_obstruction\" class=\"mw-redirect\" title=\"Small bowel obstruction\" rel=\"external_link\" target=\"_blank\">small bowel obstruction<\/a> poses the most significant problem.<sup id=\"rdp-ebb-cite_ref-dewilde161_16-1\" class=\"reference\"><a href=\"#cite_note-dewilde161-16\" rel=\"external_link\">[16]<\/a><\/sup> The use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_humidification\" title=\"Surgical humidification\" rel=\"external_link\" target=\"_blank\">surgical humidification<\/a> therapy during laparoscopic surgery may minimise the incidence of adhesion formation.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery.<sup id=\"rdp-ebb-cite_ref-dewilde161_16-2\" class=\"reference\"><a href=\"#cite_note-dewilde161-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Robotic_laparoscopic_surgery\">Robotic laparoscopic surgery<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/220px-Laproscopic_Surgery_Robot.jpg\" width=\"220\" height=\"320\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A laparoscopic robotic surgery machine.<\/div><\/div><\/div>\n<p>In recent years, electronic tools have been developed to aid surgeons. Some of the features include:\n<\/p>\n<ul><li>Visual magnification \u2014 use of a large viewing screen improves visibility<\/li>\n<li>Stabilization \u2014 Electromechanical damping of vibrations, due to machinery or shaky human hands<\/li>\n<li>Simulators \u2014 use of specialized <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_reality\" title=\"Virtual reality\" rel=\"external_link\" target=\"_blank\">virtual reality<\/a> training tools to improve physicians' proficiency in surgery <sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><\/li>\n<li>Reduced number of incisions<\/li><\/ul>\n<p>There has been a distinct lack of disclosure regarding nano-scale developments in keyhole surgery and remote medicine, a \"disparity of disclosure\" which does not correlate with the rapid advancements in both the medical and nanotechnology fields over the last two decades.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Robotic surgery has been touted as a solution to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Developing_country\" title=\"Developing country\" rel=\"external_link\" target=\"_blank\">underdeveloped nations<\/a>, whereby a single central hospital can operate several remote machines at distant locations. The potential for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">robotic surgery<\/a> has had strong military interest as well, with the intention of providing mobile <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">medical care<\/a> while keeping trained doctors safe from battle.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Non-robotic_hand_guided_assistance_systems\">Non-robotic hand guided assistance systems<\/span><\/h2>\n<p>There are also user-friendly non robotic assistance systems that are single hand guided devices with a high potential to save time and money. These assistance devices are not bound by the restrictions of common medical robotic systems. The systems enhance the manual possibilities of the surgeon and his\/her team, regarding the need of replacing static holding force during the intervention.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Some of the features are:<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<ul><li>The stabilisation of the camera picture because the whole static workload is conveyed by the assistance system.<\/li>\n<li>Some systems enable a fast repositioning and very short time for fixation of less than 0.02 seconds at the desired position. Some systems are lightweight constructions (18 kg) and can withstand a force of 20 N in any position and direction.<\/li>\n<li>The benefit \u2013 a physically relaxed intervention team can work concentrated on the main goals during the intervention.<\/li>\n<li>The potentials of these systems enhance the possibilities of the mobile medical care with those lightweight assistance systems. These assistance systems meet the demands of true solo surgery assistance systems and are robust, versatile, and easy to use.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:142px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Jacbaeus.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9d\/Jacbaeus.JPG\/140px-Jacbaeus.JPG\" width=\"140\" height=\"180\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Jacbaeus.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hans Christian Jacobaeus<\/div><\/div><\/div>\n<p>It is difficult to credit one individual with the pioneering of the laparoscopic approach. In 1901, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georg_Kelling\" title=\"Georg Kelling\" rel=\"external_link\" target=\"_blank\">Georg Kelling<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dresden\" title=\"Dresden\" rel=\"external_link\" target=\"_blank\">Dresden<\/a>, Germany, performed the first laparoscopic procedure in dogs, and, in 1910, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hans_Christian_Jacobaeus\" title=\"Hans Christian Jacobaeus\" rel=\"external_link\" target=\"_blank\">Hans Christian Jacobaeus<\/a> of Sweden performed the first laparoscopic operation in humans.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The advent of computer chip-based television cameras was a seminal event in the field of laparoscopy. This technological innovation provided the means to project a magnified view of the operative field onto a monitor and, at the same time, freed both the operating surgeon's hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very few applications, mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The first publication on modern diagnostic laparoscopy by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Raoul_Palmer\" title=\"Raoul Palmer\" rel=\"external_link\" target=\"_blank\">Raoul Palmer<\/a> appeared in 1947,<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> followed by the publication of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hans_Frangenheim\" title=\"Hans Frangenheim\" rel=\"external_link\" target=\"_blank\">Hans Frangenheim<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kurt_Semm\" title=\"Kurt Semm\" rel=\"external_link\" target=\"_blank\">Kurt Semm<\/a>. Hans Lindermann and Kurt Semm practised <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> hysteroscopy during the mid-1970s.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In 1972, Clarke invented, published, patented, presented, and recorded on film laparoscopic surgery, with instruments marketed by the Ven Instrument Company of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buffalo,_New_York\" title=\"Buffalo, New York\" rel=\"external_link\" target=\"_blank\">Buffalo, New York<\/a>.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>In 1975, Tarasconi, from the Department of Ob-Gyn of the University of Passo Fundo Medical School (Passo Fundo, RS, Brazil), started his experience with organ resection by laparoscopy (Salpingectomy), first reported in the Third AAGL Meeting, Hyatt Regency Atlanta, November 1976 and later published in The Journal of Reproductive Medicine in 1981.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<p>This laparoscopic surgical procedure was the first laparoscopic organ resection reported in medical literature.\n<\/p>\n<\/p><p>In 1981, Semm, from the gynecological clinic of Kiel University, Germany, performed the first laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Appendectomy\" title=\"Appendectomy\" rel=\"external_link\" target=\"_blank\">appendectomy<\/a>. Following his lecture on laparoscopic appendectomy, the president of the German Surgical Society wrote to the Board of Directors of the German Gynecological Society suggesting suspension of Semm from medical practice. Subsequently, Semm submitted a paper on laparoscopic appendectomy to the <i>American Journal of Obstetrics and Gynecology<\/i>, at first rejected as unacceptable for publication on the grounds that the technique reported on was \"unethical,\" but finally published in the journal <i>Endoscopy<\/i>.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<p>The abstract of his paper on endoscopic appendectomy can be found at here.\nSemm established several standard procedures that were regularly performed, such as ovarian cyst enucleation, myomectomy, treatment of ectopic pregnancy and finally laparoscopic-assisted vaginal hysterectomy (nowadays termed as cervical intra-fascial Semm hysterectomy). He also developed a medical instrument company Wisap in Munich, Germany, which still produces various endoscopic instruments of high quality. In 1985, he constructed the pelvi-trainer = laparo-trainer, a practical surgical model whereby colleagues could practice laparoscopic techniques. Semm published over 1000 papers in various journals.[4] He also produced over 30 endoscopic films and more than 20,000 colored slides to teach and inform interested colleagues about his technique. His first atlas, <i>More Details on Pelviscopy and Hysteroscopy<\/i> was published in 1976, a slide atlas on pelviscopy, hysteroscopy, and fetoscopy in 1979, and his books on gynecological endoscopic surgery in German, English, and many other languages in 1984, 1987, and 2002.\n<\/p>\n<\/p><p>Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation. The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made general surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons continue to use the single clip appliers as they save as much as $200 per case for the patient, detract nothing from the quality of the clip ligation, and add only seconds to case lengths. It must be noted that both laparoscopy tubal ligations and cholecystectomies may be performed using suturing and tying, thus further reducing the expensive cost of single and multiclips (when compared to suture). Once again this may increase case lengths but costs are greatly reduced (ideal for developing countries) and widespread accidents of loose clips are eliminated.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Gynecological_diagnosis\">Gynecological diagnosis<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fertiloscope\" title=\"Fertiloscope\" rel=\"external_link\" target=\"_blank\">Fertiloscope<\/a><\/div>\n<p>In gynecology, diagnostic laparoscopy may be used to inspect the outside of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovaries\" class=\"mw-redirect\" title=\"Ovaries\" rel=\"external_link\" target=\"_blank\">ovaries<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fallopian_tubes\" class=\"mw-redirect\" title=\"Fallopian tubes\" rel=\"external_link\" target=\"_blank\">fallopian tubes<\/a>, as, for example, in the diagnosis of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Female_infertility\" title=\"Female infertility\" rel=\"external_link\" target=\"_blank\">female infertility<\/a>. Usually, one incision is placed near the navel and a second near the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pubic_hair\" title=\"Pubic hair\" rel=\"external_link\" target=\"_blank\">pubic hairline<\/a>. A special type of laparoscope called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fertiloscope\" title=\"Fertiloscope\" rel=\"external_link\" target=\"_blank\">fertiloscope<\/a>, which is modified for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transvaginal\" class=\"mw-disambig\" title=\"Transvaginal\" rel=\"external_link\" target=\"_blank\">transvaginal<\/a> application, can be used. A dye test may be performed to detect any blockage in the reproductive tract, wherein a dark blue dye is passed up through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a> and is followed with the laparoscope through its passage out into the fallopian tubes to the ovaries.<sup id=\"rdp-ebb-cite_ref-medlineplus_1-1\" class=\"reference\"><a href=\"#cite_note-medlineplus-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopic_surgery\" class=\"mw-redirect\" title=\"Arthroscopic surgery\" rel=\"external_link\" target=\"_blank\">Arthroscopic surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparotomy\" title=\"Laparotomy\" rel=\"external_link\" target=\"_blank\">Laparotomy<\/a>, an older <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_surgery\" class=\"mw-redirect\" title=\"Open surgery\" rel=\"external_link\" target=\"_blank\">open surgery<\/a> technique for operations on the abdomen<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">Percutaneous<\/a> (surgery)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Invasiveness_of_surgical_procedures\" class=\"mw-redirect\" title=\"Invasiveness of surgical procedures\" rel=\"external_link\" target=\"_blank\">Invasiveness of surgical procedures<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Natural_orifice_translumenal_endoscopic_surgery\" class=\"mw-redirect\" title=\"Natural orifice translumenal endoscopic surgery\" rel=\"external_link\" target=\"_blank\">Natural orifice translumenal endoscopic surgery<\/a> (NOTES)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Revision_weight_loss_surgery\" title=\"Revision weight loss surgery\" rel=\"external_link\" target=\"_blank\">Revision weight loss surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Single_port_laparoscopy\" class=\"mw-redirect\" title=\"Single port laparoscopy\" rel=\"external_link\" target=\"_blank\">Single port laparoscopy<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-medlineplus-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-medlineplus_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-medlineplus_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/007016.htm\" target=\"_blank\">MedlinePlus > Laparoscopy<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110726093257\/http:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/007016.htm\" target=\"_blank\">Archived<\/a> 2011-07-26 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. Update Date: 8\/21\/2009. Updated by: James Lee, MD \/\/ No longer valid <\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mastery of Endoscopic and Laparoscopic Surgery W. Stephen, M.D. Eubanks; Steve Eubanks (Editor); Lee L., M.D. Swanstrom (Editor); Nathaniel J. Soper (Editor) Lippincott Williams & Wilkins 2nd Edition 2004<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gfmer.ch\/Books\/Endoscopy_book\/Ch07_Training_Lap.html\" target=\"_blank\">\"Training in diagnostic laparoscopy\"<\/a>. Gfmer.ch. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140714210530\/http:\/\/www.gfmer.ch\/Books\/Endoscopy_book\/Ch07_Training_Lap.html\" target=\"_blank\">Archived<\/a> from the original on July 14, 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 10,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Training+in+diagnostic+laparoscopy&rft.pub=Gfmer.ch&rft_id=http%3A%2F%2Fwww.gfmer.ch%2FBooks%2FEndoscopy_book%2FCh07_Training_Lap.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bhandarkar, Deepraj; Mittal, Gaurav; Shah, Rasik; Katara, Avinash; Udwadia, Tehemton E (January 1, 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3002000\" target=\"_blank\">\"Single-incision laparoscopic cholecystectomy: How I do it?\"<\/a>. <i>Journal of Minimal Access Surgery<\/i>. <b>7<\/b> (1): 17\u201323. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0972-9941.72367\" target=\"_blank\">10.4103\/0972-9941.72367<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0972-9941\" target=\"_blank\">0972-9941<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3002000\" target=\"_blank\">3002000<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21197237\" target=\"_blank\">21197237<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Minimal+Access+Surgery&rft.atitle=Single-incision+laparoscopic+cholecystectomy%3A+How+I+do+it%3F&rft.volume=7&rft.issue=1&rft.pages=17-23&rft.date=2011-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3002000&rft.issn=0972-9941&rft_id=info%3Apmid%2F21197237&rft_id=info%3Adoi%2F10.4103%2F0972-9941.72367&rft.aulast=Bhandarkar&rft.aufirst=Deepraj&rft.au=Mittal%2C+Gaurav&rft.au=Shah%2C+Rasik&rft.au=Katara%2C+Avinash&rft.au=Udwadia%2C+Tehemton+E&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3002000&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jimenez-Rodr\u00edguez, RM; Segura-Sampedro, JJ (February 2016). \"Laparoscopic approach in gastrointestinal emergencies\". <i>World Journal of Gastroenterology<\/i>. <b>22<\/b> (9): 2701. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3748%2Fwjg.v22.i9.2701\" target=\"_blank\">10.3748\/wjg.v22.i9.2701<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Journal+of+Gastroenterology&rft.atitle=Laparoscopic+approach+in+gastrointestinal+emergencies.&rft.volume=22&rft.issue=9&rft.pages=2701&rft.date=2016-02&rft_id=info%3Adoi%2F10.3748%2Fwjg.v22.i9.2701&rft.aulast=Jimenez-Rodr%C3%ADguez&rft.aufirst=RM&rft.au=Segura-Sampedro%2C+JJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Raveenthiran, V (October\u2013December 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jiaps.com\/article.asp?issn=0971-9261;year=2010;volume=15;issue=4;spage=122;epage=128;aulast=Raveenthiran\" target=\"_blank\">\"Pediatric laparoscopy: Facts and factitious claims\"<\/a>. <i>J Indian Assoc Pediatr Surg<\/i>. <b>15<\/b> (4): 122\u2013126. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0971-9261.72434\" target=\"_blank\">10.4103\/0971-9261.72434<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2995935\" target=\"_blank\">2995935<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21170193\" target=\"_blank\">21170193<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170903120905\/http:\/\/www.jiaps.com\/article.asp?issn=0971-9261;year=2010;volume=15;issue=4;spage=122;epage=128;aulast=Raveenthiran\" target=\"_blank\">Archived<\/a> from the original on 2017-09-03.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Indian+Assoc+Pediatr+Surg&rft.atitle=Pediatric+laparoscopy%3A+Facts+and+factitious+claims&rft.volume=15&rft.issue=4&rft.pages=122-126&rft.date=2010-10%2F2010-12&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2995935&rft_id=info%3Apmid%2F21170193&rft_id=info%3Adoi%2F10.4103%2F0971-9261.72434&rft.aulast=Raveenthiran&rft.aufirst=V&rft_id=http%3A%2F%2Fwww.jiaps.com%2Farticle.asp%3Fissn%3D0971-9261%3Byear%3D2010%3Bvolume%3D15%3Bissue%3D4%3Bspage%3D122%3Bepage%3D128%3Baulast%3DRaveenthiran&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Westebring-van der Putten EP; Goossens RHM; Jakimowicz JJ; Dankelman J (2008). \"Haptics in Minimally Invasive Surgery \u2013 A Review\". <i>Minimally Invasive Therapy<\/i>. <b>17<\/b> (1): 3\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F13645700701820242\" target=\"_blank\">10.1080\/13645700701820242<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Minimally+Invasive+Therapy&rft.atitle=Haptics+in+Minimally+Invasive+Surgery+%E2%80%93+A+Review&rft.volume=17&rft.issue=1&rft.pages=3-16&rft.date=2008&rft_id=info%3Adoi%2F10.1080%2F13645700701820242&rft.au=Westebring-van+der+Putten+EP&rft.au=Goossens+RHM&rft.au=Jakimowicz+JJ&rft.au=Dankelman+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">A. G. Gallagher; N. McClure; J. McGuigan; K. Ritchie; N. P. Sheehy (2007). \"An Ergonomic Analysis of the Fulcrum Effect in the Acquisition of Endoscopic Skills\". <i>Endoscopy<\/i>. <b>1<\/b> (7): 617\u2013620. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1055%2Fs-2007-1001366\" target=\"_blank\">10.1055\/s-2007-1001366<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Endoscopy&rft.atitle=An+Ergonomic+Analysis+of+the+Fulcrum+Effect+in+the+Acquisition+of+Endoscopic+Skills&rft.volume=1&rft.issue=7&rft.pages=617-620&rft.date=2007&rft_id=info%3Adoi%2F10.1055%2Fs-2007-1001366&rft.au=A.+G.+Gallagher&rft.au=N.+McClure&rft.au=J.+McGuigan&rft.au=K.+Ritchie&rft.au=N.+P.+Sheehy&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rodriguez, Anthony, Carpel Tunnel Surgery in Review, Beklind, 2009p.234<\/span>\n<\/li>\n<li id=\"cite_note-MayolGarcia-Aguilar1997-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MayolGarcia-Aguilar1997_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mayol, Julio; Garcia-Aguilar, Julio; Ortiz-Oshiro, Elena; De-Diego Carmona, Jose A.; Fernandez-Represa, Jesus A. (1997). \"Risks of the Minimal Access Approach for Laparoscopic Surgery: Multivariate Analysis of Morbidity Related to Umbilical Trocar Insertion\". <i>World Journal of Surgery<\/i>. <b>21<\/b> (5): 529\u2013533. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FPL00012281\" target=\"_blank\">10.1007\/PL00012281<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0364-2313\" target=\"_blank\">0364-2313<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Journal+of+Surgery&rft.atitle=Risks+of+the+Minimal+Access+Approach+for+Laparoscopic+Surgery%3A+Multivariate+Analysis+of+Morbidity+Related+to+Umbilical+Trocar+Insertion&rft.volume=21&rft.issue=5&rft.pages=529-533&rft.date=1997&rft_id=info%3Adoi%2F10.1007%2FPL00012281&rft.issn=0364-2313&rft.aulast=Mayol&rft.aufirst=Julio&rft.au=Garcia-Aguilar%2C+Julio&rft.au=Ortiz-Oshiro%2C+Elena&rft.au=De-Diego+Carmona%2C+Jose+A.&rft.au=Fernandez-Represa%2C+Jesus+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S (September 1998). \"Predicting risk of complications with gynecologic laparoscopic surgery\". <i>Obstet Gynecol<\/i>. <b>92<\/b> (3): 327\u201331. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0029-7844%2898%2900209-9\" target=\"_blank\">10.1016\/S0029-7844(98)00209-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9721764\" target=\"_blank\">9721764<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstet+Gynecol&rft.atitle=Predicting+risk+of+complications+with+gynecologic+laparoscopic+surgery&rft.volume=92&rft.issue=3&rft.pages=327-31&rft.date=1998-09&rft_id=info%3Adoi%2F10.1016%2FS0029-7844%2898%2900209-9&rft_id=info%3Apmid%2F9721764&rft.aulast=Mirhashemi&rft.aufirst=R&rft.au=Harlow%2C+BL&rft.au=Ginsburg%2C+ES&rft.au=Signorello%2C+LB&rft.au=Berkowitz%2C+R&rft.au=Feldman%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Janie Fuller, DDS, (CAPT, USPHS), Walter Scott, Ph.D. (CAPT, USPHS), Binita Ashar, M.D., Julia Corrado, M.D. FDA, CDRH, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/medicaldevicesafety\/stamp\/trocar.html\" target=\"_blank\">\"Laparoscopic Trocar Injuries: A report from a U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070823235514\/http:\/\/www.fda.gov\/cdrh\/medicaldevicesafety\/stamp\/trocar.html\" target=\"_blank\">Archived<\/a> 2007-08-23 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.\n Finalized: November 7, 2003<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (January 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022-4804(08)00245-X\" target=\"_blank\">\"Heated and humidified <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\"<\/a>. <i>J. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/link.springer.com\/article\/10.1007\/s10397-007\u20130338-x\" target=\"_blank\">the original<\/a> on 2013-07-11.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gynecological+Surgery&rft.atitle=Postoperative+abdominal+adhesions+and+their+prevention+in+gynaecological+surgery.+Expert+consensus+position&rft.volume=4&rft.issue=3&rft.pages=161-168&rft.date=2007-09&rft_id=info%3Adoi%2F10.1007%2Fs10397-007-0338-x&rft.aulast=DeWilde&rft.aufirst=Rudy+Leon&rft.au=Geoffrey+Trew&rft_id=https%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs10397-007%E2%80%930338-x&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lower, A.M.; R.J.S. 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Crowe (2004). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/humrep.oxfordjournals.org\/content\/19\/8\/1877.short\" target=\"_blank\">\"Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24\u2009046 patients\"<\/a>. <i>Human Reproduction<\/i>. <b>19<\/b> (8): 1877\u20131885. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fhumrep%2Fdeh321\" target=\"_blank\">10.1093\/humrep\/deh321<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15178659\" target=\"_blank\">15178659<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160208132713\/http:\/\/humrep.oxfordjournals.org\/content\/19\/8\/1877.short\" target=\"_blank\">Archived<\/a> from the original on 2016-02-08.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Human+Reproduction&rft.atitle=Adhesion-related+readmissions+following+gynaecological+laparoscopy+or+laparotomy+in+Scotland%3A+an+epidemiological+study+of+24%E2%80%89046+patients&rft.volume=19&rft.issue=8&rft.pages=1877-1885&rft.date=2004&rft_id=info%3Adoi%2F10.1093%2Fhumrep%2Fdeh321&rft_id=info%3Apmid%2F15178659&rft.aulast=Lower&rft.aufirst=A.M.&rft.au=R.J.S.+Hawthorn&rft.au=D.+Clark&rft.au=J.H.+Boyd&rft.au=A.R.+Finlayson&rft.au=A.D.+Knight&rft.au=A.M.+Crowe&rft_id=http%3A%2F%2Fhumrep.oxfordjournals.org%2Fcontent%2F19%2F8%2F1877.short&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Peng, Y; Zheng M; Ye Q; Chen X; Yu B; Liu B (Jan 2009). \"Heated and Humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\". <i>J Surg Res<\/i>. <b>151<\/b> (1): 40\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jss.2008.03.039\" target=\"_blank\">10.1016\/j.jss.2008.03.039<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18639246\" target=\"_blank\">18639246<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Surg+Res&rft.atitle=Heated+and+Humidified+CO2+prevents+hypothermia%2C+peritoneal+injury%2C+and+intra-abdominal+adhesions+during+prolonged+laparoscopic+insufflations.&rft.volume=151&rft.issue=1&rft.pages=40-7&rft.date=2009-01&rft_id=info%3Adoi%2F10.1016%2Fj.jss.2008.03.039&rft_id=info%3Apmid%2F18639246&rft.aulast=Peng&rft.aufirst=Y&rft.au=Zheng+M&rft.au=Ye+Q&rft.au=Chen+X&rft.au=Yu+B&rft.au=Liu+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ahmed K, Keeling AN, Fakhry M, et al. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Fertil.+Steril.&rft.atitle=Laparoscopy%E2%80%94new+instruments+for+suturing+and+ligation&rft.volume=23&rft.issue=4&rft.pages=274-7&rft.date=1972-04&rft_id=info%3Adoi%2F10.1016%2FS0015-0282%2816%2938886-0&rft_id=info%3Apmid%2F4258561&rft.au=Clarke+HC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tarasconi JC (October 1981). \"Endoscopic salpingectomy\". <i>J Reprod Med<\/i>. <b>26<\/b> (10): 541\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6458700\" target=\"_blank\">6458700<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Reprod+Med&rft.atitle=Endoscopic+salpingectomy&rft.volume=26&rft.issue=10&rft.pages=541-5&rft.date=1981-10&rft_id=info%3Apmid%2F6458700&rft.au=Tarasconi+JC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Semm K (March 1983). \"Endoscopic Appendectomy\". <i>Endoscopy<\/i>. <b>15<\/b> (2): 59\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1055%2Fs-2007-1021466\" target=\"_blank\">10.1055\/s-2007-1021466<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6221925\" target=\"_blank\">6221925<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Endoscopy&rft.atitle=Endoscopic+Appendectomy&rft.volume=15&rft.issue=2&rft.pages=59-64&rft.date=1983-03&rft_id=info%3Adoi%2F10.1055%2Fs-2007-1021466&rft_id=info%3Apmid%2F6221925&rft.au=Semm+K&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li>Feder, Barnaby J., <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2006\/03\/17\/business\/17spark.html\" target=\"_blank\">\"Surgical Device Poses a Rare but Serious Peril\"<\/a> <i>The New York Times<\/i>, March 17, 2006<\/li><\/ul>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181216173846\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.600 seconds\nReal time usage: 0.747 seconds\nPreprocessor visited node count: 3651\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 159571\/2097152 bytes\nTemplate argument size: 6750\/2097152 bytes\nHighest expansion depth: 16\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 61816\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.333\/10.000 seconds\nLua memory usage: 6.63 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 623.648 1 -total\n<\/p>\n<pre>42.34% 264.059 1 Template:Reflist\n22.87% 142.659 18 Template:Cite_journal\n20.02% 124.861 10 Template:Citation_needed\n17.64% 109.984 10 Template:Fix\n12.23% 76.280 1 Template:Infobox_medical_intervention\n11.86% 73.981 1 Template:Cite_web\n11.45% 71.431 1 Template:Infobox\n 8.84% 55.132 20 Template:Category_handler\n 7.49% 46.683 10 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:68469-1!canonical and timestamp 20181216173845 and revision id 874024329\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214704\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.178 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 169.417 1 - wikipedia:Laparoscopic_surgery\n100.00% 169.417 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8568-0!*!*!*!*!*!* and timestamp 20181217214703 and revision id 24996\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery\">https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","bc5b7003f9b6b64085881e0e1ffa3d21_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Blausen_0602_Laparoscopy_02.png\/560px-Blausen_0602_Laparoscopy_02.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/440px-Gallbladderop.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/Laparoscopic_stomach_surgery.jpg\/440px-Laparoscopic_stomach_surgery.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b4\/Laparoscopic_Hand_Instruments_001_JPN.jpg\/440px-Laparoscopic_Hand_Instruments_001_JPN.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/440px-Laproscopic_Surgery_Robot.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9d\/Jacbaeus.JPG\/280px-Jacbaeus.JPG"],"bc5b7003f9b6b64085881e0e1ffa3d21_timestamp":1545083223,"94395468e1f4b75d1b8f25455b04879e_type":"article","94395468e1f4b75d1b8f25455b04879e_title":"Irreversible electroporation","94395468e1f4b75d1b8f25455b04879e_url":"https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation","94395468e1f4b75d1b8f25455b04879e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tIrreversible electroporation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (August 2013)\nIrreversible electroporationSpecialtyoncology[edit on Wikidata]\nIrreversible electroporation (IRE or NTIRE for non-thermal irreversible electroporation) is a soft tissue ablation technique using ultra short but strong electrical fields to create permanent and hence lethal nanopores in the cell membrane, to disrupt the cellular homeostasis. The resulting cell death results from apoptosis and not necrosis as in all other thermal or radiation based ablation techniques. The main use of IRE lies in tumor ablation in regions where precision and conservation of the extracellular matrix, blood flow and nerves are of importance. The technique, in the form of the NanoKnife System, became commercially available for research purposes in 2009, solely for the surgical ablation of soft tissue tumors.[1]\n\nContents \n\n1 History \n2 Mechanism \n3 Potential advantages and disadvantages \n\n3.1 Advantages of IRE \n3.2 Disadvantages of IRE \n\n\n4 Use in medical practice \n5 Clinical trials \n6 Scope of applications \n\n6.1 Kidney \n6.2 Liver \n6.3 Pancreas \n6.4 Lung \n6.5 Prostate \n6.6 Coronary arteries \n6.7 Pulmonary veins \n6.8 Other organs \n\n\n7 References \n8 Further reading \n\n\nHistory \nFirst observations of IRE effects go back to 1898.[2] Nollet reported the first systematic observations of the appearance of red spots on animal and human skin that was exposed to electric sparks.[3] However, its use for modern medicine began in 1982 with the seminal work of Neumann and colleagues.[4] Pulsed electric fields were used to temporarily permeabilize cell membranes to deliver foreign DNA into cells. In the following decade, the combination of high-voltage pulsed electric fields with the chemotherapeutic drug bleomycin and with DNA yielded novel clinical applications: electrochemotherapy and gene electrotransfer, respectively.[5][6][7][8][9]\nIn these treatment modalities, IRE was an unwanted side effect to reversible electroporation. In 2005, Davalos et al. described the first study of a potential use of IRE.[10]\n\nMechanism \nFurther information: Electroporation \u00a7 Physical mechanism\nUtilizing ultra short pulsed but very strong electrical fields, micropores and nanopores are induced in the phospholipid bilayers which form the outer cell membranes. Two kinds of damage can occur:\n\nReversible electroporation (RE): Temporary and limited pathways for molecular transport via nanopores are formed, but after the end of the electric pulse, the transport ceases and the cells remain viable. Medical applications are, for example, local introduction of intracellular cytotoxic pharmaceuticals such as bleomycin (electroporation and electrochemotherapy).\nIrreversible electroporation (IRE): After a certain degree of damage to the cell membranes by electroporation, the leakage of intracellular contents is too severe or the resealing of the cellular membrane is too slow, leaving healthy and\/or cancerous cells irreversibly damaged. They die by apoptosis, which is unique to this ablation technique, in opposition to all other ablation systems which induce necrosis either by heat or radiation.\nIt should be stated that even though the ablation method is generally accepted to be apoptosis, some findings seem to contradict a pure apoptotic cell death, making the exact process by which IRE causes cell death unclear.[11]\nThe mechanism of IRE is not completely understood. The current theory is as follows:[12]\nWhen an electrical field of more than 0.5 V\/nm[13] is applied to the resting trans-membrane potential, it is proposed that water enters the cell during this dielectric breakdown. Hydrophilic pores are formed.[14][15] A molecular dynamics simulation by Tarek[16] illustrates this proposed pore formation in two steps:[12]\n\nAfter the application of an electrical field, water molecules line up in single file and penetrate the hydrophobic center of the bilayer lipid membrane.\nThese water channels continue to grow in length and diameter and expand into water-filled pores, at which point they are stabilized by the lipid head groups that move from the membrane-water interface to the middle of the bilayer.\nIt is proposed that as the applied electrical field increases, the greater is the perturbation of the phospholipid head groups, which in turn increases the number of water filled pores.[17] This entire process can occur within a few nanoseconds.[16] Average sizes of nanopores are likely cell-type specific. In swine livers, they average around 340-360 nm, as found using SEM.[12]\n\nPotential advantages and disadvantages \nAdvantages of IRE \nTissue selectivity - conservation of vital structures within the treatment field. Its capability of preserving vital structures within the IRE-ablated zone. In all IRE ablated liver tissues, critical structures, such as the hepatic arteries, hepatic veins, portal veins and intrahepatic bile ducts were all preserved. In IRE the cell death is mediated by apoptosis. Structures mainly consisting of proteins like vascular elastic and collagenous structures, as well as peri-cellular matrix proteins are not affected by the currents. Vital and scaffolding structures (like large blood vessels, urethra or intrahepatic bile ducts) are conserved.[18] The electrically insulating myelin layer, surrounding nerve fibers, protects nerve bundles from the IRE effects to a certain degree. Up to what point nerves stay unaffected or can regenerate is not completely understood.[19]\nSharp ablation zone margins- The transition zone between reversible electroporated area and irreversible electroporated area is accepted to be only a few cell layers. Whereas, the transition areas as in radiation or thermal based ablation techniques are non-existent. Further, the absence of the heat sink effect, which is a cause of many problems and treatment failures, is advantageous and increases the predictability of the treatment field. Geometrically, rather complex treatment fields are enabled by the multi-electrode concept.[20]\nAbsence of thermally induced necrosis - The short pulse lengths relative to the time between the pulses prevents joule heating of the tissue. Hence, by design, no necrotic cell damage is to be expected (except possibly in very close proximity to the needle). Therefore, IRE has none of the typical short and long term side-effects associated with necrosis.[21][22]\nShort treatment time - A typical treatment takes less than 5 minutes. This does not include the possibly complicated electrode placement.\nReal time monitoring - The treatment volume can be visualized, both during and after the treatment. Possible visualization methods are ultrasound, MRI, and CT.[20]\nDisadvantages of IRE \nStrong muscle contractions - The strong electric fields created by IRE, due to direct stimulation of the neuromuscular junction, cause strong muscle contractions requiring special anesthesia and total body paralysis.[23]\nIncomplete ablation within targeted tumors- The originally threshold for IRE of cells was approximately 600 V\/cm with 8 pulses, a pulse duration of 100 \u03bcs, and a frequency of 10 Hz.[24] Qin et al. later discovered that even at 1,300 V\/cm with 99 pulses, a pulse duration of 100 \u03bcs, and 10 Hz, there were still islands of viable tumor cells within ablated regions.[25] This suggests that tumor tissue may respond differently to IRE than healthy parenchyma. The mechanism of cell death following IRE relies on cellular apoptosis, which results from pore formation in the cellular membrane. Tumor cells, known to be resistant to apoptotic pathways, may require higher thresholds of energy to be adequately treated.\nLocal environment - The electric fields of IRE are strongly influenced by the conductivity of the local environment. The presence of metal, for example with biliary stents, can result in variances in energy deposition. Various organs, such as the kidneys, are also subject to irregular ablation zones, due to the increased conductivity of urine.[26]\nUse in medical practice \nA number of electrodes, in the form of long needles, are placed around the target volume. The point of penetration for the electrodes is chosen according to anatomical conditions. Imaging is essential to the placement and can be achieved by ultrasound, magnetic resonance imaging or tomography. The needles are then connected to the IRE-generator, which then proceeds to sequentially build up a potential difference between two electrodes. The geometry of the IRE-treatment field is calculated in real time and can be influenced by the user. Depending on the treatment-field and number of electrodes used, the ablation takes between 1 and 10 minutes. In general muscle relaxants are administered, since even under general anesthetics, strong muscle contractions are induced by excitation of the motor end-plate.\nTypical parameters:\n\nNumber of pulses per treatment: 90\nPulse length: 100 \u03bcs\nIntermission between pulses: 100 to 1000 ms\nField strength: 1500 volt\/cm\nCurrent: ca. 50 A (tissue- and geometry dependent)\nMax ablation volume using two electrodes: 4 \u00d7 3 \u00d7 2 cm\u00b3\nThe shortly pulsed, strong electrical fields are induced through thin, sterile, disposable electrodes. The potential differences are calculated and applied by a computer system between these electrodes in accordance to a previously planned treatment field.\nOne specific device for the IRE procedure is the NanoKnife system manufactured by AngioDynamics, which received FDA 510k clearance on October 24, 2011.[27] The NanoKnife system has also received an Investigational Device Exemption (IDE) from the FDA that allows AngioDynamics to conduct clinical trials using this device.[27] The Nanoknife system transmits a low-energy direct current from a generator to electrode probes placed in the target tissues for the surgical ablation of soft tissue. In 2011, AngioDynamics received an FDA warning letter for promoting the device for indications for which it had not received approval.[28]\nIn 2013, the UK National Institute for Health and Clinical Excellence issued a guidance that the safety and efficacy of the use of irreversible electroporation of the treatment of various types of cancer has not yet been established.[29]\n\nClinical trials \nNone of the potential organ systems, which may be treated for various conditions and tumors, are covered by randomized multicenter trials or long-term follow-ups.\nIn 2010, Ball and colleagues conducted a clinical trial evaluating IRE in 21 patients treated for metastatic or primary tumors of the liver, kidney, or lung. Two patients developed positional neurapraxia because of the extended arm position requested for CT scanning. Some patients developed self-limiting ventricular tachycardias, which are now minimized by using an electrocardiogram (ECG) synchronizer. Three patients developed pneumothorax as a result of needle electrode insertion. The authors concluded that an ECG synchronizer should be used to minimize the risk of arrhythmias and that attention to the position of the arms is required to maximize CT scan quality but minimize brachial plexus strain.[30]\nA larger, single-center, prospective, non-randomized, cohort study to investigate the safety of IRE for tumor ablation in humans evaluated 38 subjects with advanced malignancy of the liver, kidney, or lung (69 separate tumors) which were unresponsive to alternative treatment. The authors reported no mortalities within the 30 days post-procedure. Transient ventricular arrhythmia occurred in four patients; ECG synchronized delivery was subsequently used in the remaining 30 patients, with two further arrhythmias (supraventricular tachycardia and atrial fibrillation). There was one report of obstruction of the upper ureter after IRE, in addition to one report of the unintentional electroporation of an adrenal gland, resulting in a transient, severe hypertension. Two patients developed temporary neurapraxia secondary to arm extension during treatment, The authors further noted that complete target tumor ablation verified by CT was achieved in 46 of the 69 tumors treated with IRE (66%), while most treatment failures occurred in renal and lung tumors. The authors concluded that IRE appears safe for clinical use if ECG-synchronized delivery is utilized to prevent arrhythmias.[31]\n\nScope of applications \nKidney \nWhile nephron-sparing surgery is the gold standard treatment for small, malignant renal masses, ablative therapies are considered a viable option in patients who are poor surgical candidates. Radiofrequency ablation (RFA) and cryoablation have been used since the 1990s; however, in lesions larger than 3 cm, their efficacy is limited. The newer ablation modalities, such as IRE, microwave ablation (MWA), and high-intensity focused ultrasound, may help overcome the challenges in tumor size.[32]\nThe first human studies have proven the safety of IRE for the ablation of renal masses; however, the effectiveness of IRE through histopathological examination of an ablated renal tumor in humans is yet to be known. Wagstaff et al. have set out to investigate the safety and effectiveness of IRE ablation of renal masses and to evaluate the efficacy of ablation using MIR and contrast-enhanced ultrasound imaging. In accordance with the prospective protocol designed by the authors, the treated patients will subsequently undergo radical nephrectomy to assess IRE ablation success.[33]\n\nLiver \nThermal ablation techniques are very effective at treating liver tumors; however, many tumors are poorly amenable to thermal ablation due to their proximity to large blood vessels or major bile ducts, that render ablation ineffective or dangerous.[34]\nIn a single-center, prospective, non-randomized cohort, the safety of IRE of liver lesions was assessed in 25 patients. The authors reported a 50% tumor response rate, and noted that IRE failed to have any effect on tumors larger than 5 cm in any dimension. There were no reports of liver damage in any of the patients treated.[31] The trend of larger tumors being incompletely ablated using IRE has persisted across other studies.[35]\n\nPancreas \nPercutaneous thermal ablation of the pancreas was first described in 1999; however, subsequent review concluded that RFA in this setting has an unacceptably high complication rate without a clear benefit in survival.[36][37] The non-thermal mechanism of cell death from IRE and the safety and feasibility seen in animal models, suggests that it may be a more reasonable option.[38]\nMartin et al. evaluated overall survival in 54 patients with local pancreatic adenocarcinoma; they compared their IRE-treated cohort to matched stage III patients treated with standard therapy. They found a statistically significant increase in local progression-free survival, distant progression-free survival, and overall survival, amongst the patients treated with IRE.[39]\n\nLung \nIn a prospective, single-arm, multi-center, phase II clinical trial, the safety and efficacy of IRE on lung cancers were evaluated. The trial included patients with primary and secondary lung malignancies and preserved lung function. The expected effectiveness was not met at interim analysis and the trial was stopped prematurely. Complications included pneumothoraces (11 of 23 patients), alveolar hemorrhage not resulting in significant hemoptysis, and needle tract seeding was found in 3 cases (13%). Disease progression was seen in 14 of 23 patients (61%). Stable disease was found in 1 (4%), partial remission in 1 (4%) and complete remission in 7 (30%) patients. The authors concluded that IRE is not effective for the treatment of lung malignancies.[40] Similarly poor treatment outcomes have been observed in other studies.[31][41]\nA major obstacle of IRE in the lung is the difficulty in positioning the electrodes; placing the probes in parallel alignment is made challenging by the interposition of ribs. Additionally, the planned and actual ablation zones in the lung are dramatically different due to the differences in conductivity between tumor, lung parenchyma, and air.[42]\n\nProstate \nThe idea of treating prostate cancer with IRE was first proposed by Gary Onik and Boris Rubinsky in 2007.[43] Prostate carcinomas are frequently located near sensitive structures which might be permanently damaged by thermal treatments or radiation therapy. The applicability of surgical methods is often limited by accessibility and precision. Surgery is also associated with a long healing time and high rate of side effects.[44] Using IRE, the urethra, bladder, rectum and neurovascular bundle can potentially be included in the treatment field without creating (permanent) damage. This would potentially give IRE superiority both for focal therapy and whole gland treatments, as compared to all other available methods. Though treatments using IRE have been practiced successfully for more than three years, it has to be considered experimental since there are no multi-center studies or long-term follow-ups.\nThe first study including 16 patients (Gleason-Score ranging from 6 to 8) was released in 2010 by G. Onik and B. Rubinsky.[45] Most publicly and broadly, IRE has been used for prostate carcinomas by M. K. Stehling in Germany.[46] In the UK, Dickson et al. have been using IRE for Gleason 6 and 7 carcinomas and reported positively about its safety and low toxicity.[47]\n\nCoronary arteries \nMaor et el have demonstrated the safety and efficiency of IRE as an ablation modality for smooth muscle cells in the walls of large vessels in rat model.[48] Therefore, IRE has been suggested as preventive treatment for coronary artery re-stenosis after percutaneous coronary intervention.\n\nPulmonary veins \nNumerous studies in animals have demonstrated the safety and efficiency of IRE as a non-thermal ablation modality for pulmonary veins in context of atrial fibrillation treatment. IRE's advantages in comparison with RF-ablation and cryoablation are: well defined ablation area and the lack of peripheral thermal damage. Therefore, IRE has been suggested as a part of novel treatment for atrial fibrillation.[49]\n\nOther organs \nIRE has also been investigated in ex-vivo human eye models for treatment of uveal melanoma[50] and in thyroid cancer.[51]\nSuccessful ablations in animal tumor models have been conducted for lung,[52][53] brain,[54][55] heart,[56] skin,[57][58] bone,[59][60] head and neck cancer,[61] and blood vessels.[62]\n\nReferences \n\n\n^ Boutros, Cherif. \"Outcomes of Ablation of Unresectable Pancreatic Cancer Using the NanoKnife Irreversible Electroporation (IRE) System\". Clinical Trials.gov. US National Library of Medicine. Retrieved 26 December 2017 . \n\n^ Fuller GW (1898). Report on the investigations into the purification of the Ohio River water: at Louisville, Kentucky, made to the president and directors of the Louisville Water Company. (Report). Louisville Water Company (Louisville Ky.) \n\n^ Nollet JA (1754). 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Current evidence on the safety and efficacy of irreversible electroporation for treating primary lung cancer and metastases in the lung is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. \n\n^ Ball, Christine; Thomson, Kenneth R.; Kavnoudias, Helen (2010). \"Irreversible Electroporation\". Anesthesia & Analgesia. 110 (5): 1305\u20131309. doi:10.1213\/ane.0b013e3181d27b30. PMID 20142349. \n\n^ a b c Thomson, Kenneth R.; Cheung, Wa; Ellis, Samantha J.; Federman, Dean; Kavnoudias, Helen; Loader-Oliver, Deirdre; Roberts, Stuart; Evans, Peter; Ball, Christine (May 2011). \"Investigation of the Safety of Irreversible Electroporation in Humans\". Journal of Vascular and Interventional Radiology. 22 (5): 611\u2013621. doi:10.1016\/j.jvir.2010.12.014. PMID 21439847. \n\n^ Olweny, Ephrem O.; Cadeddu, Jeffrey A. (2012). \"Novel methods for renal tissue ablation\". 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PMID 19560023. \n\n^ Cannon, Robert; Ellis, Susan; Hayes, David; Narayanan, Govindarajan; Martin, Robert C.G. (2013-04-01). \"Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures\". Journal of Surgical Oncology. 107 (5): 544\u2013549. doi:10.1002\/jso.23280. ISSN 1096-9098. PMID 23090720. \n\n^ Goldberg, S. N.; Mallery, S.; Gazelle, G. S.; Brugge, W. R. (1999-09-01). \"EUS-guided radiofrequency ablation in the pancreas: results in a porcine model\". Gastrointestinal Endoscopy. 50 (3): 392\u2013401. doi:10.1053\/ge.1999.v50.98847. ISSN 0016-5107. PMID 10462663. \n\n^ Pezzilli, Raffaele; Serra, Carla; Ricci, Claudio; Casadei, Riccardo; Monari, Francesco; D'Ambra, Marielda; Minni, Francesco (2011-01-01). \"Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review\". Pancreas. 40 (1): 163\u2013165. doi:10.1097\/MPA.0b013e3181eab751. ISSN 1536-4828. PMID 21160378. \n\n^ Bower, Matthew; Sherwood, Leslie; Li, Yan; Martin, Robert (2011-07-01). \"Irreversible electroporation of the pancreas: Definitive local therapy without systemic effects\". Journal of Surgical Oncology. 104 (1): 22\u201328. doi:10.1002\/jso.21899. ISSN 1096-9098. PMID 21360714. \n\n^ Martin, Robert C. G.; McFarland, Kelli; Ellis, Susan; Velanovich, Vic (2013-12-01). \"Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival\". Annals of Surgical Oncology. 20 Suppl 3: S443\u2013449. doi:10.1245\/s10434-012-2736-1. ISSN 1534-4681. PMID 23128941. \n\n^ Ricke, Jens; J\u00fcrgens, Julian H. W.; Deschamps, Frederic; Tselikas, Lambros; Uhde, Katja; Kosiek, Ortrud; Baere, Thierry De (2015-01-22). \"Irreversible Electroporation (IRE) Fails to Demonstrate Efficacy in a Prospective Multicenter Phase II Trial on Lung Malignancies: The ALICE Trial\". CardioVascular and Interventional Radiology. 38 (2): 401\u2013408. doi:10.1007\/s00270-014-1049-0. ISSN 0174-1551. PMID 25609208. \n\n^ Usman, Mumal; Moore, William; Talati, Ronak; Watkins, Kevin; Bilfinger, Thomas V. (2012-06-01). \"Irreversible electroporation of lung neoplasm: a case series\". Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 18 (6): CS43\u201347. doi:10.12659\/msm.882888. ISSN 1643-3750. PMC 3560719 . PMID 22648257. \n\n^ Srimathveeravalli G, Wimmer T, Silk M; et al. (2013). \"Treatment planning considerations for IRE in the lung: placement of needle electrodes is critical\". J Vasc Interv Radiol. 24 (4): S22. doi:10.1016\/j.jvir.2013.01.047. CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) \n\n^ Onik, Gary; Mikus, Paul; Rubinsky, Boris (2007-08-01). \"Irreversible electroporation: implications for prostate ablation\". Technology in Cancer Research & Treatment. 6 (4): 295\u2013300. doi:10.1177\/153303460700600405. ISSN 1533-0346. PMID 17668936. \n\n^ Kasivisvanathan, V.; Emberton, M.; Ahmed, H. U. (2013-08-01). \"Focal therapy for prostate cancer: rationale and treatment opportunities\". Clinical Oncology. 25 (8): 461\u2013473. doi:10.1016\/j.clon.2013.05.002. ISSN 1433-2981. PMC 4042323 . PMID 23759249. \n\n^ Onik G, Rubinsky B (2009). \"Irreversible electroporation: first patient experience focal therapy of prostate cancer\". In Rubinsky B. Irreversible Electroporation (Series in Biomedical Engineering). Berlin: Springer. pp. 235\u2013247. ISBN 3-642-05419-6. \n\n^ M. K. Stehling: Adjunct Associate Professor of Radiology. Boston University School of Medicine \n\n^ Dickinson, C.L.; Valerio, M.; Ahmed, H.U.; Freeman, A.; Allen, C.; Emberton, M. (2013). \"584 Early clinical experience of focal therapy for localised prostate cancer using irreversible electroporation\". European Urology Supplements. 12 (1): e584. doi:10.1016\/s1569-9056(13)61067-2. \n\n^ Maor, Elad; Ivorra, Antoni; Rubinsky, Boris (2009-03-09). \"Non Thermal Irreversible Electroporation: Novel Technology for Vascular Smooth Muscle Cells Ablation\". PLoS ONE. 4 (3): e4757. doi:10.1371\/journal.pone.0004757. PMC 2650260 . PMID 19270746. \n\n^ Xie, Fei; Varghese, Frency; Pakhomov, Andrei G.; Semenov, Iurii; Xiao, Shu; Philpott, Jonathan; Zemlin, Christian (2015-12-14). \"Ablation of Myocardial Tissue With Nanosecond Pulsed Electric Fields\". PLoS ONE. 10 (12): e0144833. doi:10.1371\/journal.pone.0144833. PMC 4687652 . PMID 26658139. \n\n^ Mandel, Yossi; Laufer, Shlomi; Belkin, Michael; Rubinsky, Boris; Pe'er, Jacob; Frenkel, Shahar (2013-01-01). \"Irreversible electroporation of human primary uveal melanoma in enucleated eyes\". PLoS One. 8 (9): e71789. doi:10.1371\/journal.pone.0071789. ISSN 1932-6203. PMC 3764134 . PMID 24039721. \n\n^ Meijerink, Martijn R.; Scheffer, Hester J.; de Bree, Remco; Sedee, Robert-Jan (2015-08-01). \"Percutaneous Irreversible Electroporation for Recurrent Thyroid Cancer--A Case Report\". Journal of Vascular and Interventional Radiology: JVIR. 26 (8): 1180\u20131182. doi:10.1016\/j.jvir.2015.05.004. ISSN 1535-7732. PMID 26210244. \n\n^ Deodhar, Ajita; Monette, S\u00e9bastien; Jr, Gordon W. Single; Jr, William C. Hamilton; Thornton, Raymond H.; Sofocleous, Constantinos T.; Maybody, Majid; Solomon, Stephen B. (2011-03-31). \"Percutaneous Irreversible Electroporation Lung Ablation: Preliminary Results in a Porcine Model\". CardioVascular and Interventional Radiology. 34 (6): 1278\u20131287. doi:10.1007\/s00270-011-0143-9. ISSN 0174-1551. PMID 21455641. \n\n^ Dupuy, Damian E.; Aswad, Bassam; Ng, Thomas (2010-12-30). \"Irreversible Electroporation in a Swine Lung Model\". CardioVascular and Interventional Radiology. 34 (2): 391\u2013395. doi:10.1007\/s00270-010-0091-9. ISSN 0174-1551. PMID 21191587. \n\n^ Garcia, P. A.; Pancotto, T.; Rossmeisl, J. H.; Henao-Guerrero, N.; Gustafson, N. R.; Daniel, G. B.; Robertson, J. L.; Ellis, T. L.; Davalos, R. V. (2011-02-01). \"Non-Thermal Irreversible Electroporation (N-TIRE) and Adjuvant Fractionated Radiotherapeutic Multimodal Therapy for Intracranial Malignant Glioma in a Canine Patient\". Technology in Cancer Research & Treatment. 10 (1): 73\u201383. doi:10.7785\/tcrt.2012.500181. ISSN 1533-0346. PMC 4527477 . PMID 21214290. \n\n^ Garcia, Paulo A.; Jr, John H. Rossmeisl; Ii, Robert E. Neal; Ellis, Thomas L.; Olson, John D.; Henao-Guerrero, Natalia; Robertson, John; Davalos, Rafael V. (2010-07-29). \"Intracranial Nonthermal Irreversible Electroporation: In Vivo Analysis\". The Journal of Membrane Biology. 236 (1): 127\u2013136. CiteSeerX 10.1.1.679.527 . doi:10.1007\/s00232-010-9284-z. ISSN 0022-2631. PMID 20668843. \n\n^ Lavee, Jacob; Onik, Gary; Mikus, Paul; Rubinsky, Boris (2007). \"A Novel Nonthermal Energy Source for Surgical Epicardial Atrial Ablation: Irreversible Electroporation\". The Heart Surgery Forum. 10 (2): E162\u2013E167. doi:10.1532\/hsf98.20061202. PMID 17597044. \n\n^ Al-Sakere, Bassim; Andr\u00e9, Franck; Bernat, Claire; Connault, Elisabeth; Opolon, Paule; Davalos, Rafael V.; Rubinsky, Boris; Mir, Lluis M. (2007-11-07). \"Tumor Ablation with Irreversible Electroporation\". PLoS ONE. 2 (11): e1135. doi:10.1371\/journal.pone.0001135. PMC 2065844 . PMID 17989772. \n\n^ Calmels, L.; Al-Sakere, B.; Ruaud, J.-P.; Leroy-Willig, A.; Mir, L. M. (2012-12-01). \"In vivo MRI Follow-up of Murine Tumors Treated by Electrochemotherapy and other Electroporation-based Treatments\". Technology in Cancer Research & Treatment. 11 (6): 561\u2013570. doi:10.7785\/tcrt.2012.500270. ISSN 1533-0346. PMID 22712607. \n\n^ Fini, M.; Tschon, M.; Ronchetti, M.; Cavani, F.; Bianchi, G.; Mercuri, M.; Alberghini, M.; Cadossi, R. (2010-11-01). \"Ablation of bone cells by electroporation\". Bone & Joint Journal. 92-B (11): 1614\u20131620. doi:10.1302\/0301-620X.92B11.24664. ISSN 2049-4394. PMID 21037363. \n\n^ Fini M, Tschon M, Alberghini M, Bianchi G, Mercuri M, Campanacci L, Cavani F, Ronchett, de Terlizzi M, Cadossi R (2011). \"Cell electroporation in bone tissue\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 115\u2013127. ISBN 1-4419-8362-7. \n\n^ Wong D, Lee EW, Kee ST (2011). \"Translational research on irreversible electroporation: VX2 rabbit head and neck\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 231\u2013236. ISBN 1-4419-8362-7. \n\n^ Maor, Elad; Ivorra, Antoni; Rubinsky, Boris (2009-01-01). \"Non thermal irreversible electroporation: novel technology for vascular smooth muscle cells ablation\". PLoS One. 4 (3): e4757. doi:10.1371\/journal.pone.0004757. ISSN 1932-6203. PMC 2650260 . PMID 19270746. \n\n\nFurther reading \n\nRubinsky B (2009). Irreversible Electroporation (Series in Biomedical Engineering). Berlin: Springer. ISBN 978-3-642-05419-8. \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation\">https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:08.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 650 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","94395468e1f4b75d1b8f25455b04879e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Irreversible_electroporation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Irreversible electroporation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Irreversible electroporation<\/b> (<b>IRE<\/b> or <b>NTIRE<\/b> for <i><b>non-thermal irreversible electroporation<\/b><\/i>) is a soft tissue <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ablation#Medicine\" title=\"Ablation\" rel=\"external_link\" target=\"_blank\">ablation<\/a> technique using ultra short but strong <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_field\" title=\"Electric field\" rel=\"external_link\" target=\"_blank\">electrical fields<\/a> to create permanent and hence lethal nanopores in the cell membrane, to disrupt the cellular homeostasis. The resulting cell death results from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apoptosis\" title=\"Apoptosis\" rel=\"external_link\" target=\"_blank\">apoptosis<\/a> and not <a href=\"https:\/\/en.wikipedia.org\/wiki\/Necrosis\" title=\"Necrosis\" rel=\"external_link\" target=\"_blank\">necrosis<\/a> as in all other thermal or radiation based ablation techniques. The main use of IRE lies in tumor ablation in regions where precision and conservation of the extracellular matrix, blood flow and nerves are of importance. The technique, in the form of the NanoKnife System, became commercially available for research purposes in 2009, solely for the surgical ablation of soft tissue tumors.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>First observations of IRE effects go back to 1898.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Nollet reported the first systematic observations of the appearance of red spots on animal and human skin that was exposed to electric sparks.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> However, its use for modern medicine began in 1982 with the seminal work of Neumann and colleagues.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Pulsed electric fields were used to temporarily permeabilize cell membranes to deliver foreign DNA into cells. In the following decade, the combination of high-voltage pulsed electric fields with the chemotherapeutic drug bleomycin and with DNA yielded novel clinical applications: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrochemotherapy\" title=\"Electrochemotherapy\" rel=\"external_link\" target=\"_blank\">electrochemotherapy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gene_electrotransfer\" class=\"mw-redirect\" title=\"Gene electrotransfer\" rel=\"external_link\" target=\"_blank\">gene electrotransfer<\/a>, respectively.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>In these treatment modalities, IRE was an unwanted side effect to reversible electroporation. In 2005, Davalos et al. described the first study of a potential use of IRE.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroporation#Physical_mechanism\" title=\"Electroporation\" rel=\"external_link\" target=\"_blank\">Electroporation \u00a7 Physical mechanism<\/a><\/div>\n<p>Utilizing ultra short pulsed but very strong electrical fields, micropores and nanopores are induced in the phospholipid bilayers which form the outer cell membranes. Two kinds of damage can occur:\n<\/p>\n<ol><li>Reversible electroporation (RE): Temporary and limited pathways for molecular transport via nanopores are formed, but after the end of the electric pulse, the transport ceases and the cells remain viable. Medical applications are, for example, local introduction of intracellular cytotoxic pharmaceuticals such as bleomycin (electroporation and electrochemotherapy).<\/li>\n<li>Irreversible electroporation (IRE): After a certain degree of damage to the cell membranes by electroporation, the leakage of intracellular contents is too severe or the resealing of the cellular membrane is too slow, leaving healthy and\/or cancerous cells irreversibly damaged. They die by apoptosis, which is unique to this ablation technique, in opposition to all other ablation systems which induce necrosis either by heat or radiation.<\/li><\/ol>\n<p>It should be stated that even though the ablation method is generally accepted to be apoptosis, some findings seem to contradict a pure apoptotic cell death, making the exact process by which IRE causes cell death unclear.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>The mechanism of IRE is not completely understood. The current theory is as follows:<sup id=\"rdp-ebb-cite_ref-:0_12-0\" class=\"reference\"><a href=\"#cite_note-:0-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>When an electrical field of more than 0.5 V\/nm<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> is applied to the resting trans-membrane potential, it is proposed that water enters the cell during this dielectric breakdown. Hydrophilic pores are formed.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> A molecular dynamics simulation by Tarek<sup id=\"rdp-ebb-cite_ref-:1_16-0\" class=\"reference\"><a href=\"#cite_note-:1-16\" rel=\"external_link\">[16]<\/a><\/sup> illustrates this proposed pore formation in two steps:<sup id=\"rdp-ebb-cite_ref-:0_12-1\" class=\"reference\"><a href=\"#cite_note-:0-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<ol><li>After the application of an electrical field, water molecules line up in single file and penetrate the hydrophobic center of the bilayer lipid membrane.<\/li>\n<li>These water channels continue to grow in length and diameter and expand into water-filled pores, at which point they are stabilized by the lipid head groups that move from the membrane-water interface to the middle of the bilayer.<\/li><\/ol>\n<p>It is proposed that as the applied electrical field increases, the greater is the perturbation of the phospholipid head groups, which in turn increases the number of water filled pores.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> This entire process can occur within a few nanoseconds.<sup id=\"rdp-ebb-cite_ref-:1_16-1\" class=\"reference\"><a href=\"#cite_note-:1-16\" rel=\"external_link\">[16]<\/a><\/sup> Average sizes of nanopores are likely cell-type specific. In swine livers, they average around 340-360 nm, as found using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scanning_electron_microscopy\" class=\"mw-redirect\" title=\"Scanning electron microscopy\" rel=\"external_link\" target=\"_blank\">SEM<\/a>.<sup id=\"rdp-ebb-cite_ref-:0_12-2\" class=\"reference\"><a href=\"#cite_note-:0-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_advantages_and_disadvantages\">Potential advantages and disadvantages<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Advantages_of_IRE\">Advantages of IRE<\/span><\/h3>\n<ol><li>Tissue selectivity - conservation of vital structures within the treatment field. Its capability of preserving vital structures within the IRE-ablated zone. In all IRE ablated liver tissues, critical structures, such as the hepatic arteries, hepatic veins, portal veins and intrahepatic bile ducts were all preserved. In IRE the cell death is mediated by apoptosis. Structures mainly consisting of proteins like vascular elastic and collagenous structures, as well as peri-cellular matrix proteins are not affected by the currents. Vital and scaffolding structures (like large blood vessels, urethra or intrahepatic bile ducts) are conserved.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> The electrically insulating myelin layer, surrounding nerve fibers, protects nerve bundles from the IRE effects to a certain degree. Up to what point nerves stay unaffected or can regenerate is not completely understood.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><\/li>\n<li>Sharp ablation zone margins- The transition zone between reversible electroporated area and irreversible electroporated area is accepted to be only a few cell layers. Whereas, the transition areas as in radiation or thermal based ablation techniques are non-existent. Further, the absence of the heat sink effect, which is a cause of many problems and treatment failures, is advantageous and increases the predictability of the treatment field. Geometrically, rather complex treatment fields are enabled by the multi-electrode concept.<sup id=\"rdp-ebb-cite_ref-:2_20-0\" class=\"reference\"><a href=\"#cite_note-:2-20\" rel=\"external_link\">[20]<\/a><\/sup><\/li>\n<li>Absence of thermally induced necrosis - The short pulse lengths relative to the time between the pulses prevents joule heating of the tissue. Hence, by design, no necrotic cell damage is to be expected (except possibly in very close proximity to the needle). Therefore, IRE has none of the typical short and long term side-effects associated with necrosis.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><\/li>\n<li>Short treatment time - A typical treatment takes less than 5 minutes. This does not include the possibly complicated electrode placement.<\/li>\n<li>Real time monitoring - The treatment volume can be visualized, both during and after the treatment. Possible visualization methods are ultrasound, MRI, and CT.<sup id=\"rdp-ebb-cite_ref-:2_20-1\" class=\"reference\"><a href=\"#cite_note-:2-20\" rel=\"external_link\">[20]<\/a><\/sup><\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Disadvantages_of_IRE\">Disadvantages of IRE<\/span><\/h3>\n<ol><li>Strong muscle contractions - The strong electric fields created by IRE, due to direct stimulation of the neuromuscular junction, cause strong muscle contractions requiring special anesthesia and total body paralysis.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><\/li>\n<li>Incomplete ablation within targeted tumors- The originally threshold for IRE of cells was approximately 600 V\/cm with 8 pulses, a pulse duration of 100 \u03bcs, and a frequency of 10 Hz.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> Qin et al. later discovered that even at 1,300 V\/cm with 99 pulses, a pulse duration of 100 \u03bcs, and 10 Hz, there were still islands of viable tumor cells within ablated regions.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> This suggests that tumor tissue may respond differently to IRE than healthy parenchyma. The mechanism of cell death following IRE relies on cellular apoptosis, which results from pore formation in the cellular membrane. Tumor cells, known to be resistant to apoptotic pathways, may require higher thresholds of energy to be adequately treated.<\/li>\n<li>Local environment - The electric fields of IRE are strongly influenced by the conductivity of the local environment. The presence of metal, for example with biliary stents, can result in variances in energy deposition. Various organs, such as the kidneys, are also subject to irregular ablation zones, due to the increased conductivity of urine.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Use_in_medical_practice\">Use in medical practice<\/span><\/h2>\n<p>A number of electrodes, in the form of long needles, are placed around the target volume. The point of penetration for the electrodes is chosen according to anatomical conditions. Imaging is essential to the placement and can be achieved by ultrasound, magnetic resonance imaging or tomography. The needles are then connected to the IRE-generator, which then proceeds to sequentially build up a potential difference between two electrodes. The geometry of the IRE-treatment field is calculated in real time and can be influenced by the user. Depending on the treatment-field and number of electrodes used, the ablation takes between 1 and 10 minutes. In general muscle relaxants are administered, since even under general anesthetics, strong muscle contractions are induced by excitation of the motor end-plate.\n<\/p><p>Typical parameters:\n<\/p>\n<ul><li>Number of pulses per treatment: 90<\/li>\n<li>Pulse length: 100 \u03bcs<\/li>\n<li>Intermission between pulses: 100 to 1000 ms<\/li>\n<li>Field strength: 1500 volt\/cm<\/li>\n<li>Current: ca. 50 A (tissue- and geometry dependent)<\/li>\n<li>Max ablation volume using two electrodes: 4 \u00d7 3 \u00d7 2 cm\u00b3<\/li><\/ul>\n<p>The shortly pulsed, strong electrical fields are induced through thin, sterile, disposable electrodes. The potential differences are calculated and applied by a computer system between these electrodes in accordance to a previously planned treatment field.\n<\/p><p>One specific device for the IRE procedure is the NanoKnife system manufactured by AngioDynamics, which received FDA 510k clearance on October 24, 2011.<sup id=\"rdp-ebb-cite_ref-ReferenceA_27-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-27\" rel=\"external_link\">[27]<\/a><\/sup> The NanoKnife system has also received an Investigational Device Exemption (IDE) from the FDA that allows AngioDynamics to conduct clinical trials using this device.<sup id=\"rdp-ebb-cite_ref-ReferenceA_27-1\" class=\"reference\"><a href=\"#cite_note-ReferenceA-27\" rel=\"external_link\">[27]<\/a><\/sup> The Nanoknife system transmits a low-energy direct current from a generator to electrode probes placed in the target tissues for the surgical ablation of soft tissue. In 2011, AngioDynamics received an FDA warning letter for promoting the device for indications for which it had not received approval.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p><p>In 2013, the UK National Institute for Health and Clinical Excellence issued a guidance that the safety and efficacy of the use of irreversible electroporation of the treatment of various types of cancer has not yet been established.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Clinical_trials\">Clinical trials<\/span><\/h2>\n<p>None of the potential organ systems, which may be treated for various conditions and tumors, are covered by randomized multicenter trials or long-term follow-ups.\n<\/p><p>In 2010, Ball and colleagues conducted a clinical trial evaluating IRE in 21 patients treated for metastatic or primary tumors of the liver, kidney, or lung. Two patients developed positional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurapraxia\" title=\"Neurapraxia\" rel=\"external_link\" target=\"_blank\">neurapraxia<\/a> because of the extended arm position requested for CT scanning. Some patients developed self-limiting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_tachycardias\" class=\"mw-redirect\" title=\"Ventricular tachycardias\" rel=\"external_link\" target=\"_blank\">ventricular tachycardias<\/a>, which are now minimized by using an electrocardiogram (ECG) synchronizer. Three patients developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumothorax\" title=\"Pneumothorax\" rel=\"external_link\" target=\"_blank\">pneumothorax<\/a> as a result of needle electrode insertion. The authors concluded that an ECG synchronizer should be used to minimize the risk of arrhythmias and that attention to the position of the arms is required to maximize CT scan quality but minimize <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brachial_plexus\" title=\"Brachial plexus\" rel=\"external_link\" target=\"_blank\">brachial plexus<\/a> strain.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>A larger, single-center, prospective, non-randomized, cohort study to investigate the safety of IRE for tumor ablation in humans evaluated 38 subjects with advanced malignancy of the liver, kidney, or lung (69 separate tumors) which were unresponsive to alternative treatment. The authors reported no mortalities within the 30 days post-procedure. Transient ventricular arrhythmia occurred in four patients; ECG synchronized delivery was subsequently used in the remaining 30 patients, with two further arrhythmias (supraventricular tachycardia and atrial fibrillation). There was one report of obstruction of the upper ureter after IRE, in addition to one report of the unintentional electroporation of an adrenal gland, resulting in a transient, severe hypertension. Two patients developed temporary neurapraxia secondary to arm extension during treatment, The authors further noted that complete target tumor ablation verified by CT was achieved in 46 of the 69 tumors treated with IRE (66%), while most treatment failures occurred in renal and lung tumors. The authors concluded that IRE appears safe for clinical use if ECG-synchronized delivery is utilized to prevent arrhythmias.<sup id=\"rdp-ebb-cite_ref-:3_31-0\" class=\"reference\"><a href=\"#cite_note-:3-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Scope_of_applications\">Scope of applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Kidney\">Kidney<\/span><\/h3>\n<p>While nephron-sparing surgery is the gold standard treatment for small, malignant renal masses, ablative therapies are considered a viable option in patients who are poor surgical candidates. Radiofrequency ablation (RFA) and cryoablation have been used since the 1990s; however, in lesions larger than 3 cm, their efficacy is limited. The newer ablation modalities, such as IRE, microwave ablation (MWA), and high-intensity focused ultrasound, may help overcome the challenges in tumor size.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>The first human studies have proven the safety of IRE for the ablation of renal masses; however, the effectiveness of IRE through histopathological examination of an ablated renal tumor in humans is yet to be known. Wagstaff et al. have set out to investigate the safety and effectiveness of IRE ablation of renal masses and to evaluate the efficacy of ablation using MIR and contrast-enhanced ultrasound imaging. In accordance with the prospective protocol designed by the authors, the treated patients will subsequently undergo radical nephrectomy to assess IRE ablation success.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Liver\">Liver<\/span><\/h3>\n<p>Thermal ablation techniques are very effective at treating liver tumors; however, many tumors are poorly amenable to thermal ablation due to their proximity to large blood vessels or major bile ducts, that render ablation ineffective or dangerous.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>In a single-center, prospective, non-randomized cohort, the safety of IRE of liver lesions was assessed in 25 patients. The authors reported a 50% tumor response rate, and noted that IRE failed to have any effect on tumors larger than 5 cm in any dimension. There were no reports of liver damage in any of the patients treated.<sup id=\"rdp-ebb-cite_ref-:3_31-1\" class=\"reference\"><a href=\"#cite_note-:3-31\" rel=\"external_link\">[31]<\/a><\/sup> The trend of larger tumors being incompletely ablated using IRE has persisted across other studies.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pancreas\">Pancreas<\/span><\/h3>\n<p>Percutaneous thermal ablation of the pancreas was first described in 1999; however, subsequent review concluded that RFA in this setting has an unacceptably high complication rate without a clear benefit in survival.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> The non-thermal mechanism of cell death from IRE and the safety and feasibility seen in animal models, suggests that it may be a more reasonable option.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p><p>Martin et al. evaluated overall survival in 54 patients with local pancreatic adenocarcinoma; they compared their IRE-treated cohort to matched stage III patients treated with standard therapy. They found a statistically significant increase in local progression-free survival, distant progression-free survival, and overall survival, amongst the patients treated with IRE.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lung\">Lung<\/span><\/h3>\n<p>In a prospective, single-arm, multi-center, phase II clinical trial, the safety and efficacy of IRE on lung cancers were evaluated. The trial included patients with primary and secondary lung malignancies and preserved lung function. The expected effectiveness was not met at interim analysis and the trial was stopped prematurely. Complications included pneumothoraces (11 of 23 patients), alveolar hemorrhage not resulting in significant hemoptysis, and needle tract seeding was found in 3 cases (13%). Disease progression was seen in 14 of 23 patients (61%). Stable disease was found in 1 (4%), partial remission in 1 (4%) and complete remission in 7 (30%) patients. The authors concluded that IRE is not effective for the treatment of lung malignancies.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup> Similarly poor treatment outcomes have been observed in other studies.<sup id=\"rdp-ebb-cite_ref-:3_31-2\" class=\"reference\"><a href=\"#cite_note-:3-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p><p>A major obstacle of IRE in the lung is the difficulty in positioning the electrodes; placing the probes in parallel alignment is made challenging by the interposition of ribs. Additionally, the planned and actual ablation zones in the lung are dramatically different due to the differences in conductivity between tumor, lung parenchyma, and air.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Prostate\">Prostate<\/span><\/h3>\n<p>The idea of treating prostate cancer with IRE was first proposed by Gary Onik and Boris Rubinsky in 2007.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> Prostate carcinomas are frequently located near sensitive structures which might be permanently damaged by thermal treatments or radiation therapy. The applicability of surgical methods is often limited by accessibility and precision. Surgery is also associated with a long healing time and high rate of side effects.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> Using IRE, the urethra, bladder, rectum and neurovascular bundle can potentially be included in the treatment field without creating (permanent) damage. This would potentially give IRE superiority both for focal therapy and whole gland treatments, as compared to all other available methods. Though treatments using IRE have been practiced successfully for more than three years, it has to be considered experimental since there are no multi-center studies or long-term follow-ups.\n<\/p><p>The first study including 16 patients (Gleason-Score ranging from 6 to 8) was released in 2010 by G. Onik and B. Rubinsky.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> Most publicly and broadly, IRE has been used for prostate carcinomas by M. K. Stehling in Germany.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> In the UK, Dickson et al. have been using IRE for Gleason 6 and 7 carcinomas and reported positively about its safety and low toxicity.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Coronary_arteries\">Coronary arteries<\/span><\/h3>\n<p>Maor et el have demonstrated the safety and efficiency of IRE as an ablation modality for smooth muscle cells in the walls of large vessels in rat model.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> Therefore, IRE has been suggested as preventive treatment for coronary artery re-stenosis after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_coronary_intervention\" title=\"Percutaneous coronary intervention\" rel=\"external_link\" target=\"_blank\">percutaneous coronary intervention<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pulmonary_veins\">Pulmonary veins<\/span><\/h3>\n<p>Numerous studies in animals have demonstrated the safety and efficiency of IRE as a non-thermal ablation modality for pulmonary veins in context of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a> treatment. IRE's advantages in comparison with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiofrequency_ablation\" title=\"Radiofrequency ablation\" rel=\"external_link\" target=\"_blank\">RF-ablation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryoablation\" title=\"Cryoablation\" rel=\"external_link\" target=\"_blank\">cryoablation<\/a> are: well defined ablation area and the lack of peripheral thermal damage. Therefore, IRE has been suggested as a part of novel treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a>.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_organs\">Other organs<\/span><\/h3>\n<p>IRE has also been investigated in ex-vivo human eye models for treatment of uveal melanoma<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> and in thyroid cancer.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p><p>Successful ablations in animal tumor models have been conducted for lung,<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> brain,<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup> heart,<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> skin,<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup> bone,<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup> head and neck cancer,<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup> and blood vessels.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Boutros, Cherif. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02041936\" target=\"_blank\">\"Outcomes of Ablation of Unresectable Pancreatic Cancer Using the NanoKnife Irreversible Electroporation (IRE) System\"<\/a>. <i>Clinical Trials.gov<\/i>. 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Oncol<\/i>. <b>26<\/b> (36): 5896\u2013903. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1200%2FJCO.2007.15.6794\" target=\"_blank\">10.1200\/JCO.2007.15.6794<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2645111\" target=\"_blank\">2645111<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19029422\" target=\"_blank\">19029422<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Clin.+Oncol.&rft.atitle=%28Dec+2008%29.+Phase+I+trial+of+interleukin-12+plasmid++electroporation+in+patients+with+metastatic+melanoma&rft.volume=26&rft.issue=36&rft.pages=5896-903&rft.date=2008&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2645111&rft_id=info%3Apmid%2F19029422&rft_id=info%3Adoi%2F10.1200%2FJCO.2007.15.6794&rft.au=Daud+AI%2C+DeConti+RC%2C+Andrews+S%2C+Urbas+P%2C+Riker+AI&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2645111&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. 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(2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2989557\" target=\"_blank\">\"Irreversible Electroporation: A Novel Image-Guided Cancer Therapy\"<\/a>. <i>Gut and Liver<\/i>. <b>4<\/b> (Suppl.1): S99\u2013S104. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.5009%2Fgnl.2010.4.s1.s99\" target=\"_blank\">10.5009\/gnl.2010.4.s1.s99<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2989557\" target=\"_blank\">2989557<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21103304\" target=\"_blank\">21103304<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gut+and+Liver&rft.atitle=Irreversible+Electroporation%3A+A+Novel+Image-Guided+Cancer+Therapy&rft.volume=4&rft.issue=Suppl.1&rft.pages=S99-S104&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2989557&rft_id=info%3Apmid%2F21103304&rft_id=info%3Adoi%2F10.5009%2Fgnl.2010.4.s1.s99&rft.aulast=Lee&rft.aufirst=Edward+W.&rft.au=Thai%2C+Susan&rft.au=Kee%2C+Stephen+T.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2989557&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ii, Robert E. 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(2006-07-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/lpdocs\/epic03\/wrapper.htm?arnumber=1643410\" target=\"_blank\">\"In vivo results of a new focal tissue ablation technique: irreversible electroporation\"<\/a>. <i>IEEE Transactions on Biomedical Engineering<\/i>. <b>53<\/b> (7): 1409\u20131415. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FTBME.2006.873745\" target=\"_blank\">10.1109\/TBME.2006.873745<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0018-9294\" target=\"_blank\">0018-9294<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16830945\" target=\"_blank\">16830945<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+Transactions+on+Biomedical+Engineering&rft.atitle=In+vivo+results+of+a+new+focal+tissue+ablation+technique%3A+irreversible+electroporation&rft.volume=53&rft.issue=7&rft.pages=1409-1415&rft.date=2006-07-01&rft.issn=0018-9294&rft_id=info%3Apmid%2F16830945&rft_id=info%3Adoi%2F10.1109%2FTBME.2006.873745&rft.aulast=Edd&rft.aufirst=J.F.&rft.au=Horowitz%2C+L.&rft.au=Davalos%2C+R.V.&rft.au=Mir%2C+L.M.&rft.au=Rubinsky%2C+B.&rft_id=http%3A%2F%2Fieeexplore.ieee.org%2Flpdocs%2Fepic03%2Fwrapper.htm%3Farnumber%3D1643410&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Arena, Christopher B; 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Current evidence on the safety and efficacy of irreversible electroporation for treating primary lung cancer and metastases in the lung is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ball, Christine; Thomson, Kenneth R.; Kavnoudias, Helen (2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.wkhealth.com\/linkback\/openurl?sid=WKPTLP:landingpage&an=00000539-201005000-00012\" target=\"_blank\">\"Irreversible Electroporation\"<\/a>. <i>Anesthesia & Analgesia<\/i>. <b>110<\/b> (5): 1305\u20131309. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1213%2Fane.0b013e3181d27b30\" target=\"_blank\">10.1213\/ane.0b013e3181d27b30<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20142349\" target=\"_blank\">20142349<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+%26+Analgesia&rft.atitle=Irreversible+Electroporation&rft.volume=110&rft.issue=5&rft.pages=1305-1309&rft.date=2010&rft_id=info%3Adoi%2F10.1213%2Fane.0b013e3181d27b30&rft_id=info%3Apmid%2F20142349&rft.aulast=Ball&rft.aufirst=Christine&rft.au=Thomson%2C+Kenneth+R.&rft.au=Kavnoudias%2C+Helen&rft_id=http%3A%2F%2Fcontent.wkhealth.com%2Flinkback%2Fopenurl%3Fsid%3DWKPTLP%3Alandingpage%26an%3D00000539-201005000-00012&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:3-31\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:3_31-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_31-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_31-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomson, Kenneth R.; Cheung, Wa; Ellis, Samantha J.; Federman, Dean; Kavnoudias, Helen; Loader-Oliver, Deirdre; Roberts, Stuart; Evans, Peter; Ball, Christine (May 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1051044310011796\" target=\"_blank\">\"Investigation of the Safety of Irreversible Electroporation in Humans\"<\/a>. <i>Journal of Vascular and Interventional Radiology<\/i>. <b>22<\/b> (5): 611\u2013621. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jvir.2010.12.014\" target=\"_blank\">10.1016\/j.jvir.2010.12.014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21439847\" target=\"_blank\">21439847<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Vascular+and+Interventional+Radiology&rft.atitle=Investigation+of+the+Safety+of+Irreversible+Electroporation+in+Humans&rft.volume=22&rft.issue=5&rft.pages=611-621&rft.date=2011-05&rft_id=info%3Adoi%2F10.1016%2Fj.jvir.2010.12.014&rft_id=info%3Apmid%2F21439847&rft.aulast=Thomson&rft.aufirst=Kenneth+R.&rft.au=Cheung%2C+Wa&rft.au=Ellis%2C+Samantha+J.&rft.au=Federman%2C+Dean&rft.au=Kavnoudias%2C+Helen&rft.au=Loader-Oliver%2C+Deirdre&rft.au=Roberts%2C+Stuart&rft.au=Evans%2C+Peter&rft.au=Ball%2C+Christine&rft_id=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1051044310011796&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Olweny, Ephrem O.; Cadeddu, Jeffrey A. (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.wkhealth.com\/linkback\/openurl?sid=WKPTLP:landingpage&an=00042307-201209000-00007\" target=\"_blank\">\"Novel methods for renal tissue ablation\"<\/a>. <i>Current Opinion in Urology<\/i>. <b>22<\/b> (5): 379\u2013384. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Fmou.0b013e328355ecf5\" target=\"_blank\">10.1097\/mou.0b013e328355ecf5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22706069\" target=\"_blank\">22706069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Urology&rft.atitle=Novel+methods+for+renal+tissue+ablation&rft.volume=22&rft.issue=5&rft.pages=379-384&rft.date=2012&rft_id=info%3Adoi%2F10.1097%2Fmou.0b013e328355ecf5&rft_id=info%3Apmid%2F22706069&rft.aulast=Olweny&rft.aufirst=Ephrem+O.&rft.au=Cadeddu%2C+Jeffrey+A.&rft_id=http%3A%2F%2Fcontent.wkhealth.com%2Flinkback%2Fopenurl%3Fsid%3DWKPTLP%3Alandingpage%26an%3D00042307-201209000-00007&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wagstaff, Peter GK; Bruin, Daniel M de; Zondervan, Patricia J; Heijink, C Dilara Savci; Engelbrecht, Marc RW; Delden, Otto M van; Leeuwen, Ton G van; Wijkstra, Hessel; Rosette, Jean JMCH de la (2015-03-22). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biomedcentral.com\/1471-2407\/15\/165\" target=\"_blank\">\"The efficacy and safety of irreversible electroporation for the ablation of renal masses: a prospective, human, in-vivo study protocol\"<\/a>. <i>BMC Cancer<\/i>. <b>15<\/b> (1): 165. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2Fs12885-015-1189-x\" target=\"_blank\">10.1186\/s12885-015-1189-x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4376341\" target=\"_blank\">4376341<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25886058\" target=\"_blank\">25886058<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Cancer&rft.atitle=The+efficacy+and+safety+of+irreversible+electroporation+for+the+ablation+of+renal+masses%3A+a+prospective%2C+human%2C+in-vivo+study+protocol&rft.volume=15&rft.issue=1&rft.pages=165&rft.date=2015-03-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4376341&rft_id=info%3Apmid%2F25886058&rft_id=info%3Adoi%2F10.1186%2Fs12885-015-1189-x&rft.aulast=Wagstaff&rft.aufirst=Peter+GK&rft.au=Bruin%2C+Daniel+M+de&rft.au=Zondervan%2C+Patricia+J&rft.au=Heijink%2C+C+Dilara+Savci&rft.au=Engelbrecht%2C+Marc+RW&rft.au=Delden%2C+Otto+M+van&rft.au=Leeuwen%2C+Ton+G+van&rft.au=Wijkstra%2C+Hessel&rft.au=Rosette%2C+Jean+JMCH+de+la&rft_id=http%3A%2F%2Fwww.biomedcentral.com%2F1471-2407%2F15%2F165&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gervais, Debra A.; Goldberg, S. Nahum; Brown, Daniel B.; Soulen, Michael C.; Millward, Steven F.; Rajan, Dheeraj K. (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1051044309003261\" target=\"_blank\">\"Society of Interventional Radiology Position Statement on Percutaneous Radiofrequency Ablation for the Treatment of Liver Tumors\"<\/a>. <i>Journal of Vascular and Interventional Radiology<\/i>. <b>20<\/b> (7): S342\u2013S347. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jvir.2009.04.029\" target=\"_blank\">10.1016\/j.jvir.2009.04.029<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19560023\" target=\"_blank\">19560023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Vascular+and+Interventional+Radiology&rft.atitle=Society+of+Interventional+Radiology+Position+Statement+on+Percutaneous+Radiofrequency+Ablation+for+the+Treatment+of+Liver+Tumors&rft.volume=20&rft.issue=7&rft.pages=S342-S347&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fj.jvir.2009.04.029&rft_id=info%3Apmid%2F19560023&rft.aulast=Gervais&rft.aufirst=Debra+A.&rft.au=Goldberg%2C+S.+Nahum&rft.au=Brown%2C+Daniel+B.&rft.au=Soulen%2C+Michael+C.&rft.au=Millward%2C+Steven+F.&rft.au=Rajan%2C+Dheeraj+K.&rft_id=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1051044309003261&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cannon, Robert; Ellis, Susan; Hayes, David; Narayanan, Govindarajan; Martin, Robert C.G. (2013-04-01). \"Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures\". <i>Journal of Surgical Oncology<\/i>. <b>107<\/b> (5): 544\u2013549. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjso.23280\" target=\"_blank\">10.1002\/jso.23280<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1096-9098\" target=\"_blank\">1096-9098<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23090720\" target=\"_blank\">23090720<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Surgical+Oncology&rft.atitle=Safety+and+early+efficacy+of+irreversible+electroporation+for+hepatic+tumors+in+proximity+to+vital+structures&rft.volume=107&rft.issue=5&rft.pages=544-549&rft.date=2013-04-01&rft.issn=1096-9098&rft_id=info%3Apmid%2F23090720&rft_id=info%3Adoi%2F10.1002%2Fjso.23280&rft.aulast=Cannon&rft.aufirst=Robert&rft.au=Ellis%2C+Susan&rft.au=Hayes%2C+David&rft.au=Narayanan%2C+Govindarajan&rft.au=Martin%2C+Robert+C.G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Goldberg, S. N.; Mallery, S.; Gazelle, G. S.; Brugge, W. R. (1999-09-01). \"EUS-guided radiofrequency ablation in the pancreas: results in a porcine model\". <i>Gastrointestinal Endoscopy<\/i>. <b>50<\/b> (3): 392\u2013401. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fge.1999.v50.98847\" target=\"_blank\">10.1053\/ge.1999.v50.98847<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0016-5107\" target=\"_blank\">0016-5107<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10462663\" target=\"_blank\">10462663<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastrointestinal+Endoscopy&rft.atitle=EUS-guided+radiofrequency+ablation+in+the+pancreas%3A+results+in+a+porcine+model&rft.volume=50&rft.issue=3&rft.pages=392-401&rft.date=1999-09-01&rft.issn=0016-5107&rft_id=info%3Apmid%2F10462663&rft_id=info%3Adoi%2F10.1053%2Fge.1999.v50.98847&rft.aulast=Goldberg&rft.aufirst=S.+N.&rft.au=Mallery%2C+S.&rft.au=Gazelle%2C+G.+S.&rft.au=Brugge%2C+W.+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pezzilli, Raffaele; Serra, Carla; Ricci, Claudio; Casadei, Riccardo; Monari, Francesco; D'Ambra, Marielda; Minni, Francesco (2011-01-01). \"Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review\". <i>Pancreas<\/i>. <b>40<\/b> (1): 163\u2013165. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FMPA.0b013e3181eab751\" target=\"_blank\">10.1097\/MPA.0b013e3181eab751<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1536-4828\" target=\"_blank\">1536-4828<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21160378\" target=\"_blank\">21160378<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pancreas&rft.atitle=Radiofrequency+ablation+for+advanced+ductal+pancreatic+carcinoma%3A+is+this+approach+beneficial+for+our+patients%3F+A+systematic+review&rft.volume=40&rft.issue=1&rft.pages=163-165&rft.date=2011-01-01&rft.issn=1536-4828&rft_id=info%3Apmid%2F21160378&rft_id=info%3Adoi%2F10.1097%2FMPA.0b013e3181eab751&rft.aulast=Pezzilli&rft.aufirst=Raffaele&rft.au=Serra%2C+Carla&rft.au=Ricci%2C+Claudio&rft.au=Casadei%2C+Riccardo&rft.au=Monari%2C+Francesco&rft.au=D%27Ambra%2C+Marielda&rft.au=Minni%2C+Francesco&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bower, Matthew; Sherwood, Leslie; Li, Yan; Martin, Robert (2011-07-01). \"Irreversible electroporation of the pancreas: Definitive local therapy without systemic effects\". <i>Journal of Surgical Oncology<\/i>. <b>104<\/b> (1): 22\u201328. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjso.21899\" target=\"_blank\">10.1002\/jso.21899<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1096-9098\" target=\"_blank\">1096-9098<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21360714\" target=\"_blank\">21360714<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Surgical+Oncology&rft.atitle=Irreversible+electroporation+of+the+pancreas%3A+Definitive+local+therapy+without+systemic+effects&rft.volume=104&rft.issue=1&rft.pages=22-28&rft.date=2011-07-01&rft.issn=1096-9098&rft_id=info%3Apmid%2F21360714&rft_id=info%3Adoi%2F10.1002%2Fjso.21899&rft.aulast=Bower&rft.aufirst=Matthew&rft.au=Sherwood%2C+Leslie&rft.au=Li%2C+Yan&rft.au=Martin%2C+Robert&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Martin, Robert C. G.; McFarland, Kelli; Ellis, Susan; Velanovich, Vic (2013-12-01). \"Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival\". <i>Annals of Surgical Oncology<\/i>. 20 Suppl 3: S443\u2013449. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1245%2Fs10434-012-2736-1\" target=\"_blank\">10.1245\/s10434-012-2736-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1534-4681\" target=\"_blank\">1534-4681<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23128941\" target=\"_blank\">23128941<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Surgical+Oncology&rft.atitle=Irreversible+electroporation+in+locally+advanced+pancreatic+cancer%3A+potential+improved+overall+survival&rft.volume=20+Suppl+3&rft.pages=S443-449&rft.date=2013-12-01&rft.issn=1534-4681&rft_id=info%3Apmid%2F23128941&rft_id=info%3Adoi%2F10.1245%2Fs10434-012-2736-1&rft.aulast=Martin&rft.aufirst=Robert+C.+G.&rft.au=McFarland%2C+Kelli&rft.au=Ellis%2C+Susan&rft.au=Velanovich%2C+Vic&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ricke, Jens; J\u00fcrgens, Julian H. W.; Deschamps, Frederic; Tselikas, Lambros; Uhde, Katja; Kosiek, Ortrud; Baere, Thierry De (2015-01-22). \"Irreversible Electroporation (IRE) Fails to Demonstrate Efficacy in a Prospective Multicenter Phase II Trial on Lung Malignancies: The ALICE Trial\". <i>CardioVascular and Interventional Radiology<\/i>. <b>38<\/b> (2): 401\u2013408. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00270-014-1049-0\" target=\"_blank\">10.1007\/s00270-014-1049-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0174-1551\" target=\"_blank\">0174-1551<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25609208\" target=\"_blank\">25609208<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CardioVascular+and+Interventional+Radiology&rft.atitle=Irreversible+Electroporation+%28IRE%29+Fails+to+Demonstrate+Efficacy+in+a+Prospective+Multicenter+Phase+II+Trial+on+Lung+Malignancies%3A+The+ALICE+Trial&rft.volume=38&rft.issue=2&rft.pages=401-408&rft.date=2015-01-22&rft.issn=0174-1551&rft_id=info%3Apmid%2F25609208&rft_id=info%3Adoi%2F10.1007%2Fs00270-014-1049-0&rft.aulast=Ricke&rft.aufirst=Jens&rft.au=J%C3%BCrgens%2C+Julian+H.+W.&rft.au=Deschamps%2C+Frederic&rft.au=Tselikas%2C+Lambros&rft.au=Uhde%2C+Katja&rft.au=Kosiek%2C+Ortrud&rft.au=Baere%2C+Thierry+De&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Usman, Mumal; Moore, William; Talati, Ronak; Watkins, Kevin; Bilfinger, Thomas V. (2012-06-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3560719\" target=\"_blank\">\"Irreversible electroporation of lung neoplasm: a case series\"<\/a>. <i>Medical Science Monitor: International Medical Journal of Experimental and Clinical Research<\/i>. <b>18<\/b> (6): CS43\u201347. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.12659%2Fmsm.882888\" target=\"_blank\">10.12659\/msm.882888<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1643-3750\" target=\"_blank\">1643-3750<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3560719\" target=\"_blank\">3560719<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22648257\" target=\"_blank\">22648257<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+Science+Monitor%3A+International+Medical+Journal+of+Experimental+and+Clinical+Research&rft.atitle=Irreversible+electroporation+of+lung+neoplasm%3A+a+case+series&rft.volume=18&rft.issue=6&rft.pages=CS43-47&rft.date=2012-06-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3560719&rft.issn=1643-3750&rft_id=info%3Apmid%2F22648257&rft_id=info%3Adoi%2F10.12659%2Fmsm.882888&rft.aulast=Usman&rft.aufirst=Mumal&rft.au=Moore%2C+William&rft.au=Talati%2C+Ronak&rft.au=Watkins%2C+Kevin&rft.au=Bilfinger%2C+Thomas+V.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3560719&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Srimathveeravalli G, Wimmer T, Silk M; et al. 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(<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Onik, Gary; Mikus, Paul; Rubinsky, Boris (2007-08-01). \"Irreversible electroporation: implications for prostate ablation\". <i>Technology in Cancer Research & Treatment<\/i>. <b>6<\/b> (4): 295\u2013300. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F153303460700600405\" target=\"_blank\">10.1177\/153303460700600405<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1533-0346\" target=\"_blank\">1533-0346<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17668936\" target=\"_blank\">17668936<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Technology+in+Cancer+Research+%26+Treatment&rft.atitle=Irreversible+electroporation%3A+implications+for+prostate+ablation&rft.volume=6&rft.issue=4&rft.pages=295-300&rft.date=2007-08-01&rft.issn=1533-0346&rft_id=info%3Apmid%2F17668936&rft_id=info%3Adoi%2F10.1177%2F153303460700600405&rft.aulast=Onik&rft.aufirst=Gary&rft.au=Mikus%2C+Paul&rft.au=Rubinsky%2C+Boris&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kasivisvanathan, V.; Emberton, M.; Ahmed, H. U. (2013-08-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4042323\" target=\"_blank\">\"Focal therapy for prostate cancer: rationale and treatment opportunities\"<\/a>. <i>Clinical Oncology<\/i>. <b>25<\/b> (8): 461\u2013473. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.clon.2013.05.002\" target=\"_blank\">10.1016\/j.clon.2013.05.002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1433-2981\" target=\"_blank\">1433-2981<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4042323\" target=\"_blank\">4042323<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23759249\" target=\"_blank\">23759249<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oncology&rft.atitle=Focal+therapy+for+prostate+cancer%3A+rationale+and+treatment+opportunities&rft.volume=25&rft.issue=8&rft.pages=461-473&rft.date=2013-08-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4042323&rft.issn=1433-2981&rft_id=info%3Apmid%2F23759249&rft_id=info%3Adoi%2F10.1016%2Fj.clon.2013.05.002&rft.aulast=Kasivisvanathan&rft.aufirst=V.&rft.au=Emberton%2C+M.&rft.au=Ahmed%2C+H.+U.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4042323&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Onik G, Rubinsky B (2009). \"Irreversible electroporation: first patient experience focal therapy of prostate cancer\". 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Laufer, Shlomi; Belkin, Michael; Rubinsky, Boris; Pe'er, Jacob; Frenkel, Shahar (2013-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3764134\" target=\"_blank\">\"Irreversible electroporation of human primary uveal melanoma in enucleated eyes\"<\/a>. <i>PLoS One<\/i>. <b>8<\/b> (9): e71789. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0071789\" target=\"_blank\">10.1371\/journal.pone.0071789<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1932-6203\" target=\"_blank\">1932-6203<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3764134\" target=\"_blank\">3764134<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24039721\" target=\"_blank\">24039721<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLoS+One&rft.atitle=Irreversible+electroporation+of+human+primary+uveal+melanoma+in+enucleated+eyes&rft.volume=8&rft.issue=9&rft.pages=e71789&rft.date=2013-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3764134&rft.issn=1932-6203&rft_id=info%3Apmid%2F24039721&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0071789&rft.aulast=Mandel&rft.aufirst=Yossi&rft.au=Laufer%2C+Shlomi&rft.au=Belkin%2C+Michael&rft.au=Rubinsky%2C+Boris&rft.au=Pe%27er%2C+Jacob&rft.au=Frenkel%2C+Shahar&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3764134&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meijerink, Martijn R.; 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(2010-11-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bjj.boneandjoint.org.uk\/content\/92-B\/11\/1614\" target=\"_blank\">\"Ablation of bone cells by electroporation\"<\/a>. <i>Bone & Joint Journal<\/i>. <b>92-B<\/b> (11): 1614\u20131620. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.92B11.24664\" target=\"_blank\">10.1302\/0301-620X.92B11.24664<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2049-4394\" target=\"_blank\">2049-4394<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21037363\" target=\"_blank\">21037363<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bone+%26+Joint+Journal&rft.atitle=Ablation+of+bone+cells+by+electroporation&rft.volume=92-B&rft.issue=11&rft.pages=1614-1620&rft.date=2010-11-01&rft.issn=2049-4394&rft_id=info%3Apmid%2F21037363&rft_id=info%3Adoi%2F10.1302%2F0301-620X.92B11.24664&rft.aulast=Fini&rft.aufirst=M.&rft.au=Tschon%2C+M.&rft.au=Ronchetti%2C+M.&rft.au=Cavani%2C+F.&rft.au=Bianchi%2C+G.&rft.au=Mercuri%2C+M.&rft.au=Alberghini%2C+M.&rft.au=Cadossi%2C+R.&rft_id=http%3A%2F%2Fwww.bjj.boneandjoint.org.uk%2Fcontent%2F92-B%2F11%2F1614&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-60\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Fini M, Tschon M, Alberghini M, Bianchi G, Mercuri M, Campanacci L, Cavani F, Ronchett, de Terlizzi M, Cadossi R (2011). \"Cell electroporation in bone tissue\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 115\u2013127. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-4419-8362-7.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Wong D, Lee EW, Kee ST (2011). \"Translational research on irreversible electroporation: VX2 rabbit head and neck\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 231\u2013236. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-4419-8362-7.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maor, Elad; Ivorra, Antoni; Rubinsky, Boris (2009-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2650260\" target=\"_blank\">\"Non thermal irreversible electroporation: novel technology for vascular smooth muscle cells ablation\"<\/a>. <i>PLoS One<\/i>. <b>4<\/b> (3): e4757. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0004757\" target=\"_blank\">10.1371\/journal.pone.0004757<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1932-6203\" target=\"_blank\">1932-6203<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2650260\" target=\"_blank\">2650260<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19270746\" target=\"_blank\">19270746<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLoS+One&rft.atitle=Non+thermal+irreversible+electroporation%3A+novel+technology+for+vascular+smooth+muscle+cells+ablation&rft.volume=4&rft.issue=3&rft.pages=e4757&rft.date=2009-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2650260&rft.issn=1932-6203&rft_id=info%3Apmid%2F19270746&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0004757&rft.aulast=Maor&rft.aufirst=Elad&rft.au=Ivorra%2C+Antoni&rft.au=Rubinsky%2C+Boris&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2650260&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<div class=\"refbegin\" style=\"\">\n<ul><li><cite class=\"citation book\">Rubinsky B (2009). <i>Irreversible Electroporation (Series in Biomedical Engineering)<\/i>. Berlin: Springer. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-642-05419-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Irreversible+Electroporation+%28Series+in+Biomedical+Engineering%29&rft.place=Berlin&rft.pub=Springer&rft.date=2009&rft.isbn=978-3-642-05419-8&rft.au=Rubinsky+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181217085730\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.840 seconds\nReal time usage: 0.953 seconds\nPreprocessor visited node count: 4131\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 152232\/2097152 bytes\nTemplate argument size: 731\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 186557\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.520\/10.000 seconds\nLua memory usage: 5.98 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 853.699 1 -total\n<\/p>\n<pre>74.32% 634.470 1 Template:Reflist\n50.33% 429.695 52 Template:Cite_journal\n 8.86% 75.632 1 Template:Medical_citations_needed\n 8.51% 72.624 1 Template:Cite_web\n 7.00% 59.739 1 Template:Infobox_medical_intervention\n 6.41% 54.763 1 Template:Infobox\n 6.12% 52.215 1 Template:Ambox\n 5.76% 49.143 3 Template:ISBN\n 2.18% 18.596 3 Template:Catalog_lookup_link\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:40142982-1!canonical and timestamp 20181217085729 and revision id 873167422\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Irreversible_electroporation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214703\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.022 seconds\nReal time usage: 0.168 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.538 1 - wikipedia:Irreversible_electroporation\n100.00% 156.538 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8033-0!*!*!*!*!*!* and timestamp 20181217214703 and revision id 24144\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation\">https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","94395468e1f4b75d1b8f25455b04879e_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png"],"94395468e1f4b75d1b8f25455b04879e_timestamp":1545083223,"3748414858d7d69051899d8143a4c1e7_type":"article","3748414858d7d69051899d8143a4c1e7_title":"Image-guided surgery","3748414858d7d69051899d8143a4c1e7_url":"https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery","3748414858d7d69051899d8143a4c1e7_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tImage-guided surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tImage-guided surgery (IGS) is any surgical procedure where the surgeon uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras,ultrasonic, electromagnetic or a combination or fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room. This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application. \nImage-guided surgery helps surgeons perform safer and less invasive procedures and has become a recognized standard of care in managing disorders including cranial, otorhinolaryngology, spine, orthopedic, and cardiovascular.[1] \n\nContents \n\n1 Benefits \n2 Applications \n3 See also \n4 References \n5 Further reading \n\n\nBenefits \nThe benefits of Image-guided surgery include greater control of the surgical procedure, real-time feedback on the effect of the intervention, reduced tissue trauma and disruption in gaining access to the anatomical structure. Image-guided surgery allows for: reduced post-operative neural deficits and adverse events associated with endovenous laser ablative procedures[2], and more effective removal of brain tumors that were once considered inoperable due to their size or location.[3]\n\nApplications \nThe various applications of navigation for neurosurgery have been widely used and reported for almost two decades.[3] According to a study in 2000, researchers were already anticipating that a significant portion of neurosurgery would be performed using computer-based interventions.[4] Recent advancements in ultrasound, including intravascular ultrasound (IVUS) allow for real-time cross sectional mapping of vessels and lateral tissues providing calibrated measurements of vessel diameters, contours and morphology.\nPart of the wider field of computer-assisted surgery, image-guided surgery can take place in hybrid operating rooms using intraoperative imaging. A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. Most image-guided surgical procedures are minimally invasive. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is interventional radiology.\nImage-guided surgery was originally developed for treatment of brain tumors using stereotactic surgery and radiosurgery that are guided by computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) using a technology known as the N-localizer.[5][6][7]\nA hand-held surgical probe is an essential component of any image-guided surgery system as it provides the surgeon with a map of the designated area.[8] During the surgical procedure, the IGS tracks the probe position and displays the anatomy beneath it as, for example, three orthogonal image slices on a workstation-based 3D imaging system. Existing IGS systems use different tracking techniques including mechanical, optical, ultrasonic, and electromagnetic. \nWhen fluorescence modality is adopted to such devices, the technique is also called fluorescence image-guided surgery.\nImage-guided surgery using medical ultrasound utilises sounds waves and as such does not require the protection and safety precautions necessary with ionising radiation modalities such as fluoroscopy, CT, X-Ray and tomography.\n\nSee also \nComputer assisted surgery\nInterventional radiology\nIntraoperative MRI\nRadiosurgery\nStereotactic surgery\nReferences \n\n\n^ \"Surgery and Treatment - Dedicated Computing\". Dedicated Computing. Retrieved 2018-03-14 . \n\n^ \"Dr Joseph Grace et al - Neural Defecits Post Ultrasound Guided Endovenous Laser Ablation Union International de Phlebology World Congress 2018 Melbourne Australia\". docs.google.com. Retrieved 2018-03-03 . \n\n^ a b Mezger U, Jendrewski C, Bartels M (2013). \"Navigation in surgery\". Langenbecks Arch Surg. 398: 501\u201314. doi:10.1007\/s00423-013-1059-4. PMC 3627858 . PMID 23430289. \n\n^ Kelly PJ (Jan 2000). \"What is past is prologue\". Neurosurgery. 46 (1): 16\u201327. doi:10.1093\/neurosurgery\/46.1.16. \n\n^ Galloway, RL Jr. (2015). \"Introduction and Historical Perspectives on Image-Guided Surgery\". In Golby, AJ. Image-Guided Neurosurgery. Amsterdam: Elsevier. pp. 3\u20134. \n\n^ Tse, VCK; Kalani, MYS; Adler, JR (2015). \"Techniques of Stereotactic Localization\". In Chin, LS; Regine, WF. Principles and Practice of Stereotactic Radiosurgery. New York: Springer. p. 28. \n\n^ Saleh, H; Kassas, B (2015). \"Developing Stereotactic Frames for Cranial Treatment\". In Benedict, SH; Schlesinger, DJ; Goetsch, SJ; Kavanagh, BD. Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Boca Raton: CRC Press. pp. 156\u2013159. \n\n^ \"Image-Guided Surgery\". care.american-rhinologic.org. Retrieved 2018-03-14 . \n\n\nFurther reading \nKhan, FR; Henderson, JM (2013). \"Deep Brain Stimulation Surgical Techniques\". In Lozano, AM; Hallet, M. Brain Stimulation: Handbook of Clinical Neurology. 116. Amsterdam: Elsevier. pp. 28\u201330. \nArle, J (2009). \"Development of a Classic: the Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames\". In Lozano, AM; Gildenberg, PL; Tasker, RR. Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. pp. 456\u2013461. \nBrown RA, Nelson JA (June 2012). \"Invention of the N-localizer for stereotactic neurosurgery and its use in the Brown-Roberts-Wells stereotactic frame\". Neurosurgery. 70 (Operative Supplement 2): 173\u2013176. doi:10.1227\/NEU.0b013e318246a4f7. PMID 22186842. \nBrown RA, Nelson JA (2016). \"The invention and early history of the N-localizer for stereotactic neurosurgery\". Cureus. 8 (6): e642. doi:10.7759\/cureus.642. PMC 4959822 . PMID 27462476. CS1 maint: Uses authors parameter (link) \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery\">https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:18.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 326 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3748414858d7d69051899d8143a4c1e7_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Image-guided_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Image-guided surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Image-guided surgery<\/b> (<b>IGS<\/b>) is any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> procedure where the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeon<\/a> uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras,ultrasonic, electromagnetic or a combination or fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room. This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application. \n<\/p><p>Image-guided surgery helps surgeons perform safer and less invasive procedures and has become a recognized standard of care in managing disorders including cranial, otorhinolaryngology, spine, orthopedic, and cardiovascular.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> \n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Benefits\">Benefits<\/span><\/h2>\n<p>The benefits of Image-guided surgery include greater control of the surgical procedure, real-time feedback on the effect of the intervention, reduced tissue trauma and disruption in gaining access to the anatomical structure. Image-guided surgery allows for: reduced post-operative neural deficits and adverse events associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endovenous_laser_treatment\" title=\"Endovenous laser treatment\" rel=\"external_link\" target=\"_blank\">endovenous laser ablative<\/a> procedures<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>, and more effective removal of brain tumors that were once considered inoperable due to their size or location.<sup id=\"rdp-ebb-cite_ref-auto_3-0\" class=\"reference\"><a href=\"#cite_note-auto-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>The various applications of navigation for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurosurgery\" title=\"Neurosurgery\" rel=\"external_link\" target=\"_blank\">neurosurgery<\/a> have been widely used and reported for almost two decades.<sup id=\"rdp-ebb-cite_ref-auto_3-1\" class=\"reference\"><a href=\"#cite_note-auto-3\" rel=\"external_link\">[3]<\/a><\/sup> According to a study in 2000, researchers were already anticipating that a significant portion of neurosurgery would be performed using computer-based interventions.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Recent advancements in ultrasound, including intravascular ultrasound (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravascular_ultrasound\" title=\"Intravascular ultrasound\" rel=\"external_link\" target=\"_blank\">IVUS<\/a>) allow for real-time cross sectional mapping of vessels and lateral tissues providing calibrated measurements of vessel diameters, contours and morphology.\n<\/p><p>Part of the wider field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">computer-assisted surgery<\/a>, image-guided surgery can take place in hybrid operating rooms using intraoperative imaging. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hybrid_operating_room\" title=\"Hybrid operating room\" rel=\"external_link\" target=\"_blank\">hybrid operating room<\/a> is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. Most image-guided surgical procedures are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive\" class=\"mw-redirect\" title=\"Minimally invasive\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a>. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">interventional radiology<\/a>.\n<\/p><p>Image-guided surgery was originally developed for treatment of brain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumors\" class=\"mw-redirect\" title=\"Tumors\" rel=\"external_link\" target=\"_blank\">tumors<\/a> using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">stereotactic surgery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiosurgery\" title=\"Radiosurgery\" rel=\"external_link\" target=\"_blank\">radiosurgery<\/a> that are guided by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">computed tomography<\/a> (CT), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">magnetic resonance imaging<\/a> (MRI) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positron_emission_tomography\" title=\"Positron emission tomography\" rel=\"external_link\" target=\"_blank\">positron emission tomography<\/a> (PET) using a technology known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/N-localizer\" title=\"N-localizer\" rel=\"external_link\" target=\"_blank\">N-localizer<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>A hand-held surgical probe is an essential component of any image-guided surgery system as it provides the surgeon with a map of the designated area.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> During the surgical procedure, the IGS tracks the probe position and displays the anatomy beneath it as, for example, three orthogonal image slices on a workstation-based 3D imaging system. Existing IGS systems use different tracking techniques including mechanical, optical, ultrasonic, and electromagnetic. \n<\/p><p>When <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorescence\" title=\"Fluorescence\" rel=\"external_link\" target=\"_blank\">fluorescence<\/a> modality is adopted to such devices, the technique is also called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorescence_image-guided_surgery\" title=\"Fluorescence image-guided surgery\" rel=\"external_link\" target=\"_blank\">fluorescence image-guided surgery<\/a>.\n<\/p><p>Image-guided surgery using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasound\" title=\"Medical ultrasound\" rel=\"external_link\" target=\"_blank\">medical ultrasound<\/a> utilises sounds waves and as such does not require the protection and safety precautions necessary with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionizing_radiation\" title=\"Ionizing radiation\" rel=\"external_link\" target=\"_blank\">ionising radiation<\/a> modalities such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a>, CT, X-Ray and tomography.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_assisted_surgery\" class=\"mw-redirect\" title=\"Computer assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer assisted surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">Interventional radiology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraoperative_MRI\" title=\"Intraoperative MRI\" rel=\"external_link\" target=\"_blank\">Intraoperative MRI<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiosurgery\" title=\"Radiosurgery\" rel=\"external_link\" target=\"_blank\">Radiosurgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">Stereotactic surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.dedicatedcomputing.com\/oem\/markets\/healthcare\/surgery-and-treatment\/\" target=\"_blank\">\"Surgery and Treatment - Dedicated Computing\"<\/a>. <i>Dedicated Computing<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dedicated+Computing&rft.atitle=Surgery+and+Treatment+-+Dedicated+Computing&rft_id=https%3A%2F%2Fwww.dedicatedcomputing.com%2Foem%2Fmarkets%2Fhealthcare%2Fsurgery-and-treatment%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/docs.google.com\/document\/d\/e\/2PACX-1vQnU5wYkr4eqtjFatBkgD0GjM7PbfTmhX2LC9fhKqji0SWYgX0m3W_jnL2P7WPF3uRh4OjkXEuv0Lo7\/pub\" target=\"_blank\">\"Dr Joseph Grace et al - Neural Defecits Post Ultrasound Guided Endovenous Laser Ablation Union International de Phlebology World Congress 2018 Melbourne Australia\"<\/a>. <i>docs.google.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=docs.google.com&rft.atitle=Dr+Joseph+Grace+et+al+-+Neural+Defecits+Post+Ultrasound+Guided+Endovenous+Laser+Ablation+Union+International+de+Phlebology+World+Congress+2018+Melbourne+Australia&rft_id=https%3A%2F%2Fdocs.google.com%2Fdocument%2Fd%2Fe%2F2PACX-1vQnU5wYkr4eqtjFatBkgD0GjM7PbfTmhX2LC9fhKqji0SWYgX0m3W_jnL2P7WPF3uRh4OjkXEuv0Lo7%2Fpub&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-auto-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-auto_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-auto_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mezger U, Jendrewski C, Bartels M (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3627858\" target=\"_blank\">\"Navigation in surgery\"<\/a>. <i>Langenbecks Arch Surg<\/i>. <b>398<\/b>: 501\u201314. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00423-013-1059-4\" target=\"_blank\">10.1007\/s00423-013-1059-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3627858\" target=\"_blank\">3627858<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23430289\" target=\"_blank\">23430289<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Langenbecks+Arch+Surg&rft.atitle=Navigation+in+surgery&rft.volume=398&rft.pages=501-14&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3627858&rft_id=info%3Apmid%2F23430289&rft_id=info%3Adoi%2F10.1007%2Fs00423-013-1059-4&rft.aulast=Mezger&rft.aufirst=U&rft.au=Jendrewski%2C+C&rft.au=Bartels%2C+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3627858&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kelly PJ (Jan 2000). \"What is past is prologue\". <i>Neurosurgery<\/i>. <b>46<\/b> (1): 16\u201327. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fneurosurgery%2F46.1.16\" target=\"_blank\">10.1093\/neurosurgery\/46.1.16<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgery&rft.atitle=What+is+past+is+prologue&rft.volume=46&rft.issue=1&rft.pages=16-27&rft.date=2000-01&rft_id=info%3Adoi%2F10.1093%2Fneurosurgery%2F46.1.16&rft.au=Kelly+PJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Galloway, RL Jr. (2015). \"Introduction and Historical Perspectives on Image-Guided Surgery\". In Golby, AJ. <i>Image-Guided Neurosurgery<\/i>. Amsterdam: Elsevier. pp. 3\u20134.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Introduction+and+Historical+Perspectives+on+Image-Guided+Surgery&rft.btitle=Image-Guided+Neurosurgery&rft.place=Amsterdam&rft.pages=3-4&rft.pub=Elsevier&rft.date=2015&rft.aulast=Galloway&rft.aufirst=RL+Jr.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Tse, VCK; Kalani, MYS; Adler, JR (2015). \"Techniques of Stereotactic Localization\". In Chin, LS; Regine, WF. <i>Principles and Practice of Stereotactic Radiosurgery<\/i>. New York: Springer. p. 28.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Techniques+of+Stereotactic+Localization&rft.btitle=Principles+and+Practice+of+Stereotactic+Radiosurgery&rft.place=New+York&rft.pages=28&rft.pub=Springer&rft.date=2015&rft.aulast=Tse&rft.aufirst=VCK&rft.au=Kalani%2C+MYS&rft.au=Adler%2C+JR&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Saleh, H; Kassas, B (2015). \"Developing Stereotactic Frames for Cranial Treatment\". In Benedict, SH; Schlesinger, DJ; Goetsch, SJ; Kavanagh, BD. <i>Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy<\/i>. Boca Raton: CRC Press. pp. 156\u2013159.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Developing+Stereotactic+Frames+for+Cranial+Treatment&rft.btitle=Stereotactic+Radiosurgery+and+Stereotactic+Body+Radiation+Therapy&rft.place=Boca+Raton&rft.pages=156-159&rft.pub=CRC+Press&rft.date=2015&rft.aulast=Saleh&rft.aufirst=H&rft.au=Kassas%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/care.american-rhinologic.org\/igs\" target=\"_blank\">\"Image-Guided Surgery\"<\/a>. <i>care.american-rhinologic.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=care.american-rhinologic.org&rft.atitle=Image-Guided+Surgery&rft_id=http%3A%2F%2Fcare.american-rhinologic.org%2Figs&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Khan, FR; Henderson, JM (2013). \"Deep Brain Stimulation Surgical Techniques\". In Lozano, AM; Hallet, M. <i>Brain Stimulation: Handbook of Clinical Neurology<\/i>. <b>116<\/b>. Amsterdam: Elsevier. pp. 28\u201330.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Deep+Brain+Stimulation+Surgical+Techniques&rft.btitle=Brain+Stimulation%3A+Handbook+of+Clinical+Neurology&rft.place=Amsterdam&rft.pages=28-30&rft.pub=Elsevier&rft.date=2013&rft.aulast=Khan&rft.aufirst=FR&rft.au=Henderson%2C+JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Arle, J (2009). \"Development of a Classic: the Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames\". In Lozano, AM; Gildenberg, PL; Tasker, RR. <i>Textbook of Stereotactic and Functional Neurosurgery<\/i>. Berlin: Springer-Verlag. pp. 456\u2013461.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Development+of+a+Classic%3A+the+Todd-Wells+Apparatus%2C+the+BRW%2C+and+the+CRW+Stereotactic+Frames&rft.btitle=Textbook+of+Stereotactic+and+Functional+Neurosurgery&rft.place=Berlin&rft.pages=456-461&rft.pub=Springer-Verlag&rft.date=2009&rft.aulast=Arle&rft.aufirst=J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Brown RA, Nelson JA (June 2012). \"Invention of the N-localizer for stereotactic neurosurgery and its use in the Brown-Roberts-Wells stereotactic frame\". <i>Neurosurgery<\/i>. <b>70<\/b> (Operative Supplement 2): 173\u2013176. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1227%2FNEU.0b013e318246a4f7\" target=\"_blank\">10.1227\/NEU.0b013e318246a4f7<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22186842\" target=\"_blank\">22186842<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgery&rft.atitle=Invention+of+the+N-localizer+for+stereotactic+neurosurgery+and+its+use+in+the+Brown-Roberts-Wells+stereotactic+frame&rft.volume=70&rft.issue=Operative+Supplement+2&rft.pages=173-176&rft.date=2012-06&rft_id=info%3Adoi%2F10.1227%2FNEU.0b013e318246a4f7&rft_id=info%3Apmid%2F22186842&rft.aulast=Brown&rft.aufirst=RA&rft.au=Nelson%2C+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Brown RA, Nelson JA (2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4959822\" target=\"_blank\">\"The invention and early history of the N-localizer for stereotactic neurosurgery\"<\/a>. <i>Cureus<\/i>. <b>8<\/b> (6): e642. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7759%2Fcureus.642\" target=\"_blank\">10.7759\/cureus.642<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4959822\" target=\"_blank\">4959822<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27462476\" target=\"_blank\">27462476<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cureus&rft.atitle=The+invention+and+early+history+of+the+N-localizer+for+stereotactic+neurosurgery&rft.volume=8&rft.issue=6&rft.pages=e642&rft.date=2016&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4959822&rft_id=info%3Apmid%2F27462476&rft_id=info%3Adoi%2F10.7759%2Fcureus.642&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4959822&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1331\nCached time: 20181127134715\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.172 seconds\nReal time usage: 0.204 seconds\nPreprocessor visited node count: 577\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 20670\/2097152 bytes\nTemplate argument size: 84\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 27544\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.115\/10.000 seconds\nLua memory usage: 3.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 176.287 1 -total\n<\/p>\n<pre>87.46% 154.175 1 Template:Reflist\n39.61% 69.835 1 Template:Cite_news\n28.51% 50.259 4 Template:Cite_journal\n15.35% 27.059 5 Template:Cite_book\n 5.25% 9.258 2 Template:Cite_web\n 1.49% 2.625 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1455545-1!canonical and timestamp 20181127134715 and revision id 851647294\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214703\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.170 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.508 1 - wikipedia:Image-guided_surgery\n100.00% 163.508 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8304-0!*!*!*!*!*!* and timestamp 20181217214702 and revision id 24517\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery\">https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3748414858d7d69051899d8143a4c1e7_images":[],"3748414858d7d69051899d8143a4c1e7_timestamp":1545083222,"18026209e7901858227ab2cae8f033cf_type":"article","18026209e7901858227ab2cae8f033cf_title":"Hip replacement","18026209e7901858227ab2cae8f033cf_url":"https:\/\/www.limswiki.org\/index.php\/Hip_replacement","18026209e7901858227ab2cae8f033cf_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHip replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about human hip replacement. For hip replacement in animals, see Hip replacement (animal).\nHip replacementAn X-ray showing a right hip (left of image) has been replaced, with the ball of this ball-and-socket joint replaced by a metal head that is set in the femur and the socket replaced by a white plastic cup (clear in this X-ray).ICD-9-CM81.51\u201381.53MeSHD019644 MedlinePlus002975 [edit on Wikidata]\nHip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedic operations, though patient satisfaction short- and long-term varies widely. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.[1]\n\nContents \n\n1 Medical uses \n2 Modern process \n3 Techniques \n\n3.1 Posterior approach \n3.2 Lateral approach \n3.3 Antero-lateral approach \n3.4 Anterior approach \n3.5 Minimally invasive approaches \n\n\n4 Implants \n\n4.1 Acetabular cup \n4.2 Femoral component \n4.3 Articular interface \n\n\n5 Configuration \n6 Risks \n\n6.1 Infection \n6.2 Dislocation \n6.3 Limb Length Inequality \n6.4 Fracture \n6.5 Vein thrombosis \n6.6 Osteolysis \n6.7 Loosening \n6.8 Metal sensitivity \n6.9 Metal toxicity \n6.10 Nerve palsy \n6.11 Chronic pain \n6.12 Death \n6.13 Metal-on-metal hip implant failure \n\n\n7 Alternatives and variations \n\n7.1 Conservative management \n7.2 Preoperative care \n7.3 Hemiarthroplasty \n7.4 Hip resurfacing \n7.5 Viscosupplementation \n\n\n8 Prevalence and cost \n9 History \n10 See also \n11 References \n12 External links \n\n\nMedical uses \nTotal hip replacement is most commonly used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis, protrusio acetabuli, certain hip fractures, benign and malignant bone tumors, arthritis associated with Paget's disease, ankylosing spondylitis and juvenile rheumatoid arthritis. The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medications, have failed.\n\nModern process \n Main components of a hip prosthesis[2]\n A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup\nThe modern artificial joint owes much to the 1962 work of Sir John Charnley at Wrightington Hospital. His work in the field of tribology resulted in a design that almost completely replaced the other designs by the 1970s. Charnley's design consisted of three parts:\n\nstainless steel one-piece femoral stem and head\npolyethylene (originally Teflon), acetabular component, both of which were fixed to the bone using\nPMMA (acrylic) bone cement\nThe replacement joint, which was known as the Low Friction Arthroplasty, was lubricated with synovial fluid. The small femoral head (7⁄8  in (22.2 mm)) was chosen for Charnley's belief that it would have lower friction against the acetabular component and thus wear out the acetabulum more slowly. Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs. The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component. The ultra high molecular weight polyethylene or UHMWPE acetabular component was introduced in 1962. Charnley's other major contribution was to use polymethylmethacrylate (PMMA) bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants.\nThe Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device. Its development occurred following a collaboration between Orthopaedic Surgeon Robin Ling and University of Exeter engineer Clive Lee and it was first implanted at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1970.[3] The Exeter Hip is a cemented device, but with a slightly different stem geometry. Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions.\nEarly implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place. That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem. It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early 1980s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone. Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking (AML) stem design. With time, other forms of stem surface treatment and stem geometry have been developed and improved.\nInitial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length (some heads seat more or less onto the stem) and to select from various materials from which the head is formed. A modern acetabulum component is also made up of two parts: a metal shell with a coating for bone attachment and a separate liner. First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.\nTo combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. Ceramic heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. Highly crosslinked UHMWPE was introduced in the late 1990s. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices. All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery.\nWhen currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion. Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. Uncemented stems can cause pain with activity in up to 20% of patients during the first year after placement as the bone adapts to the device. This is rarely seen with cemented stems.\nOnce an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active athletes including race car drivers Bobby Labonte and Dale Jarrett, and the 8-time Major-winning American golfer Tom Watson, who shot a 67 in the opening round of the Masters Tournament in the year following his operation.\n\nTechniques \nThere are several incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool),[4] antero-lateral (Watson-Jones),[5] anterior (Smith-Petersen)[6] and greater trochanter osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral (Watson-Jones) or posterior approach.[citation needed ]\n\nPosterior approach \nThe posterior (Moore or Southern) approach accesses the joint and capsule through the back, taking piriformis muscle and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip abductors and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.\n\nLateral approach \nThe lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors (gluteus medius and gluteus minimus) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley),[citation needed ] or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using sutures. Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.\n\nAntero-lateral approach \nThe anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.\n\nAnterior approach \nThe anterior approach uses an interval between the sartorius muscle and tensor fasciae latae. Dr. Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches.[7] The anterior approach has been shown in studies to variably improve early functional recovery, with possible complications of femoral component loosening and early revision compared to other approaches[8][9][10][11][12][13]\n\nMinimally invasive approaches \nThe dual incision approach and other minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller. This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a \"minimally invasive\" approach compared to traditional approaches which were quite large comparatively.\nComputer-assisted surgery and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques.[14][15]\n\nImplants \n Metal on metal prosthetic hip\n Cement-free implant sixteen days after surgery. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant. Ceramic head. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw.\nThe prosthetic implant used in hip replacement consists of three parts: the acetabular cup, the femoral component, and the articular interface. Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups.[16] Correct selection of the prosthesis is important.\n\nAcetabular cup \nThe acetabular cup is the component which is placed into the acetabulum (hip socket). Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement. Some acetabular cups are one piece, while others are modular. One-piece (monobloc) shells are either UHMWPE (ultra-high-molecular-weight polyethylene) or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place. A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner. Two types of porous coating used to form a friction fit are sintered beads and a foam metal design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.[17] Permanent fixation is achieved as bone grows onto or into the porous coating. Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a Morse taper.[citation needed ]\n\nFemoral component \nThis section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) (Learn how and when to remove this template message)The femoral component is the component that fits in the femur (thigh bone). Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head (ball). There are two types of fixation: cemented and uncemented. Cemented stems use acrylic bone cement to form a mantle between the stem and to the bone. Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials (titanium, cobalt chromium, stainless steel, and polymer composites) and they can be monolithic or modular. Modular components consist of different head dimensions and\/or modular neck orientations; these attach via a taper similar to a Morse taper. These options allow for variability in leg length, offset and version. Femoral heads are made of metal or ceramic material. Metal heads, made of cobalt chromium for hardness, are machined to size and then polished to reduce wear of the socket liner. Ceramic heads are more smooth than polished metal heads, have a lower coefficient of friction than a cobalt chrome head, and in theory will wear down the socket liner more slowly. As of early 2011, follow-up studies in patients have not demonstrated significant reductions in wear rates between the various types of femoral heads on the market. Ceramic implants are more brittle and may break after being implanted.\nArticular interface \nThis section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) (Learn how and when to remove this template message)The articular interface is not part of either implant, rather it is the area between the acetabular cup and femoral component. The articular interface of the hip is a simple ball and socket joint. Size, material properties and machining tolerances at the articular interface can be selected based on patient demand to optimise implant function and longevity whilst mitigating associated risks. The interface size is measured by the outside diameter of the head or the inside diameter of the socket. Common sizes of femoral heads are 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm (7⁄8  in) was common in the first modern prostheses, now even larger sizes are available from 38 to over 54 mm. Larger-diameter heads lead to increased stability and range of motion whilst lowering the risk of dislocation. At the same time they are also subject to higher stresses such as friction and inertia. Different combinations of materials have different physical properties which can be coupled to reduce the amount of wear debris generated by friction. Typical pairings of materials include metal on polyethylene (MOP), metal on crosslinked polyethylene (MOXP), ceramic on ceramic (COC), ceramic on crosslinked polyethylene (COXP) and metal on metal (MOM). Each combination has different advantages and disadvantages.\nConfiguration \nPost-operative projectional radiography is routinely performed to ensure proper configuration of hip prostheses.\nThe direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.[18] For this purpose, the acetabular inclination and the acetabular anteversion are measurements of cup angulation in the coronal plane and the sagittal plane, respectively.\n\n\n\t\t\n\t\t\t\n\t\t\t\nAcetabular inclination.[19] This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the transischial line which is tangential to the inferior margins of the ischium bones.[19]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAcetabular inclination is normally between 30 and 50\u00b0.[19] A larger angle increases the risk of dislocation.[18]\n\n\t\t\t\n\t\t\n\n\n\t\t\n\t\t\t\n\t\t\t\nAcetabular anteversion.[20] This parameter is calculated on a lateral radiograph as the angle between the transverse plane and a line going through the (anterior and posterior) margins of the acetabular cup.[20]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAcetabular anteversion is normally between 5 and 25\u00b0.[18] An anteversion below or above this range increases the risk of dislocation.[18] There is an intra-individual variability in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.[18]\n\n\t\t\t\n\t\t\n\n\n\t\t\n\t\t\t\n\t\t\t\nLeg length discrepancy after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops[19] or the transischial line[18] as references for the horizontal plane. A discrepancy of up to 1 cm is generally tolerated.[19][18]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nCenter of rotation: The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and\/or the native femoral head on the contralateral side.[19] The vertical center of rotation instead uses the transischial line for reference.[19] The parameter should be equal on both sides.[19]\n\n\t\t\t\n\t\t\n\nRisks \nRisks and complications in hip replacement are similar to those associated with all joint replacements. They can include infection, dislocation, limb length inequality, loosening, impingement, osteolysis, metal sensitivity, nerve palsy, chronic pain and death. Weight loss surgery before a hip replacement does not appear to change outcomes.[21]\n\nInfection \nInfection is one of the most common causes for revision of a total hip replacement, along with loosening and dislocation. The incidence of infection in primary hip replacement is around 1% or less in the United States.[22] Risk factors for infection include obesity, diabetes, smoking, immunosuppressive medications or diseases, and history of infection.\nModern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.[23] They are:\n1.There is a sinus tract communicating with the prosthesis; or\n2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n\n<\/p>Four of the following six criteria exist:\n1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n2.Elevated synovial leukocyte count,\n3.Elevated synovial neutrophil percentage (PMN%),\n4.Presence of purulence in the affected joint,\n5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\nNone of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\n\nDislocation \n Dislocated artificial hip\n Liner wear, particularly when over 2 mm, increases the risk of dislocation.[24] Liner creep, on the other hand, is normal remoulding.[18]\nDislocation is the most common complication of hip replacement surgery. The most common causes vary by the duration since the surgery.\nHip prosthesis dislocation mostly occurs in the first 3 months after insertion, mainly because of incomplete scar formation and relaxed soft tissues.[24] It takes eight to twelve weeks for the soft tissues injured or cut during surgery to heal. During this period, the hip ball can come out of the socket. The chance of this is diminished if less tissue is cut, if the tissue cut is repaired and if large diameter head balls are used.\nDislocations occurring between 3 months and 5 years after insertion usually occur due to malposition of the components, or dysfunction of nearby muscles.[24]\nRisk factors of late dislocation (after 5 years) mainly include:[24]\n\nFemale gender\nYounger age at primary hip arthroplasty\nPrevious subluxation without complete dislocation\nPrevious trauma\nSubstantial weight loss\nRecent onset or progression of dementia or a neurological disorder\nMalposition of the cup\nWear of the liner, particularly when it causes movement of the head of more than 2 mm within the cup compared to its original position\nProsthesis loosening with migration\nSurgeons who perform more of the operations each year tend to have fewer patients dislocate. Doing the surgery from an anterior approach seems to lower dislocation rates when small diameter heads are used, but the benefit has not been shown when compared to modern posterior incisions with the use of larger diameter heads. The use of larger diameter head size does in it self decrease the risk of dislocation, even though this correlation is only found in head sizes up to 28 mm, thereafter no additional decrease in dislocation rate is found.[25] Patients can decrease the risk further by keeping the leg out of certain positions during the first few months after surgery.\n\nLimb Length Inequality \nMost adults prior to a hip replacement have a limb length inequality of 0\u20132 cm which they were born with and which causes no clinical deficits.[26] It is common for patients to feel a limb length inequality after total hip replacement.[27] Sometimes the leg seems long immediately after surgery when in fact both are equal length. An arthritic hip can develop contractures that make the leg behave as if it is short. When these are relieved with replacement surgery and normal motion and function are restored, the body feels that the limb is now longer than it was. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The cause of this feeling is variable, and usually related to abductor muscle weakness, pelvic obliquity, and minor lengthening of the hip during surgery (<1 cm) to achieve stability and restore the joint to pre-arthritic mechanics. If the limb length difference remains bothersome to the patient more than 6 months after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction.\n\nFracture \nBones with internal fixation devices in situ are at risk of periprosthetic fractures at the end of the implant, an area of relative mechanical stress. Post-operative femoral fractures are graded by the Vancouver classification.\n\nVein thrombosis \nVenous thrombosis such as deep vein thrombosis and pulmonary embolism are relatively common following hip replacement surgery. Standard treatment with anticoagulants is for 7\u201310 days; however treatment for more than 21 days may be superior.[28] Research from 2013 has on the other hand suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital.[29]\nSome physicians and patients may consider having an ultrasonography for deep vein thrombosis after hip replacement.[30] However, this kind of screening should only be done when indicated because to perform it routinely would be unnecessary health care.[30]\n\nOsteolysis \nMany long-term problems with hip replacements are the result of osteolysis. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that come off the cup liner over time. An inflammatory process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. In an attempt to eliminate the generation of wear particles, ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results. Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were also developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication. At the same time that these two bearing surfaces were being developed, highly cross linked polyethylene plastic liners were also developed. The greater cross linking significantly reduces the amount of plastic wear debris given off over time. The newer ceramic and metal prostheses do not always have the long-term track record of established metal on poly bearings. Ceramic pieces can break leading to catastrophic failure. This occurs in about 2% of the implants placed. They may also cause an audible, high pitched squeaking noise with activity. Metal-on-metal arthroplasty releases metal debris into the body raising concerns about the potential dangers of these accumulating over time. Highly cross linked polyethylene is not as strong as regular polyethylene. These plastic liners can crack or break free of the metal shell that holds them.\n\nLoosening \n Hip prosthesis displaying aseptic loosening (arrows)\n Hip prosthesis zones according to DeLee and Charnley,[31] and Gruen.[32] These are used to describe the location of for example areas of loosening.\nOn radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.[33] The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.[34] In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).[33] The direct anterior approach has been shown to itself be a risk factor for early femoral component loosening.[9][35][8]\n\nMetal sensitivity \nConcerns are being raised about the metal sensitivity and potential dangers of metal particulate debris. New publications[36][37] have demonstrated development of pseudotumors, soft tissue masses containing necrotic tissue, around the hip joint. It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris.\nMetal hypersensitivity is a well-established phenomenon and is common, affecting about 10\u201315% of the population.[38] Contact with metals can cause immune reactions such as skin hives, eczema, redness and itching. Although little is known about the short- and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo, there have been many reports of immunologic type responses temporally associated with implantation of metal components. Individual case reports link hypersensitivity immune reactions with adverse performance of metallic clinical cardiovascular, orthopedic and plastic surgical and dental implants.[38]\n\nMetal toxicity \nMain article: Metallosis\nMost hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All implants release their constituent ions into the blood. Typically these are excreted in the urine, but in certain individuals the ions can accumulate in the body. In implants which involve metal-on-metal contact, microscopic fragments of cobalt and chromium can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients.[39][40]\n\nNerve palsy \nPost operative sciatic nerve palsy is another possible complication. The incidence of this complication is low. Femoral nerve palsy is another but much more rare complication. Both of these will typically resolve over time, but the healing process is slow. Patients with pre-existing nerve injury are at greater risk of experiencing this complication and are also slower to recover.\n\nChronic pain \nA few patients who have had a hip replacement suffer chronic pain after the surgery. Groin pain can develop if the muscle that raises the hip (iliopsoas) rubs against the edge of the acetabular cup. Bursitis can develop at the trochanter where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far. Also some patients can experience pain in cold or damp weather.[citation needed ] Incision made in the front of the hip (anterior approach) can cut a nerve running down the thigh leading to numbness in the thigh and occasionally chronic pain at the point where the nerve was cut (a neuroma).\n\nDeath \nThe rate of death for elective hip replacements is significantly less than 1%.[41][42]\n\nMetal-on-metal hip implant failure \nSee also: Implant failure\nBy 2010, reports in the orthopaedic literature increasingly cited the problem of early failure of metal on metal prostheses in a small percentage of patients.[43] Failures may relate to release of minute metallic particles or metal ions from wear of the implants, causing pain and disability severe enough to require revision surgery in 1\u20133% of patients.[44] Design deficits of some prothesis models, especially with heat-treated alloys and a lack of special surgical experience accounting for most of the failures. In 2010, surgeons at medical centers such as the Mayo Clinic reported reducing their use of metal-on-metal implants by 80 percent over the previous year in favor of those made from other materials, like combinations of metal and plastic.[45] The cause of these failures remain controversial, and may include both design factors, technique factors, and factors related to patient immune responses (allergy type reactions). In the United Kingdom the Medicines and Healthcare Products Regulatory Agency commenced an annual monitoring regime for metal-on-metal hip replacement patients from May 2010.[46] Data which are shown in The Australian Orthopaedic Association's 2008 National Joint replacement registry, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR (Birmingham Hip Resurfacing) Hips and found that less than one-third of one percent may have been revised due to the patient's reaction to the metal component.[47] Other similar metal-on-metal designs have not fared as well, where some reports show 76% to 100% of the people with these metal-on-metal implants and have aseptic implant failures requiring revision also have evidence of histological inflammation accompanied by extensive lymphocyte infiltrates, characteristic of delayed type hypersensitivity responses.[48] It is not clear to what extent this phenomenon negatively affects orthopedic patients. However, for patients presenting with signs of an allergic reactions, evaluation for sensitivity should be conducted. Removal of the device that is not needed should be considered, since removal may alleviate the symptoms. Patients who have allergic reactions to cheap jewelry are more likely to have reactions to orthopedic implants. There is increasing awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implant is optimal for each patient.\nOn March 12, 2012, The Lancet published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal hip implants failed at much greater rates than other types of hip implants and calling for a ban on all metal-on-metal hips.[49] The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure.[50] Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.[51][52]\nOn February 10, 2011, the U.S. FDA issued an advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems.[53] On June 27\u201328, 2012, an advisory panel met to decide whether to impose new standards, taking into account findings of the study in The Lancet.[40][54][55] No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated.[56] Currently, FDA has not required hip implants to be tested in clinical trials before they can be sold in the U.S.[57] Instead, companies making new hip implants only need to prove that they are \"substantially equivalent\" to other hip implants already on the market. The exception is metal-on-metal implants, which were not tested in clinical trials but because of the high revision rate of metal-on-metal hips, in the future the FDA has stated that clinical trials will be required for approval and that post-market studies will be required to keep metal on metal hip implants on the market.[58]\n\nAlternatives and variations \nConservative management \nThe first line approach as an alternative to hip replacement is conservative management which involves a multimodal approach of oral medication, injections, activity modification and physical therapy.[59] Conservative management can prevent or delay the need for hip replacement.\n\nPreoperative care \nPreoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before hip or knee replacement, with low risk of negative effects.[60]\n\nHemiarthroplasty \nHemiarthroplasty is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture of the neck of the femur (a hip fracture). The procedure is performed by removing the head of the femur and replacing it with a metal or composite prosthesis. The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a composite of metal and HDPE which forms two interphases (bipolar prosthesis) has also been used. The monopolar prosthesis has not been shown to have any advantage over bipolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the acetabulum.[61]\n\n\n\t\t\n\t\t\t\n\t\t\t\nHip prosthesis for hemiarthroplasty. This example is bipolar, meaning that the head has 2 separate articulations.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nX-ray of the hips, with a right-sided hemiarthroplasty.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nFemoral (neck) offset is defined as the perpendicular distance between the intramedullary or longitudinal axis of the femur and the center of rotation of the native or prosthetic femoral head. An unnatural offset is associated with hip dislocation.[62]\n\n\t\t\t\n\t\t\n\nHip resurfacing \nHip resurfacing is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and become a common procedure. Health-related quality of life measures are markedly improved and patient satisfaction is favorable after hip resurfacing arthroplasty.[63]\nThe minimally invasive hip resurfacing procedure is a further refinement to hip resurfacing.\n\nViscosupplementation \nCurrent alternatives also include viscosupplementation, or the injection of artificial lubricants into the joint.[64] Use of these medications in the hip is off label. The cost of treatment is typically not covered by health insurance organizations.\nSome believe that the future of osteoarthritis treatment is bioengineering, targeting the growth and\/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal stem cells in one patient.[65] It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits. The FDA has stated that this procedure is being practiced without conforming to regulations, but Centeno claims that it is exempt from FDA regulation. It has not been shown in controlled clinical trials to be effective[citation needed ], and costs over $7,000.\n\nPrevalence and cost \nTotal hip replacement incidence varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year.[66] Approximately 0.8% of Americans have undergone the procedure.[67]\nAccording to the International Federation of Healthcare Plans, the average cost of a total hip replacement in 2012 was $40,364 in the United States, $11,889 in the United Kingdom, $10,987 in France, $9,574 in Switzerland, and $7,731 in Spain.[1] In the United States, the average cost of a total hip replacement varies widely by geographic region, ranging from $11,327 (Birmingham, Alabama) to $73,927 (Boston, Massachusetts).[68]\n\nHistory \nThe earliest recorded attempts at hip replacement were carried out in Germany in 1891 by Themistocles Gluck (1853\u20131942),[69][70] who used ivory to replace the femoral head (the ball on the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.[71]\nOn September 28, 1940 at Columbia Hospital in Columbia, South Carolina, American surgeon Dr. Austin T. Moore (1899\u20131963)[72] performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head made of the cobalt-chrome alloy Vitallium. It was about a foot in length and bolted to the resected end of the femoral shaft (hemiarthroplasty). A later version, the so-called Austin Moore Prosthesis which was introduced in 1952, is still in use today, although rarely. Like modern hip implants, it is inserted into the medullary canal of the femur, and depends on bone growth through a hole in the stem for long-term attachment.\n\nSee also \nAbductor wedge\nFemoral Acetabular Impingement\nGruen zone\nHip examination\n2010 DePuy Hip Recall\nReferences \n\n\n^ a b \"2012 comparative price report\" (PDF) . International Federation of Health Plans. Retrieved 4 October 2015 . \n\n^ Andrew Still (2002-11-02). \"Total Hip Replacement\". University of Southern California. Retrieved 2017-01-05 . \n\n^ Timperley, A John (20 October 2017). \"Robin Ling obituary\". The Guardian. Retrieved 22 October 2017 . \n\n^ Pai VS (1997). \"A comparison of three lateral approaches in primary total hip replacement\". Int Orthop. 21 (6): 393\u2013398. doi:10.1007\/s002640050193. PMC 3619565 . PMID 9498150. Archived from the original on 2002-01-08. \n\n^ \"Anterolateral Approach to Hip Joint: (Watson Jones) \u2013 Wheeless' Textbook of Orthopaedics\". Retrieved 2007-11-26 . \n\n^ \"Anterior Approach to the Hip (Smith Petersen) \u2013 Wheeless' Textbook of Orthopaedics\". Retrieved 2007-11-26 . \n\n^ Maratt, Joseph D.; Gagnier, Joel J.; Butler, Paul D.; Hallstrom, Brian R.; Urquhart, Andrew G.; Roberts, Karl C. (September 2016). \"No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty\". The Journal of Arthroplasty. 31 (9): 127\u2013130. doi:10.1016\/j.arth.2016.02.071. \n\n^ a b Meneghini, R. Michael; Elston, Addison S.; Chen, Antonia F.; Kheir, Michael M.; Fehring, Thomas K.; Springer, Bryan D. (January 2017). \"Direct Anterior Approach\". The Journal of Bone and Joint Surgery. 99 (2): 99\u2013105. doi:10.2106\/JBJS.16.00060. PMID 28099299. \n\n^ a b Eto, Shuichi; Hwang, Katherine; Huddleston, James I.; Amanatullah, Derek F.; Maloney, William J.; Goodman, Stuart B. (March 2017). \"The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty\". The Journal of Arthroplasty. 32 (3): 1001\u20131005. doi:10.1016\/j.arth.2016.09.012. PMID 27843039. \n\n^ Christensen, Christian P.; Jacobs, Cale A. (September 2015). \"Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study\". The Journal of Arthroplasty. 30 (9): 94\u201397. doi:10.1016\/j.arth.2014.12.038. \n\n^ Higgins, Brendan T.; Barlow, Daniel R.; Heagerty, Nathan E.; Lin, Tim J. (March 2015). \"Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis\". The Journal of Arthroplasty. 30 (3): 419\u2013434. doi:10.1016\/j.arth.2014.10.020. \n\n^ Meermans, G.; Konan, S.; Das, R.; Volpin, A.; Haddad, F. S. (June 2017). \"The direct anterior approach in total hip arthroplasty\". The Bone & Joint Journal. 99-B (6): 732\u2013740. doi:10.1302\/0301-620X.99B6.38053. \n\n^ Graves, Sara C.; Dropkin, Benjamin M.; Keeney, Benjamin J.; Lurie, Jon D.; Tomek, Ivan M. (30 November 2015). \"Does Surgical Approach Affect Patient-reported Function After Primary THA?\". Clinical Orthopaedics and Related Research. 474 (4): 971\u2013981. doi:10.1007\/s11999-015-4639-5. PMC 4773324 . \n\n^ Parsley, Brian S. (February 2018). \"Robotics in Orthopedics: A Brave New World\". The Journal of Arthroplasty. doi:10.1016\/j.arth.2018.02.032. \n\n^ Jacofsky, David J.; Allen, Mark (October 2016). \"Robotics in Arthroplasty: A Comprehensive Review\". The Journal of Arthroplasty. 31 (10): 2353\u20132363. doi:10.1016\/j.arth.2016.05.026. \n\n^ Nieuwenhuijse, M. J.; Nelissen, R. G. H. H.; Schoones, J. W.; Sedrakyan, A. (9 September 2014). \"Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies\". BMJ. 349 (sep09 1): g5133\u2013g5133. doi:10.1136\/bmj.g5133. \n\n^ Amirouche, Farid (2014). \"Factors influencing initial cup stability in total hip arthroplasty\". Clinical Biomechanics. 29 (10): 1177\u201385. doi:10.1016\/j.clinbiomech.2014.09.006. PMID 25266242. \n\n^ a b c d e f g h Iain Watt, Susanne Boldrik, Evert van Langelaan and Robin Smithuis. \"Hip - Arthroplasty -Normal and abnormal imaging findings\". Radiology Assistant. Retrieved 2017-05-21 . CS1 maint: Multiple names: authors list (link) \n\n^ a b c d e f g h Vanrusselt, Jan; Vansevenant, Milan; Vanderschueren, Geert; Vanhoenacker, Filip (2015). \"Postoperative radiograph of the hip arthroplasty: what the radiologist should know\". Insights into Imaging. 6 (6): 591\u2013600. doi:10.1007\/s13244-015-0438-5. ISSN 1869-4101. PMID 26487647. \n\n^ a b Shin, W. C.; Lee, S. M.; Lee, K. W.; Cho, H. J.; Lee, J. S.; Suh, K. T. (2015). \"The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty\". The Bone & Joint Journal. 97-B (5): 611\u2013616. doi:10.1302\/0301-620X.97B5.34735. ISSN 2049-4394. \n\n^ Smith, TO; Aboelmagd, T; Hing, CB; MacGregor, A (September 2016). \"Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis\". The Bone & Joint Journal. 98-B (9): 1160\u20131166. doi:10.1302\/0301-620x.98b9.38024. PMID 27587514. \n\n^ Bozic, Kevin J; Kurtz, Steven M; Lau, Edmund; Ong, Kevin; Vail, Thomas P; Berry, Daniel J (January 2009). \"The Epidemiology of Revision Total Hip Arthroplasty in the United States\". The Journal of Bone and Joint Surgery. American Volume. 91 (1): 128\u2013133. doi:10.2106\/JBJS.H.00155. \n\n^ Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. (22 September 2011). \"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society\". Clinical Orthopaedics and Related Research. 469 (11): 2992\u20132994. doi:10.1007\/s11999-011-2102-9. PMC 3183178 . \n\n^ a b c d Daniel J. Berry, Jay Lieberman (2012). Surgery of the Hip. Elsevier Health Sciences. p. 1035. ISBN 9781455727056. \n\n^ Hailer, Nils P.; Weiss, R\u00fcdiger J.; Stark, Andr\u00e9; K\u00e4rrholm, Johan (October 2012). \"The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register\". Acta Orthopaedica. 83 (5): 442\u2013448. doi:10.3109\/17453674.2012.733919. ISSN 1745-3682. PMC 3488169 . PMID 23039167. \n\n^ Knutson, Gary A (2005). \"Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance\". Chiropractic & Osteopathy. 13 (1): 11. doi:10.1186\/1746-1340-13-11. PMC 1232860 . \n\n^ Maloney, William J; Keeney, James A (June 2004). \"Leg length discrepancy after total hip arthroplasty\". The Journal of Arthroplasty. 19 (4): 108\u2013110. doi:10.1016\/j.arth.2004.02.018. \n\n^ Sobieraj, DM; Lee, S; Coleman, CI; Tongbram, V; Chen, W; Colby, J; Kluger, J; Makanji, S; Ashaye, AO; White, CM (May 15, 2012). \"Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review\". Annals of Internal Medicine. 156 (10): 720\u20137. doi:10.7326\/0003-4819-156-10-201205150-00423. PMID 22412039. \n\n^ J\u00f8rgensen, Christoffer C.; Jacobsen, Michael K.; Soeballe, Kjeld; Hansen, Torben B.; Husted, Henrik; Kj\u00e6rsgaard-Andersen, Per; Hansen, Lars T.; Laursen, Mogens B.; Kehlet, Henrik (2013). \"Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study\". BMJ Open. 3 (12): e003965. doi:10.1136\/bmjopen-2013-003965. ISSN 2044-6055. PMC 3863129 . PMID 24334158. \n\n^ a b American Academy of Orthopaedic Surgeons (February 2013), \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Orthopaedic Surgeons, retrieved 19 May 2013 , which cites\nMembers of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (Apr 18, 2012). \"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\". The Journal of Bone and Joint Surgery. American Volume. 94 (8): 673\u20134. doi:10.2106\/JBJS.9408edit. PMC 3326687 . PMID 22517384. \n \n^ John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). The Adult Hip, Volume 1. Lippincott Williams & Wilkins. p. 958. ISBN 978-0-7817-5092-9. CS1 maint: Multiple names: authors list (link) \n\n^ Neumann, Daniel R.P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofst\u00e4dter, Thomas; Dorn, Ulrich (2010). \"Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty\". The Journal of Arthroplasty. 25 (5): 700\u2013708. doi:10.1016\/j.arth.2009.05.018. ISSN 0883-5403. \n\n^ a b Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012). \"CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications\". RadioGraphics. 32 (4): 1089\u20131107. doi:10.1148\/rg.324115183. ISSN 0271-5333. \n\n^ Steffen Breusch, Henrik Malchau (2005). The Well-Cemented Total Hip Arthroplasty: Theory and Practice. Springer Science & Business Media. p. 336. ISBN 978-3-540-24197-3. \n\n^ Angerame, Marc R.; Fehring, Thomas K.; Masonis, John L.; Mason, J. Bohannon; Odum, Susan M.; Springer, Bryan D. (February 2018). \"Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?\". The Journal of Arthroplasty. doi:10.1016\/j.arth.2018.01.014. \n\n^ Pandit H, Glyn-Jones S, McLardy-Smith P, et al. (July 2008). \"Pseudotumours associated with metal-on-metal hip resurfacings\". J Bone Joint Surg Br. 90 (7): 847\u201351. doi:10.1302\/0301-620X.90B7.20213. PMID 18591590. \n\n^ Boardman DR, Middleton FR, Kavanagh TG (March 2006). \"A benign psoas mass following metal-on-metal resurfacing of the hip\". J Bone Joint Surg Br. 88 (3): 402\u20134. doi:10.1302\/0301-620X.88B3.16748. PMID 16498023. \r\nKorovessis P, Petsinis G, Repanti M, Repantis T (June 2006). \"Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up\". J Bone Joint Surg Am. 88 (6): 1183\u201391. doi:10.2106\/JBJS.D.02916. PMID 16757749. \n\n^ a b Hallab N, Merritt K, Jacobs JJ (March 2001). \"Metal sensitivity in patients with orthopaedic implants\". J Bone Joint Surg Am. 83-A (3): 428\u201336. PMID 11263649. \n\n^ http:\/\/www.epi.hss.state.ak.us\/bulletins\/docs\/b2010_14.pdf \n\n^ a b \"FDA seeks more advice on metal hip implants\". Reuters. 29 March 2012. Retrieved 20 May 2012 . \n\n^ Cot\u00e9, John (July 22, 2007). \"Hip replacement is not viewed as high-risk surgery; Death is rare, but underlying medical condition a factor\". San Francisco Chronicle. \n\n^ Medscape Conference Coverage, American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, AAOS 2009: Certain Factors Increase Risk for Death After Total Hip Arthroplasty, Barbara Boughton, March 3, 2009. \n\n^ Mikael, Mark M.; Hanssen, Arlen D.; Sierra, Rafael J. (2009). \"Failure of Metal-on-Metal Total Hip Arthroplasty Mimicking Hip Infection\". The Journal of Bone and Joint Surgery. American Volume. 2009 (91): 443\u2013446. doi:10.2106\/JBJS.H.00603. PMID 19181991. Retrieved 2010-05-07 . \n\n^ Meier, Barry (March 3, 2010). \"As Use of Metal-on-Metal Hip Implants Grows, Studies Raise Concerns\". The New York Times. \n\n^ Meier, Barry (March 3, 2010). \"Concerns Over 'Metal on Metal' Hip Implants\". The New York Times. \n\n^ \"Medical Device Alert: All metal-on-metal (MoM) hip replacements\". Medicines and Healthcare products Regulatory Agency. 22 April 2010. MDA\/2010\/033. Archived from the original on 25 April 2010. Retrieved 2010-05-07 . \n\n^ Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2008 \n\n^ Milosev I, Trebse R, Kovac S, C\u00f6r A, Pisot V (June 2006). \"Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years\". J Bone Joint Surg Am. 88 (6): 1173\u201382. doi:10.2106\/JBJS.E.00604. PMID 16757748. \n\n^ Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW (March 2012). \"Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales\". Lancet. 379 (9822): 1199\u2013204. doi:10.1016\/S0140-6736(12)60353-5. PMID 22417410. \n\n^ Gallagher, James (13 March 2012). \"Metal-on-metal hip replacements 'high failure rate' \". BBC. Retrieved 20 May 2012 . \n\n^ Pijls, B. G.; Meessen, J. M. T. A.; Schoones, J. W.; Fiocco, M.; Heide, H. J. L. van der; Sedrakyan, A.; Nelissen, R. G. H. H. (2016). \"Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis\". PLOS One. 11 (6): e0156051. doi:10.1371\/journal.pone.0156051. ISSN 1932-6203. PMC 4905643 . PMID 27295038. \n\n^ Roberts, Michelle (5 March 2012). \"Surgeons call for end to metal hip replacements\". BBC. Retrieved 20 May 2012 . \n\n^ \"Metal-on-Metal Hip Implants\". Food and Drug Administration. February 10, 2011. Retrieved January 4, 2012 . \n\n^ \"Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee Meeting Announcement\". Food and Drug Administration. 27 March 2012. FDA-2012-N-0293. Retrieved 20 May 2012 . \n\n^ FDA Executive Summary Memorandum \u2013 Metal-on-Metal Hip Implant System (PDF) (Report). Food and Drug Administration. 27 June 2012. Retrieved 15 March 2013 . \n\n^ \"Concerns about Metal-on-Metal Hip Implants\". Food and Drug Administration. 17 January 2013. Retrieved 15 March 2013 . \n\n^ \"Study Suggests Women Have Higher Risk of Hip Implant Failure - For The Media - JAMA Network\". media.jamanetwork.com. \n\n^ Rising, Joshua P.; Reynolds, Ian S.; Sedrakyan, Art (2012). \"Delays and Difficulties in Assessing Metal-on-Metal Hip Implants\". New England Journal of Medicine. 367 (1): e1. doi:10.1056\/NEJMp1206794. PMID 22716934. \n\n^ Cibulka MT, White DM, Woehrle J, et al. (April 2009). \"Hip pain and mobility deficits\u2014hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association\". J Orthop Sports Phys Ther. 39 (4): A1\u201325. doi:10.2519\/jospt.2009.0301. PMC 3963282 . PMID 19352008. \n\n^ McDonald, S; Page, MJ; Beringer, K; Wasiak, J; Sprowson, A (2014). \"Preoperative education for hip or knee replacement\". The Cochrane Database of Systematic Reviews (published 13 May 2014) (5): CD003526. doi:10.1002\/14651858.CD003526.pub3. PMID 24820247. \n\n^ van der Meulen, M.C.H.; Allen, W.A.; Giddings, V.L.; Athanasiou, K.A.; Poser, R.D.; Goodman, S.B.; Smith, R.L.; Beaupr\u00e9, G.S. \"Effect of hemiarthroplasty on acetabular cartilage\". 1996 Project Reports. VA Palo Alto Health Care System's Bone and Joint Rehabilitation Research and Development Center. \n\n^ Jones, Carl; Briffa, Nikolai; Jacob, Joshua; Hargrove, Richard (2017). \"The Dislocated Hip Hemiarthroplasty: Current Concepts of Etiological factors and Management\". The Open Orthopaedics Journal. 11 (Suppl-7, M4): 1200\u20131212. doi:10.2174\/1874325001711011200. ISSN 1874-3250. \n\n^ Koutras C, Antoniou SA, Talias MA, Heep H (19 May 2015). \"Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis\". J Arthroplasty. 30 (11): 1938\u201352. doi:10.1016\/j.arth.2015.05.014. PMID 26067708. \n\n^ van den Bekerom MP, Lamme B, Sermon A, Mulier M (August 2008). \"What is the evidence for viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature\". Arch Orthop Trauma Surg. 128 (8): 815\u2013823. doi:10.1007\/s00402-007-0447-z. PMID 17874246. \n\n^ Centeno CJ, Kisiday J, Freeman M, Schultz JR (July 2006). \"Partial regeneration of the human hip via autologous bone marrow nucleated cell transfer: A case study\". Pain Physician. 9 (3): 253\u20136. PMID 16886034. Archived from the original on 2009-02-12. \n\n^ Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, G\u00f3mez-Barrena E, de Pina Mde F, Manno V, Torre M, Walter WL, de Steiger R, Geesink RG, Peltola M, R\u00f6der C (2011). \"International survey of primary and revision total knee replacement\". Int Orthop. 35 (12): 1783\u20139. doi:10.1007\/s00264-011-1235-5. PMC 3224613 . PMID 21404023. \n\n^ Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ (2015). \"Prevalence of Total Hip and Knee Replacement in the United States\". J Bone Joint Surg Am. 97 (17): 1386\u201397. doi:10.2106\/JBJS.N.01141. PMC 4551172 . PMID 26333733. \n\n^ \"A study of cost variations for knee and hip replacement surgeries in the U.S.\" (PDF) . Blue Cross Blue Shield Association. 21 January 2015. Archived from the original (PDF) on 22 October 2015. Retrieved 4 October 2015 . \n\n^ \"History of Artificial Joints - ppt video online download\". slideplayer.com. \n\n^ Brand, RA; Mont, MA; Manring, M (2011). \"Biographical sketch: Themistocles Gluck (1853\u20131942)\". Clin. Orthop. Relat. Res. 469 (6): 1525\u20131527. doi:10.1007\/s11999-011-1836-8. PMC 3094624 . PMID 21403990. \n\n^ Gomez PF; Morcuende JA (2005). \"Early attempts at hip arthroplasty\u20141700s to 1950s\". Iowa Orthop J. 25: 25\u20139. PMC 1888777 . PMID 16089067. \n\n^ \"What You Need to Know About Joint Replacement Surgery\". about.com. \n\n\nExternal links \nEdheads Virtual Hip Surgery + Surgery Photos\nAAOS Hip Replacement\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hip_replacement\">https:\/\/www.limswiki.org\/index.php\/Hip_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 23:07.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 583 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","18026209e7901858227ab2cae8f033cf_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Hip_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Hip replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about human hip replacement. For hip replacement in animals, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement_(animal)\" title=\"Hip replacement (animal)\" rel=\"external_link\" target=\"_blank\">Hip replacement (animal)<\/a>.<\/div>\n\n<p><b>Hip replacement<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> procedure in which the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip\" title=\"Hip\" rel=\"external_link\" target=\"_blank\">hip<\/a> joint is replaced by a prosthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implant<\/a>, that is, a <b>hip prosthesis<\/b>. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopaedic_surgery\" class=\"mw-redirect\" title=\"Orthopaedic surgery\" rel=\"external_link\" target=\"_blank\">orthopaedic surgery<\/a> is generally conducted to relieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\" title=\"Arthritis\" rel=\"external_link\" target=\"_blank\">arthritis<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a> or in some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fractures<\/a>. A total hip replacement (total hip arthroplasty) consists of replacing both the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a> and the femoral head while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiarthroplasty\" class=\"mw-redirect\" title=\"Hemiarthroplasty\" rel=\"external_link\" target=\"_blank\">hemiarthroplasty<\/a> generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedic operations, though patient satisfaction short- and long-term varies widely. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.<sup id=\"rdp-ebb-cite_ref-ifhp_1-0\" class=\"reference\"><a href=\"#cite_note-ifhp-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>Total hip replacement is most commonly used to treat joint failure caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a>. Other indications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\" title=\"Rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">rheumatoid arthritis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Avascular_necrosis\" title=\"Avascular necrosis\" rel=\"external_link\" target=\"_blank\">avascular necrosis<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protrusio_acetabuli\" title=\"Protrusio acetabuli\" rel=\"external_link\" target=\"_blank\">protrusio acetabuli<\/a>, certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fractures<\/a>, benign and malignant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_tumor\" title=\"Bone tumor\" rel=\"external_link\" target=\"_blank\">bone tumors<\/a>, arthritis associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paget%27s_disease_of_bone\" title=\"Paget's disease of bone\" rel=\"external_link\" target=\"_blank\">Paget's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankylosing_spondylitis\" title=\"Ankylosing spondylitis\" rel=\"external_link\" target=\"_blank\">ankylosing spondylitis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Juvenile_rheumatoid_arthritis\" class=\"mw-redirect\" title=\"Juvenile rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">juvenile rheumatoid arthritis<\/a>. The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a> and pain medications, have failed.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Modern_process\">Modern process<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:162px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_components.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/Hip_prosthesis_components.jpg\/160px-Hip_prosthesis_components.jpg\" width=\"160\" height=\"197\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_components.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Main components of a hip prosthesis<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/220px-Hip_prosthesis.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> hip prosthesis, with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a> head and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> acetabular cup<\/div><\/div><\/div>\n<p>The modern artificial joint owes much to the 1962 work of Sir <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Charnley\" title=\"John Charnley\" rel=\"external_link\" target=\"_blank\">John Charnley<\/a> at Wrightington Hospital. His work in the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tribology\" title=\"Tribology\" rel=\"external_link\" target=\"_blank\">tribology<\/a> resulted in a design that almost completely replaced the other designs by the 1970s. Charnley's design consisted of three parts:\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_Steel\" class=\"mw-redirect\" title=\"Stainless Steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> one-piece femoral stem and head<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> (originally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon\" class=\"mw-redirect\" title=\"Teflon\" rel=\"external_link\" target=\"_blank\">Teflon<\/a>), acetabular component, both of which were fixed to the bone using<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">PMMA<\/a> (acrylic) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">bone cement<\/a><\/li><\/ol>\n<p>The replacement joint, which was known as the Low Friction <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">Arthroplasty<\/a>, was lubricated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synovial_fluid\" title=\"Synovial fluid\" rel=\"external_link\" target=\"_blank\">synovial fluid<\/a>. The small femoral head (<span class=\"frac nowrap\"><sup>7<\/sup>⁄<sub>8<\/sub><\/span> in (22.2 mm)) was chosen for Charnley's belief that it would have lower friction against the acetabular component and thus wear out the acetabulum more slowly. Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs. The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component. The ultra high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/UHMWPE\" class=\"mw-redirect\" title=\"UHMWPE\" rel=\"external_link\" target=\"_blank\">UHMWPE<\/a> acetabular component was introduced in 1962. Charnley's other major contribution was to use polymethylmethacrylate (PMMA) bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants.\n<\/p><p>The Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device. Its development occurred following a collaboration between Orthopaedic Surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robin_Ling\" title=\"Robin Ling\" rel=\"external_link\" target=\"_blank\">Robin Ling<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Exeter\" title=\"University of Exeter\" rel=\"external_link\" target=\"_blank\">University of Exeter<\/a> engineer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clive_Lee\" title=\"Clive Lee\" rel=\"external_link\" target=\"_blank\">Clive Lee<\/a> and it was first implanted at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1970.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> The Exeter Hip is a cemented device, but with a slightly different stem geometry. Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions.\n<\/p><p>Early implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place. That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem. It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early 1980s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone. Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking (AML) stem design. With time, other forms of stem surface treatment and stem geometry have been developed and improved.\n<\/p><p>Initial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length (some heads seat more or less onto the stem) and to select from various materials from which the head is formed. A modern acetabulum component is also made up of two parts: a metal shell with a coating for bone attachment and a separate liner. First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.\n<\/p><p>To combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">Ceramic<\/a> heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. Highly crosslinked UHMWPE was introduced in the late 1990s. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices. All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery.\n<\/p><p>When currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion. Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. Uncemented stems can cause pain with activity in up to 20% of patients during the first year after placement as the bone adapts to the device. This is rarely seen with cemented stems.\n<\/p><p>Once an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sportsperson\" class=\"mw-redirect\" title=\"Sportsperson\" rel=\"external_link\" target=\"_blank\">athletes<\/a> including race car drivers <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bobby_Labonte\" title=\"Bobby Labonte\" rel=\"external_link\" target=\"_blank\">Bobby Labonte<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dale_Jarrett\" title=\"Dale Jarrett\" rel=\"external_link\" target=\"_blank\">Dale Jarrett<\/a>, and the 8-time Major-winning American golfer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tom_Watson_(golfer)\" title=\"Tom Watson (golfer)\" rel=\"external_link\" target=\"_blank\">Tom Watson<\/a>, who shot a 67 in the opening round of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Masters_Tournament\" title=\"Masters Tournament\" rel=\"external_link\" target=\"_blank\">Masters Tournament<\/a> in the year following his operation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Techniques\">Techniques<\/span><\/h2>\n<p>There are several incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool),<sup id=\"rdp-ebb-cite_ref-pmid9498150_4-0\" class=\"reference\"><a href=\"#cite_note-pmid9498150-4\" rel=\"external_link\">[4]<\/a><\/sup> antero-lateral (Watson-Jones),<sup id=\"rdp-ebb-cite_ref-titleAnterolateral_Approach_to_Hip_Joint:_(Watson_Jones)_-_Wheeless'_Textbook_of_Orthopaedics_5-0\" class=\"reference\"><a href=\"#39;_Textbook_of_Orthopaedics-5\" rel=\"external_link\">[5]<\/a><\/sup> anterior (Smith-Petersen)<sup id=\"rdp-ebb-cite_ref-titleAnterior_Approach_to_the_Hip_(Smith_Petersen)_-_Wheeless'_Textbook_of_Orthopaedics_6-0\" class=\"reference\"><a href=\"#39;_Textbook_of_Orthopaedics-6\" rel=\"external_link\">[6]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greater_trochanter\" title=\"Greater trochanter\" rel=\"external_link\" target=\"_blank\">greater trochanter<\/a> osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral (Watson-Jones) or posterior approach.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2007)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Posterior_approach\">Posterior approach<\/span><\/h3>\n<p>The <i>posterior (Moore or Southern) approach<\/i> accesses the joint and capsule through the back, taking <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piriformis_muscle\" title=\"Piriformis muscle\" rel=\"external_link\" target=\"_blank\">piriformis muscle<\/a> and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abduction_(kinesiology)\" class=\"mw-redirect\" title=\"Abduction (kinesiology)\" rel=\"external_link\" target=\"_blank\">abductors<\/a> and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lateral_approach\">Lateral approach<\/span><\/h3>\n<p>The <i>lateral approach<\/i> is also commonly used for hip replacement. The approach requires elevation of the hip abductors (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_medius\" title=\"Gluteus medius\" rel=\"external_link\" target=\"_blank\">gluteus medius<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_minimus\" title=\"Gluteus minimus\" rel=\"external_link\" target=\"_blank\">gluteus minimus<\/a>) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley),<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2007)\">citation needed<\/span><\/a><\/i>]<\/sup> or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a>. Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Antero-lateral_approach\">Antero-lateral approach<\/span><\/h3>\n<p>The <i>anterolateral approach<\/i> develops the interval between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensor_fasciae_latae\" class=\"mw-redirect\" title=\"Tensor fasciae latae\" rel=\"external_link\" target=\"_blank\">tensor fasciae latae<\/a> and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Anterior_approach\">Anterior approach<\/span><\/h3>\n<p>The <i>anterior approach<\/i> uses an interval between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sartorius_muscle\" title=\"Sartorius muscle\" rel=\"external_link\" target=\"_blank\">sartorius muscle<\/a> and tensor fasciae latae. Dr. Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> The anterior approach has been shown in studies to variably improve early functional recovery, with possible complications of femoral component loosening and early revision compared to other approaches<sup id=\"rdp-ebb-cite_ref-Direct_Anterior_Approach_8-0\" class=\"reference\"><a href=\"#cite_note-Direct_Anterior_Approach-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-James_I_2016_9-0\" class=\"reference\"><a href=\"#cite_note-James_I_2016-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Minimally_invasive_approaches\">Minimally invasive approaches<\/span><\/h3>\n<p>The dual incision approach and other minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller. This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a \"minimally invasive\" approach compared to traditional approaches which were quite large comparatively.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer-assisted surgery<\/a> and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implants\">Implants<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MetalonmetalhipreplaceMark.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/MetalonmetalhipreplaceMark.png\/220px-MetalonmetalhipreplaceMark.png\" width=\"220\" height=\"183\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MetalonmetalhipreplaceMark.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Metal on metal prosthetic hip<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip-replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Hip-replacement.jpg\/170px-Hip-replacement.jpg\" width=\"170\" height=\"294\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip-replacement.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cement-free implant sixteen days after surgery. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant. Ceramic head. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw.<\/div><\/div><\/div>\n<p>The prosthetic implant used in hip replacement consists of three parts: the acetabular cup, the femoral component, and the articular interface. Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Correct selection of the prosthesis is important.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Acetabular_cup\">Acetabular cup<\/span><\/h3>\n<p>The acetabular cup is the component which is placed into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a> (hip socket). Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement. Some acetabular cups are one piece, while others are modular. One-piece (monobloc) shells are either UHMWPE (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultra-high-molecular-weight_polyethylene\" title=\"Ultra-high-molecular-weight polyethylene\" rel=\"external_link\" target=\"_blank\">ultra-high-molecular-weight polyethylene<\/a>) or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place. A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner. Two types of porous coating used to form a friction fit are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintered<\/a> beads and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foam_metal\" class=\"mw-redirect\" title=\"Foam metal\" rel=\"external_link\" target=\"_blank\">foam metal<\/a> design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.<sup id=\"rdp-ebb-cite_ref-Amirouche_17-0\" class=\"reference\"><a href=\"#cite_note-Amirouche-17\" rel=\"external_link\">[17]<\/a><\/sup> Permanent fixation is achieved as bone grows onto or into the porous coating. Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morse_taper\" class=\"mw-redirect\" title=\"Morse taper\" rel=\"external_link\" target=\"_blank\">Morse taper<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Femoral_component\">Femoral component<\/span><\/h3>\n<p>The femoral component is the component that fits in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> (thigh bone). Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head (ball). There are two types of fixation: cemented and uncemented. Cemented stems use acrylic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">bone cement<\/a> to form a mantle between the stem and to the bone. Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials (titanium, cobalt chromium, stainless steel, and polymer composites) and they can be monolithic or modular. Modular components consist of different head dimensions and\/or modular neck orientations; these attach via a taper similar to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morse_taper\" class=\"mw-redirect\" title=\"Morse taper\" rel=\"external_link\" target=\"_blank\">Morse taper<\/a>. These options allow for variability in leg length, offset and version. Femoral heads are made of metal or ceramic material. Metal heads, made of cobalt chromium for hardness, are machined to size and then polished to reduce wear of the socket liner. Ceramic heads are more smooth than polished metal heads, have a lower coefficient of friction than a cobalt chrome head, and in theory will wear down the socket liner more slowly. As of early 2011, follow-up studies in patients have not demonstrated significant reductions in wear rates between the various types of femoral heads on the market. Ceramic implants are more brittle and may break after being implanted.\n<\/p><h3><span class=\"mw-headline\" id=\"Articular_interface\">Articular interface<\/span><\/h3>\n<p>The articular interface is not part of either implant, rather it is the area between the acetabular cup and femoral component. The articular interface of the hip is a simple ball and socket joint. Size, material properties and machining <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering_tolerance\" title=\"Engineering tolerance\" rel=\"external_link\" target=\"_blank\">tolerances<\/a> at the articular interface can be selected based on patient demand to optimise implant function and longevity whilst mitigating associated risks. The interface size is measured by the outside diameter of the head or the inside diameter of the socket. Common sizes of femoral heads are 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm (<span class=\"frac nowrap\"><sup>7<\/sup>⁄<sub>8<\/sub><\/span> in) was common in the first modern prostheses, now even larger sizes are available from 38 to over 54 mm. Larger-diameter heads lead to increased stability and range of motion whilst lowering the risk of dislocation. At the same time they are also subject to higher stresses such as friction and inertia. Different combinations of materials have different physical properties which can be coupled to reduce the amount of wear debris generated by friction. Typical pairings of materials include metal on polyethylene (MOP), metal on crosslinked polyethylene (MOXP), ceramic on ceramic (COC), ceramic on crosslinked polyethylene (COXP) and metal on metal (MOM). Each combination has different advantages and disadvantages.\n<\/p><h2><span class=\"mw-headline\" id=\"Configuration\">Configuration<\/span><\/h2>\n<p>Post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">projectional radiography<\/a> is routinely performed to ensure proper configuration of hip prostheses.\n<\/p><p>The direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-0\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> For this purpose, the <i>acetabular inclination<\/i> and the <i>acetabular anteversion<\/i> are measurements of cup angulation in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronal_plane\" title=\"Coronal plane\" rel=\"external_link\" target=\"_blank\">coronal plane<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sagittal_plane\" title=\"Sagittal plane\" rel=\"external_link\" target=\"_blank\">sagittal plane<\/a>, respectively.\n<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Acetabular_inclination_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Acetabular_inclination_of_hip_prosthesis.jpg\/230px-Acetabular_inclination_of_hip_prosthesis.jpg\" width=\"230\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular inclination.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-0\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the <i>transischial line<\/i> which is tangential to the inferior margins of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ischium\" title=\"Ischium\" rel=\"external_link\" target=\"_blank\">ischium<\/a> bones.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-1\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:23.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Range_of_acetabular_inclination.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Range_of_acetabular_inclination.png\/230px-Range_of_acetabular_inclination.png\" width=\"230\" height=\"103\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular inclination is normally between 30 and 50\u00b0.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-2\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> A larger angle increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-1\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Acetabular_anteversion_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Acetabular_anteversion_of_hip_prosthesis.jpg\/104px-Acetabular_anteversion_of_hip_prosthesis.jpg\" width=\"104\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular anteversion.<sup id=\"rdp-ebb-cite_ref-ShinLee2015_20-0\" class=\"reference\"><a href=\"#cite_note-ShinLee2015-20\" rel=\"external_link\">[20]<\/a><\/sup> This parameter is calculated on a lateral radiograph as the angle between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transverse_plane\" title=\"Transverse plane\" rel=\"external_link\" target=\"_blank\">transverse plane<\/a> and a line going through the (anterior and posterior) margins of the acetabular cup.<sup id=\"rdp-ebb-cite_ref-ShinLee2015_20-1\" class=\"reference\"><a href=\"#cite_note-ShinLee2015-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:22px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Range_of_acetabular_anteversion.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Range_of_acetabular_anteversion.png\/230px-Range_of_acetabular_anteversion.png\" width=\"230\" height=\"106\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular anteversion is normally between 5 and 25\u00b0.<sup id=\"rdp-ebb-cite_ref-Watt_18-2\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> An anteversion below or above this range increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-3\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> There is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intra-individual_variability\" class=\"mw-redirect\" title=\"Intra-individual variability\" rel=\"external_link\" target=\"_blank\">intra-individual variability<\/a> in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.<sup id=\"rdp-ebb-cite_ref-Watt_18-4\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:24px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Leg_length_discrepancy_after_hip_replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Leg_length_discrepancy_after_hip_replacement.jpg\/230px-Leg_length_discrepancy_after_hip_replacement.jpg\" width=\"230\" height=\"102\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><i>Leg length discrepancy<\/i> after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-3\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> or the transischial line<sup id=\"rdp-ebb-cite_ref-Watt_18-5\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> as references for the horizontal plane. A discrepancy of up to 1 cm is generally tolerated.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-4\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Watt_18-6\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:22px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Center_of_rotation_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Center_of_rotation_of_hip_prosthesis.jpg\/230px-Center_of_rotation_of_hip_prosthesis.jpg\" width=\"230\" height=\"106\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><i>Center of rotation<\/i>: The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and\/or the native femoral head on the contralateral side.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-5\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> The vertical center of rotation instead uses the transischial line for reference.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-6\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> The parameter should be equal on both sides.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-7\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Risks and complications in hip replacement are similar to those associated with all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement#Risks_and_complications\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacements<\/a>. They can include infection, dislocation, limb length inequality, loosening, impingement, osteolysis, metal sensitivity, nerve palsy, chronic pain and death. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">Weight loss surgery<\/a> before a hip replacement does not appear to change outcomes.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Infection\">Infection<\/span><\/h3>\n<p>Infection is one of the most common causes for revision of a total hip replacement, along with loosening and dislocation. The incidence of infection in primary hip replacement is around 1% or less in the United States.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> Risk factors for infection include obesity, diabetes, smoking, immunosuppressive medications or diseases, and history of infection.\n<\/p><p>Modern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> They are:\n<\/p><p>1.There is a sinus tract communicating with the prosthesis; or\n<p>2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n<\/p>\n<\/p><p>Four of the following six criteria exist:\n<\/p><p>1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n<\/p><p>2.Elevated synovial leukocyte count,\n<\/p><p>3.Elevated synovial neutrophil percentage (PMN%),\n<\/p><p>4.Presence of purulence in the affected joint,\n<\/p><p>5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n<\/p><p>6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\n<\/p><p>None of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dislocation\">Dislocation<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dislocated_hip_replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/76\/Dislocated_hip_replacement.jpg\/170px-Dislocated_hip_replacement.jpg\" width=\"170\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dislocated_hip_replacement.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Dislocated artificial hip<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:162px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_liner_creep_and_wear.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Hip_prosthesis_liner_creep_and_wear.png\/160px-Hip_prosthesis_liner_creep_and_wear.png\" width=\"160\" height=\"153\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_liner_creep_and_wear.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Liner wear, particularly when over 2 mm, increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-berry2012_24-0\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup> Liner creep, on the other hand, is normal remoulding.<sup id=\"rdp-ebb-cite_ref-Watt_18-7\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup><\/div><\/div><\/div>\n<p>Dislocation is the most common complication of hip replacement surgery. The most common causes vary by the duration since the surgery.\n<\/p><p>Hip prosthesis <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_dislocation\" title=\"Joint dislocation\" rel=\"external_link\" target=\"_blank\">dislocation<\/a> mostly occurs in the first 3 months after insertion, mainly because of incomplete scar formation and relaxed soft tissues.<sup id=\"rdp-ebb-cite_ref-berry2012_24-1\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup> It takes eight to twelve weeks for the soft tissues injured or cut during surgery to heal. During this period, the hip ball can come out of the socket. The chance of this is diminished if less tissue is cut, if the tissue cut is repaired and if large diameter head balls are used.\n<\/p><p>Dislocations occurring between 3 months and 5 years after insertion usually occur due to malposition of the components, or dysfunction of nearby muscles.<sup id=\"rdp-ebb-cite_ref-berry2012_24-2\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>Risk factors of late dislocation (after 5 years) mainly include:<sup id=\"rdp-ebb-cite_ref-berry2012_24-3\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<ul><li>Female gender<\/li>\n<li>Younger age at primary hip arthroplasty<\/li>\n<li>Previous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subluxation\" title=\"Subluxation\" rel=\"external_link\" target=\"_blank\">subluxation<\/a> without complete dislocation<\/li>\n<li>Previous trauma<\/li>\n<li>Substantial weight loss<\/li>\n<li>Recent onset or progression of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurological_disorder\" title=\"Neurological disorder\" rel=\"external_link\" target=\"_blank\">neurological disorder<\/a><\/li>\n<li>Malposition of the cup<\/li>\n<li>Wear of the liner, particularly when it causes movement of the head of more than 2 mm within the cup compared to its original position<\/li>\n<li>Prosthesis loosening with migration<\/li><\/ul>\n<p>Surgeons who perform more of the operations each year tend to have fewer patients dislocate. Doing the surgery from an anterior approach seems to lower dislocation rates when small diameter heads are used, but the benefit has not been shown when compared to modern posterior incisions with the use of larger diameter heads. The use of larger diameter head size does in it self decrease the risk of dislocation, even though this correlation is only found in head sizes up to 28 mm, thereafter no additional decrease in dislocation rate is found.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Patients can decrease the risk further by keeping the leg out of certain positions during the first few months after surgery.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Limb_Length_Inequality\">Limb Length Inequality<\/span><\/h3>\n<p>Most adults prior to a hip replacement have a limb length inequality of 0\u20132 cm which they were born with and which causes no clinical deficits.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> It is common for patients to feel a limb length inequality after total hip replacement.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> Sometimes the leg seems long immediately after surgery when in fact both are equal length. An arthritic hip can develop contractures that make the leg behave as if it is short. When these are relieved with replacement surgery and normal motion and function are restored, the body feels that the limb is now longer than it was. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The cause of this feeling is variable, and usually related to abductor muscle weakness, pelvic obliquity, and minor lengthening of the hip during surgery (<1 cm) to achieve stability and restore the joint to pre-arthritic mechanics. If the limb length difference remains bothersome to the patient more than 6 months after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fracture\">Fracture<\/span><\/h3>\n<p>Bones with internal fixation devices in situ are at risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periprosthetic\" title=\"Periprosthetic\" rel=\"external_link\" target=\"_blank\">periprosthetic<\/a> fractures at the end of the implant, an area of relative mechanical stress. Post-operative femoral fractures are graded by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vancouver_classification\" title=\"Vancouver classification\" rel=\"external_link\" target=\"_blank\">Vancouver classification<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Vein_thrombosis\">Vein thrombosis<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Venous_thrombosis\" title=\"Venous thrombosis\" rel=\"external_link\" target=\"_blank\">Venous thrombosis<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_vein_thrombosis\" title=\"Deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">deep vein thrombosis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_embolism\" title=\"Pulmonary embolism\" rel=\"external_link\" target=\"_blank\">pulmonary embolism<\/a> are relatively common following hip replacement surgery. Standard treatment with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticoagulant\" title=\"Anticoagulant\" rel=\"external_link\" target=\"_blank\">anticoagulants<\/a> is for 7\u201310 days; however treatment for more than 21 days may be superior.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> Research from 2013 has on the other hand suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p><p>Some physicians and patients may consider having an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonography_for_deep_vein_thrombosis\" class=\"mw-redirect\" title=\"Ultrasonography for deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">ultrasonography for deep vein thrombosis<\/a> after hip replacement.<sup id=\"rdp-ebb-cite_ref-AAOSfive_30-0\" class=\"reference\"><a href=\"#cite_note-AAOSfive-30\" rel=\"external_link\">[30]<\/a><\/sup> However, this kind of screening should only be done when indicated because to perform it routinely would be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unnecessary_health_care\" title=\"Unnecessary health care\" rel=\"external_link\" target=\"_blank\">unnecessary health care<\/a>.<sup id=\"rdp-ebb-cite_ref-AAOSfive_30-1\" class=\"reference\"><a href=\"#cite_note-AAOSfive-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Osteolysis\">Osteolysis<\/span><\/h3>\n<p>Many long-term problems with hip replacements are the result of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteolysis\" title=\"Osteolysis\" rel=\"external_link\" target=\"_blank\">osteolysis<\/a>. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that come off the cup liner over time. An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammatory<\/a> process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. In an attempt to eliminate the generation of wear particles, ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results. Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were also developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication. At the same time that these two bearing surfaces were being developed, highly cross linked polyethylene plastic liners were also developed. The greater cross linking significantly reduces the amount of plastic wear debris given off over time. The newer ceramic and metal prostheses do not always have the long-term track record of established metal on poly bearings. Ceramic pieces can break leading to catastrophic failure. This occurs in about 2% of the implants placed. They may also cause an audible, high pitched squeaking noise with activity. Metal-on-metal arthroplasty releases metal debris into the body raising concerns about the potential dangers of these accumulating over time. Highly cross linked polyethylene is not as strong as regular polyethylene. These plastic liners can crack or break free of the metal shell that holds them.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Loosening\">Loosening<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_aseptic_loosening_ar1938-1.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Hip_joint_aseptic_loosening_ar1938-1.png\/170px-Hip_joint_aseptic_loosening_ar1938-1.png\" width=\"170\" height=\"254\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_aseptic_loosening_ar1938-1.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hip prosthesis displaying aseptic loosening (arrows)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:212px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_zones_by_DeLee_and_Charnley_system,_and_Gruen_system.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\/210px-Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\" width=\"210\" height=\"215\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_zones_by_DeLee_and_Charnley_system,_and_Gruen_system.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_prosthesis_zones\" title=\"Hip prosthesis zones\" rel=\"external_link\" target=\"_blank\">Hip prosthesis zones<\/a> according to DeLee and Charnley,<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> and Gruen.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> These are used to describe the location of for example areas of loosening.<\/div><\/div><\/div>\n<p>On radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.<sup id=\"rdp-ebb-cite_ref-RothMaertz2012_33-0\" class=\"reference\"><a href=\"#cite_note-RothMaertz2012-33\" rel=\"external_link\">[33]<\/a><\/sup> The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).<sup id=\"rdp-ebb-cite_ref-RothMaertz2012_33-1\" class=\"reference\"><a href=\"#cite_note-RothMaertz2012-33\" rel=\"external_link\">[33]<\/a><\/sup> The direct anterior approach has been shown to itself be a risk factor for early femoral component loosening.<sup id=\"rdp-ebb-cite_ref-James_I_2016_9-1\" class=\"reference\"><a href=\"#cite_note-James_I_2016-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Direct_Anterior_Approach_8-1\" class=\"reference\"><a href=\"#cite_note-Direct_Anterior_Approach-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal_sensitivity\">Metal sensitivity<\/span><\/h3>\n<p>Concerns are being raised about the metal sensitivity and potential dangers of metal particulate debris. New publications<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> have demonstrated development of <i>pseudotumors<\/i>, soft tissue masses containing necrotic tissue, around the hip joint. It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris.\n<\/p><p>Metal hypersensitivity is a well-established phenomenon and is common, affecting about 10\u201315% of the population.<sup id=\"rdp-ebb-cite_ref-Hallab01_38-0\" class=\"reference\"><a href=\"#cite_note-Hallab01-38\" rel=\"external_link\">[38]<\/a><\/sup> Contact with metals can cause immune reactions such as skin hives, eczema, redness and itching. Although little is known about the short- and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo, there have been many reports of immunologic type responses temporally associated with implantation of metal components. Individual case reports link hypersensitivity immune reactions with adverse performance of metallic clinical cardiovascular, orthopedic and plastic surgical and dental implants.<sup id=\"rdp-ebb-cite_ref-Hallab01_38-1\" class=\"reference\"><a href=\"#cite_note-Hallab01-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal_toxicity\">Metal toxicity<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallosis\" title=\"Metallosis\" rel=\"external_link\" target=\"_blank\">Metallosis<\/a><\/div>\n<p>Most hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All implants release their constituent ions into the blood. Typically these are excreted in the urine, but in certain individuals the ions can accumulate in the body. In implants which involve metal-on-metal contact, microscopic fragments of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a> can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-reuters-20120329_40-0\" class=\"reference\"><a href=\"#cite_note-reuters-20120329-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Nerve_palsy\">Nerve palsy<\/span><\/h3>\n<p>Post operative sciatic nerve palsy is another possible complication. The incidence of this complication is low. Femoral nerve palsy is another but much more rare complication. Both of these will typically resolve over time, but the healing process is slow. Patients with pre-existing nerve injury are at greater risk of experiencing this complication and are also slower to recover.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chronic_pain\">Chronic pain<\/span><\/h3>\n<p>A few patients who have had a hip replacement suffer chronic pain after the surgery. Groin pain can develop if the muscle that raises the hip (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Iliopsoas\" title=\"Iliopsoas\" rel=\"external_link\" target=\"_blank\">iliopsoas<\/a>) rubs against the edge of the acetabular cup. Bursitis can develop at the trochanter where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far. Also some patients can experience pain in cold or damp weather.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2012)\">citation needed<\/span><\/a><\/i>]<\/sup> Incision made in the front of the hip (anterior approach) can cut a nerve running down the thigh leading to numbness in the thigh and occasionally chronic pain at the point where the nerve was cut (a neuroma).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Death\">Death<\/span><\/h3>\n<p>The rate of death for elective hip replacements is significantly less than 1%.<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal-on-metal_hip_implant_failure\">Metal-on-metal hip implant failure<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_failure\" title=\"Implant failure\" rel=\"external_link\" target=\"_blank\">Implant failure<\/a><\/div>\n<p>By 2010, reports in the orthopaedic literature increasingly cited the problem of early failure of metal on metal prostheses in a small percentage of patients.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> Failures may relate to release of minute metallic particles or metal ions from wear of the implants, causing pain and disability severe enough to require revision surgery in 1\u20133% of patients.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> Design deficits of some prothesis models, especially with heat-treated alloys and a lack of special surgical experience accounting for most of the failures. In 2010, surgeons at medical centers such as the Mayo Clinic reported reducing their use of metal-on-metal implants by 80 percent over the previous year in favor of those made from other materials, like combinations of metal and plastic.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> The cause of these failures remain controversial, and may include both design factors, technique factors, and factors related to patient immune responses (allergy type reactions). In the United Kingdom the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicines_and_Healthcare_Products_Regulatory_Agency\" class=\"mw-redirect\" title=\"Medicines and Healthcare Products Regulatory Agency\" rel=\"external_link\" target=\"_blank\">Medicines and Healthcare Products Regulatory Agency<\/a> commenced an annual monitoring regime for metal-on-metal hip replacement patients from May 2010.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> Data which are shown in The Australian Orthopaedic Association's 2008 National <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_registry\" title=\"Joint replacement registry\" rel=\"external_link\" target=\"_blank\">Joint replacement registry<\/a>, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR (Birmingham Hip Resurfacing) Hips and found that less than one-third of one percent may have been revised due to the patient's reaction to the metal component.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> Other similar metal-on-metal designs have not fared as well, where some reports show 76% to 100% of the people with these metal-on-metal implants and have aseptic implant failures requiring revision also have evidence of histological inflammation accompanied by extensive lymphocyte infiltrates, characteristic of delayed type hypersensitivity responses.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> It is not clear to what extent this phenomenon negatively affects orthopedic patients. However, for patients presenting with signs of an allergic reactions, evaluation for sensitivity should be conducted. Removal of the device that is not needed should be considered, since removal may alleviate the symptoms. Patients who have allergic reactions to cheap jewelry are more likely to have reactions to orthopedic implants. There is increasing awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implant is optimal for each patient.\n<\/p><p>On March 12, 2012, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Lancet\" title=\"The Lancet\" rel=\"external_link\" target=\"_blank\">The Lancet<\/a><\/i> published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal hip implants failed at much greater rates than other types of hip implants and calling for a ban on all metal-on-metal hips.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup> The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p><p>On February 10, 2011, the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> issued an advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> On June 27\u201328, 2012, an advisory panel met to decide whether to impose new standards, taking into account findings of the study in <i>The Lancet<\/i>.<sup id=\"rdp-ebb-cite_ref-reuters-20120329_40-1\" class=\"reference\"><a href=\"#cite_note-reuters-20120329-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDA-summary-memo_55-0\" class=\"reference\"><a href=\"#cite_note-FDA-summary-memo-55\" rel=\"external_link\">[55]<\/a><\/sup> No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated.<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> Currently, FDA has not required hip implants to be tested in clinical trials before they can be sold in the U.S.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup> Instead, companies making new hip implants only need to prove that they are \"substantially equivalent\" to other hip implants already on the market. The exception is metal-on-metal implants, which were not tested in clinical trials but because of the high revision rate of metal-on-metal hips, in the future the FDA has stated that clinical trials will be required for approval and that post-market studies will be required to keep metal on metal hip implants on the market.<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternatives_and_variations\">Alternatives and variations<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Conservative_management\">Conservative management<\/span><\/h3>\n<p>The first line approach as an alternative to hip replacement is conservative management which involves a multimodal approach of oral medication, injections, activity modification and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a>.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup> Conservative management can prevent or delay the need for hip replacement.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Preoperative_care\">Preoperative care<\/span><\/h3>\n<p>Preoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before hip or knee replacement, with low risk of negative effects.<sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemiarthroplasty\">Hemiarthroplasty<\/span><\/h3>\n<p><b>Hemiarthroplasty<\/b> is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture of the neck of the femur (a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fracture<\/a>). The procedure is performed by removing the head of the femur and replacing it with a metal or composite <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a>. The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composite<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/HDPE\" class=\"mw-redirect\" title=\"HDPE\" rel=\"external_link\" target=\"_blank\">HDPE<\/a> which forms two interphases (bipolar prosthesis) has also been used. The monopolar prosthesis has not been shown to have any advantage over bipolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a>.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/p>\n<ul class=\"gallery mw-gallery-packed\">\n\t\t<li class=\"gallerybox\" style=\"width: 242.66666666667px\"><div style=\"width: 242.66666666667px\">\n\t\t\t<div class=\"thumb\" style=\"width: 240.66666666667px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bipolar_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/47\/Bipolar_hip_prosthesis.jpg\/361px-Bipolar_hip_prosthesis.jpg\" width=\"241\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Hip prosthesis for hemiarthroplasty. This example is bipolar, meaning that the head has 2 separate articulations.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 215.33333333333px\"><div style=\"width: 215.33333333333px\">\n\t\t\t<div class=\"thumb\" style=\"width: 213.33333333333px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_hips_with_a_hemiarthroplasty.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/X-ray_of_hips_with_a_hemiarthroplasty.jpg\/320px-X-ray_of_hips_with_a_hemiarthroplasty.jpg\" width=\"214\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> of the hips, with a right-sided hemiarthroplasty.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265.33333333333px\"><div style=\"width: 265.33333333333px\">\n\t\t\t<div class=\"thumb\" style=\"width: 263.33333333333px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Femoral_offset_in_hemiarthroplasty.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Femoral_offset_in_hemiarthroplasty.jpg\/395px-Femoral_offset_in_hemiarthroplasty.jpg\" width=\"264\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Femoral (neck) offset is defined as the perpendicular distance between the intramedullary or longitudinal axis of the femur and the center of rotation of the native or prosthetic femoral head. An unnatural offset is associated with hip dislocation.<sup id=\"rdp-ebb-cite_ref-JonesBriffa2017_62-0\" class=\"reference\"><a href=\"#cite_note-JonesBriffa2017-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h3><span class=\"mw-headline\" id=\"Hip_resurfacing\">Hip resurfacing<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_resurfacing\" title=\"Hip resurfacing\" rel=\"external_link\" target=\"_blank\">Hip resurfacing<\/a> is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and become a common procedure. Health-related quality of life measures are markedly improved and patient satisfaction is favorable after hip resurfacing arthroplasty.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_hip_resurfacing\" title=\"Minimally invasive hip resurfacing\" rel=\"external_link\" target=\"_blank\">minimally invasive hip resurfacing<\/a> procedure is a further refinement to hip resurfacing.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Viscosupplementation\">Viscosupplementation<\/span><\/h3>\n<p>Current alternatives also include viscosupplementation, or the injection of artificial lubricants into the joint.<sup id=\"rdp-ebb-cite_ref-pmid17874246_64-0\" class=\"reference\"><a href=\"#cite_note-pmid17874246-64\" rel=\"external_link\">[64]<\/a><\/sup> Use of these medications in the hip is off label. The cost of treatment is typically not covered by health insurance organizations.\n<\/p><p>Some believe that the future of osteoarthritis treatment is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioengineering\" class=\"mw-redirect\" title=\"Bioengineering\" rel=\"external_link\" target=\"_blank\">bioengineering<\/a>, targeting the growth and\/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stem_cell\" title=\"Stem cell\" rel=\"external_link\" target=\"_blank\">stem cells<\/a> in one patient.<sup id=\"rdp-ebb-cite_ref-pmid16886034_65-0\" class=\"reference\"><a href=\"#cite_note-pmid16886034-65\" rel=\"external_link\">[65]<\/a><\/sup> It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits. The FDA has stated that this procedure is being practiced without conforming to regulations, but Centeno claims that it is exempt from FDA regulation. It has not been shown in controlled clinical trials to be effective<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>, and costs over $7,000.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prevalence_and_cost\">Prevalence and cost<\/span><\/h2>\n<p>Total hip replacement incidence varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year.<sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup> Approximately 0.8% of Americans have undergone the procedure.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup>\n<\/p><p>According to the International Federation of Healthcare Plans, the average cost of a total hip replacement in 2012 was $40,364 in the United States, $11,889 in the United Kingdom, $10,987 in France, $9,574 in Switzerland, and $7,731 in Spain.<sup id=\"rdp-ebb-cite_ref-ifhp_1-1\" class=\"reference\"><a href=\"#cite_note-ifhp-1\" rel=\"external_link\">[1]<\/a><\/sup> In the United States, the average cost of a total hip replacement varies widely by geographic region, ranging from $11,327 (Birmingham, Alabama) to $73,927 (Boston, Massachusetts).<sup id=\"rdp-ebb-cite_ref-68\" class=\"reference\"><a href=\"#cite_note-68\" rel=\"external_link\">[68]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The earliest recorded attempts at hip replacement were carried out in Germany in 1891 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Themistocles_Gluck\" title=\"Themistocles Gluck\" rel=\"external_link\" target=\"_blank\">Themistocles Gluck<\/a> (1853\u20131942),<sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup> who used ivory to replace the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_head\" title=\"Femoral head\" rel=\"external_link\" target=\"_blank\">femoral head<\/a> (the ball on the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.<sup id=\"rdp-ebb-cite_ref-pmid16089067_71-0\" class=\"reference\"><a href=\"#cite_note-pmid16089067-71\" rel=\"external_link\">[71]<\/a><\/sup>\n<\/p><p>On September 28, 1940 at Columbia Hospital in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbia,_South_Carolina\" title=\"Columbia, South Carolina\" rel=\"external_link\" target=\"_blank\">Columbia, South Carolina<\/a>, American surgeon Dr. Austin T. Moore (1899\u20131963)<sup id=\"rdp-ebb-cite_ref-72\" class=\"reference\"><a href=\"#cite_note-72\" rel=\"external_link\">[72]<\/a><\/sup> performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head made of the cobalt-chrome alloy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitallium\" title=\"Vitallium\" rel=\"external_link\" target=\"_blank\">Vitallium<\/a>. It was about a foot in length and bolted to the resected end of the femoral shaft (hemiarthroplasty). A later version, the so-called Austin Moore Prosthesis which was introduced in 1952, is still in use today, although rarely. Like modern hip implants, it is inserted into the medullary canal of the femur, and depends on bone growth through a hole in the stem for long-term attachment.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Abductor_wedge\" title=\"Abductor wedge\" rel=\"external_link\" target=\"_blank\">Abductor wedge<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_Acetabular_Impingement\" class=\"mw-redirect\" title=\"Femoral Acetabular Impingement\" rel=\"external_link\" target=\"_blank\">Femoral Acetabular Impingement<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gruen_zone\" class=\"mw-redirect\" title=\"Gruen zone\" rel=\"external_link\" target=\"_blank\">Gruen zone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_examination\" title=\"Hip examination\" rel=\"external_link\" target=\"_blank\">Hip examination<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/2010_DePuy_Hip_Recall\" title=\"2010 DePuy Hip Recall\" rel=\"external_link\" target=\"_blank\">2010 DePuy Hip Recall<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-ifhp-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ifhp_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ifhp_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/hushp.harvard.edu\/sites\/default\/files\/downloadable_files\/IFHP%202012%20Comparative%20Price%20Report.pdf\" target=\"_blank\">\"2012 comparative price report\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. International Federation of Health Plans<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 October<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=2012+comparative+price+report&rft.pub=International+Federation+of+Health+Plans&rft_id=http%3A%2F%2Fhushp.harvard.edu%2Fsites%2Fdefault%2Ffiles%2Fdownloadable_files%2FIFHP%25202012%2520Comparative%2520Price%2520Report.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Andrew Still (2002-11-02). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/illumin.usc.edu\/61\/total-hip-replacement\/\" target=\"_blank\">\"Total Hip Replacement\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Southern_California\" title=\"University of Southern California\" rel=\"external_link\" target=\"_blank\">University of Southern California<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-01-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=University+of+Southern+California&rft.atitle=Total+Hip+Replacement&rft.date=2002-11-02&rft.au=Andrew+Still&rft_id=http%3A%2F%2Fillumin.usc.edu%2F61%2Ftotal-hip-replacement%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Timperley, A John (20 October 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theguardian.com\/science\/2017\/oct\/20\/robin-ling-obituary\" target=\"_blank\">\"Robin Ling obituary\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Guardian\" title=\"The Guardian\" rel=\"external_link\" target=\"_blank\">The Guardian<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">22 October<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Guardian&rft.atitle=Robin+Ling+obituary&rft.date=2017-10-20&rft.aulast=Timperley&rft.aufirst=A+John&rft_id=https%3A%2F%2Fwww.theguardian.com%2Fscience%2F2017%2Foct%2F20%2Frobin-ling-obituary&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid9498150-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid9498150_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pai VS (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20020108155635\/http:\/\/www.link.springer.de\/link\/service\/journals\/00264\/bibs\/8021006\/80210393.htm\" target=\"_blank\">\"A comparison of three lateral approaches in primary total hip replacement\"<\/a>. <i>Int Orthop<\/i>. <b>21<\/b> (6): 393\u2013398. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs002640050193\" target=\"_blank\">10.1007\/s002640050193<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3619565\" target=\"_blank\">3619565<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9498150\" target=\"_blank\">9498150<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/link.springer.de\/link\/service\/journals\/00264\/bibs\/8021006\/80210393.htm\" target=\"_blank\">the original<\/a> on 2002-01-08.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Orthop&rft.atitle=A+comparison+of+three+lateral+approaches+in+primary+total+hip+replacement&rft.volume=21&rft.issue=6&rft.pages=393-398&rft.date=1997&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3619565&rft_id=info%3Apmid%2F9498150&rft_id=info%3Adoi%2F10.1007%2Fs002640050193&rft.au=Pai+VS&rft_id=http%3A%2F%2Flink.springer.de%2Flink%2Fservice%2Fjournals%2F00264%2Fbibs%2F8021006%2F80210393.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleAnterolateral_Approach_to_Hip_Joint:_(Watson_Jones)_-_Wheeless'_Textbook_of_Orthopaedics-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#39;_Textbook_of_Orthopaedics_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wheelessonline.com\/ortho\/anterolateral_approach_to_hip_joint_watson_jones\" target=\"_blank\">\"Anterolateral Approach to Hip Joint: (Watson Jones) \u2013 Wheeless' Textbook of Orthopaedics\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Anterolateral+Approach+to+Hip+Joint%3A+%28Watson+Jones%29+%E2%80%93+Wheeless%27+Textbook+of+Orthopaedics&rft_id=http%3A%2F%2Fwww.wheelessonline.com%2Fortho%2Fanterolateral_approach_to_hip_joint_watson_jones&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleAnterior_Approach_to_the_Hip_(Smith_Petersen)_-_Wheeless'_Textbook_of_Orthopaedics-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#39;_Textbook_of_Orthopaedics_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wheelessonline.com\/ortho\/anterior_approach_to_the_hip_smith_peterson\" target=\"_blank\">\"Anterior Approach to the Hip (Smith Petersen) \u2013 Wheeless' Textbook of Orthopaedics\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Anterior+Approach+to+the+Hip+%28Smith+Petersen%29+%E2%80%93+Wheeless%27+Textbook+of+Orthopaedics&rft_id=http%3A%2F%2Fwww.wheelessonline.com%2Fortho%2Fanterior_approach_to_the_hip_smith_peterson&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maratt, Joseph D.; Gagnier, Joel J.; Butler, Paul D.; Hallstrom, Brian R.; Urquhart, Andrew G.; Roberts, Karl C. (September 2016). \"No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>31<\/b> (9): 127\u2013130. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2016.02.071\" target=\"_blank\">10.1016\/j.arth.2016.02.071<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=No+Difference+in+Dislocation+Seen+in+Anterior+Vs+Posterior+Approach+Total+Hip+Arthroplasty&rft.volume=31&rft.issue=9&rft.pages=127-130&rft.date=2016-09&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2016.02.071&rft.aulast=Maratt&rft.aufirst=Joseph+D.&rft.au=Gagnier%2C+Joel+J.&rft.au=Butler%2C+Paul+D.&rft.au=Hallstrom%2C+Brian+R.&rft.au=Urquhart%2C+Andrew+G.&rft.au=Roberts%2C+Karl+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Direct_Anterior_Approach-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Direct_Anterior_Approach_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Direct_Anterior_Approach_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meneghini, R. Michael; Elston, Addison S.; Chen, Antonia F.; Kheir, Michael M.; Fehring, Thomas K.; Springer, Bryan D. (January 2017). \"Direct Anterior Approach\". <i>The Journal of Bone and Joint Surgery<\/i>. <b>99<\/b> (2): 99\u2013105. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.16.00060\" target=\"_blank\">10.2106\/JBJS.16.00060<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28099299\" target=\"_blank\">28099299<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery&rft.atitle=Direct+Anterior+Approach&rft.volume=99&rft.issue=2&rft.pages=99-105&rft.date=2017-01&rft_id=info%3Adoi%2F10.2106%2FJBJS.16.00060&rft_id=info%3Apmid%2F28099299&rft.aulast=Meneghini&rft.aufirst=R.+Michael&rft.au=Elston%2C+Addison+S.&rft.au=Chen%2C+Antonia+F.&rft.au=Kheir%2C+Michael+M.&rft.au=Fehring%2C+Thomas+K.&rft.au=Springer%2C+Bryan+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-James_I_2016-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-James_I_2016_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-James_I_2016_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eto, Shuichi; Hwang, Katherine; Huddleston, James I.; Amanatullah, Derek F.; Maloney, William J.; Goodman, Stuart B. 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Retrieved <span class=\"nowrap\">2017-05-21<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Radiology+Assistant&rft.atitle=Hip+-+Arthroplasty+-Normal+and+abnormal+imaging+findings&rft.au=Iain+Watt%2C+Susanne+Boldrik%2C+Evert+van+Langelaan+and+Robin+Smithuis&rft_id=http%3A%2F%2Fwww.radiologyassistant.nl%2Fen%2Fp431c8258e7ac3%2Fhip-arthroplasty.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Vanrusselt2015-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Vanrusselt2015_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vanrusselt, Jan; Vansevenant, Milan; Vanderschueren, Geert; Vanhoenacker, Filip (2015). \"Postoperative radiograph of the hip arthroplasty: what the radiologist should know\". <i>Insights into Imaging<\/i>. <b>6<\/b> (6): 591\u2013600. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs13244-015-0438-5\" target=\"_blank\">10.1007\/s13244-015-0438-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1869-4101\" target=\"_blank\">1869-4101<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26487647\" target=\"_blank\">26487647<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Insights+into+Imaging&rft.atitle=Postoperative+radiograph+of+the+hip+arthroplasty%3A+what+the+radiologist+should+know&rft.volume=6&rft.issue=6&rft.pages=591-600&rft.date=2015&rft.issn=1869-4101&rft_id=info%3Apmid%2F26487647&rft_id=info%3Adoi%2F10.1007%2Fs13244-015-0438-5&rft.aulast=Vanrusselt&rft.aufirst=Jan&rft.au=Vansevenant%2C+Milan&rft.au=Vanderschueren%2C+Geert&rft.au=Vanhoenacker%2C+Filip&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ShinLee2015-20\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ShinLee2015_20-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ShinLee2015_20-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shin, W. 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Systematic review and meta-analysis\". <i>The Bone & Joint Journal<\/i>. <b>98-B<\/b> (9): 1160\u20131166. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620x.98b9.38024\" target=\"_blank\">10.1302\/0301-620x.98b9.38024<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27587514\" target=\"_blank\">27587514<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Bone+%26+Joint+Journal&rft.atitle=Does+bariatric+surgery+prior+to+total+hip+or+knee+arthroplasty+reduce+post-operative+complications+and+improve+clinical+outcomes+for+obese+patients%3F+Systematic+review+and+meta-analysis.&rft.volume=98-B&rft.issue=9&rft.pages=1160-1166&rft.date=2016-09&rft_id=info%3Adoi%2F10.1302%2F0301-620x.98b9.38024&rft_id=info%3Apmid%2F27587514&rft.aulast=Smith&rft.aufirst=TO&rft.au=Aboelmagd%2C+T&rft.au=Hing%2C+CB&rft.au=MacGregor%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bozic, Kevin J; Kurtz, Steven M; Lau, Edmund; Ong, Kevin; Vail, Thomas P; Berry, Daniel J (January 2009). \"The Epidemiology of Revision Total Hip Arthroplasty in the United States\". <i>The Journal of Bone and Joint Surgery. American Volume<\/i>. <b>91<\/b> (1): 128\u2013133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.H.00155\" target=\"_blank\">10.2106\/JBJS.H.00155<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=The+Epidemiology+of+Revision+Total+Hip+Arthroplasty+in+the+United+States&rft.volume=91&rft.issue=1&rft.pages=128-133&rft.date=2009-01&rft_id=info%3Adoi%2F10.2106%2FJBJS.H.00155&rft.aulast=Bozic&rft.aufirst=Kevin+J&rft.au=Kurtz%2C+Steven+M&rft.au=Lau%2C+Edmund&rft.au=Ong%2C+Kevin&rft.au=Vail%2C+Thomas+P&rft.au=Berry%2C+Daniel+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. (22 September 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3183178\" target=\"_blank\">\"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society\"<\/a>. <i>Clinical Orthopaedics and Related Research<\/i>. <b>469<\/b> (11): 2992\u20132994. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-011-2102-9\" target=\"_blank\">10.1007\/s11999-011-2102-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3183178\" target=\"_blank\">3183178<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Orthopaedics+and+Related+Research&rft.atitle=New+Definition+for+Periprosthetic+Joint+Infection%3A+From+the+Workgroup+of+the+Musculoskeletal+Infection+Society&rft.volume=469&rft.issue=11&rft.pages=2992-2994&rft.date=2011-09-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3183178&rft_id=info%3Adoi%2F10.1007%2Fs11999-011-2102-9&rft.aulast=Parvizi&rft.aufirst=Javad&rft.au=Zmistowski%2C+Benjamin&rft.au=Berbari%2C+Elie+F.&rft.au=Bauer%2C+Thomas+W.&rft.au=Springer%2C+Bryan+D.&rft.au=Della+Valle%2C+Craig+J.&rft.au=Garvin%2C+Kevin+L.&rft.au=Mont%2C+Michael+A.&rft.au=Wongworawat%2C+Montri+D.&rft.au=Zalavras%2C+Charalampos+G.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3183178&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-berry2012-24\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-berry2012_24-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Daniel J. Berry, Jay Lieberman (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.se\/books?id=Kc-AhYLnIF4C&pg=PA1035\" target=\"_blank\"><i>Surgery of the Hip<\/i><\/a>. Elsevier Health Sciences. p. 1035. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781455727056.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Surgery+of+the+Hip&rft.pages=1035&rft.pub=Elsevier+Health+Sciences&rft.date=2012&rft.isbn=9781455727056&rft.au=Daniel+J.+Berry%2C+Jay+Lieberman&rft_id=https%3A%2F%2Fbooks.google.se%2Fbooks%3Fid%3DKc-AhYLnIF4C%26pg%3DPA1035&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hailer, Nils P.; Weiss, R\u00fcdiger J.; Stark, Andr\u00e9; K\u00e4rrholm, Johan (October 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3488169\" target=\"_blank\">\"The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register\"<\/a>. <i>Acta Orthopaedica<\/i>. <b>83<\/b> (5): 442\u2013448. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17453674.2012.733919\" target=\"_blank\">10.3109\/17453674.2012.733919<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1745-3682\" target=\"_blank\">1745-3682<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3488169\" target=\"_blank\">3488169<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23039167\" target=\"_blank\">23039167<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Orthopaedica&rft.atitle=The+risk+of+revision+due+to+dislocation+after+total+hip+arthroplasty+depends+on+surgical+approach%2C+femoral+head+size%2C+sex%2C+and+primary+diagnosis.+An+analysis+of+78%2C098+operations+in+the+Swedish+Hip+Arthroplasty+Register&rft.volume=83&rft.issue=5&rft.pages=442-448&rft.date=2012-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3488169&rft.issn=1745-3682&rft_id=info%3Apmid%2F23039167&rft_id=info%3Adoi%2F10.3109%2F17453674.2012.733919&rft.aulast=Hailer&rft.aufirst=Nils+P.&rft.au=Weiss%2C+R%C3%BCdiger+J.&rft.au=Stark%2C+Andr%C3%A9&rft.au=K%C3%A4rrholm%2C+Johan&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3488169&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Knutson, Gary A (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\" target=\"_blank\">\"Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance\"<\/a>. <i>Chiropractic & Osteopathy<\/i>. <b>13<\/b> (1): 11. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1746-1340-13-11\" target=\"_blank\">10.1186\/1746-1340-13-11<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\" target=\"_blank\">1232860<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chiropractic+%26+Osteopathy&rft.atitle=Anatomic+and+functional+leg-length+inequality%3A+A+review+and+recommendation+for+clinical+decision-making.+Part+I%2C+anatomic+leg-length+inequality%3A+prevalence%2C+magnitude%2C+effects+and+clinical+significance&rft.volume=13&rft.issue=1&rft.pages=11&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1232860&rft_id=info%3Adoi%2F10.1186%2F1746-1340-13-11&rft.aulast=Knutson&rft.aufirst=Gary+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1232860&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maloney, William J; Keeney, James A (June 2004). \"Leg length discrepancy after total hip arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>19<\/b> (4): 108\u2013110. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2004.02.018\" target=\"_blank\">10.1016\/j.arth.2004.02.018<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Leg+length+discrepancy+after+total+hip+arthroplasty&rft.volume=19&rft.issue=4&rft.pages=108-110&rft.date=2004-06&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2004.02.018&rft.aulast=Maloney&rft.aufirst=William+J&rft.au=Keeney%2C+James+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sobieraj, DM; Lee, S; Coleman, CI; Tongbram, V; Chen, W; Colby, J; Kluger, J; Makanji, S; Ashaye, AO; White, CM (May 15, 2012). \"Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review\". <i>Annals of Internal Medicine<\/i>. <b>156<\/b> (10): 720\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7326%2F0003-4819-156-10-201205150-00423\" target=\"_blank\">10.7326\/0003-4819-156-10-201205150-00423<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22412039\" target=\"_blank\">22412039<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Internal+Medicine&rft.atitle=Prolonged+versus+standard-duration+venous+thromboprophylaxis+in+major+orthopedic+surgery%3A+a+systematic+review&rft.volume=156&rft.issue=10&rft.pages=720-7&rft.date=2012-05-15&rft_id=info%3Adoi%2F10.7326%2F0003-4819-156-10-201205150-00423&rft_id=info%3Apmid%2F22412039&rft.aulast=Sobieraj&rft.aufirst=DM&rft.au=Lee%2C+S&rft.au=Coleman%2C+CI&rft.au=Tongbram%2C+V&rft.au=Chen%2C+W&rft.au=Colby%2C+J&rft.au=Kluger%2C+J&rft.au=Makanji%2C+S&rft.au=Ashaye%2C+AO&rft.au=White%2C+CM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">J\u00f8rgensen, Christoffer C.; Jacobsen, Michael K.; Soeballe, Kjeld; Hansen, Torben B.; Husted, Henrik; Kj\u00e6rsgaard-Andersen, Per; Hansen, Lars T.; Laursen, Mogens B.; Kehlet, Henrik (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3863129\" target=\"_blank\">\"Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study\"<\/a>. <i>BMJ Open<\/i>. <b>3<\/b> (12): e003965. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmjopen-2013-003965\" target=\"_blank\">10.1136\/bmjopen-2013-003965<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2044-6055\" target=\"_blank\">2044-6055<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3863129\" target=\"_blank\">3863129<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24334158\" target=\"_blank\">24334158<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+Open&rft.atitle=Thromboprophylaxis+only+during+hospitalisation+in+fast-track+hip+and+knee+arthroplasty%2C+a+prospective+cohort+study&rft.volume=3&rft.issue=12&rft.pages=e003965&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3863129&rft.issn=2044-6055&rft_id=info%3Apmid%2F24334158&rft_id=info%3Adoi%2F10.1136%2Fbmjopen-2013-003965&rft.aulast=J%C3%B8rgensen&rft.aufirst=Christoffer+C.&rft.au=Jacobsen%2C+Michael+K.&rft.au=Soeballe%2C+Kjeld&rft.au=Hansen%2C+Torben+B.&rft.au=Husted%2C+Henrik&rft.au=Kj%C3%A6rsgaard-Andersen%2C+Per&rft.au=Hansen%2C+Lars+T.&rft.au=Laursen%2C+Mogens+B.&rft.au=Kehlet%2C+Henrik&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3863129&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AAOSfive-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AAOSfive_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AAOSfive_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Academy_of_Orthopaedic_Surgeons2013\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Orthopaedic_Surgeons\" title=\"American Academy of Orthopaedic Surgeons\" rel=\"external_link\" target=\"_blank\">American Academy of Orthopaedic Surgeons<\/a> (February 2013), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-academy-of-orthopaedic-surgeons\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, American Academy of Orthopaedic Surgeons<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">19 May<\/span> 2013<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.date=2013-02&rft.au=American+Academy+of+Orthopaedic+Surgeons&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-academy-of-orthopaedic-surgeons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, which cites\n<ul><li><cite class=\"citation journal\">Members of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (Apr 18, 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">\"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\"<\/a>. <i>The Journal of Bone and Joint Surgery. American Volume<\/i>. <b>94<\/b> (8): 673\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.9408edit\" target=\"_blank\">10.2106\/JBJS.9408edit<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">3326687<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22517384\" target=\"_blank\">22517384<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=Preventing+venous+thromboembolic+disease+in+patients+undergoing+elective+total+hip+and+knee+arthroplasty.&rft.volume=94&rft.issue=8&rft.pages=673-4&rft.date=2012-04-18&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rft_id=info%3Apmid%2F22517384&rft_id=info%3Adoi%2F10.2106%2FJBJS.9408edit&rft.au=Members+of+2007+and+2011+AAOS+Guideline+Development+Work+Groups+on+PE%2FVTED+Prophylaxis&rft.au=Mont%2C+M&rft.au=Jacobs%2C+J&rft.au=Lieberman%2C+J&rft.au=Parvizi%2C+J&rft.au=Lachiewicz%2C+P&rft.au=Johanson%2C+N&rft.au=Watters%2C+W&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/span><\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=-fwULYB1gJIC&pg=PA958\" target=\"_blank\"><i>The Adult Hip, Volume 1<\/i><\/a>. Lippincott Williams & Wilkins. p. 958. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7817-5092-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Adult+Hip%2C+Volume+1&rft.pages=958&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2007&rft.isbn=978-0-7817-5092-9&rft.au=John+J.+Callaghan%2C+Aaron+G.+Rosenberg%2C+Harry+E.+Rubash&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D-fwULYB1gJIC%26pg%3DPA958&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Neumann, Daniel R.P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofst\u00e4dter, Thomas; Dorn, Ulrich (2010). \"Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>25<\/b> (5): 700\u2013708. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2009.05.018\" target=\"_blank\">10.1016\/j.arth.2009.05.018<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0883-5403\" target=\"_blank\">0883-5403<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Long-Term+Results+of+a+Contemporary+Metal-on-Metal+Total+Hip+Arthroplasty&rft.volume=25&rft.issue=5&rft.pages=700-708&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2009.05.018&rft.issn=0883-5403&rft.aulast=Neumann&rft.aufirst=Daniel+R.P.&rft.au=Thaler%2C+Christoph&rft.au=Hitzl%2C+Wolfgang&rft.au=Huber%2C+Monika&rft.au=Hofst%C3%A4dter%2C+Thomas&rft.au=Dorn%2C+Ulrich&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-RothMaertz2012-33\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-RothMaertz2012_33-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-RothMaertz2012_33-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012). \"CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications\". <i>RadioGraphics<\/i>. <b>32<\/b> (4): 1089\u20131107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1148%2Frg.324115183\" target=\"_blank\">10.1148\/rg.324115183<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0271-5333\" target=\"_blank\">0271-5333<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=RadioGraphics&rft.atitle=CT+of+the+Hip+Prosthesis%3A+Appearance+of+Components%2C+Fixation%2C+and+Complications&rft.volume=32&rft.issue=4&rft.pages=1089-1107&rft.date=2012&rft_id=info%3Adoi%2F10.1148%2Frg.324115183&rft.issn=0271-5333&rft.aulast=Roth&rft.aufirst=Trenton+D.&rft.au=Maertz%2C+Nathan+A.&rft.au=Parr%2C+J.+Andrew&rft.au=Buckwalter%2C+Kenneth+A.&rft.au=Choplin%2C+Robert+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Steffen Breusch, Henrik Malchau (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.se\/books?id=PQ6NZAeJUXcC&pg=PA337&lpg=PA336\" target=\"_blank\"><i>The Well-Cemented Total Hip Arthroplasty: Theory and Practice<\/i><\/a>. Springer Science & Business Media. p. 336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-24197-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Well-Cemented+Total+Hip+Arthroplasty%3A+Theory+and+Practice&rft.pages=336&rft.pub=Springer+Science+%26+Business+Media&rft.date=2005&rft.isbn=978-3-540-24197-3&rft.au=Steffen+Breusch%2C+Henrik+Malchau&rft_id=https%3A%2F%2Fbooks.google.se%2Fbooks%3Fid%3DPQ6NZAeJUXcC%26pg%3DPA337%26lpg%3DPA336&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Angerame, Marc R.; Fehring, Thomas K.; Masonis, John L.; Mason, J. Bohannon; Odum, Susan M.; Springer, Bryan D. (February 2018). \"Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?\". <i>The Journal of Arthroplasty<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2018.01.014\" target=\"_blank\">10.1016\/j.arth.2018.01.014<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Early+Failure+of+Primary+Total+Hip+Arthroplasty%3A+Is+Surgical+Approach+a+Risk+Factor%3F&rft.date=2018-02&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2018.01.014&rft.aulast=Angerame&rft.aufirst=Marc+R.&rft.au=Fehring%2C+Thomas+K.&rft.au=Masonis%2C+John+L.&rft.au=Mason%2C+J.+Bohannon&rft.au=Odum%2C+Susan+M.&rft.au=Springer%2C+Bryan+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pandit H, Glyn-Jones S, McLardy-Smith P, et al. (July 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bjj.boneandjoint.org.uk\/cgi\/pmidlookup?view=long&pmid=18591590\" target=\"_blank\">\"Pseudotumours associated with metal-on-metal hip resurfacings\"<\/a>. <i>J Bone Joint Surg Br<\/i>. <b>90<\/b> (7): 847\u201351. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.90B7.20213\" target=\"_blank\">10.1302\/0301-620X.90B7.20213<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18591590\" target=\"_blank\">18591590<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Br&rft.atitle=Pseudotumours+associated+with+metal-on-metal+hip+resurfacings&rft.volume=90&rft.issue=7&rft.pages=847-51&rft.date=2008-07&rft_id=info%3Adoi%2F10.1302%2F0301-620X.90B7.20213&rft_id=info%3Apmid%2F18591590&rft.aulast=Pandit&rft.aufirst=H&rft.au=Glyn-Jones%2C+S&rft.au=McLardy-Smith%2C+P&rft_id=http%3A%2F%2Fbjj.boneandjoint.org.uk%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D18591590&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Boardman DR, Middleton FR, Kavanagh TG (March 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bjj.boneandjoint.org.uk\/cgi\/pmidlookup?view=long&pmid=16498023\" target=\"_blank\">\"A benign psoas mass following metal-on-metal resurfacing of the hip\"<\/a>. <i>J Bone Joint Surg Br<\/i>. <b>88<\/b> (3): 402\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.88B3.16748\" target=\"_blank\">10.1302\/0301-620X.88B3.16748<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16498023\" target=\"_blank\">16498023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Br&rft.atitle=A+benign+psoas+mass+following+metal-on-metal+resurfacing+of+the+hip&rft.volume=88&rft.issue=3&rft.pages=402-4&rft.date=2006-03&rft_id=info%3Adoi%2F10.1302%2F0301-620X.88B3.16748&rft_id=info%3Apmid%2F16498023&rft.aulast=Boardman&rft.aufirst=DR&rft.au=Middleton%2C+FR&rft.au=Kavanagh%2C+TG&rft_id=http%3A%2F%2Fbjj.boneandjoint.org.uk%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D16498023&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><br \/><cite class=\"citation journal\">Korovessis P, Petsinis G, Repanti M, Repantis T (June 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jbjs.org\/article.aspx?volume=88&page=1183\" target=\"_blank\">\"Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>88<\/b> (6): 1183\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.D.02916\" target=\"_blank\">10.2106\/JBJS.D.02916<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16757749\" target=\"_blank\">16757749<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Metallosis+after+contemporary+metal-on-metal+total+hip+arthroplasty.+Five+to+nine-year+follow-up&rft.volume=88&rft.issue=6&rft.pages=1183-91&rft.date=2006-06&rft_id=info%3Adoi%2F10.2106%2FJBJS.D.02916&rft_id=info%3Apmid%2F16757749&rft.aulast=Korovessis&rft.aufirst=P&rft.au=Petsinis%2C+G&rft.au=Repanti%2C+M&rft.au=Repantis%2C+T&rft_id=http%3A%2F%2Fwww.jbjs.org%2Farticle.aspx%3Fvolume%3D88%26page%3D1183&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Hallab01-38\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Hallab01_38-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Hallab01_38-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hallab N, Merritt K, Jacobs JJ (March 2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jbjs.org\/article.aspx?volume=83-A&page=428\" target=\"_blank\">\"Metal sensitivity in patients with orthopaedic implants\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>83-A<\/b> (3): 428\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11263649\" target=\"_blank\">11263649<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Metal+sensitivity+in+patients+with+orthopaedic+implants&rft.volume=83-A&rft.issue=3&rft.pages=428-36&rft.date=2001-03&rft_id=info%3Apmid%2F11263649&rft.aulast=Hallab&rft.aufirst=N&rft.au=Merritt%2C+K&rft.au=Jacobs%2C+JJ&rft_id=http%3A%2F%2Fwww.jbjs.org%2Farticle.aspx%3Fvolume%3D83-A%26page%3D428&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.epi.hss.state.ak.us\/bulletins\/docs\/b2010_14.pdf\" target=\"_blank\">http:\/\/www.epi.hss.state.ak.us\/bulletins\/docs\/b2010_14.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-reuters-20120329-40\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-reuters-20120329_40-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-reuters-20120329_40-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.reuters.com\/article\/2012\/03\/29\/usa-fda-hips-idUSL3E8ET6X820120329\" target=\"_blank\">\"FDA seeks more advice on metal hip implants\"<\/a>. 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Retrieved <span class=\"nowrap\">20 May<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=FDA+seeks+more+advice+on+metal+hip+implants&rft.date=2012-03-29&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2F2012%2F03%2F29%2Fusa-fda-hips-idUSL3E8ET6X820120329&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Cot\u00e9, John (July 22, 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.sfgate.com\/2007-07-22\/news\/17254067_1_hip-replacement-hip-replacement-surgery-blood-clot\" target=\"_blank\">\"Hip replacement is not viewed as high-risk surgery; Death is rare, but underlying medical condition a factor\"<\/a>. <i>San Francisco Chronicle<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=San+Francisco+Chronicle&rft.atitle=Hip+replacement+is+not+viewed+as+high-risk+surgery%3B+Death+is+rare%2C+but+underlying+medical+condition+a+factor&rft.date=2007-07-22&rft.au=Cot%C3%A9%2C+John&rft_id=http%3A%2F%2Farticles.sfgate.com%2F2007-07-22%2Fnews%2F17254067_1_hip-replacement-hip-replacement-surgery-blood-clot&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/viewarticle\/588980\" target=\"_blank\">Medscape Conference Coverage<\/a>, American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, AAOS 2009: Certain Factors Increase Risk for Death After Total Hip Arthroplasty, Barbara Boughton, March 3, 2009.<\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mikael, Mark M.; Hanssen, Arlen D.; Sierra, Rafael J. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Orthop&rft.atitle=International+survey+of+primary+and+revision+total+knee+replacement&rft.volume=35&rft.issue=12&rft.pages=1783-9&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3224613&rft_id=info%3Apmid%2F21404023&rft_id=info%3Adoi%2F10.1007%2Fs00264-011-1235-5&rft.aulast=Kurtz&rft.aufirst=SM&rft.au=Ong%2C+KL&rft.au=Lau%2C+E&rft.au=Widmer%2C+M&rft.au=Maravic%2C+M&rft.au=G%C3%B3mez-Barrena%2C+E&rft.au=de+Pina+Mde%2C+F&rft.au=Manno%2C+V&rft.au=Torre%2C+M&rft.au=Walter%2C+WL&rft.au=de+Steiger%2C+R&rft.au=Geesink%2C+RG&rft.au=Peltola%2C+M&rft.au=R%C3%B6der%2C+C&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3224613&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-67\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ (2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4551172\" target=\"_blank\">\"Prevalence of Total Hip and Knee Replacement in the United States\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>97<\/b> (17): 1386\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.N.01141\" target=\"_blank\">10.2106\/JBJS.N.01141<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4551172\" target=\"_blank\">4551172<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26333733\" target=\"_blank\">26333733<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Prevalence+of+Total+Hip+and+Knee+Replacement+in+the+United+States&rft.volume=97&rft.issue=17&rft.pages=1386-97&rft.date=2015&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4551172&rft_id=info%3Apmid%2F26333733&rft_id=info%3Adoi%2F10.2106%2FJBJS.N.01141&rft.aulast=Maradit+Kremers&rft.aufirst=H&rft.au=Larson%2C+DR&rft.au=Crowson%2C+CS&rft.au=Kremers%2C+WK&rft.au=Washington%2C+RE&rft.au=Steiner%2C+CA&rft.au=Jiranek%2C+WA&rft.au=Berry%2C+DJ&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4551172&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-68\" rel=\"external_link\">^<\/a><\/b><\/span> <span 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Blue Cross Blue Shield Association. 21 January 2015. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bcbs.com\/healthofamerica\/BCBS_BHI_Report-Jan-_21_Final.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 22 October 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 October<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=A+study+of+cost+variations+for+knee+and+hip+replacement+surgeries+in+the+U.S.&rft.pub=Blue+Cross+Blue+Shield+Association&rft.date=2015-01-21&rft_id=http%3A%2F%2Fwww.bcbs.com%2Fhealthofamerica%2FBCBS_BHI_Report-Jan-_21_Final.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-69\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/slideplayer.com\/slide\/1659480\/\" target=\"_blank\">\"History of Artificial Joints - ppt video online download\"<\/a>. <i>slideplayer.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=slideplayer.com&rft.atitle=History+of+Artificial+Joints+-++ppt+video+online+download&rft_id=http%3A%2F%2Fslideplayer.com%2Fslide%2F1659480%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-70\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brand, RA; Mont, MA; Manring, M (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3094624\" target=\"_blank\">\"Biographical sketch: Themistocles Gluck (1853\u20131942)\"<\/a>. <i>Clin. 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Res<\/i>. <b>469<\/b> (6): 1525\u20131527. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-011-1836-8\" target=\"_blank\">10.1007\/s11999-011-1836-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3094624\" target=\"_blank\">3094624<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21403990\" target=\"_blank\">21403990<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin.+Orthop.+Relat.+Res.&rft.atitle=Biographical+sketch%3A+Themistocles+Gluck+%281853%E2%80%931942%29&rft.volume=469&rft.issue=6&rft.pages=1525-1527&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3094624&rft_id=info%3Apmid%2F21403990&rft_id=info%3Adoi%2F10.1007%2Fs11999-011-1836-8&rft.aulast=Brand&rft.aufirst=RA&rft.au=Mont%2C+MA&rft.au=Manring%2C+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3094624&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid16089067-71\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid16089067_71-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gomez PF; Morcuende JA (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1888777\" target=\"_blank\">\"Early attempts at hip arthroplasty\u20141700s to 1950s\"<\/a>. <i>Iowa Orthop J<\/i>. <b>25<\/b>: 25\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1888777\" target=\"_blank\">1888777<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16089067\" target=\"_blank\">16089067<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Iowa+Orthop+J&rft.atitle=Early+attempts+at+hip+arthroplasty%E2%80%941700s+to+1950s&rft.volume=25&rft.pages=25-9&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1888777&rft_id=info%3Apmid%2F16089067&rft.au=Gomez+PF&rft.au=Morcuende+JA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1888777&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-72\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-72\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthopedics.about.com\/cs\/jointreplacement1\/p\/austinmoore.htm\" target=\"_blank\">\"What You Need to Know About Joint Replacement Surgery\"<\/a>. <i>about.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=about.com&rft.atitle=What+You+Need+to+Know+About+Joint+Replacement+Surgery&rft_id=http%3A%2F%2Forthopedics.about.com%2Fcs%2Fjointreplacement1%2Fp%2Faustinmoore.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060619082711\/http:\/\/www.edheads.org\/activities\/hip\/\" target=\"_blank\">Edheads Virtual Hip Surgery + Surgery Photos<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthoinfo.aaos.org\/fact\/thr_report.cfm?Thread_ID=271&topcategory=Hip\" target=\"_blank\">AAOS Hip Replacement<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181129125012\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.024 seconds\nReal time usage: 1.180 seconds\nPreprocessor visited node count: 4852\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 203601\/2097152 bytes\nTemplate argument size: 3090\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 228472\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.610\/10.000 seconds\nLua memory usage: 9.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 988.562 1 -total\n<\/p>\n<pre>63.81% 630.782 1 Template:Reflist\n37.69% 372.617 46 Template:Cite_journal\n11.15% 110.266 13 Template:Cite_web\n 8.60% 85.032 5 Template:Citation_needed\n 7.46% 73.733 5 Template:Fix\n 6.70% 66.232 1 Template:Infobox_medical_intervention\n 6.00% 59.309 1 Template:Infobox\n 5.27% 52.104 1 Template:About\n 4.16% 41.111 6 Template:Convert\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1125423-1!canonical and timestamp 20181129125010 and revision id 870719990\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214702\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.024 seconds\nReal time usage: 0.186 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 174.339 1 - wikipedia:Hip_replacement\n100.00% 174.339 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8200-0!*!*!*!*!*!* and timestamp 20181217214702 and revision id 24346\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hip_replacement\">https:\/\/www.limswiki.org\/index.php\/Hip_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","18026209e7901858227ab2cae8f033cf_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Hip_replacement_Image_3684-PH.jpg\/560px-Hip_replacement_Image_3684-PH.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/Hip_prosthesis_components.jpg\/320px-Hip_prosthesis_components.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/440px-Hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/MetalonmetalhipreplaceMark.png\/440px-MetalonmetalhipreplaceMark.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Hip-replacement.jpg\/340px-Hip-replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Acetabular_inclination_of_hip_prosthesis.jpg\/460px-Acetabular_inclination_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Range_of_acetabular_inclination.png\/460px-Range_of_acetabular_inclination.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Acetabular_anteversion_of_hip_prosthesis.jpg\/208px-Acetabular_anteversion_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Range_of_acetabular_anteversion.png\/460px-Range_of_acetabular_anteversion.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Leg_length_discrepancy_after_hip_replacement.jpg\/460px-Leg_length_discrepancy_after_hip_replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Center_of_rotation_of_hip_prosthesis.jpg\/460px-Center_of_rotation_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/76\/Dislocated_hip_replacement.jpg\/340px-Dislocated_hip_replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Hip_prosthesis_liner_creep_and_wear.png\/320px-Hip_prosthesis_liner_creep_and_wear.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Hip_joint_aseptic_loosening_ar1938-1.png\/340px-Hip_joint_aseptic_loosening_ar1938-1.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\/420px-Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/47\/Bipolar_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/X-ray_of_hips_with_a_hemiarthroplasty.jpg\/639px-X-ray_of_hips_with_a_hemiarthroplasty.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Femoral_offset_in_hemiarthroplasty.jpg\/790px-Femoral_offset_in_hemiarthroplasty.jpg"],"18026209e7901858227ab2cae8f033cf_timestamp":1545083222,"fbf0299abb9ffbed2af10e692d621894_type":"article","fbf0299abb9ffbed2af10e692d621894_title":"High-intensity focused ultrasound","fbf0299abb9ffbed2af10e692d621894_url":"https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound","fbf0299abb9ffbed2af10e692d621894_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHigh-intensity focused ultrasound\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article contains content that is written like an advertisement. Please help improve it by removing promotional content and inappropriate external links, and by adding encyclopedic content written from a neutral point of view. (January 2015) (Learn how and when to remove this template message)\nHigh-intensity focused ultrasoundA schematic diagram showing the basic principle of HIFU for treatment of a soft tissue tumour in the liver. The focal region can be placed at depth within a tumour, where a series of adjacent \u2018lesions\u2019 known as a lesion array can be formed as shown.SynonymsMagnetic resonance guided focused ultrasound surgery (MRgFUS), Focused Ultrasound Surgery (FUS)[edit on Wikidata]\nHigh-intensity focused ultrasound (HIFU) is a non-invasive therapeutic technique that uses non-ionizing ultrasonic waves to heat tissue. HIFU can be used to increase the flow of blood or lymph, or to destroy tissue, such as tumors, through a number of mechanisms. The technology can be used to treat a range of disorders and as of 2015 is at various stages of development and commercialization. [1]\nThe technology is similar to ultrasonic imaging, although lower frequencies and continuous, rather than pulsed waves are used to achieve the necessary thermal doses. Acoustic lenses are used to achieve the necessary intensity at the target tissue without damaging the surrounding tissue. An analogy is using a magnifying glass to focus sunlight; only the focal point of the magnifying glass has high intensity. Although lenses have traditionally been used, phased arrays are increasingly common as they allow the focal position to be easily changed. HIFU may be combined with other imaging techniques such as medical ultrasound or MRI to enable guidance of the treatment and monitoring.\n\nContents \n\n1 Medical uses \n\n1.1 Treatments With Approval (FDA or Otherwise) \n\n\n2 Method of use \n\n2.1 Devices and mechanisms \n\n\n3 Mechanism of action \n\n3.1 Theory \n3.2 Focusing \n\n\n4 Image-guidance \n5 History \n6 Approval \n7 References \n8 External links \n\n\nMedical uses \nThis section needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the section and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (April 2016)\nThere is no clear consensus on the boundaries between HIFU and other forms of therapeutic ultrasound. In academic literature, HIFU usually refers to the high levels of energy required to destroy tissue, although it is also sometimes used to describe lower intensity applications such as occupational therapy and physical therapy.\nEither way, HIFU is used to non-invasively heat tissue deep in the body without making incisions. The main applications are the destruction of tissue, increasing perfusion and physical therapy. The use of ultrasound in the treatment of musculoskeletal conditions however is less common than it was.[2]\n\n Treatments With Approval (FDA or Otherwise) \nEssential tremor, Parkinson's and other neurological disorders\nA focused ultrasound system is approved in Israel, Europe, Korea and Russia to treat essential tremor,[3] neuropathic pain,[4] and Parkinsonian tremor.[5] This approach enables treatment of the brain without incisions and without radiation. In 2016, the US Food and Drug Administration (FDA) approved Insightec\u2019s Exablate Neuro system to treat essential tremor.[6]\nUterine adenomyosis and fibroids\nTreatment for symptomatic uterine fibroids became the first approved application of HIFU by the US Food and Drug Administration (FDA) in October 2004.[7] Studies have shown that HIFU is safe and effective, and that patients have sustained symptomatic relief is sustained for at least two years without the risk of complications involved in surgery or other more invasive approaches.[8] Up to 16-20% of patients will require additional treatment.[9]\nProstate cancer\nHIFU is being studied in men with prostate cancer.[10][11]\nOther cancers\nFurther information: Hyperthermia therapy\nHIFU has been successfully applied in treatment of cancer to destroy solid tumors of the bone, brain, breast, liver,[12] pancreas, rectum, kidney, testes, prostate.[13]\nPalliative care\nHIFU has been found to have palliative effects. CE approval has been given for palliative treatment of bone metastasis.[14] Experimentally, a palliative effect was found in cases of advanced pancreatic cancer.[15]\nHIFU may also be used to produce heating for other purposes than cell destruction. For example, HIFU and other devices may be used to activate temperature-sensitive liposomes filled with cancer drug \"cargo\", to release the drug in high concentrations only at focused tumor sites and when triggered to do so by the hyperthermia device (See Hyperthermia therapy).\n\nCosmetic medicine\nSee also: Non-surgical liposuction\nHIFU devices have been cleared to treat subcutaneous adipose tissue for the purposes of body contouring (known colloquially, and incorrectly since there is no suction involved, as \"non-invasive liposuction\"). These devices are available in the US,[16][17] Canada, the EU, Australia, and certain countries in Asia. HIFU is also cleared, with lower energy levels, for eyebrow lifts.[citation needed ]\n\nOther approved applications\nAn ultrasound-guided device received CE approval for thyroid nodule treatment in 2007, and in 2011 received CE approval for treatment of breast fibroadenoma.[citation needed ]\nAnother device that is guided by optical cameras received CE approval for the treatment of glaucoma in 2011.[18]\n\nMethod of use \nThis section needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the section and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (April 2016)\nHIFU beams are precisely focused on a small region of diseased tissue to locally deposit high levels of energy. The temperature of tissue at the focus will rise to between 65 and 85 \u00b0C, destroying the diseased tissue by coagulative necrosis. Higher temperatures are usually avoided to prevent boiling of liquids inside the tissue. Each sonication (individual ultrasound energy deposition) treats a precisely defined portion of the targeted tissue. The entire therapeutic target is treated by using multiple sonications to create a volume of treated tissue, according to a protocol developed by the physician. Anesthesia is not required, but sedation is generally recommended.[19]\n\nDevices and mechanisms \nThe focusing effect of the transducer allows high sound pressures to be delivered to a focal point without causing unwanted damage to other tissue. This increase in pressure can cause a number of effects including heating and cavitation.\n\n The transducers differ from ultrasonic imaging probes that lots of people are familiar with. In this picture, two examples of HIFU transducers are shown on the left. They both have acoustic bowl-shaped lenses focus the sound inside the body. For comparison, on the right is an ultrasound imaging probe that might be used for cardiac imaging.\nUltrasound sources may be used to generate regional heating and mechanical changes in biological tissue, e.g. in and cancer treatment.\nFocused ultrasound may be used to generate highly localized heating to treat cysts and tumors (benign or malignant), This is known as Magnetic Resonance guided Focused Ultrasound (MRgFUS) or High Intensity Focused Ultrasound (HIFU). These procedures generally use lower frequencies than medical diagnostic ultrasound (from 0.250 to 2 MHz), but significantly higher energies. HIFU treatment is often guided by MRI.\nFocused ultrasound may be used to break up kidney stones by lithotripsy.\nUltrasound may be used for cataract treatment by phacoemulsification.\nLow-intensity ultrasound has been found to have physiological effects such as ability to stimulate bone-growth, and potential to temporarily disrupt the blood\u2013brain barrier for drug delivery.[20][needs update ]\nIn 2015 the FDA authorized two HIFU devices for the ablation of prostate tissue.[21]\n\nMechanism of action \nAs an acoustic wave propagates through the tissue, part of it is absorbed and converted to heat. With focused beams, a very small region of heating can be achieved deep in tissues (usually on the order of millimeters). Tissue damage occurs as a function of both the temperature to which the tissue is heated and how long the tissue is exposed to this heat level in a metric referred to as \"thermal dose\". By focusing at more than one place or by scanning the focus, a volume can be thermally ablated.[22][23][24]\nThere is some evidence that HIFU can be applied to cancers to disrupt the tumor microenvironment and trigger an immune response, as well as possibly enhance the efficacy of immunotherapy.[25][26] \nAt high enough acoustic intensities, cavitation (microbubbles forming and interacting with the ultrasound field) can occur. Microbubbles produced in the field oscillate and grow (due to factors including rectified diffusion), and can eventually implode (inertial or transient cavitation). During inertial cavitation, very high temperatures occur inside the bubbles, and the collapse is associated with a shock wave and jets that can mechanically damage tissue.[27] Because the onset of cavitation and the resulting tissue damage can be unpredictable, it has generally been avoided in clinical applications thus far. However, researchers have been working on a method of controlling this cavitation, called histotripsy which often involves adding an agent that lowers the temperature at which cavitation occurs.[28][29][30]\n\nTheory \nThere are several ways to focus ultrasound\u2014via a lens (for example, a polystyrene lens), a curved transducer, a phased array, or any combination of the three. This concentrates it into a small focal zone; it is similar in concept to focusing light through a magnifying glass. This can be determined using an exponential model of ultrasound attenuation. The ultrasound intensity profile is bounded by an exponentially decreasing function where the decrease in ultrasound is a function of distance traveled through tissue:\n\n \n \n \n I\n =\n \n I\n \n o\n \n \n \n \n e\n \n \n −\n 2\n α\n \n z\n \n \n \n \n \n {\\displaystyle I=I_{o}{e}^{-2\\alpha \\mathrm {z} }}\n \n\n \n\n<\/p>\n \n \n \n \n I\n \n o\n \n \n \n \n {\\displaystyle I_{o}}\n \n\n is the initial intensity of the beam, \n<\/p>\n \n \n \n α\n \n \n {\\displaystyle \\alpha }\n \n\n is the attenuation coefficient (in units of inverse length), and z is distance traveled through the attenuating medium (e.g. tissue).\n\n<\/p>In this model, \n \n \n \n \n \n \n −\n ∂\n I\n \n \n ∂\n \n z\n \n \n \n \n =\n 2\n α\n I\n =\n Q\n \n \n {\\displaystyle {\\frac {-\\partial I}{\\partial \\mathrm {z} }}=2\\alpha I=Q}\n \n\n [31] is a measure of the power density of the heat absorbed from the ultrasound field. Sometimes, SAR is also used to express the amount of heat absorbed by a specific medium, and is obtained by dividing Q by the tissue density. This demonstrates that tissue heating is proportional to intensity, and that intensity is inversely proportional to the area over which an ultrasound beam is spread\u2014therefore, focusing the beam into a sharp point (i.e. increasing the beam intensity) creates a rapid temperature rise at the focus.[citation needed ]\n\n<\/p>The amount of damage caused in the tissue can be modeled using Cumulative Equivalent Minutes (CEM). Several formulations of the CEM equation have been suggested over the years, but the equation currently in use for most research done in HIFU therapy comes from a 1984 paper by Dewey and Sapareto:[32]\n\n \n \n \n \n \n C\n E\n M\n \n \n =\n \n ∫\n \n \n t\n \n o\n \n \n \n \n \n t\n \n f\n \n \n \n \n \n R\n \n \n T\n \n \n r\n e\n f\n e\n r\n e\n n\n c\n e\n \n \n \n −\n T\n \n \n d\n t\n \n \n {\\displaystyle {\\mathit {CEM}}=\\int _{t_{o}}^{t_{f}}R^{T_{\\mathrm {reference} }-T}dt}\n \n\n \n\n<\/p>with the integral being over the treatment time, R=0.5 for temperatures over 43 \u00b0C and 0.25 for temperatures between 43 \u00b0C and 37 \u00b0C, a reference temperature of 43 \u00b0C, and time in minutes. This formula is an empirical formula derived from experiments performed by Dewey and Sapareto by measuring the survival of cell cultures after exposure to heat.[citation needed ]\n\nFocusing \nThe ultrasound beam can be focused in these ways:\n\nGeometrically, for example with a lens or with a spherically curved transducer.\nElectronically, by adjusting the relative phases of elements in an array of transducers (a \"phased array\"). By dynamically adjusting the electronic signals to the elements of a phased array, the beam can be steered to different locations, and aberrations in the ultrasound beam due to tissue structures can be corrected.[citation needed ]\nImage-guidance \nBecause of the non-invasive nature of HIFU, it is not possible to know where the focal position of the transducer is inside the body. For safe and accurate targeting, HIFU therapy requires monitoring and so is usually performed in conjunction with other imaging techniques.\nX-ray CT is often used prior to transcranial therapy to measure the skull thickness. MRI is often used for localization of target volume, characterization of diffusion, perfusion, flow, and temperature. \nRegular diagnostic ultrasound is of limited use during regular ablation because the acoustic properties of lesioned and unlesioned tissue differ very little. It can be useful if cavitation damage has occurred however as the region will become hyperechoic.[33] A promising new technique is ultrasonic thermography.\n\nHistory \nThis section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2016) (Learn how and when to remove this template message)\nThe first investigations of HIFU for non-invasive ablation were reported by Lynn et al. in the early 1940s. Extensive important early work was performed in the 1950s and 1960s by William Fry and Francis Fry at the University of Illinois and Carl Townsend, Howard White and George Gardner at the Interscience Research Institute of Champaign, Ill., culminating in clinical treatments of neurological disorders. In particular High Intensity ultrasound and ultrasound visualization was accomplished stereotaxically with a Cincinnati precision milling machine to perform accurate ablation of brain tumors. Until recently, clinical trials of HIFU for ablation were few (although significant work in hyperthermia was performed with ultrasonic heating), perhaps due to the complexity of the treatments and the difficulty of targeting the beam noninvasively. With recent advances in medical imaging and ultrasound technology, interest in HIFU ablation of tumors has increased.\nThe first commercial HIFU machine, called the Sonablate 200, was developed by the American company Focus Surgery, Inc. (Milipitas, CA) and launched in Europe in 1994 after receiving CE approval, bringing a first medical validation of the technology for benign prostatic hyperplasia (BPH). Comprehensive studies by practitioners at more than one site using the device demonstrated clinical efficacy for the destruction of prostatic tissue without loss of blood or long term side effects. Later studies on localized prostate cancer by Murat and colleagues at the Edouard Herriot Hospital in Lyon in 2006 showed that after treatment with the Ablatherm (EDAP TMS, Lyon, France), progression-free survival rates are very high for low- and intermediate- risk patients with recurrent prostate cancer (70% and 50% respectively)[34] HIFU treatment of prostate cancer is currently[when? ] an approved therapy in Europe[clarification needed ], Canada, South Korea, Australia, and elsewhere.[citation needed ] As of 2012[update], clinical trials for the Sonablate 500 in the United States are ongoing for prostate cancer patients and those who have experienced radiation failure.[35]\nUse of magnetic resonance-guided focused ultrasound was first cited and patented in 1992.[36][37] The technology was later transferred to InsighTec in Haifa Israel in 1998. The InsighTec ExAblate 2000 was the first MRgFUS system to obtain FDA market approval[7] in the United States.\n\nApproval \nCurrently, there are HIFU systems approved to treat uterine fibroids, pain from bone metastases and the prostate in Asia, Canada, Europe, Israel, Latin America and the United States. There is regulatory approval to treat a range of cancers, including breast, kidney, liver, the pancreas and soft tissue sarcoma in Europe and Asia. There is a brain system approved in Europe, Korea and Russia to treat essential tremor, Parkinsonian tremor and neuropathic pain. Non-image guided HIFU devices may be marketed for cosmetic purposes (typically for body fat reduction) in some jurisdictions.\n\nReferences \n\n\n^ Overview of focused ultrasound \n\n^ Robertson, VJ; Baker, KG (2001). \"A review of therapeutic ultrasound: Effectiveness studies\". Physical Therapy. 81 (7): 1339\u201350. PMID 11444997. \n\n^ Elias, W. 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Chapter 9: The principles of cavitation: Thomson Science, London, Blackie Academic and Professional. pp. 151\u2013182. \n\n^ Maxwell, Adam; Sapozhnikov, Oleg; Bailey, Michael; Crum, Lawrence; Xu, Zhen; Fowlkes, Brian; Cain, Charles; Khokhlova, Vera (2012). \"Disintegration of Tissue Using High Intensity Focused Ultrasound: Two Approaches That Utilize Shock Waves\" (PDF) . Acoustics Today. 8 (4): 24. doi:10.1121\/1.4788649. \n\n^ G., Leighton, T. (1994). The acoustic bubble. London: Academic Press. ISBN 9780124419209. OCLC 30091395. \n\n^ Wrenn, Steven P.; Dicker, Stephen M.; Small, Eleanor F.; Dan, Nily R.; Mleczko, Micha\u0142; Schmitz, Georg; Lewin, Peter A. (2012). \"Bursting Bubbles and Bilayers\". Theranostics. 2 (12): 1140\u201359. doi:10.7150\/thno.4305. PMC 3563150 . PMID 23382772. \n\n^ P Hariharan et al. (2007)[full citation needed ] \n\n^ Sapareto, Stephen A.; Dewey, William C. (1984). \"Thermal dose determination in cancer therapy\". International Journal of Radiation Oncology, Biology, Physics. 10 (6): 787\u2013800. doi:10.1016\/0360-3016(84)90379-1. PMID 6547421. \n\n^ Chan, Arthur H.; Vaezy, Shahram; Crum, Lawrence A. (2003). \"High-intensity Focused Ultrasound\". AccessScience. McGraw-Hill Education. doi:10.1036\/1097-8542.YB031005. \n\n^ Gelet, A; Murat, Fran\u00e7ois-Joseph; Poissonier, L (2007). \"Recurrent Prostate Cancer After Radiotherapy \u2013 Salvage Treatment by High-intensity Focused Ultrasound\". European Oncological Disease. 1 (1): 60\u20132. \n\n^ USHIFU (2012). \"Clinical Information about HIFU in the U.S\". Archived from the original on August 7, 2009. \n\n^ Hynynen, K.; Damianou, C.; Darkazanli, A.; Unger, E.; Levy, M.; Schenck, J. F. (1992). \"On-line MRI monitored noninvasive ultrasound surgery\". Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society: 350\u2013351. doi:10.1109\/IEMBS.1992.5760999. ISBN 978-0-7803-0785-8. \n\n^ US 5247935, \"Magnetic resonance guided focussed ultrasound surgery\", issued March 19, 1992   \n\n\nExternal links \nTherapeutic Ultrasound at Curlie\nDespite Doubts, Cancer Therapy Draws Patients from The New York Times on 18\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound\">https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,659 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","fbf0299abb9ffbed2af10e692d621894_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-High-intensity_focused_ultrasound skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">High-intensity focused ultrasound<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>High-intensity focused ultrasound<\/b> (<b>HIFU<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-invasive_procedure\" title=\"Non-invasive procedure\" rel=\"external_link\" target=\"_blank\">non-invasive<\/a> therapeutic technique that uses non-ionizing ultrasonic waves to heat tissue. HIFU can be used to increase <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfusion\" title=\"Perfusion\" rel=\"external_link\" target=\"_blank\">the flow of blood or lymph<\/a>, or to destroy tissue, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neoplasm\" title=\"Neoplasm\" rel=\"external_link\" target=\"_blank\">tumors<\/a>, through a number of mechanisms. The technology can be used to treat a range of disorders and as of 2015 is at various stages of development and commercialization. <sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The technology is similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasound\" title=\"Medical ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasonic imaging<\/a>, although lower frequencies and continuous, rather than pulsed waves are used to achieve the necessary thermal doses. Acoustic lenses are used to achieve the necessary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intensity_(physics)\" title=\"Intensity (physics)\" rel=\"external_link\" target=\"_blank\">intensity<\/a> at the target tissue without damaging the surrounding tissue. An analogy is using a magnifying glass to focus sunlight; only the focal point of the magnifying glass has high intensity. Although lenses have traditionally been used, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phased_array\" title=\"Phased array\" rel=\"external_link\" target=\"_blank\">phased arrays<\/a> are increasingly common as they allow the focal position to be easily changed. HIFU may be combined with other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">imaging techniques<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasound\" title=\"Medical ultrasound\" rel=\"external_link\" target=\"_blank\">medical ultrasound<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> to enable guidance of the treatment and monitoring.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n\n<p>There is no clear consensus on the boundaries between HIFU and other forms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapeutic_ultrasound\" title=\"Therapeutic ultrasound\" rel=\"external_link\" target=\"_blank\">therapeutic ultrasound<\/a>. In academic literature, HIFU usually refers to the high levels of energy required to destroy tissue, although it is also sometimes used to describe lower intensity applications such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_therapy\" title=\"Occupational therapy\" rel=\"external_link\" target=\"_blank\">occupational therapy<\/a> and physical therapy.\n<\/p><p>Either way, HIFU is used to non-invasively heat tissue deep in the body without making incisions. The main applications are the destruction of tissue, increasing perfusion and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a>. The use of ultrasound in the treatment of musculoskeletal conditions however is less common than it was.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Treatments_With_Approval_.28FDA_or_Otherwise.29\"><\/span><span class=\"mw-headline\" id=\"Treatments_With_Approval_(FDA_or_Otherwise)\">Treatments With Approval (FDA or Otherwise)<\/span><\/h3>\n<dl><dt>Essential tremor, Parkinson's and other neurological disorders<\/dt>\n<dd>A focused ultrasound system is approved in Israel, Europe, Korea and Russia to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Essential_tremor\" title=\"Essential tremor\" rel=\"external_link\" target=\"_blank\">essential tremor<\/a>,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathic_pain\" title=\"Neuropathic pain\" rel=\"external_link\" target=\"_blank\">neuropathic pain<\/a>,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinsonian tremor<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> This approach enables treatment of the brain without incisions and without radiation. In 2016, the US Food and Drug Administration (<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a><\/i>) approved Insightec\u2019s Exablate Neuro system to treat essential tremor.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><\/dd><\/dl>\n<dl><dt>Uterine adenomyosis and fibroids<\/dt>\n<dd>Treatment for symptomatic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterine_fibroids\" class=\"mw-redirect\" title=\"Uterine fibroids\" rel=\"external_link\" target=\"_blank\">uterine fibroids<\/a> became the first approved application of HIFU by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">US Food and Drug Administration<\/a> (FDA) in October 2004.<sup id=\"rdp-ebb-cite_ref-FDA_approval_7-0\" class=\"reference\"><a href=\"#cite_note-FDA_approval-7\" rel=\"external_link\">[7]<\/a><\/sup> Studies have shown that HIFU is safe and effective, and that patients have sustained symptomatic relief is sustained for at least two years without the risk of complications involved in surgery or other more invasive approaches.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Up to 16-20% of patients will require additional treatment.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><\/dd>\n<dt>Prostate cancer<\/dt>\n<dd>HIFU is being studied in men with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate_cancer\" title=\"Prostate cancer\" rel=\"external_link\" target=\"_blank\">prostate cancer<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><\/dd><\/dl>\n<dl><dt>Other cancers<\/dt><\/dl>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperthermia_therapy\" title=\"Hyperthermia therapy\" rel=\"external_link\" target=\"_blank\">Hyperthermia therapy<\/a><\/div>\n<dl><dd>HIFU has been successfully applied in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oncology\" title=\"Oncology\" rel=\"external_link\" target=\"_blank\">treatment of cancer<\/a> to destroy solid tumors of the bone, brain, breast, liver,<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> pancreas, rectum, kidney, testes, prostate.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/dd><\/dl>\n<dl><dt>Palliative care<\/dt><\/dl>\n<p>HIFU has been found to have palliative effects. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CE_marking\" title=\"CE marking\" rel=\"external_link\" target=\"_blank\">CE approval<\/a> has been given for palliative treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_metastasis\" title=\"Bone metastasis\" rel=\"external_link\" target=\"_blank\">bone metastasis<\/a>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Experimentally, a palliative effect was found in cases of advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatic_cancer\" title=\"Pancreatic cancer\" rel=\"external_link\" target=\"_blank\">pancreatic cancer<\/a>.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>HIFU may also be used to produce heating for other purposes than cell destruction. For example, HIFU and other devices may be used to activate temperature-sensitive liposomes filled with cancer drug \"cargo\", to release the drug in high concentrations only at focused tumor sites and when triggered to do so by the hyperthermia device (See <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperthermia_therapy\" title=\"Hyperthermia therapy\" rel=\"external_link\" target=\"_blank\">Hyperthermia therapy<\/a>).\n<\/p>\n<dl><dt>Cosmetic medicine<\/dt>\n<dd><div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-surgical_liposuction\" class=\"mw-redirect\" title=\"Non-surgical liposuction\" rel=\"external_link\" target=\"_blank\">Non-surgical liposuction<\/a><\/div><\/dd><\/dl>\n<p>HIFU devices have been cleared to treat subcutaneous adipose tissue for the purposes of body contouring (known colloquially, and incorrectly since there is no suction involved, as \"non-invasive liposuction\"). These devices are available in the US,<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Canada, the EU, Australia, and certain countries in Asia. HIFU is also cleared, with lower energy levels, for eyebrow lifts.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<dl><dt>Other approved applications<\/dt>\n<dd>An ultrasound-guided device received CE approval for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thyroid_nodule\" title=\"Thyroid nodule\" rel=\"external_link\" target=\"_blank\">thyroid nodule<\/a> treatment in 2007, and in 2011 received CE approval for treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibroadenoma\" title=\"Fibroadenoma\" rel=\"external_link\" target=\"_blank\">breast fibroadenoma<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2017)\">citation needed<\/span><\/a><\/i>]<\/sup><\/dd><\/dl>\n<p>Another device that is guided by optical cameras received CE approval for the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a> in 2011.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Method_of_use\">Method of use<\/span><\/h2>\n\n<p>HIFU beams are precisely focused on a small region of diseased tissue to locally deposit high levels of energy. The temperature of tissue at the focus will rise to between 65 and 85 \u00b0C, destroying the diseased tissue by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulative_necrosis\" title=\"Coagulative necrosis\" rel=\"external_link\" target=\"_blank\">coagulative necrosis<\/a>. Higher temperatures are usually avoided to prevent boiling of liquids inside the tissue. Each <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sonication\" title=\"Sonication\" rel=\"external_link\" target=\"_blank\">sonication<\/a> (individual ultrasound energy deposition) treats a precisely defined portion of the targeted tissue. The entire therapeutic target is treated by using multiple sonications to create a volume of treated tissue, according to a protocol developed by the physician. Anesthesia is not required, but sedation is generally recommended.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Devices_and_mechanisms\">Devices and mechanisms<\/span><\/h3>\n<p>The focusing effect of the transducer allows high sound pressures to be delivered to a focal point without causing unwanted damage to other tissue. This increase in pressure can cause a number of effects including heating and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cavitation\" title=\"Cavitation\" rel=\"external_link\" target=\"_blank\">cavitation<\/a>.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\/220px-HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The transducers differ from ultrasonic imaging probes that lots of people are familiar with. In this picture, two examples of HIFU transducers are shown on the left. They both have acoustic bowl-shaped lenses focus the sound inside the body. For comparison, on the right is an ultrasound imaging probe that might be used for cardiac imaging.<\/div><\/div><\/div>\n<ul><li>Ultrasound sources may be used to generate regional heating and mechanical changes in biological tissue, e.g. in and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Experimental_cancer_treatment\" title=\"Experimental cancer treatment\" rel=\"external_link\" target=\"_blank\">cancer treatment<\/a>.<\/li>\n<li>Focused ultrasound may be used to generate highly localized heating to treat cysts and tumors (benign or malignant), This is known as Magnetic Resonance guided Focused Ultrasound (MRgFUS) or High Intensity Focused Ultrasound (HIFU). These procedures generally use lower frequencies than medical diagnostic ultrasound (from 0.250 to 2 MHz), but significantly higher energies. HIFU treatment is often guided by <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>.<\/li>\n<li>Focused ultrasound may be used to break up <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\" class=\"mw-redirect\" title=\"Kidney stone\" rel=\"external_link\" target=\"_blank\">kidney stones<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_shock_wave_lithotripsy\" class=\"mw-redirect\" title=\"Extracorporeal shock wave lithotripsy\" rel=\"external_link\" target=\"_blank\">lithotripsy<\/a>.<\/li>\n<li>Ultrasound may be used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract\" title=\"Cataract\" rel=\"external_link\" target=\"_blank\">cataract<\/a> treatment by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phacoemulsification\" title=\"Phacoemulsification\" rel=\"external_link\" target=\"_blank\">phacoemulsification<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Low_intensity_pulsed_ultrasound\" class=\"mw-redirect\" title=\"Low intensity pulsed ultrasound\" rel=\"external_link\" target=\"_blank\">Low-intensity ultrasound<\/a> has been found to have physiological effects such as ability to stimulate bone-growth, and potential to temporarily disrupt the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood%E2%80%93brain_barrier\" title=\"Blood\u2013brain barrier\" rel=\"external_link\" target=\"_blank\">blood\u2013brain barrier<\/a> for drug delivery.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag is dated. (April 2016)\">needs update<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<p>In 2015 the FDA authorized two HIFU devices for the ablation of prostate tissue.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism_of_action\">Mechanism of action<\/span><\/h2>\n<p>As an acoustic wave propagates through the tissue, part of it is absorbed and converted to heat. With focused beams, a very small region of heating can be achieved deep in tissues (usually on the order of millimeters). Tissue damage occurs as a function of both the temperature to which the tissue is heated and how long the tissue is exposed to this heat level in a metric referred to as \"thermal dose\". By focusing at more than one place or by scanning the focus, a volume can be thermally ablated.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>There is some evidence that HIFU can be applied to cancers to disrupt the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor_microenvironment\" title=\"Tumor microenvironment\" rel=\"external_link\" target=\"_blank\">tumor microenvironment<\/a> and trigger an immune response, as well as possibly enhance the efficacy of immunotherapy.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> \n<\/p><p>At high enough acoustic intensities, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cavitation\" title=\"Cavitation\" rel=\"external_link\" target=\"_blank\">cavitation<\/a> (microbubbles forming and interacting with the ultrasound field) can occur. Microbubbles produced in the field oscillate and grow (due to factors including rectified <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffusion<\/a>), and can eventually implode (inertial or transient cavitation). During inertial cavitation, very high temperatures occur inside the bubbles, and the collapse is associated with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shock_wave\" title=\"Shock wave\" rel=\"external_link\" target=\"_blank\">shock wave<\/a> and jets that can mechanically damage tissue.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> Because the onset of cavitation and the resulting tissue damage can be unpredictable, it has generally been avoided in clinical applications thus far. However, researchers have been working on a method of controlling this cavitation, called histotripsy which often involves adding an agent that lowers the temperature at which cavitation occurs.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Theory\">Theory<\/span><\/h3>\n<p>There are several ways to <a href=\"https:\/\/en.wiktionary.org\/wiki\/focus\" class=\"extiw\" title=\"wikt:focus\" rel=\"external_link\" target=\"_blank\">focus<\/a> ultrasound\u2014via a lens (for example, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polystyrene\" title=\"Polystyrene\" rel=\"external_link\" target=\"_blank\">polystyrene<\/a> lens), a curved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transducer\" title=\"Transducer\" rel=\"external_link\" target=\"_blank\">transducer<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phased_array\" title=\"Phased array\" rel=\"external_link\" target=\"_blank\">phased array<\/a>, or any combination of the three. This concentrates it into a small focal zone; it is similar in concept to focusing light through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnifying_glass\" title=\"Magnifying glass\" rel=\"external_link\" target=\"_blank\">magnifying glass<\/a>. This can be determined using an exponential model of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound_attenuation_spectroscopy\" title=\"Ultrasound attenuation spectroscopy\" rel=\"external_link\" target=\"_blank\">ultrasound attenuation<\/a>. The ultrasound intensity profile is bounded by an exponentially decreasing function where the decrease in ultrasound is a function of distance traveled through tissue:\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/30826c36d2cbdcc18756a1dc7c98d15bdfafc581\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.671ex; width:11.521ex; height:3.009ex;\" alt=\"I=I_{o}{e}^{{-2\\alpha {\\mathrm {z}}}}\"\/><\/span>\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/6c462307420358828e01df3a8b777bc2fb54f5c0\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.671ex; width:2.053ex; height:2.509ex;\" alt=\"I_o\"\/><\/span> is the initial intensity of the beam, <span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/b79333175c8b3f0840bfb4ec41b8072c83ea88d3\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.338ex; width:1.488ex; height:1.676ex;\" alt=\"\\alpha \"\/><\/span> is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Attenuation_coefficient\" title=\"Attenuation coefficient\" rel=\"external_link\" target=\"_blank\">attenuation coefficient<\/a> (in units of inverse length), and z is distance traveled through the attenuating medium (e.g. tissue).\n<\/p>\n<\/p><p>In this model, <span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/653bc421a42a86e43910263b1c12fbe4b8a71fdf\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -2.005ex; width:16.991ex; height:5.509ex;\" alt=\"{\\frac {-\\partial I}{\\partial {\\mathrm {z}}}}=2\\alpha I=Q\"\/><\/span><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> is a measure of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Power_density\" title=\"Power density\" rel=\"external_link\" target=\"_blank\">power density<\/a> of the heat absorbed from the ultrasound field. Sometimes, SAR is also used to express the amount of heat absorbed by a specific medium, and is obtained by dividing Q by the tissue density. This demonstrates that tissue heating is proportional to intensity, and that intensity is inversely proportional to the area over which an ultrasound beam is spread\u2014therefore, focusing the beam into a sharp point (i.e. increasing the beam intensity) creates a rapid temperature rise at the focus.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<\/p><p>The amount of damage caused in the tissue can be modeled using Cumulative Equivalent Minutes (CEM). Several formulations of the CEM equation have been suggested over the years, but the equation currently in use for most research done in HIFU therapy comes from a 1984 paper by Dewey and Sapareto:<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/ca9f450deaf32200408c635153ef2d88e8ec7bff\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -2.671ex; width:25.859ex; height:6.509ex;\" alt=\"{\\mathit {CEM}}=\\int _{{t_{o}}}^{{t_{f}}}R^{{T_{{{\\mathrm {reference}}}}-T}}dt\"\/><\/span>\n<\/p>\n<\/p><p>with the integral being over the treatment time, R=0.5 for temperatures over 43 \u00b0C and 0.25 for temperatures between 43 \u00b0C and 37 \u00b0C, a reference temperature of 43 \u00b0C, and time in minutes. This formula is an empirical formula derived from experiments performed by Dewey and Sapareto by measuring the survival of cell cultures after exposure to heat.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Focusing\">Focusing<\/span><\/h3>\n<p>The ultrasound beam can be focused in these ways:\n<\/p>\n<ul><li>Geometrically, for example with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lens<\/a> or with a spherically curved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transducer\" title=\"Transducer\" rel=\"external_link\" target=\"_blank\">transducer<\/a>.<\/li>\n<li>Electronically, by adjusting the relative phases of elements in an array of transducers (a \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Phased_array\" title=\"Phased array\" rel=\"external_link\" target=\"_blank\">phased array<\/a>\"). By dynamically adjusting the electronic signals to the elements of a phased array, the beam can be steered to different locations, and aberrations in the ultrasound beam due to tissue structures can be corrected.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2016)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Image-guidance\">Image-guidance<\/span><\/h2>\n<p>Because of the non-invasive nature of HIFU, it is not possible to know where the focal position of the transducer is inside the body. For safe and accurate targeting, HIFU therapy requires monitoring and so is usually performed in conjunction with other imaging techniques.\n<\/p><p>X-ray <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT<\/a> is often used prior to transcranial therapy to measure the skull thickness. <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> is often used for localization of target volume, characterization of diffusion, perfusion, flow, and temperature. \n<\/p><p>Regular diagnostic ultrasound is of limited use during regular ablation because the acoustic properties of lesioned and unlesioned tissue differ very little. It can be useful if cavitation damage has occurred however as the region will become hyperechoic.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> A promising new technique is ultrasonic thermography.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n\n<p>The first investigations of HIFU for non-invasive ablation were reported by Lynn et al. in the early 1940s. Extensive important early work was performed in the 1950s and 1960s by William Fry and Francis Fry at the University of Illinois and Carl Townsend, Howard White and George Gardner at the Interscience Research Institute of Champaign, Ill., culminating in clinical treatments of neurological disorders. In particular High Intensity ultrasound and ultrasound visualization was accomplished stereotaxically with a Cincinnati precision milling machine to perform accurate ablation of brain tumors. Until recently, clinical trials of HIFU for ablation were few (although significant work in hyperthermia was performed with ultrasonic heating), perhaps due to the complexity of the treatments and the difficulty of targeting the beam noninvasively. With recent advances in medical imaging and ultrasound technology, interest in HIFU ablation of tumors has increased.\n<\/p><p>The first commercial HIFU machine, called the Sonablate 200, was developed by the American company Focus Surgery, Inc. (Milipitas, CA) and launched in Europe in 1994 after receiving CE approval, bringing a first medical validation of the technology for benign prostatic hyperplasia (BPH). Comprehensive studies by practitioners at more than one site using the device demonstrated clinical efficacy for the destruction of prostatic tissue without loss of blood or long term side effects. Later studies on localized prostate cancer by Murat and colleagues at the Edouard Herriot Hospital in Lyon in 2006 showed that after treatment with the Ablatherm (EDAP TMS, Lyon, France), progression-free survival rates are very high for low- and intermediate- risk patients with recurrent prostate cancer (70% and 50% respectively)<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> HIFU treatment of prostate cancer is currently<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (December 2016)\">when?<\/span><\/a><\/i>]<\/sup> an approved therapy in Europe<sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"Everywhere in Europe? Including Russia and Turkey? Or just in some countries? Or just the EU? (December 2016)\">clarification needed<\/span><\/a><\/i>]<\/sup>, Canada, South Korea, Australia, and elsewhere.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> As of 2012<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, clinical trials for the Sonablate 500 in the United States are ongoing for prostate cancer patients and those who have experienced radiation failure.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p><p>Use of magnetic resonance-guided focused ultrasound was first cited and patented in 1992.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> The technology was later transferred to InsighTec in Haifa Israel in 1998. The InsighTec ExAblate 2000 was the first MRgFUS system to obtain FDA market approval<sup id=\"rdp-ebb-cite_ref-FDA_approval_7-1\" class=\"reference\"><a href=\"#cite_note-FDA_approval-7\" rel=\"external_link\">[7]<\/a><\/sup> in the United States.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Approval\">Approval<\/span><\/h2>\n<p>Currently, there are HIFU systems approved to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterine_fibroids\" class=\"mw-redirect\" title=\"Uterine fibroids\" rel=\"external_link\" target=\"_blank\">uterine fibroids<\/a>, pain from bone metastases and the prostate in Asia, Canada, Europe, Israel, Latin America and the United States. There is regulatory approval to treat a range of cancers, including breast, kidney, liver, the pancreas and soft tissue sarcoma in Europe and Asia. There is a brain system approved in Europe, Korea and Russia to treat essential tremor, Parkinsonian tremor and neuropathic pain. Non-image guided HIFU devices may be marketed for cosmetic purposes (typically for body fat reduction) in some jurisdictions.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fusfoundation.org\/diseases-and-conditions-all\/overview\" target=\"_blank\">Overview of focused ultrasound<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Robertson, VJ; Baker, KG (2001). \"A review of therapeutic ultrasound: Effectiveness studies\". <i>Physical Therapy<\/i>. <b>81<\/b> (7): 1339\u201350. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11444997\" target=\"_blank\">11444997<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+Therapy&rft.atitle=A+review+of+therapeutic+ultrasound%3A+Effectiveness+studies&rft.volume=81&rft.issue=7&rft.pages=1339-50&rft.date=2001&rft_id=info%3Apmid%2F11444997&rft.aulast=Robertson&rft.aufirst=VJ&rft.au=Baker%2C+KG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Elias, W. Jeffrey; Huss, Diane; Voss, Tiffini; Loomba, Johanna; Khaled, Mohamad; Zadicario, Eyal; Frysinger, Robert C.; Sperling, Scott A.; Wylie, Scott; Monteith, Stephen J.; Druzgal, Jason; Shah, Binit B.; Harrison, Madaline; Wintermark, Max (2013). \"A Pilot Study of Focused Ultrasound Thalamotomy for Essential Tremor\". <i>New England Journal of Medicine<\/i>. <b>369<\/b> (7): 640\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMoa1300962\" target=\"_blank\">10.1056\/NEJMoa1300962<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23944301\" target=\"_blank\">23944301<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=A+Pilot+Study+of+Focused+Ultrasound+Thalamotomy+for+Essential+Tremor&rft.volume=369&rft.issue=7&rft.pages=640-8&rft.date=2013&rft_id=info%3Adoi%2F10.1056%2FNEJMoa1300962&rft_id=info%3Apmid%2F23944301&rft.aulast=Elias&rft.aufirst=W.+Jeffrey&rft.au=Huss%2C+Diane&rft.au=Voss%2C+Tiffini&rft.au=Loomba%2C+Johanna&rft.au=Khaled%2C+Mohamad&rft.au=Zadicario%2C+Eyal&rft.au=Frysinger%2C+Robert+C.&rft.au=Sperling%2C+Scott+A.&rft.au=Wylie%2C+Scott&rft.au=Monteith%2C+Stephen+J.&rft.au=Druzgal%2C+Jason&rft.au=Shah%2C+Binit+B.&rft.au=Harrison%2C+Madaline&rft.au=Wintermark%2C+Max&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jeanmonod, Daniel; 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(2007). \"Sustained Relief of Leiomyoma Symptoms by Using Focused Ultrasound Surgery\". <i>Obstetrics & Gynecology<\/i>. <b>110<\/b> (2, Part 1): 279\u201387. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.AOG.0000275283.39475.f6\" target=\"_blank\">10.1097\/01.AOG.0000275283.39475.f6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17666601\" target=\"_blank\">17666601<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstetrics+%26+Gynecology&rft.atitle=Sustained+Relief+of+Leiomyoma+Symptoms+by+Using+Focused+Ultrasound+Surgery&rft.volume=110&rft.issue=2%2C+Part+1&rft.pages=279-87&rft.date=2007&rft_id=info%3Adoi%2F10.1097%2F01.AOG.0000275283.39475.f6&rft_id=info%3Apmid%2F17666601&rft.aulast=Stewart&rft.aufirst=Elizabeth+A.&rft.au=Gostout%2C+Bobbie&rft.au=Rabinovici%2C+Jaron&rft.au=Kim%2C+Hyun+S.&rft.au=Regan%2C+Lesley&rft.au=Tempany%2C+Clare+M.+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">J\u00e1come-Pita, F; S\u00e1nchez-Salas, R; Barret, E; Amaruch, N; Gonzalez-Enguita, C; Cathelineau, X (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4049329\" target=\"_blank\">\"Focal therapy in prostate cancer: the current situation\"<\/a>. <i>Ecancermedicalscience<\/i>. <b>8<\/b>: 435. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3332%2Fecancer.2014.435\" target=\"_blank\">10.3332\/ecancer.2014.435<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4049329\" target=\"_blank\">4049329<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24944577\" target=\"_blank\">24944577<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ecancermedicalscience&rft.atitle=Focal+therapy+in+prostate+cancer%3A+the+current+situation&rft.volume=8&rft.pages=435&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4049329&rft_id=info%3Apmid%2F24944577&rft_id=info%3Adoi%2F10.3332%2Fecancer.2014.435&rft.aulast=J%C3%A1come-Pita&rft.aufirst=F&rft.au=S%C3%A1nchez-Salas%2C+R&rft.au=Barret%2C+E&rft.au=Amaruch%2C+N&rft.au=Gonzalez-Enguita%2C+C&rft.au=Cathelineau%2C+X&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4049329&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medpagetoday.com\/MeetingCoverage\/AUA\/57896\" target=\"_blank\">'Cautious Optimism' for HIFU in Prostate Cancer. 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Philips Healthcare. April 20, 2011. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/new.fusfoundation.org\/Focused-Ultrasound-Technology-News\/philips-sonalleve-receives-ce-mark-for-mr-guided-focused-ultrasound-ablation-of-metastatic-bone-cancer\" target=\"_blank\">the original<\/a> on October 5, 2013<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">March 8,<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=510%28k%29+Premarket+Notification+Database&rft.atitle=510%28k%29+Premarket+Notification+-+K112626&rft_id=http%3A%2F%2Fwww.accessdata.fda.gov%2Fscripts%2Fcdrh%2Fcfdocs%2Fcfpmn%2Fpmn.cfm%3FID%3DK112626&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> Premarket notification, device in classification \"focused ultrasound for tissue heat or mechanical cellular disruption\", classification description \"Focused ultrasound stimulator system for aesthetic use\"<\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/digital.eyeworld.org\/i\/325050-jun-2014\/57\" target=\"_blank\">http:\/\/digital.eyeworld.org\/i\/325050-jun-2014\/57<\/a><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.springer.com\/us\/book\/9783319225357\" target=\"_blank\"><i>Therapeutic Ultrasound<\/i><\/a>. New York: Springer. 2016. pp. 3\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-319-22536-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Therapeutic+Ultrasound&rft.place=New+York&rft.pages=3-20&rft.pub=Springer&rft.date=2016&rft.isbn=978-3-319-22536-4&rft_id=https%3A%2F%2Fwww.springer.com%2Fus%2Fbook%2F9783319225357&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hynynen, Kullervo; McDannold, Nathan; Sheikov, Nickolai A.; Jolesz, Ferenc A.; Vykhodtseva, Natalia (2005). \"Local and reversible blood\u2013brain barrier disruption by noninvasive focused ultrasound at frequencies suitable for trans-skull sonications\". <i>NeuroImage<\/i>. <b>24<\/b> (1): 12\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.neuroimage.2004.06.046\" target=\"_blank\">10.1016\/j.neuroimage.2004.06.046<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15588592\" target=\"_blank\">15588592<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=NeuroImage&rft.atitle=Local+and+reversible+blood%E2%80%93brain+barrier+disruption+by+noninvasive+focused+ultrasound+at+frequencies+suitable+for+trans-skull+sonications&rft.volume=24&rft.issue=1&rft.pages=12-20&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fj.neuroimage.2004.06.046&rft_id=info%3Apmid%2F15588592&rft.aulast=Hynynen&rft.aufirst=Kullervo&rft.au=McDannold%2C+Nathan&rft.au=Sheikov%2C+Nickolai+A.&rft.au=Jolesz%2C+Ferenc+A.&rft.au=Vykhodtseva%2C+Natalia&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf15\/DEN150011.pdf\" target=\"_blank\">http:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf15\/DEN150011.pdf<\/a><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (April 2016)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Huisman, Merel; Lam, Mie K; Bartels, Lambertus W; Nijenhuis, Robbert J; Moonen, Chrit T; Knuttel, Floor M; Verkooijen, Helena M; van Vulpen, Marco; van den Bosch, Maurice A (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4193684\" target=\"_blank\">\"Feasibility of volumetric MRI-guided high intensity focused ultrasound (MR-HIFU) for painful bone metastases\"<\/a>. <i>Journal of Therapeutic Ultrasound<\/i>. <b>2<\/b>: 16. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F2050-5736-2-16\" target=\"_blank\">10.1186\/2050-5736-2-16<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4193684\" target=\"_blank\">4193684<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25309743\" target=\"_blank\">25309743<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Therapeutic+Ultrasound&rft.atitle=Feasibility+of+volumetric+MRI-guided+high+intensity+focused+ultrasound+%28MR-HIFU%29+for+painful+bone+metastases&rft.volume=2&rft.pages=16&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4193684&rft_id=info%3Apmid%2F25309743&rft_id=info%3Adoi%2F10.1186%2F2050-5736-2-16&rft.aulast=Huisman&rft.aufirst=Merel&rft.au=Lam%2C+Mie+K&rft.au=Bartels%2C+Lambertus+W&rft.au=Nijenhuis%2C+Robbert+J&rft.au=Moonen%2C+Chrit+T&rft.au=Knuttel%2C+Floor+M&rft.au=Verkooijen%2C+Helena+M&rft.au=van+Vulpen%2C+Marco&rft.au=van+den+Bosch%2C+Maurice+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4193684&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">K\u00f6hler, Max O.; Mougenot, Charles; Quesson, Bruno; Enholm, Julia; Le Bail, Brigitte; Laurent, Christophe; Moonen, Chrit T. W.; Ehnholm, G\u00f6sta J. (2009). \"Volumetric HIFU ablation under 3D guidance of rapid MRI thermometry\". <i>Medical Physics<\/i>. <b>36<\/b> (8): 3521\u201335. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2009MedPh..36.3521K\" target=\"_blank\">2009MedPh..36.3521K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1118%2F1.3152112\" target=\"_blank\">10.1118\/1.3152112<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19746786\" target=\"_blank\">19746786<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+Physics&rft.atitle=Volumetric+HIFU+ablation+under+3D+guidance+of+rapid+MRI+thermometry&rft.volume=36&rft.issue=8&rft.pages=3521-35&rft.date=2009&rft_id=info%3Apmid%2F19746786&rft_id=info%3Adoi%2F10.1118%2F1.3152112&rft_id=info%3Abibcode%2F2009MedPh..36.3521K&rft.aulast=K%C3%B6hler&rft.aufirst=Max+O.&rft.au=Mougenot%2C+Charles&rft.au=Quesson%2C+Bruno&rft.au=Enholm%2C+Julia&rft.au=Le+Bail%2C+Brigitte&rft.au=Laurent%2C+Christophe&rft.au=Moonen%2C+Chrit+T.+W.&rft.au=Ehnholm%2C+G%C3%B6sta+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Monteith, Stephen J.; Kassell, Neal F.; Goren, Oded; Harnof, Sagi (2013). \"Transcranial MR-guided focused ultrasound sonothrombolysis in the treatment of intracerebral hemorrhage\". <i>Neurosurgical Focus<\/i>. <b>34<\/b> (5): E14. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3171%2F2013.2.FOCUS1313\" target=\"_blank\">10.3171\/2013.2.FOCUS1313<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23634918\" target=\"_blank\">23634918<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgical+Focus&rft.atitle=Transcranial+MR-guided+focused+ultrasound+sonothrombolysis+in+the+treatment+of+intracerebral+hemorrhage&rft.volume=34&rft.issue=5&rft.pages=E14&rft.date=2013&rft_id=info%3Adoi%2F10.3171%2F2013.2.FOCUS1313&rft_id=info%3Apmid%2F23634918&rft.aulast=Monteith&rft.aufirst=Stephen+J.&rft.au=Kassell%2C+Neal+F.&rft.au=Goren%2C+Oded&rft.au=Harnof%2C+Sagi&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Haen, Sebastian P.; Pereira, Philippe L.; Salih, Helmut R.; Rammensee, Hans-Georg; Gouttefangeas, C\u00e9cile (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3254009\" target=\"_blank\">\"More Than Just Tumor Destruction: Immunomodulation by Thermal Ablation of Cancer\"<\/a>. <i>Clinical and Developmental Immunology<\/i>. <b>2011<\/b>: 1\u201319. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1155%2F2011%2F160250\" target=\"_blank\">10.1155\/2011\/160250<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3254009\" target=\"_blank\">3254009<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22242035\" target=\"_blank\">22242035<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+and+Developmental+Immunology&rft.atitle=More+Than+Just+Tumor+Destruction%3A+Immunomodulation+by+Thermal+Ablation+of+Cancer&rft.volume=2011&rft.pages=1-19&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3254009&rft_id=info%3Apmid%2F22242035&rft_id=info%3Adoi%2F10.1155%2F2011%2F160250&rft.aulast=Haen&rft.aufirst=Sebastian+P.&rft.au=Pereira%2C+Philippe+L.&rft.au=Salih%2C+Helmut+R.&rft.au=Rammensee%2C+Hans-Georg&rft.au=Gouttefangeas%2C+C%C3%A9cile&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3254009&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wu, Feng (2013). \"High intensity focused ultrasound ablation and antitumor immune response\". <i>The Journal of the Acoustical Society of America<\/i>. <b>134<\/b> (2): 1695\u2013701. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2013ASAJ..134.1695W\" target=\"_blank\">2013ASAJ..134.1695W<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1121%2F1.4812893\" target=\"_blank\">10.1121\/1.4812893<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23927210\" target=\"_blank\">23927210<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+the+Acoustical+Society+of+America&rft.atitle=High+intensity+focused+ultrasound+ablation+and+antitumor+immune+response&rft.volume=134&rft.issue=2&rft.pages=1695-701&rft.date=2013&rft_id=info%3Apmid%2F23927210&rft_id=info%3Adoi%2F10.1121%2F1.4812893&rft_id=info%3Abibcode%2F2013ASAJ..134.1695W&rft.aulast=Wu&rft.aufirst=Feng&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Leighton, T.G. 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(1994). <i>The acoustic bubble<\/i>. London: Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780124419209. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/30091395\" target=\"_blank\">30091395<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+acoustic+bubble&rft.place=London&rft.pub=Academic+Press&rft.date=1994&rft_id=info%3Aoclcnum%2F30091395&rft.isbn=9780124419209&rft.aulast=G.&rft.aufirst=Leighton%2C+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wrenn, Steven P.; Dicker, Stephen M.; Small, Eleanor F.; Dan, Nily R.; Mleczko, Micha\u0142; Schmitz, Georg; Lewin, Peter A. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3563150\" target=\"_blank\">\"Bursting Bubbles and Bilayers\"<\/a>. <i>Theranostics<\/i>. <b>2<\/b> (12): 1140\u201359. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7150%2Fthno.4305\" target=\"_blank\">10.7150\/thno.4305<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3563150\" target=\"_blank\">3563150<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23382772\" target=\"_blank\">23382772<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Theranostics&rft.atitle=Bursting+Bubbles+and+Bilayers&rft.volume=2&rft.issue=12&rft.pages=1140-59&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3563150&rft_id=info%3Apmid%2F23382772&rft_id=info%3Adoi%2F10.7150%2Fthno.4305&rft.aulast=Wrenn&rft.aufirst=Steven+P.&rft.au=Dicker%2C+Stephen+M.&rft.au=Small%2C+Eleanor+F.&rft.au=Dan%2C+Nily+R.&rft.au=Mleczko%2C+Micha%C5%82&rft.au=Schmitz%2C+Georg&rft.au=Lewin%2C+Peter+A.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3563150&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">P Hariharan et al. (2007)<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (April 2016)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sapareto, Stephen A.; Dewey, William C. (1984). \"Thermal dose determination in cancer therapy\". <i>International Journal of Radiation Oncology, Biology, Physics<\/i>. <b>10<\/b> (6): 787\u2013800. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0360-3016%2884%2990379-1\" target=\"_blank\">10.1016\/0360-3016(84)90379-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6547421\" target=\"_blank\">6547421<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics&rft.atitle=Thermal+dose+determination+in+cancer+therapy&rft.volume=10&rft.issue=6&rft.pages=787-800&rft.date=1984&rft_id=info%3Adoi%2F10.1016%2F0360-3016%2884%2990379-1&rft_id=info%3Apmid%2F6547421&rft.aulast=Sapareto&rft.aufirst=Stephen+A.&rft.au=Dewey%2C+William+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chan, Arthur H.; Vaezy, Shahram; Crum, Lawrence A. (2003). \"High-intensity Focused Ultrasound\". <i>AccessScience<\/i>. McGraw-Hill Education. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1036%2F1097-8542.YB031005\" target=\"_blank\">10.1036\/1097-8542.YB031005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AccessScience&rft.atitle=High-intensity+Focused+Ultrasound&rft.date=2003&rft_id=info%3Adoi%2F10.1036%2F1097-8542.YB031005&rft.aulast=Chan&rft.aufirst=Arthur+H.&rft.au=Vaezy%2C+Shahram&rft.au=Crum%2C+Lawrence+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gelet, A; Murat, Fran\u00e7ois-Joseph; Poissonier, L (2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.touchoncology.com\/articles\/recurrent-prostate-cancer-after-radiotherapy-salvage-treatment-high-intensity-focused-ultra\" target=\"_blank\">\"Recurrent Prostate Cancer After Radiotherapy \u2013 Salvage Treatment by High-intensity Focused Ultrasound\"<\/a>. <i>European Oncological Disease<\/i>. <b>1<\/b> (1): 60\u20132.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Oncological+Disease&rft.atitle=Recurrent+Prostate+Cancer+After+Radiotherapy+%E2%80%93+Salvage+Treatment+by+High-intensity+Focused+Ultrasound&rft.volume=1&rft.issue=1&rft.pages=60-2&rft.date=2007&rft.aulast=Gelet&rft.aufirst=A&rft.au=Murat%2C+Fran%C3%A7ois-Joseph&rft.au=Poissonier%2C+L&rft_id=http%3A%2F%2Fwww.touchoncology.com%2Farticles%2Frecurrent-prostate-cancer-after-radiotherapy-salvage-treatment-high-intensity-focused-ultra&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">USHIFU (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090807071512\/http:\/\/www.ushifu.com\/index.php?option=com_content&view=article&id=3&Itemid=3\" target=\"_blank\">\"Clinical Information about HIFU in the U.S\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ushifu.com\/index.php?option=com_content&view=article&id=3&Itemid=3\" target=\"_blank\">the original<\/a> on August 7, 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Clinical+Information+about+HIFU+in+the+U.S&rft.date=2012&rft.au=USHIFU&rft_id=http%3A%2F%2Fwww.ushifu.com%2Findex.php%3Foption%3Dcom_content%26view%3Darticle%26id%3D3%26Itemid%3D3&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hynynen, K.; Damianou, C.; Darkazanli, A.; Unger, E.; Levy, M.; Schenck, J. F. (1992). \"On-line MRI monitored noninvasive ultrasound surgery\". <i>Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society<\/i>: 350\u2013351. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FIEMBS.1992.5760999\" target=\"_blank\">10.1109\/IEMBS.1992.5760999<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7803-0785-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+Annual+International+Conference+of+the+IEEE+Engineering+in+Medicine+and+Biology+Society&rft.atitle=On-line+MRI+monitored+noninvasive+ultrasound+surgery&rft.pages=350-351&rft.date=1992&rft_id=info%3Adoi%2F10.1109%2FIEMBS.1992.5760999&rft.isbn=978-0-7803-0785-8&rft.aulast=Hynynen&rft.aufirst=K.&rft.au=Damianou%2C+C.&rft.au=Darkazanli%2C+A.&rft.au=Unger%2C+E.&rft.au=Levy%2C+M.&rft.au=Schenck%2C+J.+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><span class=\"citation patent\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/worldwide.espacenet.com\/textdoc?DB=EPODOC&IDX=US5247935\" target=\"_blank\">US 5247935<\/a>, \"Magnetic resonance guided focussed ultrasound surgery\", issued March 19, 1992<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Apatent&rft.number=5247935&rft.cc=US&rft.title=Magnetic+resonance+guided+focussed+ultrasound+surgery&rft.date=March 19, 1992&rft.appldate=March 19, 1992\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/curlie.org\/Science\/Technology\/Acoustics,_Ultrasound_and_Vibration\/Ultrasound\/Therapeutic_Ultrasound\" target=\"_blank\">Therapeutic Ultrasound<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Curlie\" title=\"Curlie\" rel=\"external_link\" target=\"_blank\">Curlie<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2008\/01\/18\/health\/18prostate.html?_r=1&fta=y\" target=\"_blank\">Despite Doubts, Cancer Therapy Draws Patients<\/a> from <i>The New York Times<\/i> on 18<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1255\nCached time: 20181217214702\nCache expiry: 3600\nDynamic content: true\nCPU time usage: 0.796 seconds\nReal time usage: 0.980 seconds\nPreprocessor visited node count: 4270\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 114671\/2097152 bytes\nTemplate argument size: 7355\/2097152 bytes\nHighest expansion depth: 21\/40\nExpensive parser function count: 16\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 91613\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.474\/10.000 seconds\nLua memory usage: 5.9 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 846.896 1 -total\n<\/p>\n<pre>52.32% 443.094 1 Template:Reflist\n32.79% 277.719 21 Template:Cite_journal\n12.88% 109.109 9 Template:Fix\n 9.44% 79.925 5 Template:Citation_needed\n 8.97% 75.984 10 Template:Delink\n 8.76% 74.164 1 Template:Infobox_medical_intervention\n 8.25% 69.907 1 Template:Infobox\n 7.98% 67.585 1 Template:Advert\n 6.51% 55.110 4 Template:Ambox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3606007-1!canonical!math=5 and timestamp 20181217214701 and revision id 864025477\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/High-intensity_focused_ultrasound\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214702\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.021 seconds\nReal time usage: 1.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1158.558 1 - wikipedia:High-intensity_focused_ultrasound\n100.00% 1158.558 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8020-0!*!*!*!*!*!* and timestamp 20181217214700 and revision id 24131\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound\">https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","fbf0299abb9ffbed2af10e692d621894_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Diagram_showing_liver_lesioning_using_a_HIFU_transducer.png\/560px-Diagram_showing_liver_lesioning_using_a_HIFU_transducer.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\/440px-HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"fbf0299abb9ffbed2af10e692d621894_timestamp":1545083220,"e1d34a169eacda7dd24e34bd666ecd73_type":"article","e1d34a169eacda7dd24e34bd666ecd73_title":"Harding test","e1d34a169eacda7dd24e34bd666ecd73_url":"https:\/\/www.limswiki.org\/index.php\/Harding_test","e1d34a169eacda7dd24e34bd666ecd73_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHarding test\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe term Harding test is generically understood to mean an automatic test for photosensitive epilepsy (PSE) provocative image sequences in television content. This is properly known as a PSE test since the publication of the Digital Production Partnership (DPP) technical requirements[1] and the DPP PSE Devices[2] document (in the UK) updated in November 2018.\nThe Harding FPA (flash and pattern analyser) is proprietary software that is used to analyse video content for flashing and stationary patterns which may cause harm to those who suffer from photosensitive epilepsy. It is an implementation of the guidelines set by the regulator Ofcom in the UK. It is available in both tape-based and file-based versions, allowing video streams from SDI, composite, component, HDMI, and files to all be analysed, in resolutions up to 8k. Versions for both Microsoft Windows and Apple Mac OS X are available. There are other manufacturers of similar and different solutions now available which are also approved on the DPP Devices list.[3]\n\nPhotosensitive epilepsy \nPhotosensitive epilepsy affects approximately one in 4,000 people and is a form of epilepsy in which seizures are triggered by visual stimuli that form patterns in time or space, such as flashing lights, bold regular patterns, or regular moving patterns. In 1993, an advert for Pot Noodles induced seizures in three people in the United Kingdom, leading to the then regulator the ITC introducing these guidelines. \nThe Broadcast Code of Advertising Practice requires that TV ads are tested and pass the 'flash test'. Clearcast, the company responsible for clearing ads for UK commercial broadcasters, is flash testing all ads before clearance.\n\nTesting procedures \nThe algorithms behind PSE testing look at video frames from second to second and analyse for potentially provocative image sequences. Luminance flashes, Red flashes and spatial patterns over prescribed amplitude and frequency limits are then logged. Any such over limit violations give rise to the media being failed. Otherwise the media is passed fit for broadcast and a pass certificate can be automatically generated.\nThe first PSE test was developed by Cambridge Research Systems Ltd. and are based on research by Professor Graham Harding.[4] All Harding FPA products implement the same guidelines. There are also other approved manufacturers' products which either use the same algorithm in different packages or have independently developed software and algorithms that broadly provide PSE checks to the same specifications.\nThe PSE testing is currently used by all television stations in the UK to check for compliance with the guidelines. If a programme fails, it usually means re-editing the offending scenes. Normally the problem can be rectified by reducing the number of flashes in the scene and\/or reducing the intensity of colours (most notably saturated red).[5] After re-editing the problem areas, the entire programme has to be re-tested in order to obtain a PSE test certificate.\nIn 2010, HardingTest.com was launched to provide users with a way of testing video remotely, without the need to have an in-house Harding FPA machine. This provided a much-needed service for freelance editors and smaller production companies who previously had to export their movie to video tape to send to a larger post-production facility for testing, all of which increased time and expense. This service means users can upload a digital video file and have it tested and results returned within minutes rather than hours.\n\nReferences \n\n\n^ \"Technical Standards\". DPP. Archived from the original on 2014-10-21. \n\n^ \"PSE Devices\". DPP. Retrieved 2018-11-28 . \n\n^ \"How To Interpret HardingFPA Results\". Cambridge Research Systems Ltd. 2011. Retrieved 23 February 2016 . \n\n^ \"Epilepsy fears over 2012 footage\". BBC News. London. 2007-06-05. Retrieved 2008-04-09 . \n\n^ Harding, G.F.; Harding, P.F. (2010). \"Photosensitive epilepsy and image safety\". Applied Ergonomics. 41 (4): 504\u2013508. doi:10.1016\/j.apergo.2008.08.005. PMID 18930180. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Harding_test\">https:\/\/www.limswiki.org\/index.php\/Harding_test<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 21:40.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 416 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e1d34a169eacda7dd24e34bd666ecd73_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Harding_test skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Harding test<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>The term <b>Harding test<\/b> is generically understood to mean an automatic test for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitive_epilepsy\" title=\"Photosensitive epilepsy\" rel=\"external_link\" target=\"_blank\">photosensitive epilepsy<\/a> (PSE) provocative image sequences in television content. This is properly known as a PSE test since the publication of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_Production_Partnership_(DPP)\" class=\"mw-redirect\" title=\"Digital Production Partnership (DPP)\" rel=\"external_link\" target=\"_blank\">Digital Production Partnership (DPP)<\/a> technical requirements<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> and the DPP PSE Devices<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> document (in the UK) updated in November 2018.\n<\/p><p>The Harding FPA (flash and pattern analyser) is proprietary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Software\" title=\"Software\" rel=\"external_link\" target=\"_blank\">software<\/a> that is used to analyse video content for flashing and stationary patterns which may cause harm to those who suffer from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitive_epilepsy\" title=\"Photosensitive epilepsy\" rel=\"external_link\" target=\"_blank\">photosensitive epilepsy<\/a>. It is an implementation of the guidelines set by the regulator <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ofcom\" title=\"Ofcom\" rel=\"external_link\" target=\"_blank\">Ofcom<\/a> in the UK. It is available in both tape-based and file-based versions, allowing video streams from SDI, composite, component, HDMI, and files to all be analysed, in resolutions up to 8k. Versions for both Microsoft Windows and Apple Mac OS X are available. There are other manufacturers of similar and different solutions now available which are also approved on the DPP Devices list.<sup id=\"rdp-ebb-cite_ref-HardingProds_3-0\" class=\"reference\"><a href=\"#cite_note-HardingProds-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Photosensitive_epilepsy\">Photosensitive epilepsy<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitive_epilepsy\" title=\"Photosensitive epilepsy\" rel=\"external_link\" target=\"_blank\">Photosensitive epilepsy<\/a> affects approximately one in 4,000 people and is a form of epilepsy in which seizures are triggered by visual stimuli that form patterns in time or space, such as flashing lights, bold regular patterns, or regular moving patterns. In 1993, an advert for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pot_Noodles\" class=\"mw-redirect\" title=\"Pot Noodles\" rel=\"external_link\" target=\"_blank\">Pot Noodles<\/a> induced seizures in three people in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">United Kingdom<\/a>, leading to the then regulator the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Independent_Television_Commission\" title=\"Independent Television Commission\" rel=\"external_link\" target=\"_blank\">ITC<\/a> introducing these guidelines. \n<\/p><p>The Broadcast Code of Advertising Practice requires that TV ads are tested and pass the 'flash test'. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clearcast\" title=\"Clearcast\" rel=\"external_link\" target=\"_blank\">Clearcast<\/a>, the company responsible for clearing ads for UK commercial broadcasters, is flash testing all ads before clearance.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Testing_procedures\">Testing procedures<\/span><\/h2>\n<p>The algorithms behind PSE testing look at video frames from second to second and analyse for potentially provocative image sequences. Luminance flashes, Red flashes and spatial patterns over prescribed amplitude and frequency limits are then logged. Any such over limit violations give rise to the media being failed. Otherwise the media is passed fit for broadcast and a pass certificate can be automatically generated.\n<\/p><p>The first PSE test was developed by Cambridge Research Systems Ltd. and are based on research by Professor Graham Harding.<sup id=\"rdp-ebb-cite_ref-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage_4-0\" class=\"reference\"><a href=\"#cite_note-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage-4\" rel=\"external_link\">[4]<\/a><\/sup> All Harding FPA products implement the same guidelines. There are also other approved manufacturers' products which either use the same algorithm in different packages or have independently developed software and algorithms that broadly provide PSE checks to the same specifications.\n<\/p><p>The PSE testing is currently used by all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Television\" title=\"Television\" rel=\"external_link\" target=\"_blank\">television<\/a> stations in the UK to check for compliance with the guidelines. If a programme fails, it usually means re-editing the offending scenes. Normally the problem can be rectified by reducing the number of flashes in the scene and\/or reducing the intensity of colours (most notably saturated red).<sup id=\"rdp-ebb-cite_ref-HardingPhoto10_5-0\" class=\"reference\"><a href=\"#cite_note-HardingPhoto10-5\" rel=\"external_link\">[5]<\/a><\/sup> After re-editing the problem areas, the entire programme has to be re-tested in order to obtain a PSE test certificate.\n<\/p><p>In 2010, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/HardingTest.com\" target=\"_blank\">HardingTest.com<\/a> was launched to provide users with a way of testing video remotely, without the need to have an in-house Harding FPA machine. This provided a much-needed service for freelance editors and smaller production companies who previously had to export their movie to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Video_tape\" class=\"mw-redirect\" title=\"Video tape\" rel=\"external_link\" target=\"_blank\">video tape<\/a> to send to a larger <a href=\"https:\/\/en.wikipedia.org\/wiki\/Post-production\" title=\"Post-production\" rel=\"external_link\" target=\"_blank\">post-production<\/a> facility for testing, all of which increased time and expense. This service means users can upload a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_video\" title=\"Digital video\" rel=\"external_link\" target=\"_blank\">digital video<\/a> file and have it tested and results returned within minutes rather than hours.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20141021053640\/http:\/\/www.digitalproductionpartnership.co.uk\/downloads\/standards\/\" target=\"_blank\">\"Technical Standards\"<\/a>. DPP. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.digitalproductionpartnership.co.uk\/downloads\/standards\/\" target=\"_blank\">the original<\/a> on 2014-10-21.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Technical+Standards&rft.pub=DPP&rft_id=http%3A%2F%2Fwww.digitalproductionpartnership.co.uk%2Fdownloads%2Fstandards%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#publication-6902\">\"PSE Devices\"<\/a>. DPP<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-11-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=PSE+Devices&rft.pub=DPP&rft_id=https%3A%2F%2Fwww.digitalproductionpartnership.co.uk%2Fpublications%2Ftype%2Ftechnical-guides%2F%23publication-6902&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HardingProds-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HardingProds_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hardingfpa.com\/technical-support\/how-to-interpret-hardingfpa-results\/\" target=\"_blank\">\"How To Interpret HardingFPA Results\"<\/a>. Cambridge Research Systems Ltd. 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=How+To+Interpret+HardingFPA+Results&rft.pub=Cambridge+Research+Systems+Ltd&rft.date=2011&rft_id=http%3A%2F%2Fwww.hardingfpa.com%2Ftechnical-support%2Fhow-to-interpret-hardingfpa-results%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/england\/london\/6724245.stm\" target=\"_blank\">\"Epilepsy fears over 2012 footage\"<\/a>. <i>BBC News<\/i>. London. 2007-06-05<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-04-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BBC+News&rft.atitle=Epilepsy+fears+over+2012+footage&rft.date=2007-06-05&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F1%2Fhi%2Fengland%2Flondon%2F6724245.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HardingPhoto10-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HardingPhoto10_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Harding, G.F.; Harding, P.F. (2010). \"Photosensitive epilepsy and image safety\". <i>Applied Ergonomics<\/i>. <b>41<\/b> (4): 504\u2013508. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.apergo.2008.08.005\" target=\"_blank\">10.1016\/j.apergo.2008.08.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18930180\" target=\"_blank\">18930180<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Applied+Ergonomics&rft.atitle=Photosensitive+epilepsy+and+image+safety&rft.volume=41&rft.issue=4&rft.pages=504-508&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.apergo.2008.08.005&rft_id=info%3Apmid%2F18930180&rft.au=Harding%2C+G.F.&rft.au=Harding%2C+P.F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181130065951\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.124 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 280\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7184\/2097152 bytes\nTemplate argument size: 76\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 13246\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.080\/10.000 seconds\nLua memory usage: 2.38 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.761 1 Template:Reflist\n100.00% 138.761 1 -total\n<\/p>\n<pre>56.54% 78.450 3 Template:Cite_web\n25.54% 35.442 1 Template:Cite_journal\n 5.45% 7.566 1 Template:Cite_news\n 1.90% 2.631 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:16153400-1!canonical and timestamp 20181130065951 and revision id 871272375\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Harding_test\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214700\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.143 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 137.435 1 - wikipedia:Harding_test\n100.00% 137.435 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8104-0!*!*!*!*!*!* and timestamp 20181217214700 and revision id 24223\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Harding_test\">https:\/\/www.limswiki.org\/index.php\/Harding_test<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e1d34a169eacda7dd24e34bd666ecd73_images":[],"e1d34a169eacda7dd24e34bd666ecd73_timestamp":1545083220,"5ff6b49fb2382d04d168fa8c319633ae_type":"article","5ff6b49fb2382d04d168fa8c319633ae_title":"Glucose test","5ff6b49fb2382d04d168fa8c319633ae_url":"https:\/\/www.limswiki.org\/index.php\/Glucose_test","5ff6b49fb2382d04d168fa8c319633ae_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tGlucose test\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tGlucose testMedical diagnosticsPurposeestimate blood sugar levels\nMany types of glucose tests exist and they can be used to estimate blood sugar levels at a given time or, over a longer period of time, to obtain average levels or to see how fast body is able to normalize changed glucose levels. Eating food for example leads to elevated blood sugar levels. In healthy people these levels quickly return to normal via increased cellular glucose uptake which is primarily mediated by increase in blood insulin levels.\nGlucose tests can reveal temporary\/long-term hyperglycemia or hypoglycemia. These conditions may not have obvious symptoms and can damage organs in the long-term. Abnormally high\/low levels, slow return to normal levels from either of these conditions and\/or inability to normalize blood sugar levels means that the person being tested probably has some kind of medical condition like type 2 diabetes which is caused by cellular insensitivity to insulin. Glucose tests are thus often used to diagnose such conditions.\n\nContents \n\n1 Testing methods \n2 Use in medical diagnosis \n3 Preparing for testing \n4 Reference ranges \n\n4.1 Fasting blood sugar \n4.2 Glucose tolerance test \n4.3 Postprandial glucose test \n4.4 Random glucose test \n\n\n5 See also \n6 References \n\n\nTesting methods \nTests that can be performed at home are used in blood glucose monitoring for illnesses that have already been diagnosed medically so that these illnesses can be maintained via medication and meal timing. Some of the home testing methods include\n\nfingerprick type of glucose meter\ncontinuous glucose monitor\nLaboratory tests are often used to diagnose illnesses and such methods include\n\nfasting blood sugar (FBS), fasting plasma glucose (FPG): 10\u201316 hours after eating[1]\nglucose tolerance test:[2] continuous testing\npostprandial glucose test (PC): 2 hours after eating[1]\nrandom glucose test\nSome laboratory tests don't measure glucose levels directly from body fluids or tissues, but still indicate elevated blood sugar levels. Such tests measure the levels of glycated hemoglobin, other glycated proteins, 1,5-anhydroglucitol etc. from blood.[1]\n\nUse in medical diagnosis \nMain articles: Hyperglycemia \u00a7 Causes, and List of causes of hypoglycemia\nGlucose testing can be used to diagnose or indicate certain medical conditions.\nHigh blood sugar may indicate\n\ngestational diabetes. This temporary form of diabetes appears during pregnancy, and with glucose-controlling medication or insulin symptoms can be improved.[3]\ntype 1 and type 2 diabetes or prediabetes. If diagnosed with diabetes, regular glucose tests can help manage or maintain conditions. Type 1, is commonly seen in children or teenagers whose bodies are not producing enough insulin. Type 2 diabetes, is typically seen in adults who are overweight. The insulin in their bodies are either not working normally, or there is not being enough produced.[4]\npancreatic cancer[4]\npancreatitis[4]\nunderactive thyroid[4]\nLow blood sugar may indicate\n\ninsulin overuse[4]\nstarvation[4]\nunderactive thyroid[4]\nAddison's disease[4]\ninsulinoma[4]\nkidney disease[4]\nPreparing for testing \nFasting prior to glucose testing may be required with some test types. Fasting blood sugar test for example requires 10\u201316 hour long period of not eating before the test.[1]\nBlood sugar levels can be affected by some drugs and prior to some glucose tests these medications should be temporarily given up or their dosages should be decreased. Such drugs may include salicylates (Aspirin), birth control pills, corticosteroids, tricyclic antidepressants, lithium, diuretics and phenytoin.[4]\nSome foods contain caffeine (coffee, tea, colas, energy drinks etc.). Blood sugar levels of healthy people are generally not significantly changed by caffeine, but in diabetics caffeine intake may elevate these levels via its ability to stimulate the adrenergic nervous system.[5]\n\nReference ranges \nFasting blood sugar \nA level below 5.6 mmol\/l (100 mg\/dl) 10\u201316 hours without eating is normal. 5.6\u20136 mmol\/l (100\u2013109 mg\/dl) may indicate prediabetes and oral glucose tolerance test (OGTT) should be done for high-risk individuals (old people, those with high blood pressure etc.). 6.1\u20136.9 mmol\/l (110\u2013125 mg\/dl) means OGTT should be done even if other indicators of diabetes are not present. 7 mmol\/l (126 mg\/dl) and above indicates diabetes and the fasting test should be repeated.[6]\n\nGlucose tolerance test \nMain article: Glucose tolerance test \u00a7 Results\nPostprandial glucose test \nMain article: Postprandial_glucose_test \u00a7 Reference_ranges\nRandom glucose test \nMain article: Random glucose test \u00a7 Reference_values\nSee also \nHyperglycemia\nHypoglycemia\nReferences \n\n\n^ a b c d Khatib, Oussama MN (2006). Guidelines for the prevention, management and care of diabetes mellitus. World Health Organization, Regional Office for the Eastern Mediterranean. pp. 30, 37. ISBN 9789290214045. OCLC 76821700. \n\n^ MedlinePlus Encyclopedia Glucose tolerance test \n\n^ \"Is the glucose test during pregnancy optional? - Today's Parent\". Today's Parent. 2017-08-30. Retrieved 2018-05-05 . \n\n^ a b c d e f g h i j k \"Blood Glucose Test: Preparation, Procedure, and More\". Healthline. Retrieved 2018-05-05 . \n\n^ \"How Does Coffee Affect Your Blood Sugar?\". WebMD. Retrieved 2018-08-30 . \n\n^ Diabetes \u2013 tests and diagnosis \n\n\nvteCommon for blood tests (CPT 82000\u201384999)Electrolytes\nSodium\nPotassium\nChloride\nCalcium\nRenal function\nCreatinine\nUrea\nBUN-to-creatinine ratio\nPlasma osmolality\nSerum osmolal gap\nAcid-base\nAnion gap\nArterial blood gas\nBase excess\nBicarbonate\nCO2 content\nIron tests\nFerritin\nSerum iron\nTransferrin saturation\nTotal iron-binding capacity\nTransferrin\nTransferrin receptor\nHormones\nACTH stimulation test\nThyroid function tests\nThyroid-stimulating hormone\nMetabolism\nBlood lipids\nCardiovascular\nCardiac marker\nTroponin test\nCPK-MB test\nLactate dehydrogenase\nMyoglobin\nGlycogen phosphorylase isoenzyme BB\nLiver function tests\nProteins\nHuman serum albumin\nSerum total protein\nALP\ntransaminases\nALT\nAST\nAST\/ALT ratio\nBilirubin\nUnconjugated\nConjugated\nPancreas\nAmylase\nLipase\nPancreatic lipase\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Glucose_test\">https:\/\/www.limswiki.org\/index.php\/Glucose_test<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:38.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 524 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5ff6b49fb2382d04d168fa8c319633ae_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Glucose_test skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Glucose test<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>Many types of <b>glucose tests<\/b> exist and they can be used to estimate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sugar_levels\" class=\"mw-redirect\" title=\"Blood sugar levels\" rel=\"external_link\" target=\"_blank\">blood sugar levels<\/a> at a given time or, over a longer period of time, to obtain average levels or to see how fast body is able to normalize changed glucose levels. Eating food for example leads to elevated blood sugar levels. In healthy people these levels quickly return to normal via increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_(biology)\" title=\"Cell (biology)\" rel=\"external_link\" target=\"_blank\">cellular<\/a> glucose uptake which is primarily mediated by increase in blood <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a> levels.\n<\/p><p>Glucose tests can reveal temporary\/long-term <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">hyperglycemia<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoglycemia\" title=\"Hypoglycemia\" rel=\"external_link\" target=\"_blank\">hypoglycemia<\/a>. These conditions may not have obvious symptoms and can damage organs in the long-term. Abnormally high\/low levels, slow return to normal levels from either of these conditions and\/or inability to normalize blood sugar levels means that the person being tested probably has some kind of medical condition like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes\" class=\"mw-redirect\" title=\"Type 2 diabetes\" rel=\"external_link\" target=\"_blank\">type 2 diabetes<\/a> which is caused by cellular insensitivity to insulin. Glucose tests are thus often used to diagnose such conditions.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Testing_methods\">Testing methods<\/span><\/h2>\n<p>Tests that can be performed at home are used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_glucose_monitoring\" title=\"Blood glucose monitoring\" rel=\"external_link\" target=\"_blank\">blood glucose monitoring<\/a> for illnesses that have already been diagnosed medically so that these illnesses can be maintained via medication and meal timing. Some of the home testing methods include\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fingerprick\" class=\"mw-redirect\" title=\"Fingerprick\" rel=\"external_link\" target=\"_blank\">fingerprick<\/a> type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_meter\" title=\"Glucose meter\" rel=\"external_link\" target=\"_blank\">glucose meter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Continuous_glucose_monitor\" title=\"Continuous glucose monitor\" rel=\"external_link\" target=\"_blank\">continuous glucose monitor<\/a><\/li><\/ul>\n<p>Laboratory tests are often used to diagnose illnesses and such methods include\n<\/p>\n<ul><li>fasting blood sugar (FBS), fasting plasma glucose (FPG): 10\u201316 hours after eating<sup id=\"rdp-ebb-cite_ref-:1_1-0\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_tolerance_test\" title=\"Glucose tolerance test\" rel=\"external_link\" target=\"_blank\">glucose tolerance test<\/a>:<sup id=\"rdp-ebb-cite_ref-Medline-GTT_2-0\" class=\"reference\"><a href=\"#cite_note-Medline-GTT-2\" rel=\"external_link\">[2]<\/a><\/sup> continuous testing<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Postprandial_glucose_test\" title=\"Postprandial glucose test\" rel=\"external_link\" target=\"_blank\">postprandial glucose test<\/a> (PC): 2 hours after eating<sup id=\"rdp-ebb-cite_ref-:1_1-1\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Random_glucose_test\" title=\"Random glucose test\" rel=\"external_link\" target=\"_blank\">random glucose test<\/a><\/li><\/ul>\n<p>Some laboratory tests don't measure glucose levels directly from body fluids or tissues, but still indicate elevated blood sugar levels. Such tests measure the levels of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycated_hemoglobin\" title=\"Glycated hemoglobin\" rel=\"external_link\" target=\"_blank\">glycated hemoglobin<\/a>, other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycation\" title=\"Glycation\" rel=\"external_link\" target=\"_blank\">glycated<\/a> proteins, <a href=\"https:\/\/en.wikipedia.org\/wiki\/1,5-anhydroglucitol\" class=\"mw-redirect\" title=\"1,5-anhydroglucitol\" rel=\"external_link\" target=\"_blank\">1,5-anhydroglucitol<\/a> etc. from blood.<sup id=\"rdp-ebb-cite_ref-:1_1-2\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use_in_medical_diagnosis\">Use in medical diagnosis<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main articles: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia#Causes\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">Hyperglycemia \u00a7 Causes<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_causes_of_hypoglycemia\" title=\"List of causes of hypoglycemia\" rel=\"external_link\" target=\"_blank\">List of causes of hypoglycemia<\/a><\/div>\n<p>Glucose testing can be used to diagnose or indicate certain medical conditions.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/High_blood_sugar\" class=\"mw-redirect\" title=\"High blood sugar\" rel=\"external_link\" target=\"_blank\">High blood sugar<\/a> may indicate\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gestational_diabetes\" title=\"Gestational diabetes\" rel=\"external_link\" target=\"_blank\">gestational diabetes<\/a>. This temporary form of diabetes appears during pregnancy, and with glucose-controlling medication or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a> symptoms can be improved.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus_type_1\" title=\"Diabetes mellitus type 1\" rel=\"external_link\" target=\"_blank\">type 1<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes\" class=\"mw-redirect\" title=\"Type 2 diabetes\" rel=\"external_link\" target=\"_blank\">type 2 diabetes<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prediabetes\" title=\"Prediabetes\" rel=\"external_link\" target=\"_blank\">prediabetes<\/a>. If diagnosed with diabetes, regular glucose tests can help manage or maintain conditions. Type 1, is commonly seen in children or teenagers whose bodies are not producing enough insulin. Type 2 diabetes, is typically seen in adults who are overweight. The insulin in their bodies are either not working normally, or there is not being enough produced.<sup id=\"rdp-ebb-cite_ref-:0_4-0\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatic_cancer\" title=\"Pancreatic cancer\" rel=\"external_link\" target=\"_blank\">pancreatic cancer<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-1\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatitis\" title=\"Pancreatitis\" rel=\"external_link\" target=\"_blank\">pancreatitis<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-2\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Underactive_thyroid\" class=\"mw-redirect\" title=\"Underactive thyroid\" rel=\"external_link\" target=\"_blank\">underactive thyroid<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-3\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li><\/ul>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Low_blood_sugar\" class=\"mw-redirect\" title=\"Low blood sugar\" rel=\"external_link\" target=\"_blank\">Low blood sugar<\/a> may indicate\n<\/p>\n<ul><li>insulin overuse<sup id=\"rdp-ebb-cite_ref-:0_4-4\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Starvation\" title=\"Starvation\" rel=\"external_link\" target=\"_blank\">starvation<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-5\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Underactive_thyroid\" class=\"mw-redirect\" title=\"Underactive thyroid\" rel=\"external_link\" target=\"_blank\">underactive thyroid<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-6\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Addison%27s_disease\" title=\"Addison's disease\" rel=\"external_link\" target=\"_blank\">Addison's disease<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-7\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulinoma\" title=\"Insulinoma\" rel=\"external_link\" target=\"_blank\">insulinoma<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-8\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_disease\" title=\"Kidney disease\" rel=\"external_link\" target=\"_blank\">kidney disease<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-9\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Preparing_for_testing\">Preparing for testing<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fasting\" title=\"Fasting\" rel=\"external_link\" target=\"_blank\">Fasting<\/a> prior to glucose testing may be required with some test types. Fasting blood sugar test for example requires 10\u201316 hour long period of not eating before the test.<sup id=\"rdp-ebb-cite_ref-:1_1-3\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Blood sugar levels can be affected by some drugs and prior to some glucose tests these medications should be temporarily given up or their dosages should be decreased. Such drugs may include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salicylates\" class=\"mw-redirect\" title=\"Salicylates\" rel=\"external_link\" target=\"_blank\">salicylates<\/a> (Aspirin), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birth_control_pills\" class=\"mw-redirect\" title=\"Birth control pills\" rel=\"external_link\" target=\"_blank\">birth control pills<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corticosteroids\" class=\"mw-redirect\" title=\"Corticosteroids\" rel=\"external_link\" target=\"_blank\">corticosteroids<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricyclic_antidepressants\" class=\"mw-redirect\" title=\"Tricyclic antidepressants\" rel=\"external_link\" target=\"_blank\">tricyclic antidepressants<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_(medication)\" title=\"Lithium (medication)\" rel=\"external_link\" target=\"_blank\">lithium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diuretics\" class=\"mw-redirect\" title=\"Diuretics\" rel=\"external_link\" target=\"_blank\">diuretics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phenytoin\" title=\"Phenytoin\" rel=\"external_link\" target=\"_blank\">phenytoin<\/a>.<sup id=\"rdp-ebb-cite_ref-:0_4-10\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Some foods contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caffeine\" title=\"Caffeine\" rel=\"external_link\" target=\"_blank\">caffeine<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Coffee\" title=\"Coffee\" rel=\"external_link\" target=\"_blank\">coffee<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tea\" title=\"Tea\" rel=\"external_link\" target=\"_blank\">tea<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cola\" title=\"Cola\" rel=\"external_link\" target=\"_blank\">colas<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Energy_drink\" title=\"Energy drink\" rel=\"external_link\" target=\"_blank\">energy drinks<\/a> etc.). Blood sugar levels of healthy people are generally not significantly changed by caffeine, but in diabetics caffeine intake may elevate these levels via its ability to stimulate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adrenergic_nervous_system\" title=\"Adrenergic nervous system\" rel=\"external_link\" target=\"_blank\">adrenergic nervous system<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Reference_ranges\">Reference ranges<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Fasting_blood_sugar\">Fasting blood sugar<\/span><\/h3>\n<p>A level below 5.6 mmol\/l (100 mg\/dl) 10\u201316 hours without eating is normal. 5.6\u20136 mmol\/l (100\u2013109 mg\/dl) may indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prediabetes\" title=\"Prediabetes\" rel=\"external_link\" target=\"_blank\">prediabetes<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_glucose_tolerance_test\" class=\"mw-redirect\" title=\"Oral glucose tolerance test\" rel=\"external_link\" target=\"_blank\">oral glucose tolerance test<\/a> (OGTT) should be done for high-risk individuals (old people, those with <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_blood_pressure\" class=\"mw-redirect\" title=\"High blood pressure\" rel=\"external_link\" target=\"_blank\">high blood pressure<\/a> etc.). 6.1\u20136.9 mmol\/l (110\u2013125 mg\/dl) means OGTT should be done even if other indicators of diabetes are not present. 7 mmol\/l (126 mg\/dl) and above indicates diabetes and the fasting test should be repeated.<sup id=\"rdp-ebb-cite_ref-Diabetes_6-0\" class=\"reference\"><a href=\"#cite_note-Diabetes-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Glucose_tolerance_test\">Glucose tolerance test<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_tolerance_test#Results\" title=\"Glucose tolerance test\" rel=\"external_link\" target=\"_blank\">Glucose tolerance test \u00a7 Results<\/a><\/div>\n<h3><span class=\"mw-headline\" id=\"Postprandial_glucose_test\">Postprandial glucose test<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Postprandial_glucose_test#Reference_ranges\" title=\"Postprandial glucose test\" rel=\"external_link\" target=\"_blank\">Postprandial_glucose_test \u00a7 Reference_ranges<\/a><\/div>\n<h3><span class=\"mw-headline\" id=\"Random_glucose_test\">Random glucose test<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Random_glucose_test#Reference_values\" title=\"Random glucose test\" rel=\"external_link\" target=\"_blank\">Random glucose test \u00a7 Reference_values<\/a><\/div>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">Hyperglycemia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoglycemia\" title=\"Hypoglycemia\" rel=\"external_link\" target=\"_blank\">Hypoglycemia<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-:1-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Khatib, Oussama MN (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/76821700\" target=\"_blank\"><i>Guidelines for the prevention, management and care of diabetes mellitus<\/i><\/a>. World Health Organization, Regional Office for the Eastern Mediterranean. pp. 30, 37. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789290214045. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/76821700\" target=\"_blank\">76821700<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Guidelines+for+the+prevention%2C+management+and+care+of+diabetes+mellitus&rft.pages=30%2C+37&rft.pub=World+Health+Organization%2C+Regional+Office+for+the+Eastern+Mediterranean&rft.date=2006&rft_id=info%3Aoclcnum%2F76821700&rft.isbn=9789290214045&rft.aulast=Khatib&rft.aufirst=Oussama+MN&rft_id=https%3A%2F%2Fwww.worldcat.org%2Foclc%2F76821700&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Medline-GTT-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Medline-GTT_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/MedlinePlus\" title=\"MedlinePlus\" rel=\"external_link\" target=\"_blank\">MedlinePlus Encyclopedia<\/a><\/i> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/medlineplus.gov\/ency\/article\/003466.htm\" target=\"_blank\">Glucose tolerance test<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.todaysparent.com\/pregnancy\/pregnancy-health\/is-the-glucose-test-during-pregnancy-optional\" target=\"_blank\">\"Is the glucose test during pregnancy optional? - Today's Parent\"<\/a>. <i>Today's Parent<\/i>. 2017-08-30<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-05-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Today%27s+Parent&rft.atitle=Is+the+glucose+test+during+pregnancy+optional%3F+-+Today%27s+Parent&rft.date=2017-08-30&rft_id=http%3A%2F%2Fwww.todaysparent.com%2Fpregnancy%2Fpregnancy-health%2Fis-the-glucose-test-during-pregnancy-optional&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthline.com\/health\/glucose-test-blood\" target=\"_blank\">\"Blood Glucose Test: Preparation, Procedure, and More\"<\/a>. <i>Healthline<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-05-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Healthline&rft.atitle=Blood+Glucose+Test%3A+Preparation%2C+Procedure%2C+and+More&rft_id=http%3A%2F%2Fwww.healthline.com%2Fhealth%2Fglucose-test-blood&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webmd.com\/diabetes\/diabetes-and-caffeine\" target=\"_blank\">\"How Does Coffee Affect Your Blood Sugar?\"<\/a>. <i>WebMD<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=WebMD&rft.atitle=How+Does+Coffee+Affect+Your+Blood+Sugar%3F&rft_id=https%3A%2F%2Fwww.webmd.com%2Fdiabetes%2Fdiabetes-and-caffeine&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Diabetes-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Diabetes_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayoclinic.com\/health\/diabetes\/DS01121\/DSECTION=tests-and-diagnosis\" target=\"_blank\">Diabetes \u2013 tests and diagnosis<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1333\nCached time: 20181207155807\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.228 seconds\nReal time usage: 0.294 seconds\nPreprocessor visited node count: 689\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 23940\/2097152 bytes\nTemplate argument size: 175\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 13412\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.114\/10.000 seconds\nLua memory usage: 2.98 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 246.340 1 -total\n<\/p>\n<pre>61.00% 150.276 1 Template:Reflist\n44.13% 108.713 1 Template:Cite_book\n16.54% 40.752 1 Template:Infobox_diagnostic\n14.38% 35.421 1 Template:Infobox\n 9.96% 24.526 4 Template:Main\n 6.63% 16.325 1 Template:Blood_tests\n 6.51% 16.043 3 Template:Cite_news\n 4.71% 11.604 1 Template:Navbox\n 1.31% 3.227 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3012322-1!canonical and timestamp 20181207155806 and revision id 859003814\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_test\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214700\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.147 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 141.123 1 - wikipedia:Glucose_test\n100.00% 141.123 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8567-0!*!*!*!*!*!* and timestamp 20181217214700 and revision id 24995\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Glucose_test\">https:\/\/www.limswiki.org\/index.php\/Glucose_test<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5ff6b49fb2382d04d168fa8c319633ae_images":[],"5ff6b49fb2382d04d168fa8c319633ae_timestamp":1545083220,"1511b5ea96046b1f5ee06ec866bbcc44_type":"article","1511b5ea96046b1f5ee06ec866bbcc44_title":"Endoscopy","1511b5ea96046b1f5ee06ec866bbcc44_url":"https:\/\/www.limswiki.org\/index.php\/Endoscopy","1511b5ea96046b1f5ee06ec866bbcc44_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tEndoscopy\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor the notion in mathematics introduced by Langlands, see Endoscopic group.\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2016) (Learn how and when to remove this template message)\nEndoscopeAn example of a flexible endoscopeMeSHD004724 OPS-301 code1-40...1-49, 1-61...1-69MedlinePlus003338 [edit on Wikidata]\n A physician training to use an endoscope\nAn endoscopy (looking inside) is used in medicine to look inside the body.[1] The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.\nThere are many types of endoscopes. Depending on the site in the body and type of procedure an endoscopy may be performed either by a doctor or a surgeon. A patient may be fully conscious or anaesthetised during the procedure. Most often the term endoscopy is used to refer to an examination of the upper part of the gastrointestinal tract, known as an esophagogastroduodenoscopy.[2]\nFor non-medical use, similar instruments are called borescopes.\n\nContents \n\n1 History \n2 Medical uses \n\n2.1 Applications \n\n\n3 Application in other fields \n4 Risks \n5 After the endoscopy \n6 Endoscope \n7 History \n\n7.1 Wolf and Storz \n7.2 Fiber optics \n7.3 Rod-lens endoscopes \n7.4 Endoscope reprocessing \n\n\n8 Recent developments \n\n8.1 Endoscopy VR simulators \n8.2 Disposable endoscopy \n8.3 Capsule endoscopy \n8.4 Augmented reality \n8.5 New imaging modalities \n\n\n9 See also \n10 References \n11 External links \n\n\nHistory \nThe self-illuminated endoscope was developed at Glasgow Royal Infirmary in Scotland (one of the first hospitals to have mains electricity) in 1894\/5 by Dr John Macintyre as part of his specialization in investigation of the larynx.[3]\n\nMedical uses \n Operation part of the endoscope\n Insertion tip of endoscope\nA health care provider may use endoscopy for any of the following:\n\ninvestigation of symptoms, such as symptoms in the digestive system including nausea, vomiting, abdominal pain, difficulty swallowing, and gastrointestinal bleeding.[4]\nconfirmation of a diagnosis, most commonly by performing a biopsy to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system.[4]\ngiving treatment, such as cauterization of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.[4]\nSpecialty professional organizations which specialize in digestive problems advise that many patients with Barrett's esophagus are too frequently receiving endoscopies.[5] Such societies recommend that patients with Barrett's esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.[6][7]\n\nApplications \n An anoscope, a proctoscope, and a rectoscope with approximate lengths\n Endoscopy surgery\nHealth care providers can use endoscopy to review any of the following body parts:\n\nThe gastrointestinal tract (GI tract):\n Esophageal Bougie Dilatoroesophagus, stomach and duodenum (esophagogastroduodenoscopy)\nsmall intestine (enteroscopy)\nlarge intestine\/colon (colonoscopy, sigmoidoscopy)\nMagnification endoscopy\nbile duct\nendoscopic retrograde cholangiopancreatography (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy\nrectum (rectoscopy) and anus (anoscopy), both also referred to as (proctoscopy)\nThe respiratory tract\nThe nose (rhinoscopy)\nThe lower respiratory tract (bronchoscopy)\nThe ear (otoscope)\nThe urinary tract (cystoscopy)\nThe female reproductive system (gynoscopy)\nThe cervix (colposcopy)\nThe uterus (hysteroscopy)\nThe fallopian tubes (falloposcopy)\nNormally closed body cavities (through a small incision):\nThe abdominal or pelvic cavity (laparoscopy)\nThe interior of a joint (arthroscopy)\nOrgans of the chest (thoracoscopy and mediastinoscopy)\nEndoscopy is used for many procedures:\n\nDuring pregnancy\nThe amnion (amnioscopy)\nThe fetus (fetoscopy)\nPlastic surgery\nPanendoscopy (or triple endoscopy)\nCombines laryngoscopy, esophagoscopy, and bronchoscopy\nOrthopedic surgery\nHand surgery, such as endoscopic carpal tunnel release\nKnee surgery, such as anterior cruciate ligament reconstruction\nEpidural space (Epiduroscopy)\nBursae (Bursectomy)\nEndodontic surgery\nMaxillary sinus surgery\nApicoectomy\nEndoscopic endonasal surgery\nEndoscopic spinal surgery\nAn Endoscopy is a simple procedure which allows a doctor to look inside human bodies using an instrument called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform surgery. This type of surgery is called Key hole surgery, and usually leaves only a tiny scar externally.\n\nApplication in other fields \nThe planning and architectural community use architectural endoscopy for pre-visualization of scale models of proposed buildings and cities\nInternal inspection of complex technical systems (borescope)\nEndoscopes are also a tool helpful in the examination of improvised explosive devices by bomb disposal personnel.\nThe FBI uses endoscopes for conducting surveillance via tight spaces.\nRisks \nThe main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding.[8] Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, it is good to remember that each of them occurs quite infrequently. A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.\n\nAfter the endoscopy \nAfter the procedure, the patient will be observed and monitored by a qualified individual in the endoscopy room, or a recovery area, until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and fleeting. When fully recovered, the patient will be instructed when to resume their usual diet (probably within a few hours) and will be allowed to be taken home. Where sedation has been used, most facilities mandate that the patient be taken home by another person and that he or she not drive or handle machinery for the remainder of the day. Patients who have had an endoscopy without sedation are able to leave unassisted.\n\nEndoscope \nMain article: Endoscope\nAn endoscope can consist of:\n\na rigid or flexible tube.\na light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiber system.\na lens system transmitting the image from the objective lens to the viewer, typically a relay lens system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a fiberscope.\nan eyepiece. Modern instruments may be videoscopes, with no eyepiece. A camera transmits image to a screen for image capture.\nan additional channel to allow entry of medical instruments or manipulators.\nPatients undergoing the procedure may be offered sedation, which includes its own risks.\n\nHistory \n Drawings of Bozzini's \"Lichtleiter\", an early endoscope\nThe first endoscope was developed in 1806 by Philipp Bozzini in Mainz with his introduction of a \"Lichtleiter\" (light conductor) \"for the examinations of the canals and cavities of the human body\".[9] However, the Vienna Medical Society disapproved of such curiosity.[10] The first to use an endoscope in a successful operation was Antonin Jean Desormeaux whose invention was the state of the art before the invention of electricity.[citation needed ]\nThe use of electric light was a major step in the improvement of endoscopy. The first such lights were external although sufficiently capable of illumination to allow cystoscopy, hysteroscopy and sigmoidoscopy as well as examination of the nasal (and later thoracic) cavities as was being performed routinely in human patients by Sir Francis Cruise (using his own commercially available endoscope) by 1865 in the Mater Misericordiae Hospital in Dublin, Ireland.[11] Later, smaller bulbs became available making internal light possible, for instance in a hysteroscope by Charles David in 1908.[12]\nHans Christian Jacobaeus has been given credit for the first large published series of endoscopic explorations of the abdomen and the thorax with laparoscopy (1912) and thoracoscopy (1910)[13] although the first reported thoracoscopic examination in a human was also by Cruise.[14]\nLaparoscopy was used in the diagnosis of liver and gallbladder disease by Heinz Kalk in the 1930s.[15] Hope reported in 1937 on the use of laparoscopy to diagnose ectopic pregnancy.[16] In 1944, Raoul Palmer placed his patients in the Trendelenburg position after gaseous distention of the abdomen and thus was able to reliably perform gynecologic laparoscopy.[17]\n\nWolf and Storz \nGeorg Wolf (1873\u20131938) a Berlin manufacturer of rigid endoscopes, established in 1906, produced the Sussmann flexible gastroscope in 1911 (Modlin, Farhadi-Journal of Clinical Gastroenterology, 2000).[18] Karl Storz began producing instruments for ENT specialists in 1945 through his company, Karl Storz GmbH.[19]\n\nFiber optics \n A Storz endoscopy unit used for laryngoscopy exams of the vocal folds and the glottis\nBasil Hirschowitz and Larry Curtiss invented the first fiber optic endoscope in 1957.[20] Earlier in the 1950s Harold Hopkins had designed a \"fibroscope\" consisting of a bundle of flexible glass fibres able to coherently transmit an image. This proved useful both medically and industrially, and subsequent research led to further improvements in image quality. Further innovations included using additional fibres to channel light to the objective end from a powerful external source, thereby achieving the high level of full spectrum illumination that was needed for detailed viewing, and colour photography.[citation needed ]\nThe previous practice of a small filament lamp on the tip of the endoscope had left the choice of either viewing in a dim red light or increasing the light output - which carried the risk of burning the inside of the patient. Alongside the advances to the optics, the ability to 'steer' the tip was developed, as well as innovations in remotely operated surgical instruments contained within the body of the endoscope itself. This was the beginning of \"key-hole surgery\" as we know it today.[citation needed ]\n\nRod-lens endoscopes \nThere were physical limits to the image quality of a fibroscope. A bundle of say 50,000 fibers gives effectively only a 50,000-pixel image, and continued flexing from use breaks fibers and so progressively loses pixels. Eventually so many are lost that the whole bundle must be replaced (at considerable expense). Harold Hopkins realised that any further optical improvement would require a different approach. Previous rigid endoscopes suffered from low light transmittance and poor image quality. The surgical requirement of passing surgical tools as well as the illumination system within the endoscope's tube - which itself is limited in dimensions by the human body - left very little room for the imaging optics. The tiny lenses of a conventional system required supporting rings that would obscure the bulk of the lens area; they were difficult to manufacture and assemble and optically nearly useless.[citation needed ]\nThe elegant solution that Hopkins invented was to fill the air-spaces between the 'little lenses' with rods of glass. These fitted exactly the endoscope's tube, making them self-aligning, and required no other support. This allowed the little lenses to be dispensed with altogether. The rod-lenses were much easier to handle and used the maximum possible diameter available.[citation needed ]\nWith the appropriate curvature and coatings to the rod ends and optimal choices of glass-types, all calculated and specified by Hopkins, the image quality was transformed - even with tubes of only 1mm in diameter. With a high quality 'telescope' of such small diameter the tools and illumination system could be comfortably housed within an outer tube. Once again it was Karl Storz who produced the first of these new endoscopes as part of a long and productive partnership between the two men.[21]\nWhilst there are regions of the body that will always require flexible endoscopes (principally the gastrointestinal tract), the rigid rod-lens endoscopes have such exceptional performance that they are still the preferred instrument and have enabled modern key-hole surgery. (Harold Hopkins was recognized and honoured for his advancement of medical-optic by the medical community worldwide. It formed a major part of the citation when he was awarded the Rumford Medal by the Royal Society in 1984.)\nBy measuring absorption of light by the blood (by passing the light through one fibre and collecting the light through another fibre) a doctor can estimate the proportion of haemoglobin in the blood and diagnose ulceration in the stomach.[citation needed ]\n\nEndoscope reprocessing \nHigh level disinfection of flexible endoscopes is required by all national guideline issuing bodies.[22] The high level disinfection of endoscopes occurs during a multi-step process called reprocessing. Reprocessing endoscopes involves over 100 individuals steps.[23] These steps can be broken down into broad categories of pre-cleaning, leak testing, manual cleaning, cleaning verification, visual inspection, high level disinfection, rinsing, drying, and storage.[24] Failure to perform all of these steps correctly can lead to residual contamination remaining on endoscopes.\nIn the UK, stringent guidelines exist regarding the decontamination and disinfection of flexible endoscopes, the most recent being CfPP 01\u201306, released in 2013[25]\nRigid endoscopes, such as an Arthroscope, can be sterilized in the same way as surgical instruments, whereas heat labile flexible endoscopes cannot.[26]\n\nRecent developments \n Low-cost waterproof USB endoscope for non-medical use.\nWith the application of robotic systems, telesurgery was introduced as the surgeon could be at a site far removed from the patient. The first transatlantic surgery has been called the Lindbergh Operation.[citation needed ]\nWireless oesophageal pH measuring devices can now be placed endoscopically, to record ph trends in an area remotely.[citation needed ]\n\nEndoscopy VR simulators \nVirtual reality simulators are being developed for training doctors on various endoscopy skills.[27]\n\nDisposable endoscopy \nDisposable endoscopy is an emerging category of endoscopic instruments. Recent developments[28] have allowed the manufacture of endoscopes inexpensive enough to be used on a single patient only. It is meeting a growing demand to lessen the risk of cross contamination and hospital acquired diseases. A European consortium of the SME are working on the DUET (disposable use of endoscopy tool) project to build a disposable endoscope.[29]\n\nCapsule endoscopy \nMain article: Capsule endoscopy\nCapsule endoscopes are pill-sized imaging devices that are swallowed by a patient and then record images of the gastrointestinal tract as they pass through naturally. Images are typically retrieved via wireless data transfer to an external receiver.\n\nAugmented reality \nThe endoscopic image can be combined with other image sources to provide the surgeon with additional information. For instance, the position of an anatomical structure or tumor might be shown in the endoscopic video.[30]\n\nNew imaging modalities \nEmerging endoscope technologies measure additional properties of light to improve contrast, such as optical polarization,[31] optical phase, [32] and additional wavelengths of light (hyperspectral endoscopy).[33]\n\nSee also \n Endoscopy portal\nReferences \n\n\n^ \"Endoscopy\". British Medical Association Complete Family Health Encyclopedia. Dorling Kindersley Limited. 1990. \n\n^ \"Endoscopy\". Cancer Research UK. Retrieved 5 November 2015 . \n\n^ \"The Scottish Society of the History of Medicine\" (PDF) . \n\n^ a b c Staff (2012). \"Upper endoscopy\". Mayo Clinic. Retrieved 24 September 2012 . \n\n^ American Gastroenterological Association, \"Five Things Physicians and Patients Should Question\" (PDF) , Choosing Wisely: an initiative of the ABIM Foundation, American Gastroenterological Association, archived from the original (PDF) on August 9, 2012, retrieved August 17, 2012 \n\n^ Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (March 2011). \"American Gastroenterological Association medical position statement on the management of Barrett's esophagus\". Gastroenterology. 140 (3): 1084\u201391. doi:10.1053\/j.gastro.2011.01.030. PMID 21376940. \n\n^ Wang KK, Sampliner RE (March 2008). \"Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus\". The American Journal of Gastroenterology. 103 (3): 788\u201397. doi:10.1111\/j.1572-0241.2008.01835.x. PMID 18341497. \n\n^ \"Endoscopy\". NHS Choices. NHS Gov.UK. Retrieved April 20, 2017 . \n\n^ Bozzini, Philipp (1806). \"Lichtleiter, eine Erfindung zur Anschauung innerer Teile und Krankheiten, nebst der Abbildung\" [Light conductor, an invention for examining internal parts and diseases, together with illustrations]. Journal der practischen Arzneykunde und Wundarzneykunst (in German). 24: 107\u201324. \n\n^ Yamada T (2009-01-22). Atlas of Gastroenterology. John Wiley & Sons. ISBN 978-1-4443-0342-1. \n\n^ Caniggia A, Nuti R, Lore F, Martini G, Turchetti V, Righi G (April 1990). \"Long-term treatment with calcitriol in postmenopausal osteoporosis\". Metabolism. 39 (4 Suppl 1): 43\u20139. doi:10.1136\/bmj.1.223.345. JSTOR 25204557. PMC 2325571 . \n\n^ Shawki O, Deshmukh S, Pacheco LA (2017). Mastering the Techniques in Hysteroscopy. Jaypee Brothers Medical Publishers. pp. 13\u2013. ISBN 978-93-86150-49-3. \n\n^ Litynski GS (1997). \"Laparoscopy--the early attempts: spotlighting Georg Kelling and Hans Christian Jacobaeus\". Jsls. 1 (1): 83\u20135. PMC 3015224 . PMID 9876654. \n\n^ Gordon S (2014). \"Art. VIII.\u2014Clinical reports of rare cases, occurring in the Whitworth and Hardwicke Hospitals\". Dublin Quarterly Journal of Medical Science. 41 (1): 83\u201399. doi:10.1007\/BF02946459. \n\n^ Wildhirt E, Kalk H (1977). Neue Deutsche Biographie (NDB). Band 11. Berlin: Duncker & Humblot. p. 60. ISBN 978-3-428-00192-7. \n\n^ Balen AH, Creighton SM, Davies MC, MacDougall J, Stanhope R (2004-04-01). Paediatric and Adolescent Gynaecology: A Multidisciplinary Approach. Cambridge University Press. pp. 131\u2013. ISBN 978-1-107-32018-5. \n\n^ Litynski GS (1997). \"Raoul Palmer, World War II, and transabdominal coelioscopy. Laparoscopy extends into gynecology\". Journal of the Society of Laparoendoscopic Surgeons. 1 (3): 289\u201392. PMC 3016739 . PMID 9876691. \n\n^ \"About Richard Wolf Germany\". Richard Wolf Medical Instruments. \n\n^ Nezhat C (2005). \"Chapter 19. 1960's\". Nezhat's History of Endoscopy. Society of Laparoendoscopic Surgeons. \n\n^ Edmonson JM (1991). \"History of the instruments for gastrointestinal endoscopy\". Gastrointestinal Endoscopy. 37 (2 Suppl): S27\u201356. doi:10.1016\/S0016-5107(91)70910-3. PMID 2044933. \n\n^ \"History\". Harold Hopkins Society. \n\n^ Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ (February 2017). \"Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures\". American Journal of Infection Control. 45 (2): e26\u2013e33. doi:10.1016\/j.ajic.2016.10.017. PMID 28159069. \n\n^ Ofstead CL, Wetzler HP, Snyder AK, Horton RA (2010). \"Endoscope reprocessing methods: a prospective study on the impact of human factors and automation\". Gastroenterology Nursing. 33 (4): 304\u201311. doi:10.1097\/SGA.0b013e3181e9431a. PMID 20679783. \n\n^ Herrin A, Loyola M, Bocian S, Diskey A, Friis CM, Herron-Rice L, Juan MR, Schmelzer M, Selking S (2016). \"Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes\". Gastroenterology Nursing. 39 (5): 404\u201318. doi:10.1097\/SGA.0000000000000266. PMID 27684640. \n\n^ \"Health Technical Memorandum 01-06: Decontamination of exible endoscopes Part C: Operational management\" (PDF) . United Kingdom Department of Health. March 2016. \n\n^ Sabnis RB, Bhattu A, Vijaykumar M (March 2014). \"Sterilization of endoscopic instruments\". Current Opinion in Urology. 24 (2): 195\u2013202. doi:10.1097\/MOU.0000000000000034. PMID 24451088. \n\n^ \"Overview of Endoscopy Haptics Simulator Project\". M2D2 Laboratory, Indian Institute of Science. YouTube. \n\n^ \"Dokument nicht gefunden\". Archived from the original on 2011-07-20. \n\n^ \"Development of a Disposable Use Endoscopy Tool\". Archived from the original on 2011-07-23. \n\n^ Augmented Reality: Path guidance to craniopharyngioma on YouTube \n\n^ Manhas S, Vizet J, Deby S, Vanel JC, Boito P, Verdier M, De Martino A, Pagnoux D (February 2015). \"Demonstration of full 4\u00d74 Mueller polarimetry through an optical fiber for endoscopic applications\". Optics Express. 23 (3): 3047\u201354. Bibcode:2015OExpr..23.3047M. doi:10.1364\/OE.23.003047. PMID 25836165. \n\n^ Gordon, GSD; Joseph, J; Alcolea, MP; Sawyer, T; Macfaden, AJ; Williams, C; Fitzpatrick, CRM; Jones, PH; di Pietro, M; Fitzgerald, RC; Wilkinson, TD; Bohndiek, SE. \"Quantitative phase and polarisation endoscopy applied to detection of early oesophageal tumourigenesis\". arXiv:1811.03977 . \n\n^ Kester RT, Bedard N, Gao L, Tkaczyk TS (May 2011). \"Real-time snapshot hyperspectral imaging endoscope\". Journal of Biomedical Optics. 16 (5): 056005. Bibcode:2011JBO....16e6005K. doi:10.1117\/1.3574756. PMC 3107836 . PMID 21639573. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Endoscopy.\nThe Atlas of Gastrointestinal Endoscopy endoatlas.com\nEl Salvador Atlas of Gastrointestinal Endoscopy\nGastrolab: Site in English, Swedish and Finnish with gastrointestinal endoscopy photolibrary\nPreventing cross-contamination from flexible endoscopes massdevice.com\nAdvances in Endoscopy advancedimagingpro.com\nvteEndoscopyGastrointestinal tract\nUpper:\nEsophagogastroduodenoscopy\nLower: Enteroscopy\nColonoscopy\nSigmoidoscopy\nProctoscopy\nAnoscopy\nCapsule endoscopy\nAccessory: Endoscopic retrograde cholangiopancreatography\nRespiratory tract\nRhinoscopy\nLaryngoscopy\nBronchoscopy\nUrinary tract\nNephroscopy\nUreteroscopy\nCystoscopy\nFemale reproductive system\nColposcopy\nHysteroscopy\nFalloposcopy\nCuldoscopy\nClosed cavity via incision\nLaparoscopy\nLaparoscopic surgery\nArthroscopy\nThoracoscopy\nMediastinoscopy\nCoelioscopy\nOther\nFetoscopy\nAngioscopy\nOtoscopy\n\nAuthority 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:37.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 924 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1511b5ea96046b1f5ee06ec866bbcc44_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Endoscopy skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Endoscopy<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For the notion in mathematics introduced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Langlands\" title=\"Robert Langlands\" rel=\"external_link\" target=\"_blank\">Langlands<\/a>, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_group\" title=\"Endoscopic group\" rel=\"external_link\" target=\"_blank\">Endoscopic group<\/a>.<\/div>\n\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Santiagodechile2007.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Santiagodechile2007.jpg\/220px-Santiagodechile2007.jpg\" width=\"220\" height=\"300\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Santiagodechile2007.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A physician training to use an endoscope<\/div><\/div><\/div>\n<p>An <i><b>endoscopy<\/b><\/i> (<i>looking inside<\/i>) is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a> to look inside the body.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> The endoscopy procedure uses an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a> to examine the interior of a hollow organ or cavity of the body. Unlike many other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">medical imaging<\/a> techniques, endoscopes are inserted directly into the organ.\n<\/p><p>There are many types of endoscopes. Depending on the site in the body and type of procedure an endoscopy may be performed either by a doctor or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeon<\/a>. A patient may be fully conscious or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthetised<\/a> during the procedure. Most often the term <i>endoscopy<\/i> is used to refer to an examination of the upper part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_gastrointestinal_tract\" class=\"mw-redirect\" title=\"Human gastrointestinal tract\" rel=\"external_link\" target=\"_blank\">gastrointestinal tract<\/a>, known as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">esophagogastroduodenoscopy<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>For non-medical use, similar instruments are called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Borescope\" title=\"Borescope\" rel=\"external_link\" target=\"_blank\">borescopes<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The self-illuminated endoscope was developed at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glasgow_Royal_Infirmary\" title=\"Glasgow Royal Infirmary\" rel=\"external_link\" target=\"_blank\">Glasgow Royal Infirmary<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scotland\" title=\"Scotland\" rel=\"external_link\" target=\"_blank\">Scotland<\/a> (one of the first hospitals to have mains electricity) in 1894\/5 by Dr <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Macintyre\" title=\"John Macintyre\" rel=\"external_link\" target=\"_blank\">John Macintyre<\/a> as part of his specialization in investigation of the larynx.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PENTAX_Colonoscope002.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/PENTAX_Colonoscope002.jpg\/220px-PENTAX_Colonoscope002.jpg\" width=\"220\" height=\"172\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PENTAX_Colonoscope002.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Operation part of the endoscope<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Insertion_tip_of_endoscope.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Insertion_tip_of_endoscope.jpg\/220px-Insertion_tip_of_endoscope.jpg\" width=\"220\" height=\"160\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Insertion_tip_of_endoscope.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Insertion tip of endoscope<\/div><\/div><\/div>\n<p>A health care provider may use <i><b>endoscopy<\/b><\/i> for any of the following:\n<\/p>\n<ul><li>investigation of symptoms, such as symptoms in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digestive_system\" class=\"mw-redirect\" title=\"Digestive system\" rel=\"external_link\" target=\"_blank\">digestive system<\/a> including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nausea\" title=\"Nausea\" rel=\"external_link\" target=\"_blank\">nausea<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vomiting\" title=\"Vomiting\" rel=\"external_link\" target=\"_blank\">vomiting<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_pain\" title=\"Abdominal pain\" rel=\"external_link\" target=\"_blank\">abdominal pain<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Difficulty_swallowing\" class=\"mw-redirect\" title=\"Difficulty swallowing\" rel=\"external_link\" target=\"_blank\">difficulty swallowing<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_bleeding\" title=\"Gastrointestinal bleeding\" rel=\"external_link\" target=\"_blank\">gastrointestinal bleeding<\/a>.<sup id=\"rdp-ebb-cite_ref-mayoendo_4-0\" class=\"reference\"><a href=\"#cite_note-mayoendo-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li>confirmation of a diagnosis, most commonly by performing a biopsy to check for conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anemia\" title=\"Anemia\" rel=\"external_link\" target=\"_blank\">anemia<\/a>, bleeding, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digestive_system_neoplasm\" title=\"Digestive system neoplasm\" rel=\"external_link\" target=\"_blank\">cancers of the digestive system<\/a>.<sup id=\"rdp-ebb-cite_ref-mayoendo_4-1\" class=\"reference\"><a href=\"#cite_note-mayoendo-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li>giving treatment, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cauterization\" title=\"Cauterization\" rel=\"external_link\" target=\"_blank\">cauterization<\/a> of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.<sup id=\"rdp-ebb-cite_ref-mayoendo_4-2\" class=\"reference\"><a href=\"#cite_note-mayoendo-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li><\/ul>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Specialty_(medicine)\" title=\"Specialty (medicine)\" rel=\"external_link\" target=\"_blank\">Specialty<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Professional_organizations\" class=\"mw-redirect\" title=\"Professional organizations\" rel=\"external_link\" target=\"_blank\">professional organizations<\/a> which specialize in digestive problems advise that many patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Barrett%27s_esophagus\" title=\"Barrett's esophagus\" rel=\"external_link\" target=\"_blank\">Barrett's esophagus<\/a> are too frequently receiving endoscopies.<sup id=\"rdp-ebb-cite_ref-AGAfive_5-0\" class=\"reference\"><a href=\"#cite_note-AGAfive-5\" rel=\"external_link\">[5]<\/a><\/sup> Such societies recommend that patients with Barrett's esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.<sup id=\"rdp-ebb-cite_ref-pmid21376940_6-0\" class=\"reference\"><a href=\"#cite_note-pmid21376940-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid18341497_7-0\" class=\"reference\"><a href=\"#cite_note-pmid18341497-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Anoscope,_proctoscope_and_rectoscope.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/Anoscope%2C_proctoscope_and_rectoscope.svg\/250px-Anoscope%2C_proctoscope_and_rectoscope.svg.png\" width=\"250\" height=\"149\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Anoscope,_proctoscope_and_rectoscope.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anoscope\" class=\"mw-redirect\" title=\"Anoscope\" rel=\"external_link\" target=\"_blank\">anoscope<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proctoscope\" class=\"mw-redirect\" title=\"Proctoscope\" rel=\"external_link\" target=\"_blank\">proctoscope<\/a>, and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectoscope\" class=\"mw-redirect\" title=\"Rectoscope\" rel=\"external_link\" target=\"_blank\">rectoscope<\/a> with approximate lengths<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\/250px-US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\" width=\"250\" height=\"166\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Endoscopy surgery<\/div><\/div><\/div>\n<p>Health care providers can use endoscopy to review any of the following body parts:\n<\/p>\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_gastrointestinal_tract\" class=\"mw-redirect\" title=\"Human gastrointestinal tract\" rel=\"external_link\" target=\"_blank\">gastrointestinal tract<\/a> (GI tract):\n<ul><li><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Esophageal_Bougie_Dilator.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7e\/Esophageal_Bougie_Dilator.jpg\/220px-Esophageal_Bougie_Dilator.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Esophageal_Bougie_Dilator.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Esophageal Bougie Dilator<\/div><\/div><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oesophagus\" class=\"mw-redirect\" title=\"Oesophagus\" rel=\"external_link\" target=\"_blank\">oesophagus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stomach\" title=\"Stomach\" rel=\"external_link\" target=\"_blank\">stomach<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duodenum\" title=\"Duodenum\" rel=\"external_link\" target=\"_blank\">duodenum<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">esophagogastroduodenoscopy<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Small_intestine\" title=\"Small intestine\" rel=\"external_link\" target=\"_blank\">small intestine<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Enteroscopy\" title=\"Enteroscopy\" rel=\"external_link\" target=\"_blank\">enteroscopy<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Large_intestine\" title=\"Large intestine\" rel=\"external_link\" target=\"_blank\">large intestine<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colon_(anatomy)\" class=\"mw-redirect\" title=\"Colon (anatomy)\" rel=\"external_link\" target=\"_blank\">colon<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colonoscopy\" title=\"Colonoscopy\" rel=\"external_link\" target=\"_blank\">colonoscopy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sigmoidoscopy\" title=\"Sigmoidoscopy\" rel=\"external_link\" target=\"_blank\">sigmoidoscopy<\/a>)<\/li>\n<li>Magnification endoscopy<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bile_duct\" title=\"Bile duct\" rel=\"external_link\" target=\"_blank\">bile duct<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_retrograde_cholangiopancreatography\" title=\"Endoscopic retrograde cholangiopancreatography\" rel=\"external_link\" target=\"_blank\">endoscopic retrograde cholangiopancreatography<\/a> (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectum\" title=\"Rectum\" rel=\"external_link\" target=\"_blank\">rectum<\/a> (rectoscopy) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anus\" title=\"Anus\" rel=\"external_link\" target=\"_blank\">anus<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Anoscopy\" title=\"Anoscopy\" rel=\"external_link\" target=\"_blank\">anoscopy<\/a>), both also referred to as (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Proctoscopy\" title=\"Proctoscopy\" rel=\"external_link\" target=\"_blank\">proctoscopy<\/a>)<\/li><\/ul><\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_tract\" title=\"Respiratory tract\" rel=\"external_link\" target=\"_blank\">respiratory tract<\/a>\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_nose\" title=\"Human nose\" rel=\"external_link\" target=\"_blank\">nose<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhinoscopy\" class=\"mw-redirect\" title=\"Rhinoscopy\" rel=\"external_link\" target=\"_blank\">rhinoscopy<\/a>)<\/li>\n<li>The lower <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_tract\" title=\"Respiratory tract\" rel=\"external_link\" target=\"_blank\">respiratory tract<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchoscopy\" title=\"Bronchoscopy\" rel=\"external_link\" target=\"_blank\">bronchoscopy<\/a>)<\/li><\/ul><\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">ear<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Otoscope\" title=\"Otoscope\" rel=\"external_link\" target=\"_blank\">otoscope<\/a>)<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_tract\" class=\"mw-redirect\" title=\"Urinary tract\" rel=\"external_link\" target=\"_blank\">urinary tract<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystoscopy\" title=\"Cystoscopy\" rel=\"external_link\" target=\"_blank\">cystoscopy<\/a>)<\/li>\n<li>The female <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reproductive_system\" title=\"Reproductive system\" rel=\"external_link\" target=\"_blank\">reproductive system<\/a> (gynoscopy)\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colposcopy\" title=\"Colposcopy\" rel=\"external_link\" target=\"_blank\">colposcopy<\/a>)<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hysteroscopy\" title=\"Hysteroscopy\" rel=\"external_link\" target=\"_blank\">hysteroscopy<\/a>)<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fallopian_tube\" title=\"Fallopian tube\" rel=\"external_link\" target=\"_blank\">fallopian tubes<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Falloposcopy\" title=\"Falloposcopy\" rel=\"external_link\" target=\"_blank\">falloposcopy<\/a>)<\/li><\/ul><\/li>\n<li>Normally closed body cavities (through a small incision):\n<ul><li>The abdominal or pelvic cavity (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopy\" title=\"Laparoscopy\" rel=\"external_link\" target=\"_blank\">laparoscopy<\/a>)<\/li>\n<li>The interior of a joint (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopy\" title=\"Arthroscopy\" rel=\"external_link\" target=\"_blank\">arthroscopy<\/a>)<\/li>\n<li>Organs of the chest (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Thoracoscopy\" title=\"Thoracoscopy\" rel=\"external_link\" target=\"_blank\">thoracoscopy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mediastinoscopy\" title=\"Mediastinoscopy\" rel=\"external_link\" target=\"_blank\">mediastinoscopy<\/a>)<\/li><\/ul><\/li><\/ul>\n<p>Endoscopy is used for many procedures:\n<\/p>\n<ul><li>During <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pregnancy\" title=\"Pregnancy\" rel=\"external_link\" target=\"_blank\">pregnancy<\/a>\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amnion\" title=\"Amnion\" rel=\"external_link\" target=\"_blank\">amnion<\/a> ()<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fetus\" title=\"Fetus\" rel=\"external_link\" target=\"_blank\">fetus<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Fetoscopy\" title=\"Fetoscopy\" rel=\"external_link\" target=\"_blank\">fetoscopy<\/a>)<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">Plastic surgery<\/a><\/li>\n<li>Panendoscopy (or triple endoscopy)\n<ul><li>Combines <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laryngoscopy\" title=\"Laryngoscopy\" rel=\"external_link\" target=\"_blank\">laryngoscopy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">esophagoscopy<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchoscopy\" title=\"Bronchoscopy\" rel=\"external_link\" target=\"_blank\">bronchoscopy<\/a><\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">Orthopedic surgery<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hand_surgery\" title=\"Hand surgery\" rel=\"external_link\" target=\"_blank\">Hand surgery<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_carpal_tunnel_release\" title=\"Endoscopic carpal tunnel release\" rel=\"external_link\" target=\"_blank\">endoscopic carpal tunnel release<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_surgery\" class=\"mw-redirect\" title=\"Knee surgery\" rel=\"external_link\" target=\"_blank\">Knee surgery<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_cruciate_ligament_reconstruction\" title=\"Anterior cruciate ligament reconstruction\" rel=\"external_link\" target=\"_blank\">anterior cruciate ligament reconstruction<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Epidural_space\" title=\"Epidural space\" rel=\"external_link\" target=\"_blank\">Epidural space<\/a> ()<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bursa_(anatomy)\" class=\"mw-redirect\" title=\"Bursa (anatomy)\" rel=\"external_link\" target=\"_blank\">Bursae<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bursectomy\" title=\"Bursectomy\" rel=\"external_link\" target=\"_blank\">Bursectomy<\/a>)<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endodontic\" class=\"mw-redirect\" title=\"Endodontic\" rel=\"external_link\" target=\"_blank\">Endodontic<\/a> surgery\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxillary_sinus\" title=\"Maxillary sinus\" rel=\"external_link\" target=\"_blank\">Maxillary sinus<\/a> surgery<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apicoectomy\" title=\"Apicoectomy\" rel=\"external_link\" target=\"_blank\">Apicoectomy<\/a><\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_endonasal_surgery\" title=\"Endoscopic endonasal surgery\" rel=\"external_link\" target=\"_blank\">Endoscopic endonasal surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_spinal_surgery\" class=\"mw-redirect\" title=\"Endoscopic spinal surgery\" rel=\"external_link\" target=\"_blank\">Endoscopic spinal surgery<\/a><\/li><\/ul>\n<p>An Endoscopy is a simple procedure which allows a doctor to look inside human bodies using an instrument called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform surgery. This type of surgery is called Key hole surgery, and usually leaves only a tiny scar externally.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Application_in_other_fields\">Application in other fields<\/span><\/h2>\n<ul><li>The planning and architectural community use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Architectural_endoscopy\" title=\"Architectural endoscopy\" rel=\"external_link\" target=\"_blank\">architectural endoscopy<\/a> for pre-visualization of scale models of proposed buildings and cities<\/li>\n<li>Internal inspection of complex technical systems (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Borescope\" title=\"Borescope\" rel=\"external_link\" target=\"_blank\">borescope<\/a>)<\/li>\n<li>Endoscopes are also a tool helpful in the examination of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Improvised_explosive_devices\" class=\"mw-redirect\" title=\"Improvised explosive devices\" rel=\"external_link\" target=\"_blank\">improvised explosive devices<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bomb_disposal\" title=\"Bomb disposal\" rel=\"external_link\" target=\"_blank\">bomb disposal<\/a> personnel.<\/li>\n<li>The FBI uses endoscopes for conducting surveillance via tight spaces.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>The main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding.<sup id=\"rdp-ebb-cite_ref-\u201cNHS\u201d_8-0\" class=\"reference\"><a href=\"#cite_note-\u201cNHS\u201d-8\" rel=\"external_link\">[8]<\/a><\/sup> Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, it is good to remember that each of them occurs quite infrequently. A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"After_the_endoscopy\">After the endoscopy<\/span><\/h2>\n<p>After the procedure, the patient will be observed and monitored by a qualified individual in the endoscopy room, or a recovery area, until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and fleeting. When fully recovered, the patient will be instructed when to resume their usual diet (probably within a few hours) and will be allowed to be taken home. Where sedation has been used, most facilities mandate that the patient be taken home by another person and that he or she not drive or handle machinery for the remainder of the day. Patients who have had an endoscopy without sedation are able to leave unassisted.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Endoscope\">Endoscope<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">Endoscope<\/a><\/div>\n<p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a> can consist of:\n<\/p>\n<ul><li>a rigid or flexible tube.<\/li>\n<li>a light delivery system to illuminate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_(anatomy)\" title=\"Organ (anatomy)\" rel=\"external_link\" target=\"_blank\">organ<\/a> or object under inspection. The light source is normally outside the body and the light is typically directed via an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_fiber\" title=\"Optical fiber\" rel=\"external_link\" target=\"_blank\">optical fiber<\/a> system.<\/li>\n<li>a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lens<\/a> system transmitting the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image\" title=\"Image\" rel=\"external_link\" target=\"_blank\">image<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Objective_lens\" class=\"mw-redirect\" title=\"Objective lens\" rel=\"external_link\" target=\"_blank\">objective lens<\/a> to the viewer, typically a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relay_lens\" title=\"Relay lens\" rel=\"external_link\" target=\"_blank\">relay lens<\/a> system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberscope\" title=\"Fiberscope\" rel=\"external_link\" target=\"_blank\">fiberscope<\/a>.<\/li>\n<li>an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eyepiece\" title=\"Eyepiece\" rel=\"external_link\" target=\"_blank\">eyepiece<\/a>. Modern instruments may be videoscopes, with no eyepiece. A camera transmits image to a screen for image capture.<\/li>\n<li>an additional channel to allow entry of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_instrument\" class=\"mw-redirect\" title=\"Medical instrument\" rel=\"external_link\" target=\"_blank\">medical instruments<\/a> or manipulators.<\/li><\/ul>\n<p>Patients undergoing the procedure may be offered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedation\" title=\"Sedation\" rel=\"external_link\" target=\"_blank\">sedation<\/a>, which includes its own risks.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History_2\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bozzini_Lichtleiter.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c8\/Bozzini_Lichtleiter.jpg\/220px-Bozzini_Lichtleiter.jpg\" width=\"220\" height=\"143\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bozzini_Lichtleiter.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Drawings of Bozzini's \"Lichtleiter\", an early <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a><\/div><\/div><\/div>\n<p>The first endoscope was developed in 1806 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Philipp_Bozzini\" title=\"Philipp Bozzini\" rel=\"external_link\" target=\"_blank\">Philipp Bozzini<\/a> in Mainz with his introduction of a \"Lichtleiter\" (light conductor) \"for the examinations of the canals and cavities of the human body\".<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> However, the disapproved of such curiosity.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The first to use an endoscope in a successful operation was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antonin_Jean_Desormeaux\" title=\"Antonin Jean Desormeaux\" rel=\"external_link\" target=\"_blank\">Antonin Jean Desormeaux<\/a> whose invention was the state of the art before the invention of electricity.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The use of electric light was a major step in the improvement of endoscopy. The first such lights were external although sufficiently capable of illumination to allow cystoscopy, hysteroscopy and sigmoidoscopy as well as examination of the nasal (and later thoracic) cavities as was being performed routinely in human patients by Sir Francis Cruise (using his own commercially available endoscope) by 1865 in the Mater Misericordiae Hospital in Dublin, Ireland.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> Later, smaller bulbs became available making internal light possible, for instance in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hysteroscopy\" title=\"Hysteroscopy\" rel=\"external_link\" target=\"_blank\">hysteroscope<\/a> by in 1908.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hans_Christian_Jacobaeus\" title=\"Hans Christian Jacobaeus\" rel=\"external_link\" target=\"_blank\">Hans Christian Jacobaeus<\/a> has been given credit for the first large published series of endoscopic explorations of the abdomen and the thorax with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopy\" title=\"Laparoscopy\" rel=\"external_link\" target=\"_blank\">laparoscopy<\/a> (1912) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thoracoscopy\" title=\"Thoracoscopy\" rel=\"external_link\" target=\"_blank\">thoracoscopy<\/a> (1910)<sup id=\"rdp-ebb-cite_ref-pmid9876654_13-0\" class=\"reference\"><a href=\"#cite_note-pmid9876654-13\" rel=\"external_link\">[13]<\/a><\/sup> although the first reported thoracoscopic examination in a human was also by Cruise.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Laparoscopy was used in the diagnosis of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallbladder\" title=\"Gallbladder\" rel=\"external_link\" target=\"_blank\">gallbladder<\/a> disease by in the 1930s.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Hope reported in 1937 on the use of laparoscopy to diagnose <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ectopic_pregnancy\" title=\"Ectopic pregnancy\" rel=\"external_link\" target=\"_blank\">ectopic pregnancy<\/a>.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> In 1944, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Raoul_Palmer\" title=\"Raoul Palmer\" rel=\"external_link\" target=\"_blank\">Raoul Palmer<\/a> placed his patients in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trendelenburg_position\" title=\"Trendelenburg position\" rel=\"external_link\" target=\"_blank\">Trendelenburg position<\/a> after gaseous distention of the abdomen and thus was able to reliably perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gynecology\" class=\"mw-redirect\" title=\"Gynecology\" rel=\"external_link\" target=\"_blank\">gynecologic<\/a> laparoscopy.<sup id=\"rdp-ebb-cite_ref-Litynski_1997_17-0\" class=\"reference\"><a href=\"#cite_note-Litynski_1997-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Wolf_and_Storz\">Wolf and Storz<\/span><\/h3>\n<p>Georg Wolf (1873\u20131938) a Berlin manufacturer of rigid endoscopes, established in 1906, produced the Sussmann flexible gastroscope in 1911 (Modlin, Farhadi-Journal of Clinical Gastroenterology, 2000).<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Karl Storz began producing instruments for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otolaryngology\" class=\"mw-redirect\" title=\"Otolaryngology\" rel=\"external_link\" target=\"_blank\">ENT<\/a> specialists in 1945 through his company, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Karl_Storz_GmbH\" class=\"mw-redirect\" title=\"Karl Storz GmbH\" rel=\"external_link\" target=\"_blank\">Karl Storz GmbH<\/a>.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fiber_optics\">Fiber optics<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:132px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Storz_Endoscopy_Unit.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Storz_Endoscopy_Unit.png\/130px-Storz_Endoscopy_Unit.png\" width=\"130\" height=\"311\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Storz_Endoscopy_Unit.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A Storz endoscopy unit used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laryngoscopy\" title=\"Laryngoscopy\" rel=\"external_link\" target=\"_blank\">laryngoscopy<\/a> exams of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vocal_folds\" class=\"mw-redirect\" title=\"Vocal folds\" rel=\"external_link\" target=\"_blank\">vocal folds<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glottis\" title=\"Glottis\" rel=\"external_link\" target=\"_blank\">glottis<\/a><\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Basil_Hirschowitz\" title=\"Basil Hirschowitz\" rel=\"external_link\" target=\"_blank\">Basil Hirschowitz<\/a> and Larry Curtiss invented the first fiber optic endoscope in 1957.<sup id=\"rdp-ebb-cite_ref-pmid2044933_20-0\" class=\"reference\"><a href=\"#cite_note-pmid2044933-20\" rel=\"external_link\">[20]<\/a><\/sup> Earlier in the 1950s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harold_Hopkins_(physicist)\" title=\"Harold Hopkins (physicist)\" rel=\"external_link\" target=\"_blank\">Harold Hopkins<\/a> had designed a \"fibroscope\" consisting of a bundle of flexible glass fibres able to coherently transmit an image. This proved useful both medically and industrially, and subsequent research led to further improvements in image quality. Further innovations included using additional fibres to channel light to the objective end from a powerful external source, thereby achieving the high level of full spectrum illumination that was needed for detailed viewing, and colour photography.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The previous practice of a small filament lamp on the tip of the endoscope had left the choice of either viewing in a dim red light or increasing the light output - which carried the risk of burning the inside of the patient. Alongside the advances to the optics, the ability to 'steer' the tip was developed, as well as innovations in remotely operated surgical instruments contained within the body of the endoscope itself. This was the beginning of \"key-hole surgery\" as we know it today.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Rod-lens_endoscopes\">Rod-lens endoscopes<\/span><\/h3>\n<p>There were physical limits to the image quality of a fibroscope. A bundle of say 50,000 fibers gives effectively only a 50,000-pixel image, and continued flexing from use breaks fibers and so progressively loses pixels. Eventually so many are lost that the whole bundle must be replaced (at considerable expense). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harold_Hopkins_(physicist)\" title=\"Harold Hopkins (physicist)\" rel=\"external_link\" target=\"_blank\">Harold Hopkins<\/a> realised that any further optical improvement would require a different approach. Previous rigid endoscopes suffered from low light transmittance and poor image quality. The surgical requirement of passing surgical tools as well as the illumination system within the endoscope's tube - which itself is limited in dimensions by the human body - left very little room for the imaging optics. The tiny lenses of a conventional system required supporting rings that would obscure the bulk of the lens area; they were difficult to manufacture and assemble and optically nearly useless.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The elegant solution that Hopkins invented was to fill the air-spaces between the 'little lenses' with rods of glass. These fitted exactly the endoscope's tube, making them self-aligning, and required no other support. This allowed the little lenses to be dispensed with altogether. The rod-lenses were much easier to handle and used the maximum possible diameter available.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>With the appropriate curvature and coatings to the rod ends and optimal choices of glass-types, all calculated and specified by Hopkins, the image quality was transformed - even with tubes of only 1mm in diameter. With a high quality 'telescope' of such small diameter the tools and illumination system could be comfortably housed within an outer tube. Once again it was who produced the first of these new endoscopes as part of a long and productive partnership between the two men.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Whilst there are regions of the body that will always require flexible endoscopes (principally the gastrointestinal tract), the rigid rod-lens endoscopes have such exceptional performance that they are still the preferred instrument and have enabled modern key-hole surgery. (Harold Hopkins was recognized and honoured for his advancement of medical-optic by the medical community worldwide. It formed a major part of the citation when he was awarded the Rumford Medal by the Royal Society in 1984.)\n<\/p><p>By measuring absorption of light by the blood (by passing the light through one fibre and collecting the light through another fibre) a doctor can estimate the proportion of haemoglobin in the blood and diagnose ulceration in the stomach.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Endoscope_reprocessing\">Endoscope reprocessing<\/span><\/h3>\n<p>High level disinfection of flexible endoscopes is required by all national guideline issuing bodies.<sup id=\"rdp-ebb-cite_ref-pmid28159069_22-0\" class=\"reference\"><a href=\"#cite_note-pmid28159069-22\" rel=\"external_link\">[22]<\/a><\/sup> The high level disinfection of endoscopes occurs during a multi-step process called reprocessing. Reprocessing endoscopes involves over 100 individuals steps.<sup id=\"rdp-ebb-cite_ref-pmid20679783_23-0\" class=\"reference\"><a href=\"#cite_note-pmid20679783-23\" rel=\"external_link\">[23]<\/a><\/sup> These steps can be broken down into broad categories of pre-cleaning, leak testing, manual cleaning, cleaning verification, visual inspection, high level disinfection, rinsing, drying, and storage.<sup id=\"rdp-ebb-cite_ref-pmid27684640_24-0\" class=\"reference\"><a href=\"#cite_note-pmid27684640-24\" rel=\"external_link\">[24]<\/a><\/sup> Failure to perform all of these steps correctly can lead to residual contamination remaining on endoscopes.\n<\/p><p>In the UK, stringent guidelines exist regarding the decontamination and disinfection of flexible endoscopes, the most recent being CfPP 01\u201306, released in 2013<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>Rigid endoscopes, such as an Arthroscope, can be sterilized in the same way as surgical instruments, whereas heat labile flexible endoscopes cannot.<sup id=\"rdp-ebb-cite_ref-pmid24451088_26-0\" class=\"reference\"><a href=\"#cite_note-pmid24451088-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Recent_developments\">Recent developments<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Endoscope,_USB,_2015-05-30.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/Endoscope%2C_USB%2C_2015-05-30.jpg\/220px-Endoscope%2C_USB%2C_2015-05-30.jpg\" width=\"220\" height=\"189\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Endoscope,_USB,_2015-05-30.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Low-cost waterproof USB endoscope for non-medical use.<\/div><\/div><\/div>\n<p>With the application of robotic systems, telesurgery was introduced as the surgeon could be at a site far removed from the patient. The first transatlantic surgery has been called the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_Operation\" class=\"mw-redirect\" title=\"Lindbergh Operation\" rel=\"external_link\" target=\"_blank\">Lindbergh Operation<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Wireless oesophageal pH measuring devices can now be placed endoscopically, to record ph trends in an area remotely.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Endoscopy_VR_simulators\">Endoscopy VR simulators<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_reality\" title=\"Virtual reality\" rel=\"external_link\" target=\"_blank\">Virtual reality<\/a> simulators are being developed for training doctors on various endoscopy skills.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Disposable_endoscopy\">Disposable endoscopy<\/span><\/h3>\n<p>Disposable endoscopy is an emerging category of endoscopic instruments. Recent developments<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> have allowed the manufacture of endoscopes inexpensive enough to be used on a single patient only. It is meeting a growing demand to lessen the risk of cross contamination and hospital acquired diseases. A European consortium of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/SME_(society)\" title=\"SME (society)\" rel=\"external_link\" target=\"_blank\">SME<\/a> are working on the DUET (disposable use of endoscopy tool) project to build a disposable endoscope.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Capsule_endoscopy\">Capsule endoscopy<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsule_endoscopy\" title=\"Capsule endoscopy\" rel=\"external_link\" target=\"_blank\">Capsule endoscopy<\/a><\/div>\n<p>Capsule endoscopes are pill-sized imaging devices that are swallowed by a patient and then record images of the gastrointestinal tract as they pass through naturally. Images are typically retrieved via wireless data transfer to an external receiver.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Augmented_reality\">Augmented reality<\/span><\/h3>\n<p>The endoscopic image can be combined with other image sources to provide the surgeon with additional information. For instance, the position of an anatomical structure or tumor might be shown in the endoscopic video.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"New_imaging_modalities\">New imaging modalities<\/span><\/h3>\n<p>Emerging endoscope technologies measure additional properties of light to improve contrast, such as optical polarization,<sup id=\"rdp-ebb-cite_ref-pmid25836165_31-0\" class=\"reference\"><a href=\"#cite_note-pmid25836165-31\" rel=\"external_link\">[31]<\/a><\/sup> optical phase, <sup id=\"rdp-ebb-cite_ref-pmid27279676_32-0\" class=\"reference\"><a href=\"#cite_note-pmid27279676-32\" rel=\"external_link\">[32]<\/a><\/sup> and additional wavelengths of light (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperspectral\" class=\"mw-redirect\" title=\"Hyperspectral\" rel=\"external_link\" target=\"_blank\">hyperspectral<\/a> endoscopy).<sup id=\"rdp-ebb-cite_ref-pmid21639573_33-0\" class=\"reference\"><a href=\"#cite_note-pmid21639573-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portal-puzzle.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Portal-puzzle.svg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/fd\/Portal-puzzle.svg\/16px-Portal-puzzle.svg.png\" width=\"16\" height=\"14\" class=\"noviewer\" \/><\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Endoscopy\" title=\"Portal:Endoscopy\" rel=\"external_link\" target=\"_blank\">Endoscopy portal<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation encyclopaedia\">\"Endoscopy\". <i>British Medical Association Complete Family Health Encyclopedia<\/i>. Dorling Kindersley Limited. 1990.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Endoscopy&rft.btitle=British+Medical+Association+Complete+Family+Health+Encyclopedia&rft.pub=Dorling+Kindersley+Limited&rft.date=1990&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cancerresearchuk.org\/about-cancer\/cancers-in-general\/tests\/endoscopy\" target=\"_blank\">\"Endoscopy\"<\/a>. Cancer Research UK<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 November<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Endoscopy&rft.pub=Cancer+Research+UK&rft_id=http%3A%2F%2Fwww.cancerresearchuk.org%2Fabout-cancer%2Fcancers-in-general%2Ftests%2Fendoscopy&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/sshm.ac.uk\/wp-content\/uploads\/2013\/10\/PROCEEDINGS-SESSION-1994-1995-and-1995-1996.pdf\" target=\"_blank\">\"The Scottish Society of the History of Medicine\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Scottish+Society+of+the+History+of+Medicine&rft_id=http%3A%2F%2Fsshm.ac.uk%2Fwp-content%2Fuploads%2F2013%2F10%2FPROCEEDINGS-SESSION-1994-1995-and-1995-1996.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-mayoendo-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-mayoendo_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mayoendo_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mayoendo_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Staff (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayoclinic.com\/health\/endoscopy\/MY00138\/METHOD=print\" target=\"_blank\">\"Upper endoscopy\"<\/a>. <i>Mayo Clinic<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 September<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Mayo+Clinic&rft.atitle=Upper+endoscopy&rft.date=2012&rft.au=Staff&rft_id=http%3A%2F%2Fwww.mayoclinic.com%2Fhealth%2Fendoscopy%2FMY00138%2FMETHOD%3Dprint&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AGAfive-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AGAfive_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Gastroenterological_Association\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Gastroenterological_Association\" title=\"American Gastroenterological Association\" rel=\"external_link\" target=\"_blank\">American Gastroenterological Association<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120809143636\/http:\/\/choosingwisely.org\/wp-content\/uploads\/2012\/04\/5things_12_factsheet_AGA.pdf\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>, <i>Choosing Wisely: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Gastroenterological_Association\" title=\"American Gastroenterological Association\" rel=\"external_link\" target=\"_blank\">American Gastroenterological Association<\/a>, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/choosingwisely.org\/wp-content\/uploads\/2012\/04\/5things_12_factsheet_AGA.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on August 9, 2012<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">August 17,<\/span> 2012<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.au=American+Gastroenterological+Association&rft_id=http%3A%2F%2Fchoosingwisely.org%2Fwp-content%2Fuploads%2F2012%2F04%2F5things_12_factsheet_AGA.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid21376940-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid21376940_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (March 2011). \"American Gastroenterological Association medical position statement on the management of Barrett's esophagus\". <i>Gastroenterology<\/i>. <b>140<\/b> (3): 1084\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fj.gastro.2011.01.030\" target=\"_blank\">10.1053\/j.gastro.2011.01.030<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21376940\" target=\"_blank\">21376940<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastroenterology&rft.atitle=American+Gastroenterological+Association+medical+position+statement+on+the+management+of+Barrett%27s+esophagus&rft.volume=140&rft.issue=3&rft.pages=1084-91&rft.date=2011-03&rft_id=info%3Adoi%2F10.1053%2Fj.gastro.2011.01.030&rft_id=info%3Apmid%2F21376940&rft.aulast=Spechler&rft.aufirst=SJ&rft.au=Sharma%2C+P&rft.au=Souza%2C+RF&rft.au=Inadomi%2C+JM&rft.au=Shaheen%2C+NJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid18341497-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid18341497_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wang KK, Sampliner RE (March 2008). \"Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus\". <i>The American Journal of Gastroenterology<\/i>. <b>103<\/b> (3): 788\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1572-0241.2008.01835.x\" target=\"_blank\">10.1111\/j.1572-0241.2008.01835.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18341497\" target=\"_blank\">18341497<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Gastroenterology&rft.atitle=Updated+guidelines+2008+for+the+diagnosis%2C+surveillance+and+therapy+of+Barrett%27s+esophagus&rft.volume=103&rft.issue=3&rft.pages=788-97&rft.date=2008-03&rft_id=info%3Adoi%2F10.1111%2Fj.1572-0241.2008.01835.x&rft_id=info%3Apmid%2F18341497&rft.aulast=Wang&rft.aufirst=KK&rft.au=Sampliner%2C+RE&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-\u201cNHS\u201d-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-\u201cNHS\u201d_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nhs.uk\/conditions\/Endoscopy\/Pages\/Introduction.aspx\" target=\"_blank\">\"Endoscopy\"<\/a>. <i>NHS Choices<\/i>. NHS Gov.UK<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">April 20,<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=NHS+Choices&rft.atitle=Endoscopy&rft_id=http%3A%2F%2Fwww.nhs.uk%2Fconditions%2FEndoscopy%2FPages%2FIntroduction.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bozzini, Philipp (1806). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=dn8tAAAAcAAJ&pg=PA107\" target=\"_blank\">\"Lichtleiter, eine Erfindung zur Anschauung innerer Teile und Krankheiten, nebst der Abbildung\"<\/a> [Light conductor, an invention for examining internal parts and diseases, together with illustrations]. <i>Journal der practischen Arzneykunde und Wundarzneykunst<\/i> (in German). <b>24<\/b>: 107\u201324.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+der+practischen+Arzneykunde+und+Wundarzneykunst&rft.atitle=Lichtleiter%2C+eine+Erfindung+zur+Anschauung+innerer+Teile+und+Krankheiten%2C+nebst+der+Abbildung&rft.volume=24&rft.pages=107-24&rft.date=1806&rft.aulast=Bozzini&rft.aufirst=Philipp&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Ddn8tAAAAcAAJ%26pg%3DPA107&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Yamada T (2009-01-22). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=first%20endoscope%20developed%20in%201806&f=false\"><i>Atlas of Gastroenterology<\/i><\/a>. John Wiley & Sons. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4443-0342-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Atlas+of+Gastroenterology&rft.pub=John+Wiley+%26+Sons&rft.date=2009-01-22&rft.isbn=978-1-4443-0342-1&rft.aulast=Yamada&rft.aufirst=Tadataka&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DU6BdMMytieQC%26pg%3DPA884%26lpg%3DPA884%26dq%3Dfirst%2Bendoscope%2Bdeveloped%2Bin%2B1806%23v%3Donepage%26q%3Dfirst%2520endoscope%2520developed%2520in%25201806%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Caniggia A, Nuti R, Lore F, Martini G, Turchetti V, Righi G (April 1990). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2325571\" target=\"_blank\">\"Long-term treatment with calcitriol in postmenopausal osteoporosis\"<\/a>. <i>Metabolism<\/i>. <b>39<\/b> (4 Suppl 1): 43\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.1.223.345\" target=\"_blank\">10.1136\/bmj.1.223.345<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/25204557\" target=\"_blank\">25204557<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2325571\" target=\"_blank\">2325571<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Metabolism&rft.atitle=Long-term+treatment+with+calcitriol+in+postmenopausal+osteoporosis&rft.volume=39&rft.issue=4+Suppl+1&rft.pages=43-9&rft.date=1990-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2325571&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F25204557&rft_id=info%3Adoi%2F10.1136%2Fbmj.1.223.345&rft.aulast=Caniggia&rft.aufirst=A&rft.au=Nuti%2C+R&rft.au=Lore%2C+F&rft.au=Martini%2C+G&rft.au=Turchetti%2C+V&rft.au=Righi%2C+G&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2325571&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Shawki O, Deshmukh S, Pacheco LA (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=0SYLDgAAQBAJ&pg=PA13\" target=\"_blank\"><i>Mastering the Techniques in Hysteroscopy<\/i><\/a>. Jaypee Brothers Medical Publishers. pp. 13\u2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-93-86150-49-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mastering+the+Techniques+in+Hysteroscopy&rft.pages=13-&rft.pub=Jaypee+Brothers+Medical+Publishers&rft.date=2017&rft.isbn=978-93-86150-49-3&rft.aulast=Shawki&rft.aufirst=Osama&rft.au=Deshmukh%2C+Sushma&rft.au=Pacheco%2C+Luis+Alonso&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D0SYLDgAAQBAJ%26pg%3DPA13&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid9876654-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid9876654_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Litynski GS (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3015224\" target=\"_blank\">\"Laparoscopy--the early attempts: spotlighting Georg Kelling and Hans Christian Jacobaeus\"<\/a>. <i>Jsls<\/i>. <b>1<\/b> (1): 83\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3015224\" target=\"_blank\">3015224<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9876654\" target=\"_blank\">9876654<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Jsls&rft.atitle=Laparoscopy--the+early+attempts%3A+spotlighting+Georg+Kelling+and+Hans+Christian+Jacobaeus&rft.volume=1&rft.issue=1&rft.pages=83-5&rft.date=1997&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3015224&rft_id=info%3Apmid%2F9876654&rft.aulast=Litynski&rft.aufirst=GS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3015224&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gordon S (2014). \"Art. VIII.\u2014Clinical reports of rare cases, occurring in the Whitworth and Hardwicke Hospitals\". <i>Dublin Quarterly Journal of Medical Science<\/i>. <b>41<\/b> (1): 83\u201399. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF02946459\" target=\"_blank\">10.1007\/BF02946459<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dublin+Quarterly+Journal+of+Medical+Science&rft.atitle=Art.+VIII.%E2%80%94Clinical+reports+of+rare+cases%2C+occurring+in+the+Whitworth+and+Hardwicke+Hospitals&rft.volume=41&rft.issue=1&rft.pages=83-99&rft.date=2014&rft_id=info%3Adoi%2F10.1007%2FBF02946459&rft.aulast=Gordon&rft.aufirst=Samuel&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Wildhirt E, Kalk H (1977). <i>Neue Deutsche Biographie (NDB). Band 11<\/i>. Berlin: Duncker & Humblot. p. 60. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-428-00192-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Neue+Deutsche+Biographie+%28NDB%29.+Band+11&rft.place=Berlin&rft.pages=60&rft.pub=Duncker+%26+Humblot&rft.date=1977&rft.isbn=978-3-428-00192-7&rft.aulast=Wildhirt&rft.aufirst=Egmont&rft.au=Kalk%2C+Heinrich-Otto&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Balen AH, Creighton SM, Davies MC, MacDougall J, Stanhope R (2004-04-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=pCUgAwAAQBAJ&pg=PA131\" target=\"_blank\"><i>Paediatric and Adolescent Gynaecology: A Multidisciplinary Approach<\/i><\/a>. Cambridge University Press. pp. 131\u2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-107-32018-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Paediatric+and+Adolescent+Gynaecology%3A+A+Multidisciplinary+Approach&rft.pages=131-&rft.pub=Cambridge+University+Press&rft.date=2004-04-01&rft.isbn=978-1-107-32018-5&rft.aulast=Balen&rft.aufirst=AH&rft.au=Creighton%2C+SM&rft.au=Davies%2C+MC&rft.au=MacDougall%2C+J&rft.au=Stanhope%2C+R&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DpCUgAwAAQBAJ%26pg%3DPA131&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Litynski_1997-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Litynski_1997_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Litynski GS (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3016739\" target=\"_blank\">\"Raoul Palmer, World War II, and transabdominal coelioscopy. Laparoscopy extends into gynecology\"<\/a>. <i>Journal of the Society of Laparoendoscopic Surgeons<\/i>. <b>1<\/b> (3): 289\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3016739\" target=\"_blank\">3016739<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9876691\" target=\"_blank\">9876691<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Society+of+Laparoendoscopic+Surgeons&rft.atitle=Raoul+Palmer%2C+World+War+II%2C+and+transabdominal+coelioscopy.+Laparoscopy+extends+into+gynecology&rft.volume=1&rft.issue=3&rft.pages=289-92&rft.date=1997&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3016739&rft_id=info%3Apmid%2F9876691&rft.aulast=Litynski&rft.aufirst=GS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3016739&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.richardwolfusa.com\/company\/100-years-of-innovation.html\" target=\"_blank\">\"About Richard Wolf Germany\"<\/a>. Richard Wolf Medical Instruments.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=About+Richard+Wolf+Germany&rft.pub=Richard+Wolf+Medical+Instruments&rft_id=https%3A%2F%2Fwww.richardwolfusa.com%2Fcompany%2F100-years-of-innovation.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Nezhat C (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/laparoscopy.blogs.com\/endoscopyhistory\/chapter_19\/index.html\" target=\"_blank\">\"Chapter 19. 1960's\"<\/a>. <i>Nezhat's History of Endoscopy<\/i>. Society of Laparoendoscopic Surgeons.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Nezhat%27s+History+of+Endoscopy&rft.atitle=Chapter+19.+1960%27s&rft.date=2005&rft.aulast=Nezhat&rft.aufirst=Camran&rft_id=http%3A%2F%2Flaparoscopy.blogs.com%2Fendoscopyhistory%2Fchapter_19%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid2044933-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid2044933_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Edmonson JM (1991). \"History of the instruments for gastrointestinal endoscopy\". <i>Gastrointestinal Endoscopy<\/i>. <b>37<\/b> (2 Suppl): S27\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0016-5107%2891%2970910-3\" target=\"_blank\">10.1016\/S0016-5107(91)70910-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2044933\" target=\"_blank\">2044933<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastrointestinal+Endoscopy&rft.atitle=History+of+the+instruments+for+gastrointestinal+endoscopy&rft.volume=37&rft.issue=2+Suppl&rft.pages=S27-56&rft.date=1991&rft_id=info%3Adoi%2F10.1016%2FS0016-5107%2891%2970910-3&rft_id=info%3Apmid%2F2044933&rft.aulast=Edmonson&rft.aufirst=JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.haroldhopkins.org\/history.html\" target=\"_blank\">\"History\"<\/a>. <i>Harold Hopkins Society<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Harold+Hopkins+Society&rft.atitle=History&rft_id=http%3A%2F%2Fwww.haroldhopkins.org%2Fhistory.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid28159069-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid28159069_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ (February 2017). \"Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures\". <i>American Journal of Infection Control<\/i>. <b>45<\/b> (2): e26\u2013e33. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ajic.2016.10.017\" target=\"_blank\">10.1016\/j.ajic.2016.10.017<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28159069\" target=\"_blank\">28159069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Infection+Control&rft.atitle=Longitudinal+assessment+of+reprocessing+effectiveness+for+colonoscopes+and+gastroscopes%3A+Results+of+visual+inspections%2C+biochemical+markers%2C+and+microbial+cultures&rft.volume=45&rft.issue=2&rft.pages=e26-e33&rft.date=2017-02&rft_id=info%3Adoi%2F10.1016%2Fj.ajic.2016.10.017&rft_id=info%3Apmid%2F28159069&rft.aulast=Ofstead&rft.aufirst=CL&rft.au=Wetzler%2C+HP&rft.au=Heymann%2C+OL&rft.au=Johnson%2C+EA&rft.au=Eiland%2C+JE&rft.au=Shaw%2C+MJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid20679783-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid20679783_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ofstead CL, Wetzler HP, Snyder AK, Horton RA (2010). \"Endoscope reprocessing methods: a prospective study on the impact of human factors and automation\". <i>Gastroenterology Nursing<\/i>. <b>33<\/b> (4): 304\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FSGA.0b013e3181e9431a\" target=\"_blank\">10.1097\/SGA.0b013e3181e9431a<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20679783\" target=\"_blank\">20679783<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastroenterology+Nursing&rft.atitle=Endoscope+reprocessing+methods%3A+a+prospective+study+on+the+impact+of+human+factors+and+automation&rft.volume=33&rft.issue=4&rft.pages=304-11&rft.date=2010&rft_id=info%3Adoi%2F10.1097%2FSGA.0b013e3181e9431a&rft_id=info%3Apmid%2F20679783&rft.aulast=Ofstead&rft.aufirst=CL&rft.au=Wetzler%2C+HP&rft.au=Snyder%2C+AK&rft.au=Horton%2C+RA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid27684640-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid27684640_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Herrin A, Loyola M, Bocian S, Diskey A, Friis CM, Herron-Rice L, Juan MR, Schmelzer M, Selking S (2016). \"Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes\". <i>Gastroenterology Nursing<\/i>. <b>39<\/b> (5): 404\u201318. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FSGA.0000000000000266\" target=\"_blank\">10.1097\/SGA.0000000000000266<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27684640\" target=\"_blank\">27684640<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastroenterology+Nursing&rft.atitle=Standards+of+Infection+Prevention+in+Reprocessing+Flexible+Gastrointestinal+Endoscopes&rft.volume=39&rft.issue=5&rft.pages=404-18&rft.date=2016&rft_id=info%3Adoi%2F10.1097%2FSGA.0000000000000266&rft_id=info%3Apmid%2F27684640&rft.aulast=Herrin&rft.aufirst=A&rft.au=Loyola%2C+M&rft.au=Bocian%2C+S&rft.au=Diskey%2C+A&rft.au=Friis%2C+CM&rft.au=Herron-Rice%2C+L&rft.au=Juan%2C+MR&rft.au=Schmelzer%2C+M&rft.au=Selking%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/148559\/CFPP_01-06_Operational_mgmt_Final.pdf\" target=\"_blank\">\"Health Technical Memorandum 01-06: Decontamination of exible endoscopes Part C: Operational management\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. United Kingdom Department of Health. March 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Health+Technical+Memorandum+01-06%3A+Decontamination+of++exible+endoscopes+Part+C%3A+Operational+management&rft.pub=United+Kingdom+Department+of+Health&rft.date=2016-03&rft_id=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fuploads%2Fsystem%2Fuploads%2Fattachment_data%2Ffile%2F148559%2FCFPP_01-06_Operational_mgmt_Final.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid24451088-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid24451088_26-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sabnis RB, Bhattu A, Vijaykumar M (March 2014). \"Sterilization of endoscopic instruments\". <i>Current Opinion in Urology<\/i>. <b>24<\/b> (2): 195\u2013202. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FMOU.0000000000000034\" target=\"_blank\">10.1097\/MOU.0000000000000034<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24451088\" target=\"_blank\">24451088<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Urology&rft.atitle=Sterilization+of+endoscopic+instruments&rft.volume=24&rft.issue=2&rft.pages=195-202&rft.date=2014-03&rft_id=info%3Adoi%2F10.1097%2FMOU.0000000000000034&rft_id=info%3Apmid%2F24451088&rft.aulast=Sabnis&rft.aufirst=RB&rft.au=Bhattu%2C+A&rft.au=Vijaykumar%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=ogMr5u5oqN8\" target=\"_blank\">\"Overview of Endoscopy Haptics Simulator Project\"<\/a>. <i>M2D2 Laboratory, Indian Institute of Science<\/i>. YouTube.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=M2D2+Laboratory%2C+Indian+Institute+of+Science&rft.atitle=Overview+of+Endoscopy+Haptics+Simulator+Project&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DogMr5u5oqN8&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110720064520\/http:\/\/www.fraunhofer.de\/en\/press\/research-news\/2010-2011\/15\/cameras-out-of-the-salt-shaker.jsp\" target=\"_blank\">\"Dokument nicht gefunden\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fraunhofer.de\/en\/press\/research-news\/2010-2011\/15\/cameras-out-of-the-salt-shaker.jsp\" target=\"_blank\">the original<\/a> on 2011-07-20.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Dokument+nicht+gefunden&rft_id=http%3A%2F%2Fwww.fraunhofer.de%2Fen%2Fpress%2Fresearch-news%2F2010-2011%2F15%2Fcameras-out-of-the-salt-shaker.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110723225345\/http:\/\/www.ist-world.org\/ProjectDetails.aspx?ProjectId=6ad6814768374801b7401a5ae435dec6\" target=\"_blank\">\"Development of a Disposable Use Endoscopy Tool\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ist-world.org\/ProjectDetails.aspx?ProjectId=6ad6814768374801b7401a5ae435dec6\" target=\"_blank\">the original<\/a> on 2011-07-23.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Development+of+a+Disposable+Use+Endoscopy+Tool&rft_id=http%3A%2F%2Fwww.ist-world.org%2FProjectDetails.aspx%3FProjectId%3D6ad6814768374801b7401a5ae435dec6&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=i4emmCcBb4s\" target=\"_blank\"><span class=\"plainlinks\">Augmented Reality: Path guidance to craniopharyngioma<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a><\/span>\n<\/li>\n<li id=\"cite_note-pmid25836165-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid25836165_31-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Manhas S, Vizet J, Deby S, Vanel JC, Boito P, Verdier M, De Martino A, Pagnoux D (February 2015). \"Demonstration of full 4\u00d74 Mueller polarimetry through an optical fiber for endoscopic applications\". <i>Optics Express<\/i>. <b>23<\/b> (3): 3047\u201354. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2015OExpr..23.3047M\" target=\"_blank\">2015OExpr..23.3047M<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1364%2FOE.23.003047\" target=\"_blank\">10.1364\/OE.23.003047<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25836165\" target=\"_blank\">25836165<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Optics+Express&rft.atitle=Demonstration+of+full+4%C3%974+Mueller+polarimetry+through+an+optical+fiber+for+endoscopic+applications&rft.volume=23&rft.issue=3&rft.pages=3047-54&rft.date=2015-02&rft_id=info%3Apmid%2F25836165&rft_id=info%3Adoi%2F10.1364%2FOE.23.003047&rft_id=info%3Abibcode%2F2015OExpr..23.3047M&rft.aulast=Manhas&rft.aufirst=S&rft.au=Vizet%2C+J&rft.au=Deby%2C+S&rft.au=Vanel%2C+JC&rft.au=Boito%2C+P&rft.au=Verdier%2C+M&rft.au=De+Martino%2C+A&rft.au=Pagnoux%2C+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid27279676-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid27279676_32-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation arxiv\">Gordon, GSD; Joseph, J; Alcolea, MP; Sawyer, T; Macfaden, AJ; Williams, C; Fitzpatrick, CRM; Jones, PH; di Pietro, M; Fitzgerald, RC; Wilkinson, TD; Bohndiek, SE. \"Quantitative phase and polarisation endoscopy applied to detection of early oesophageal tumourigenesis\". <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/1811.03977\" target=\"_blank\">1811.03977<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=preprint&rft.jtitle=arXiv&rft.atitle=Quantitative+phase+and+polarisation+endoscopy+applied+to+detection+of+early+oesophageal+tumourigenesis&rft_id=info%3Aarxiv%2F1811.03977&rft.aulast=Gordon&rft.aufirst=GSD&rft.au=Joseph%2C+J&rft.au=Alcolea%2C+MP&rft.au=Sawyer%2C+T&rft.au=Macfaden%2C+AJ&rft.au=Williams%2C+C&rft.au=Fitzpatrick%2C+CRM&rft.au=Jones%2C+PH&rft.au=di+Pietro%2C+M&rft.au=Fitzgerald%2C+RC&rft.au=Wilkinson%2C+TD&rft.au=Bohndiek%2C+SE&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid21639573-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid21639573_33-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kester RT, Bedard N, Gao L, Tkaczyk TS (May 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3107836\" target=\"_blank\">\"Real-time snapshot hyperspectral imaging endoscope\"<\/a>. <i>Journal of Biomedical Optics<\/i>. <b>16<\/b> (5): 056005. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2011JBO....16e6005K\" target=\"_blank\">2011JBO....16e6005K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1117%2F1.3574756\" target=\"_blank\">10.1117\/1.3574756<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3107836\" target=\"_blank\">3107836<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21639573\" target=\"_blank\">21639573<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Optics&rft.atitle=Real-time+snapshot+hyperspectral+imaging+endoscope&rft.volume=16&rft.issue=5&rft.pages=056005&rft.date=2011-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3107836&rft_id=info%3Apmid%2F21639573&rft_id=info%3Adoi%2F10.1117%2F1.3574756&rft_id=info%3Abibcode%2F2011JBO....16e6005K&rft.aulast=Kester&rft.aufirst=RT&rft.au=Bedard%2C+N&rft.au=Gao%2C+L&rft.au=Tkaczyk%2C+TS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3107836&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.endoatlas.com\/atlas_1.html\" target=\"_blank\">The Atlas of Gastrointestinal Endoscopy<\/a> endoatlas.com<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.gastrointestinalatlas.com\/english\/english.html\" target=\"_blank\">El Salvador Atlas of Gastrointestinal Endoscopy<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gastrolab.net\/welcome.htm\" target=\"_blank\">Gastrolab: Site in English, Swedish and Finnish with gastrointestinal endoscopy photolibrary<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.massdevice.com\/blogs\/massdevice\/preventing-cross-contamination-flexible-endoscopes\" target=\"_blank\">Preventing cross-contamination from flexible endoscopes<\/a> massdevice.com<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.advancedimagingpro.com\/print\/Advanced-Imaging-Magazine\/Advances-in-Endoscopy\/1$5670\" target=\"_blank\">Advances in Endoscopy<\/a> advancedimagingpro.com<\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181215162351\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.656 seconds\nReal time usage: 0.816 seconds\nPreprocessor visited node count: 3218\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 100083\/2097152 bytes\nTemplate argument size: 4897\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 90916\/5000000 bytes\nNumber of Wikibase entities loaded: 6\/400\nLua time usage: 0.359\/10.000 seconds\nLua memory usage: 6.99 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 668.617 1 -total\n<\/p>\n<pre>46.10% 308.260 1 Template:Reflist\n16.80% 112.328 14 Template:Cite_journal\n10.54% 70.488 8 Template:Fix\n 9.71% 64.913 1 Template:Commons_category\n 9.20% 61.515 1 Template:Infobox_medical_intervention\n 8.52% 56.980 1 Template:Cite_encyclopedia\n 8.40% 56.197 1 Template:Infobox\n 8.08% 54.054 7 Template:Fact\n 6.38% 42.671 11 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:197002-1!canonical and timestamp 20181215162351 and revision id 872145510\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214659\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.176 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 167.293 1 - wikipedia:Endoscopy\n100.00% 167.293 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8566-0!*!*!*!*!*!* and timestamp 20181217214659 and revision id 24994\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Endoscopy\">https:\/\/www.limswiki.org\/index.php\/Endoscopy<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1511b5ea96046b1f5ee06ec866bbcc44_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/69\/PENTAX_Colonoscope001.jpg\/560px-PENTAX_Colonoscope001.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Santiagodechile2007.jpg\/440px-Santiagodechile2007.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/PENTAX_Colonoscope002.jpg\/440px-PENTAX_Colonoscope002.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Insertion_tip_of_endoscope.jpg\/440px-Insertion_tip_of_endoscope.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/Anoscope%2C_proctoscope_and_rectoscope.svg\/500px-Anoscope%2C_proctoscope_and_rectoscope.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\/500px-US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7e\/Esophageal_Bougie_Dilator.jpg\/440px-Esophageal_Bougie_Dilator.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/c8\/Bozzini_Lichtleiter.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Storz_Endoscopy_Unit.png\/260px-Storz_Endoscopy_Unit.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/Endoscope%2C_USB%2C_2015-05-30.jpg\/440px-Endoscope%2C_USB%2C_2015-05-30.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/fd\/Portal-puzzle.svg\/32px-Portal-puzzle.svg.png"],"1511b5ea96046b1f5ee06ec866bbcc44_timestamp":1545083219,"1015376d34b6db14e7bd61c81d508dc0_type":"article","1015376d34b6db14e7bd61c81d508dc0_title":"Dialysis","1015376d34b6db14e7bd61c81d508dc0_url":"https:\/\/www.limswiki.org\/index.php\/Dialysis","1015376d34b6db14e7bd61c81d508dc0_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDialysis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about renal dialysis. For other uses, see Dialysis (disambiguation).\nRenal DialysisPatient receiving hemodialysisSpecialtynephrology ICD-9-CM39.95MeSHD006435 MedlinePlus00743 [edit on Wikidata]\nIn medicine, dialysis (from Greek \u03b4\u03b9\u03ac\u03bb\u03c5\u03c3\u03b9\u03c2, di\u00e0lysis, \"dissolution\"; from \u03b4\u03b9\u03ac, di\u00e0, \"through\", and \u03bb\u03cd\u03c3\u03b9\u03c2, l\u1ef3sis, \"loosening or splitting\") is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy.\nDialysis is used in patients with rapidly developing loss of kidney function, called acute kidney injury (previously called acute renal failure), or slowly worsening kidney function, called Stage 5 chronic kidney disease, (previously called chronic kidney failure and end-stage renal disease and end-stage kidney disease).\nDialysis is used as a temporary measure in either acute kidney injury or in those awaiting kidney transplant and as a permanent measure in those for whom a transplant is not indicated or not possible.[1]\nIn the United Kingdom and the United States, dialysis is paid for by the government for those who are eligible. The first successful dialysis was performed in 1943.\nIn research laboratories, dialysis technique can also be used to separate molecules based on their size. Additionally, it can be used to balance buffer between a sample and the solution \"dialysis bath\" or \"dialysate\"[2] that the sample is in. For dialysis in a laboratory, a tubular semipermeable membrane made of cellulose acetate or nitrocellulose is used.[3] Pore size is varied according to the size separation required with larger pore sizes allowing larger molecules to pass through the membrane. Solvents, ions and buffer can diffuse easily across the semipermeable membrane, but larger molecules are unable to pass through the pores. This can be used to purify proteins of interest from a complex mixture by removing smaller proteins and molecules.\n\nContents \n\n1 Background \n2 Principle \n3 Types \n\n3.1 Hemodialysis \n3.2 Peritoneal dialysis \n3.3 Hemofiltration \n3.4 Hemodiafiltration \n3.5 Intestinal dialysis \n\n\n4 Indications \n\n4.1 Acute indications \n4.2 Chronic indications \n\n\n5 Dialyzable substances \n\n5.1 Characteristics \n5.2 Substances \n\n\n6 Pediatric dialysis \n7 Dialysis in different countries \n\n7.1 In the United Kingdom \n7.2 In the United States \n7.3 In China \n\n\n8 History \n9 See also \n\n9.1 Materials and methods \n9.2 Medical applications \n\n\n10 References \n11 Bibliography \n12 Further reading \n13 External links \n\n\nBackground \n A hemodialysis machine\nThe kidneys have an important role in maintaining health. When the person is healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). The acidic metabolism end-products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine system, producing erythropoietin, calcitriol and renin. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.[4] Dialysis is an imperfect treatment to replace kidney function because it does not correct the compromised endocrine functions of the kidney. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal).[5] Dialysis uses highly purified (also known as \"ultrapure\") water.[6]\n\nPrinciple \nDialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across a semi-permeable membrane. Diffusion is a property of substances in water; substances in water tend to move from an area of high concentration to an area of low concentration.[7] Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side. A semipermeable membrane is a thin layer of material that contains holes of various sizes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances (for example, red blood cells, large proteins). This replicates the filtering process that takes place in the kidneys when the blood enters the kidneys and the larger substances are separated from the smaller ones in the glomerulus.[7]\n\n Osmosis diffusion ultrafiltration and dialysis\nThe two main types of dialysis, hemodialysis and peritoneal dialysis, remove wastes and excess water from the blood in different ways.[1] Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane. The blood flows in one direction and the dialysate flows in the opposite. The counter-current flow of the blood and dialysate maximizes the concentration gradient of solutes between the blood and dialysate, which helps to remove more urea and creatinine from the blood. The concentrations of solutes (for example potassium, phosphorus and urea) are undesirably high in the blood, but low or absent in the dialysis solution, and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of minerals like potassium and calcium that are similar to their natural concentration in healthy blood. For another solute, bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of bicarbonate into the blood, to act as a pH buffer to neutralize the metabolic acidosis that is often present in these patients. The levels of the components of dialysate are typically prescribed by a nephrologist according to the needs of the individual patient.\nIn peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneum as a natural semipermeable membrane. Wastes and excess water move from the blood, across the peritoneal membrane and into a special dialysis solution, called dialysate, in the abdominal cavity.\n\nTypes \nThere are three primary and two secondary types of dialysis: hemodialysis (primary), peritoneal dialysis (primary), hemofiltration (primary), hemodiafiltration (secondary) and intestinal dialysis (secondary).\n\nHemodialysis \nMain article: Hemodialysis\nIn hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny hollow synthetic fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions.[8] The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate and allows the removal of several litres of excess fluid during a typical 4-hour treatment.\nIn the United States, hemodialysis treatments are typically given in a dialysis center three times per week (due in the United States to Medicare reimbursement rules); however, as of 2005 over 2,500 people in the United States are dialyzing at home more frequently for various treatment lengths.[9] Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually called nocturnal daily hemodialysis, which a study has shown it provides a significant improvement in both small and large molecular weight clearance and decreases the need for phosphate binders.[10] These frequent long treatments are often done at home while sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week to week. In general, studies show that both increased treatment length and frequency are clinically beneficial.[11]\n\n<\/p>Hemo-dialysis was one of the most common procedures performed in U.S. hospitals in 2011, occurring in 909,000 stays (a rate of 29 stays per 10,000 population).[12]\n\nPeritoneal dialysis \n Schematic diagram of peritoneal dialysis\nMain article: Peritoneal dialysis\nIn peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane.\nThis exchange is repeated 4\u20135 times per day; automatic systems can run more frequent exchange cycles overnight. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient, often without help. This frees patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week. Peritoneal dialysis can be performed with little to no specialized equipment (other than bags of fresh dialysate).\n\nHemofiltration \nMain article: Hemofiltration\n Continuous veno-venous haemofiltration with pre- and post-dilution (CVVH)\nHemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or \"hemofilter\" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, \"dragging\" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost from the blood during this process are replaced with a \"substitution fluid\" that is infused into the extracorporeal circuit during the treatment.\n\nHemodiafiltration \nHemodiafiltration is a combination of hemodialysis and hemofiltration, thus used to purify the blood from toxins when the kidney is not working normally and also used to treat acute kidney injury (AKI).\n\nIntestinal dialysis \n Continuous veno-venous haemodiafiltration (CVVHDF)\nIn intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which is digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in fecal waste.[13][14][15] An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of polyethylene glycol or mannitol every fourth hour.[16]\n\nIndications \nThe decision to initiate dialysis or hemofiltration in patients with kidney failure depends on several factors. These can be divided into acute or chronic indications.\n\nAcute indications \nIndications for dialysis in the patient with acute kidney injury are summarized with the vowel mnemonic of \"AEIOU\":[17]\n\nAcidemia from metabolic acidosis in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload.\nElectrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI.\nIntoxication, that is, acute poisoning with a dialyzable substance. These substances can be represented by the mnemonic SLIME: salicylic acid, lithium, isopropanol, magnesium-containing laxatives and ethylene glycol.\nOverload of fluid not expected to respond to treatment with diuretics\nUremia complications, such as pericarditis, encephalopathy, or gastrointestinal bleeding.\nChronic indications \nChronic dialysis may be indicated when a patient has symptomatic kidney failure and low glomerular filtration rate (GFR < 15 mL\/min).[18] Between 1996 and 2008, there was a trend to initiate dialysis at progressively higher estimated GFR, eGFR.\nA review of the evidence shows no benefit or potential harm with early dialysis initiation, which has been defined by start of dialysis at an estimated GFR of greater than 10ml\/min\/1.732. Observational data from large registries of dialysis patients suggests that early start of dialysis may be harmful.[19]\nThe most recent published guidelines from Canada, for when to initiate dialysis, recommend an intent to defer dialysis until a patient has definite kidney failure symptoms, which may occur at an estimated GFR of 5-9ml\/min\/1.732.[20]\n\nDialyzable substances \nCharacteristics \nDialyzable substances\u2014substances removeable with dialysis\u2014have these properties:\n\nLow molecular mass\nHigh water solubility\nLow protein binding capacity\nProlonged elimination (long half-life)\nSmall volume of distribution\nSubstances \nEthylene glycol\nProcainamide\nMethanol\nIsopropyl alcohol\nBarbiturates\nLithium\nBromide\nSotalol\nChloral hydrate\nEthanol\nAcetone\nAtenolol\nTheophylline\nSalicylates\nPediatric dialysis \nOver the past 20 years, children have benefited from major improvements in both technology and clinical management of dialysis. Morbidity during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Non-invasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs.\nBiocompatible synthetic membranes, specific small size material dialyzers and new low extra-corporeal volume tubing have been developed for young infants. Arterial and venous tubing length is made of minimum length and diameter, a <80ml to <110ml volume tubing is designed for pediatric patients and a >130 to <224ml tubing are for adult patients, regardless of blood pump segment size, which can be of 6.4mm for normal dialysis or 8.0mm for high flux dialysis in all patients. All dialysis machine manufacturers design their machine to do the pediatric dialysis. In pediatric patients, the pump speed should be kept at low side, according to patient blood output capacity, and the clotting with heparin dose should be carefully monitored. The high flux dialysis (see below) is not recommended for pediatric patients.\nIn children, hemodialysis must be individualized and viewed as an \"integrated therapy\" that considers their long-term exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning.long-term chronic dialysis, however, the highest standards should be applied to these children to preserve their future \"cardiovascular life\"\u2014which might include more dialysis time and on-line hemodiafiltration online hdf with synthetic high flux membranes with the surface area of 0.2sq.m to 0.8sq.m and blood tubing lines with the low volume yet large blood pump segment of 6.4\/8.0mm, if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.\n\nDialysis in different countries \nIn the United Kingdom \nThe National Health Service provides dialysis in the United Kingdom. In England the service is commissioned by NHS England. About 23,000 patients use the service each year.[21] Patient transport services are generally provided without charge, for patients who need to travel to dialysis centres. Cornwall Clinical Commissioning Group proposed to restrict this provision to patients who did not have specific medical or financial reasons in 2018 but changed their minds after a campaign led by Kidney Care UK and decided to fund transport for patients requiring dialysis three times a week for a minimum of six weeks, or six times a month for a minimum of three months.[22]\n\nIn the United States \nSince 1972, the United States has covered the cost of dialysis and transplants for all citizens. By 2014, more than 460,000 Americans were undergoing treatment, the costs of which amount to 6 percent of the entire Medicare budget. Kidney disease is the ninth leading cause of death, and the U.S. has one of the highest mortality rates for dialysis care in the industrialized world. The rate of patients getting kidney transplants has been lower than expected. These outcomes have been blamed on a new for-profit dialysis industry responding to government payment policies.[23][24][25] A 1999 study concluded that \"patients treated in for-profit dialysis facilities have higher mortality rates and are less likely to be placed on the waiting list for a renal transplant than are patients who are treated in not-for-profit facilities\", possibly because transplantation removes a constant stream of revenue from the facility.[26] The insurance industry has complained about kickbacks and problematic relationships between charities and providers.[27]\n\nIn China \nThe Government of China provides the funding for dialysis treatment. There is a challenge to reach everyone who needs dialysis treatment because of the unequal distribution of health care resources and dialysis centers.[28] There are 395,121 individuals who receive hemodialysis or peritoneal dialysis in China per year. The percentage of the Chinese population with chronic kidney disease is 10.8%.[29] The Chinese Government is trying to increase the amount of peritoneal dialysis taking place to meet the needs of that nations's individuals with chronic kidney disease.[30]\n\nHistory \n Arm hooked up to dialysis tubing.\nA Dutch doctor, Willem Johan Kolff, constructed the first working dialyzer in 1943 during\nthe Nazi occupation of the Netherlands.[31] Due to the scarcity of available resources, Kolff had to improvise and build the initial machine using sausage casings, beverage cans, a washing machine and various other items that were available at the time. Over the following two years (1944\u20131945), Kolff used his machine to treat 16 patients suffering from acute kidney failure, but the results were unsuccessful. Then, in 1945, a 67-year-old comatose woman regained consciousness following 11 hours of hemodialysis with the dialyzer and lived for another seven years before dying from an unrelated condition. She was the first-ever patient successfully treated with dialysis.[31] Nils Alwall modified a similar construction to the Kolff dialysis machine by enclosing it inside a stainless steel canister. This allowed the removal of fluids, by applying a negative pressure to the outside canister, thus making it the first truly practical device for hemodialysis. Alwall treated his first patient in acute kidney failure on 3 September 1946.[citation needed ]\n\nSee also \nMaterials and methods \nThomas Graham (chemist), the founder of dialysis and father of colloid chemistry\nDialysis tubing\nList of US dialysis providers\nMedical applications \nApheresis, also known as plasmapheresis, is another extracorporeal technique that selectively removes specific constituents from blood\nHemodialysis\nPeritoneal dialysis\nAcute kidney failure\nKidney failure\nNephrology\nChronic kidney disease\nHepatorenal syndrome\nReferences \n\n\n^ a b Pendse S, Singh A, Zawada E. Initiation of Dialysis. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:14\u201321 \n\n^ Garrett, Reginald H.; Grisham, Charles M. (2013). Biochemistry (5th ed.). p. 107. ISBN 978-1-133-10629-6. \n\n^ Ninfa, Alexander J.; Ballou, David P.; Benore, Marilee (2009). Fundamental Laboratory Approaches for Biochemistry and Biotechnology (2nd ed.). p. 45. ISBN 978-0-470-08766-4. \n\n^ Brundage D. Renal Disorders. St. Louis, MO: Mosby; 1992 \n\n^ \"Atlas of Diseases of the Kidney, Volume 5, Principles of Dialysis: Diffusion, Convection, and Dialysis Machines\" (PDF) . Retrieved 2011-09-02 . \n\n^ \"Home Hemodialysis and Water Treatment\". Davita. Retrieved 3 June 2017 . \n\n^ a b Mosby\u2019s Dictionary of Medicine, Nursing, & Health Professions. 7th ed. St. Louis, MO; Mosby: 2006 \n\n^ Ahmad S, Misra Hemodialysis Apparatus. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:59-78. \n\n^ \"USRDS Treatment Modalities\" (PDF) . United States Renal Data System. Retrieved 2011-09-02 . \n\n^ Rocco, MV (July 2007). \"More Frequent Hemodialysis: Back to the Future?\". Advances in Chronic Kidney Disease. 14 (3): e1\u20139. doi:10.1053\/j.ackd.2007.04.006. PMID 17603969. \n\n^ Daily therapy study results compared Archived March 5, 2011, at the Wayback Machine. \n\n^ Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. [1]. \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ Irwin, Richard S.; James M. Rippe (2008). Irwin and Rippe's intensive care medicine. Lippincott Williams & Wilkins. pp. 988\u2013999. ISBN 978-0-7817-9153-3. \n\n^ Tattersall, James; Dekker, Friedo; Heimb\u00fcrger, Olof; Jager, Kitty J.; Lameire, Norbert; Lindley, Elizabeth; Van Biesen, Wim; Vanholder, Raymond; Zoccali, Carmine (2011-07-01). \"When to start dialysis: updated guidance following publication of the Initiating Dialysis Early and Late (IDEAL) study\". Nephrology, Dialysis, Transplantation. 26 (7): 2082\u20132086. doi:10.1093\/ndt\/gfr168. ISSN 1460-2385. PMID 21551086. \n\n^ Rosansky, Steven; Glassock, Richard; Clark, William (2011). \"Early Start of Dialysis: A Critical Review\". Clin J Am Soc Nephrol. 6 (5): 1222\u20131228. doi:10.2215\/cjn.09301010. PMID 21555505. \n\n^ Nesrallah, Gihad (Feb 2014). \"Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic al indications for chronic dialysis\". CMAJ. 186 (2): 112\u2013117. doi:10.1503\/cmaj.130363. PMC 3903737 . PMID 24492525. \n\n^ \"Specialised service transfer reconsidered due to incorrect data\". Health Service Journal. 13 March 2015. Retrieved 20 April 2015 . \n\n^ \"CCG backs down over patient transport funding cuts\". Health Service Journal. 10 April 2018. Retrieved 29 May 2018 . \n\n^ Fields, Robin (2010-11-09). \"In Dialysis, Life-Saving Care at Great Risk and Cost\". ProPublica. Retrieved 2017-05-18 . \n\n^ \"John Oliver sees ills in for-profit dialysis centers\". Newsweek. 2017-05-15. Retrieved 2017-05-18 . \n\n^ \"Profit motive linked to dialysis deaths - UB Reporter\". www.buffalo.edu. Retrieved 2017-05-18 . \n\n^ Garg, Pushkal P.; Frick, Kevin D.; Diener-West, Marie; Powe, Neil R. (1999-11-25). \"Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation\". New England Journal of Medicine. 341 (22): 1653\u20131660. doi:10.1056\/NEJM199911253412205. ISSN 0028-4793. PMID 10572154. \n\n^ Abelson, Reed; Thomas, Katie (2016-07-01). \"UnitedHealthcare Sues Dialysis Chain Over Billing\". The New York Times. ISSN 0362-4331. Retrieved 2017-05-18 . \n\n^ JIN, Jian; WANG, Jianxiang; MA, Xiaoyi; WANG, Yuding; LI, Renyong (April 2015). \"Equality of Medical Health Resource Allocation in China Based on the Gini Coefficient Method\". Iranian Journal of Public Health. 44 (4): 445\u2013457. ISSN 2251-6085. PMC 4441957 . PMID 26056663. \n\n^ Zhang, Luxia; Wang, Fang; Wang, Li; Wang, Wenke; Liu, Bicheng; Liu, Jian; Chen, Menghua; He, Qiang; Liao, Yunhua (2012-03-03). \"Prevalence of chronic kidney disease in China: a cross-sectional survey\". The Lancet. 379 (9818): 815\u2013822. doi:10.1016\/S0140-6736(12)60033-6. PMID 22386035. \n\n^ Li, Philip Kam-Tao; Lui, Sing Leung; Ng, Jack Kit-Chung; Cai, Guan Yan; Chan, Christopher T; Chen, Hung Chun; Cheung, Alfred K; Choi, Koon Shing; Choong, Hui Lin (2017-12-01). \"Addressing the burden of dialysis around the world: A summary of the roundtable discussion on dialysis economics at the First International Congress of Chinese Nephrologists 2015\". Nephrology. 22: 3\u20138. doi:10.1111\/nep.13143. ISSN 1440-1797. PMID 29155495. \n\n^ a b Blakeslee, Sandra (12 February 2009). \"Willem Kolff, Doctor Who Invented Kidney and Heart Machines, Dies at 97\". The New York Times. New York Times. \n\n\nBibliography \n\nAl-Mosawi A. J. (2004). \"Acacia gum supplementation of a low-protein diet in children with end-stage renal disease\". Pediatric Nephrology. 19 (10): 1156\u20131159. doi:10.1007\/s00467-004-1562-5. PMID 15293039. \nAl Mosawi A. J. (2007). \"The use of acacia gum in end stage renal failure\". Journal of Tropical Pediatrics. 53 (5): 362\u2013365. doi:10.1093\/tropej\/fmm033. PMID 17517814. \nAli A. A.; Ali K. E.; Fadlalla A. E.; Khalid K. E. (2008). \"The effects of gum arabic oral treatment on the metabolic profile of chronic renal failure patients under regular haemodialysis in Central Sudan\". Natural Product Research. 22 (1): 12\u201321. doi:10.1080\/14786410500463544. PMID 17999333. \nMiskowiak J (1991). \"Continuous Intestinal Dialysis for Uraemia by Intermittent Oral Intake of Non-Absorbable Solutions: An Experimental Study\". Scandinavian Journal of Urology and Nephrology. 25 (1): 71\u201374. doi:10.3109\/00365599109024532. \n\nFurther reading \nStefania Crowther; Lois Reynolds; Tilli Tansey, eds. (2009), History of Dialysis in the UK: c. 1950-1980, Wellcome Witnesses to Contemporary Medicine, History of Modern Biomedicine Research Group, ISBN 978-0-85484-122-6 , Wikidata Q29581768\nExternal links \n\n Dialysisat Wikipedia's sister projects \n \n \n Definitions from Wiktionary \n Media from Wikimedia Commons \n News from Wikinews \n Quotations from Wikiquote \n Texts from Wikisource \n Textbooks from Wikibooks \n Resources from Wikiversity \n \n \n\nMachine Cleans Blood While You Wait\u20141950 article on early use of dialysis machine at Bellevue Hospital New York City\u2014i.e. example of how complex and large early dialysis machines were\nHome Dialysis Museum\u2014History and pictures of dialysis machines through time\nIntroduction to Dialysis Machines\u2014Tutorial describing the main subfunctions of dialysis systems.\nFirst Nations man conducts own dialysis treatments to avoid move to the city\u2014CBC News (November 30, 2016)\nvteUrologic surgical and other procedures (ICD-9-CM V3 55\u201359+89.2, ICD-10-PCS 0T)Kidney\nNephrostomy (Percutaneous nephrostomy)\nNephrotomy\nEndoscopy\nNephroscopy\nRenal biopsy\nNephrectomy\nKidney transplantation\nNephropexy\nUreter\nUreterostomy\nUrinary diversion\nUreterosigmoidostomy\nUreterolysis\nUreteroscopy\nUrinary bladder\nCystectomy\nSuprapubic cystostomy\nCystoscopy\nUrethra\nUrethropexy\nUrethrotomy\nUrethral sounding\nUrethroplasty\nUrethral bulking injections\nCystourethrography\nGeneralMedical imaging:\nPyelogram (Intravenous pyelogram, Retrograde pyelogram)\nKidneys, ureters, and bladder x-ray\nRadioisotope renography\nCystography\nRetrograde urethrogram\nVoiding cystourethrogram\nUrodynamic testing\nCystometry\nother:\nUrinary catheterization\nDialysis\nLithotripsy:\nLaser lithotripsy\nExtracorporeal shock wave lithotripsy\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:36.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 780 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1015376d34b6db14e7bd61c81d508dc0_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Dialysis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Dialysis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about renal dialysis. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis_(disambiguation)\" class=\"mw-disambig\" title=\"Dialysis (disambiguation)\" rel=\"external_link\" target=\"_blank\">Dialysis (disambiguation)<\/a>.<\/div>\n\n<p>In medicine, <b>dialysis<\/b> (from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_(language)\" class=\"mw-redirect\" title=\"Greek (language)\" rel=\"external_link\" target=\"_blank\">Greek<\/a> \u03b4\u03b9\u03ac\u03bb\u03c5\u03c3\u03b9\u03c2, <i>di\u00e0lysis<\/i>, \"dissolution\"; from \u03b4\u03b9\u03ac, <i>di\u00e0<\/i>, \"<i>through<\/i>\", and \u03bb\u03cd\u03c3\u03b9\u03c2, <i>l\u1ef3sis<\/i>, \"loosening or splitting\") is the process of removing excess <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water\" title=\"Water\" rel=\"external_link\" target=\"_blank\">water<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solutes\" class=\"mw-redirect\" title=\"Solutes\" rel=\"external_link\" target=\"_blank\">solutes<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxins\" class=\"mw-redirect\" title=\"Toxins\" rel=\"external_link\" target=\"_blank\">toxins<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> in people whose kidneys can no longer perform these functions naturally. This is referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Renal_replacement_therapy\" title=\"Renal replacement therapy\" rel=\"external_link\" target=\"_blank\">renal replacement therapy<\/a>.\n<\/p><p>Dialysis is used in patients with rapidly developing loss of kidney function, called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_injury\" title=\"Acute kidney injury\" rel=\"external_link\" target=\"_blank\">acute kidney injury<\/a> (previously called acute renal failure), or slowly worsening kidney function, called Stage 5 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_kidney_disease\" title=\"Chronic kidney disease\" rel=\"external_link\" target=\"_blank\">chronic kidney disease<\/a>, (previously called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_kidney_failure\" class=\"mw-redirect\" title=\"Chronic kidney failure\" rel=\"external_link\" target=\"_blank\">chronic kidney failure<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/End-stage_renal_disease\" class=\"mw-redirect\" title=\"End-stage renal disease\" rel=\"external_link\" target=\"_blank\">end-stage renal disease<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/End-stage_kidney_disease\" class=\"mw-redirect\" title=\"End-stage kidney disease\" rel=\"external_link\" target=\"_blank\">end-stage kidney disease<\/a>).\n<\/p><p>Dialysis is used as a temporary measure in either acute kidney injury or in those awaiting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_transplant\" class=\"mw-redirect\" title=\"Kidney transplant\" rel=\"external_link\" target=\"_blank\">kidney transplant<\/a> and as a permanent measure in those for whom a transplant is not indicated or not possible.<sup id=\"rdp-ebb-cite_ref-Pendse_1-0\" class=\"reference\"><a href=\"#cite_note-Pendse-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>In the United Kingdom and the United States, dialysis is paid for by the government for those who are eligible. The first successful dialysis was performed in 1943.\n<\/p><p>In research laboratories, dialysis technique can also be used to separate molecules based on their size. Additionally, it can be used to balance <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buffer_solution\" title=\"Buffer solution\" rel=\"external_link\" target=\"_blank\">buffer<\/a> between a sample and the solution \"dialysis bath\" or \"dialysate\"<sup id=\"rdp-ebb-cite_ref-Garrett_2-0\" class=\"reference\"><a href=\"#cite_note-Garrett-2\" rel=\"external_link\">[2]<\/a><\/sup> that the sample is in. For dialysis in a laboratory, a tubular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semipermeable_membrane\" title=\"Semipermeable membrane\" rel=\"external_link\" target=\"_blank\">semipermeable membrane<\/a> made of cellulose acetate or nitrocellulose is used.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Pore size is varied according to the size separation required with larger pore sizes allowing larger molecules to pass through the membrane. Solvents, ions and buffer can <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffuse\" class=\"mw-redirect\" title=\"Diffuse\" rel=\"external_link\" target=\"_blank\">diffuse<\/a> easily across the semipermeable membrane, but larger molecules are unable to pass through the pores. This can be used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein_purification\" title=\"Protein purification\" rel=\"external_link\" target=\"_blank\">purify proteins<\/a> of interest from a complex mixture by removing smaller proteins and molecules.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemodialysismachine.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Hemodialysismachine.jpg\/220px-Hemodialysismachine.jpg\" width=\"220\" height=\"313\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemodialysismachine.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> machine<\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidneys<\/a> have an important role in maintaining health. When the person is healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). The acidic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolism\" title=\"Metabolism\" rel=\"external_link\" target=\"_blank\">metabolism<\/a> end-products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocrine_system\" title=\"Endocrine system\" rel=\"external_link\" target=\"_blank\">endocrine system<\/a>, producing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erythropoietin\" title=\"Erythropoietin\" rel=\"external_link\" target=\"_blank\">erythropoietin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/1,25-dihydroxycholecalciferol\" class=\"mw-redirect\" title=\"1,25-dihydroxycholecalciferol\" rel=\"external_link\" target=\"_blank\">calcitriol<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Renin\" title=\"Renin\" rel=\"external_link\" target=\"_blank\">renin<\/a>. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Dialysis is an imperfect treatment to replace kidney function because it does not correct the compromised endocrine functions of the kidney. Dialysis treatments replace some of these functions through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffusion<\/a> (waste removal) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrafiltration\" title=\"Ultrafiltration\" rel=\"external_link\" target=\"_blank\">ultrafiltration<\/a> (fluid removal).<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Dialysis uses highly purified (also known as \"ultrapure\") water.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Principle\">Principle<\/span><\/h2>\n<p>Dialysis works on the principles of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffusion<\/a> of solutes and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrafiltration\" title=\"Ultrafiltration\" rel=\"external_link\" target=\"_blank\">ultrafiltration<\/a> of fluid across a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semi-permeable_membrane\" class=\"mw-redirect\" title=\"Semi-permeable membrane\" rel=\"external_link\" target=\"_blank\">semi-permeable membrane<\/a>. Diffusion is a property of substances in water; substances in water tend to move from an area of high concentration to an area of low concentration.<sup id=\"rdp-ebb-cite_ref-Mosby_7-0\" class=\"reference\"><a href=\"#cite_note-Mosby-7\" rel=\"external_link\">[7]<\/a><\/sup> Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side. A semipermeable membrane is a thin layer of material that contains holes of various sizes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances (for example, red blood cells, large proteins). This replicates the filtering process that takes place in the kidneys when the blood enters the kidneys and the larger substances are separated from the smaller ones in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glomerulus\" title=\"Glomerulus\" rel=\"external_link\" target=\"_blank\">glomerulus<\/a>.<sup id=\"rdp-ebb-cite_ref-Mosby_7-1\" class=\"reference\"><a href=\"#cite_note-Mosby-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ae\/Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\/220px-Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg.png\" width=\"220\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Osmosis diffusion ultrafiltration and dialysis<\/div><\/div><\/div>\n<p>The two main types of dialysis, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a>, remove wastes and excess water from the blood in different ways.<sup id=\"rdp-ebb-cite_ref-Pendse_1-1\" class=\"reference\"><a href=\"#cite_note-Pendse-1\" rel=\"external_link\">[1]<\/a><\/sup> Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialyzer\" class=\"mw-redirect\" title=\"Dialyzer\" rel=\"external_link\" target=\"_blank\">dialyzer<\/a>, that contains a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semipermeable_membrane\" title=\"Semipermeable membrane\" rel=\"external_link\" target=\"_blank\">semipermeable membrane<\/a>. The blood flows in one direction and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysate\" class=\"mw-redirect\" title=\"Dialysate\" rel=\"external_link\" target=\"_blank\">dialysate<\/a> flows in the opposite. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Countercurrent_exchange\" title=\"Countercurrent exchange\" rel=\"external_link\" target=\"_blank\">counter-current flow<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> and dialysate maximizes the concentration gradient of solutes between the blood and dialysate, which helps to remove more urea and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creatinine\" title=\"Creatinine\" rel=\"external_link\" target=\"_blank\">creatinine<\/a> from the blood. The concentrations of solutes (for example <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium\" title=\"Potassium\" rel=\"external_link\" target=\"_blank\">potassium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus\" title=\"Phosphorus\" rel=\"external_link\" target=\"_blank\">phosphorus<\/a> and urea) are undesirably high in the blood, but low or absent in the dialysis solution, and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of minerals like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium\" title=\"Potassium\" rel=\"external_link\" target=\"_blank\">potassium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">calcium<\/a> that are similar to their natural concentration in healthy blood. For another solute, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicarbonate\" title=\"Bicarbonate\" rel=\"external_link\" target=\"_blank\">bicarbonate<\/a>, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicarbonate\" title=\"Bicarbonate\" rel=\"external_link\" target=\"_blank\">bicarbonate<\/a> into the blood, to act as a pH buffer to neutralize the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolic_acidosis\" title=\"Metabolic acidosis\" rel=\"external_link\" target=\"_blank\">metabolic acidosis<\/a> that is often present in these patients. The levels of the components of dialysate are typically prescribed by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrologist\" class=\"mw-redirect\" title=\"Nephrologist\" rel=\"external_link\" target=\"_blank\">nephrologist<\/a> according to the needs of the individual patient.\n<\/p><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a>, wastes and water are removed from the blood inside the body using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneum\" title=\"Peritoneum\" rel=\"external_link\" target=\"_blank\">peritoneum<\/a> as a natural semipermeable membrane. Wastes and excess water move from the blood, across the peritoneal membrane and into a special dialysis solution, called dialysate, in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_cavity\" title=\"Abdominal cavity\" rel=\"external_link\" target=\"_blank\">abdominal cavity<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>There are three primary and two secondary types of dialysis: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> (primary), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a> (primary), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemofiltration\" title=\"Hemofiltration\" rel=\"external_link\" target=\"_blank\">hemofiltration<\/a> (primary), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodiafiltration\" class=\"mw-redirect\" title=\"Hemodiafiltration\" rel=\"external_link\" target=\"_blank\">hemodiafiltration<\/a> (secondary) and (secondary).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemodialysis\">Hemodialysis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">Hemodialysis<\/a><\/div><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemodialysis-en.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Hemodialysis-en.svg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Hemodialysis-en.svg\/654px-Hemodialysis-en.svg.png\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a>\n<\/p><p>In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semipermeable_membrane\" title=\"Semipermeable membrane\" rel=\"external_link\" target=\"_blank\">partially permeable membrane<\/a>. The dialyzer is composed of thousands of tiny hollow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_fiber\" title=\"Synthetic fiber\" rel=\"external_link\" target=\"_blank\">synthetic fibers<\/a>. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate and allows the removal of several litres of excess fluid during a typical 4-hour treatment.\n<p>In the United States, hemodialysis treatments are typically given in a dialysis center three times per week (due in the United States to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicare_(United_States)\" title=\"Medicare (United States)\" rel=\"external_link\" target=\"_blank\">Medicare<\/a> reimbursement rules); however, as of 2005 over 2,500 people in the United States are dialyzing at home more frequently for various treatment lengths.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually called <i>nocturnal daily hemodialysis<\/i>, which a study has shown it provides a significant improvement in both small and large <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> clearance and decreases the need for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphate_binder\" title=\"Phosphate binder\" rel=\"external_link\" target=\"_blank\">phosphate binders<\/a>.<sup id=\"rdp-ebb-cite_ref-pmid17603969_10-0\" class=\"reference\"><a href=\"#cite_note-pmid17603969-10\" rel=\"external_link\">[10]<\/a><\/sup> These frequent long treatments are often done at home while sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week to week. In general, studies show that both increased treatment length and frequency are clinically beneficial.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<\/p><p>Hemo-dialysis was one of the most common procedures performed in U.S. hospitals in 2011, occurring in 909,000 stays (a rate of 29 stays per 10,000 population).<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Peritoneal_dialysis\">Peritoneal dialysis<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Peritoneal_dialysis.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/Peritoneal_dialysis.gif\/220px-Peritoneal_dialysis.gif\" width=\"220\" height=\"239\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Peritoneal_dialysis.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Schematic diagram of peritoneal dialysis<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">Peritoneal dialysis<\/a><\/div>\n<p>In peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a tube into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneum\" title=\"Peritoneum\" rel=\"external_link\" target=\"_blank\">peritoneal cavity<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdominal<\/a> body cavity around the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intestine\" class=\"mw-redirect\" title=\"Intestine\" rel=\"external_link\" target=\"_blank\">intestine<\/a>, where the peritoneal membrane acts as a partially permeable membrane.\n<\/p><p>This exchange is repeated 4\u20135 times per day; automatic systems can run more frequent exchange cycles overnight. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient, often without help. This frees patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week. Peritoneal dialysis can be performed with little to no specialized equipment (other than bags of fresh dialysate).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemofiltration\">Hemofiltration<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemofiltration\" title=\"Hemofiltration\" rel=\"external_link\" target=\"_blank\">Hemofiltration<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_(CVVH).svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d0\/Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg\/220px-Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg.png\" width=\"220\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_(CVVH).svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Continuous veno-venous haemofiltration with pre- and post-dilution (CVVH)<\/div><\/div><\/div>\n<p>Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or \"hemofilter\" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, \"dragging\" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost from the blood during this process are replaced with a \"substitution fluid\" that is infused into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracorporeal\" title=\"Extracorporeal\" rel=\"external_link\" target=\"_blank\">extracorporeal<\/a> circuit during the treatment.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemodiafiltration\">Hemodiafiltration<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodiafiltration\" class=\"mw-redirect\" title=\"Hemodiafiltration\" rel=\"external_link\" target=\"_blank\">Hemodiafiltration<\/a> is a combination of hemodialysis and hemofiltration, thus used to purify the blood from toxins when the kidney is not working normally and also used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_injury\" title=\"Acute kidney injury\" rel=\"external_link\" target=\"_blank\">acute kidney injury<\/a> (AKI).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Intestinal_dialysis\">Intestinal dialysis<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_HaemoDIALAfiltration_(CVVHDF).svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg\/220px-Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg.png\" width=\"220\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_HaemoDIALAfiltration_(CVVHDF).svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Continuous veno-venous haemodiafiltration (CVVHDF)<\/div><\/div><\/div>\n<p>In intestinal dialysis, the diet is supplemented with soluble fibres such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gum_arabic\" title=\"Gum arabic\" rel=\"external_link\" target=\"_blank\">acacia fibre<\/a>, which is digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in fecal waste.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_glycol\" title=\"Polyethylene glycol\" rel=\"external_link\" target=\"_blank\">polyethylene glycol<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mannitol\" title=\"Mannitol\" rel=\"external_link\" target=\"_blank\">mannitol<\/a> every fourth hour.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>The decision to initiate dialysis or hemofiltration in patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_failure\" title=\"Kidney failure\" rel=\"external_link\" target=\"_blank\">kidney failure<\/a> depends on several factors. These can be divided into acute or chronic indications.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Acute_indications\">Acute indications<\/span><\/h3>\n<p>Indications for dialysis in the patient with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_injury\" title=\"Acute kidney injury\" rel=\"external_link\" target=\"_blank\">acute kidney injury<\/a> are summarized with the vowel mnemonic of \"AEIOU\":<sup id=\"rdp-ebb-cite_ref-irwin_17-0\" class=\"reference\"><a href=\"#cite_note-irwin-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acidemia\" class=\"mw-redirect\" title=\"Acidemia\" rel=\"external_link\" target=\"_blank\">Acidemia<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolic_acidosis\" title=\"Metabolic acidosis\" rel=\"external_link\" target=\"_blank\">metabolic acidosis<\/a> in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrolyte\" title=\"Electrolyte\" rel=\"external_link\" target=\"_blank\">Electrolyte<\/a> abnormality, such as severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperkalemia\" title=\"Hyperkalemia\" rel=\"external_link\" target=\"_blank\">hyperkalemia<\/a>, especially when combined with AKI.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Substance_intoxication\" title=\"Substance intoxication\" rel=\"external_link\" target=\"_blank\">Intoxication<\/a>, that is, acute poisoning with a dialyzable substance. These substances can be represented by the mnemonic SLIME: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salicylic_acid\" title=\"Salicylic acid\" rel=\"external_link\" target=\"_blank\">salicylic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium\" title=\"Lithium\" rel=\"external_link\" target=\"_blank\">lithium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isopropanol\" class=\"mw-redirect\" title=\"Isopropanol\" rel=\"external_link\" target=\"_blank\">isopropanol<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a>-containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laxative\" title=\"Laxative\" rel=\"external_link\" target=\"_blank\">laxatives<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a>.<\/li>\n<li>Overload of fluid not expected to respond to treatment with diuretics<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Uremia\" title=\"Uremia\" rel=\"external_link\" target=\"_blank\">Uremia<\/a> complications, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericarditis\" title=\"Pericarditis\" rel=\"external_link\" target=\"_blank\">pericarditis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Encephalopathy\" title=\"Encephalopathy\" rel=\"external_link\" target=\"_blank\">encephalopathy<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_bleeding\" title=\"Gastrointestinal bleeding\" rel=\"external_link\" target=\"_blank\">gastrointestinal bleeding<\/a>.<\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Chronic_indications\">Chronic indications<\/span><\/h3>\n<p>Chronic dialysis may be indicated when a patient has symptomatic kidney failure and low glomerular filtration rate (GFR < 15 mL\/min).<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Between 1996 and 2008, there was a trend to initiate dialysis at progressively higher estimated GFR, eGFR.\nA review of the evidence shows no benefit or potential harm with early dialysis initiation, which has been defined by start of dialysis at an estimated GFR of greater than 10ml\/min\/1.73<sup>2<\/sup>. Observational data from large registries of dialysis patients suggests that early start of dialysis may be harmful.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\nThe most recent published guidelines from Canada, for when to initiate dialysis, recommend an intent to defer dialysis until a patient has definite kidney failure symptoms, which may occur at an estimated GFR of 5-9ml\/min\/1.73<sup>2<\/sup>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Dialyzable_substances\">Dialyzable substances<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Characteristics\">Characteristics<\/span><\/h3>\n<p><a href=\"https:\/\/en.wiktionary.org\/wiki\/dialyzable\" class=\"extiw\" title=\"wiktionary:dialyzable\" rel=\"external_link\" target=\"_blank\">Dialyzable<\/a> substances\u2014substances removeable with dialysis\u2014have these properties:\n<\/p>\n<ol><li>Low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_mass\" title=\"Molecular mass\" rel=\"external_link\" target=\"_blank\">molecular mass<\/a><\/li>\n<li>High water solubility<\/li>\n<li>Low protein binding capacity<\/li>\n<li>Prolonged elimination (long <a href=\"https:\/\/en.wikipedia.org\/wiki\/Half-life\" title=\"Half-life\" rel=\"external_link\" target=\"_blank\">half-life<\/a>)<\/li>\n<li>Small volume of distribution<\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Substances\">Substances<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol_poisoning\" title=\"Ethylene glycol poisoning\" rel=\"external_link\" target=\"_blank\">Ethylene glycol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Procainamide\" title=\"Procainamide\" rel=\"external_link\" target=\"_blank\">Procainamide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">Methanol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Isopropyl_alcohol\" title=\"Isopropyl alcohol\" rel=\"external_link\" target=\"_blank\">Isopropyl alcohol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barbiturates\" class=\"mw-redirect\" title=\"Barbiturates\" rel=\"external_link\" target=\"_blank\">Barbiturates<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_(medication)\" title=\"Lithium (medication)\" rel=\"external_link\" target=\"_blank\">Lithium<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_bromide\" title=\"Potassium bromide\" rel=\"external_link\" target=\"_blank\">Bromide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sotalol\" title=\"Sotalol\" rel=\"external_link\" target=\"_blank\">Sotalol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chloral_hydrate\" title=\"Chloral hydrate\" rel=\"external_link\" target=\"_blank\">Chloral hydrate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethanol\" title=\"Ethanol\" rel=\"external_link\" target=\"_blank\">Ethanol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetone\" title=\"Acetone\" rel=\"external_link\" target=\"_blank\">Acetone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atenolol\" title=\"Atenolol\" rel=\"external_link\" target=\"_blank\">Atenolol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Theophylline\" title=\"Theophylline\" rel=\"external_link\" target=\"_blank\">Theophylline<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Salicylic_acid\" title=\"Salicylic acid\" rel=\"external_link\" target=\"_blank\">Salicylates<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Pediatric_dialysis\">Pediatric dialysis<\/span><\/h2>\n<p>Over the past 20 years, children have benefited from major improvements in both technology and clinical management of dialysis. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morbidity\" class=\"mw-redirect\" title=\"Morbidity\" rel=\"external_link\" target=\"_blank\">Morbidity<\/a> during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Non-invasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs.\n<\/p><p>Biocompatible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_membranes\" class=\"mw-redirect\" title=\"Synthetic membranes\" rel=\"external_link\" target=\"_blank\">synthetic membranes<\/a>, specific small size material dialyzers and new low extra-corporeal volume tubing have been developed for young infants. Arterial and venous tubing length is made of minimum length and diameter, a <80ml to <110ml volume tubing is designed for pediatric patients and a >130 to <224ml tubing are for adult patients, regardless of blood pump segment size, which can be of 6.4mm for normal dialysis or 8.0mm for high flux dialysis in all patients. All dialysis machine manufacturers design their machine to do the pediatric dialysis. In pediatric patients, the pump speed should be kept at low side, according to patient blood output capacity, and the clotting with heparin dose should be carefully monitored. The high flux dialysis (see below) is not recommended for pediatric patients.\n<\/p><p>In children, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> must be individualized and viewed as an \"integrated therapy\" that considers their long-term exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning.long-term chronic dialysis, however, the highest standards should be applied to these children to preserve their future \"cardiovascular life\"\u2014which might include more dialysis time and on-line hemodiafiltration online hdf with synthetic high flux membranes with the surface area of 0.2sq.m to 0.8sq.m and blood tubing lines with the low volume yet large blood pump segment of 6.4\/8.0mm, if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Dialysis_in_different_countries\">Dialysis in different countries<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"In_the_United_Kingdom\">In the United Kingdom<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Health_Service\" title=\"National Health Service\" rel=\"external_link\" target=\"_blank\">National Health Service<\/a> provides dialysis in the United Kingdom. In England the service is commissioned by <a href=\"https:\/\/en.wikipedia.org\/wiki\/NHS_England\" title=\"NHS England\" rel=\"external_link\" target=\"_blank\">NHS England<\/a>. About 23,000 patients use the service each year.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_transport\" title=\"Patient transport\" rel=\"external_link\" target=\"_blank\">Patient transport<\/a> services are generally provided without charge, for patients who need to travel to dialysis centres. Cornwall <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Commissioning_Group\" class=\"mw-redirect\" title=\"Clinical Commissioning Group\" rel=\"external_link\" target=\"_blank\">Clinical Commissioning Group<\/a> proposed to restrict this provision to patients who did not have specific medical or financial reasons in 2018 but changed their minds after a campaign led by and decided to fund transport for patients requiring dialysis three times a week for a minimum of six weeks, or six times a month for a minimum of three months.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"In_the_United_States\">In the United States<\/span><\/h3>\n<p>Since 1972, the United States has covered the cost of dialysis and transplants for all citizens. By 2014, more than 460,000 Americans were undergoing treatment, the costs of which amount to 6 percent of the entire Medicare budget. Kidney disease is the ninth leading cause of death, and the U.S. has one of the highest mortality rates for dialysis care in the industrialized world. The rate of patients getting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_transplantation\" title=\"Kidney transplantation\" rel=\"external_link\" target=\"_blank\">kidney transplants<\/a> has been lower than expected. These outcomes have been blamed on a new for-profit dialysis industry responding to government payment policies.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> A 1999 study concluded that \"patients treated in for-profit dialysis facilities have higher mortality rates and are less likely to be placed on the waiting list for a renal transplant than are patients who are treated in not-for-profit facilities\", possibly because transplantation removes a constant stream of revenue from the facility.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> The insurance industry has complained about kickbacks and problematic relationships between charities and providers.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"In_China\">In China<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Government_of_China_(disambiguation)\" class=\"mw-disambig\" title=\"Government of China (disambiguation)\" rel=\"external_link\" target=\"_blank\">Government of China<\/a> provides the funding for dialysis treatment. There is a challenge to reach everyone who needs dialysis treatment because of the unequal distribution of health care resources and dialysis centers.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> There are 395,121 individuals who receive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a> in China per year. The percentage of the Chinese population with chronic kidney disease is 10.8%.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> The Chinese Government is trying to increase the amount of peritoneal dialysis taking place to meet the needs of that nations's individuals with chronic kidney disease.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dialysis_-_arm_-_01.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Dialysis_-_arm_-_01.jpg\/150px-Dialysis_-_arm_-_01.jpg\" width=\"150\" height=\"105\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dialysis_-_arm_-_01.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Arm hooked up to dialysis tubing.<\/div><\/div><\/div>\n<p>A Dutch doctor, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Willem_Johan_Kolff\" title=\"Willem Johan Kolff\" rel=\"external_link\" target=\"_blank\">Willem Johan Kolff<\/a>, constructed the first working dialyzer in 1943 during\nthe <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_the_Netherlands_(1939%E2%80%931945)\" class=\"mw-redirect\" title=\"History of the Netherlands (1939\u20131945)\" rel=\"external_link\" target=\"_blank\">Nazi occupation of the Netherlands<\/a>.<sup id=\"rdp-ebb-cite_ref-NYT_31-0\" class=\"reference\"><a href=\"#cite_note-NYT-31\" rel=\"external_link\">[31]<\/a><\/sup> Due to the scarcity of available resources, Kolff had to improvise and build the initial machine using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Casing_(sausage)\" class=\"mw-redirect\" title=\"Casing (sausage)\" rel=\"external_link\" target=\"_blank\">sausage casings<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beverage_can\" class=\"mw-redirect\" title=\"Beverage can\" rel=\"external_link\" target=\"_blank\">beverage cans<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Washing_machine\" title=\"Washing machine\" rel=\"external_link\" target=\"_blank\">washing machine<\/a> and various other items that were available at the time. Over the following two years (1944\u20131945), Kolff used his machine to treat 16 patients suffering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_failure\" class=\"mw-redirect\" title=\"Acute kidney failure\" rel=\"external_link\" target=\"_blank\">acute kidney failure<\/a>, but the results were unsuccessful. Then, in 1945, a 67-year-old comatose woman regained consciousness following 11 hours of hemodialysis with the dialyzer and lived for another seven years before dying from an unrelated condition. She was the first-ever patient successfully treated with dialysis.<sup id=\"rdp-ebb-cite_ref-NYT_31-1\" class=\"reference\"><a href=\"#cite_note-NYT-31\" rel=\"external_link\">[31]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nils_Alwall\" title=\"Nils Alwall\" rel=\"external_link\" target=\"_blank\">Nils Alwall<\/a> modified a similar construction to the Kolff dialysis machine by enclosing it inside a stainless steel canister. This allowed the removal of fluids, by applying a negative pressure to the outside canister, thus making it the first truly practical device for hemodialysis. Alwall treated his first patient in acute kidney failure on 3 September 1946.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Materials_and_methods\">Materials and methods<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thomas_Graham_(chemist)\" title=\"Thomas Graham (chemist)\" rel=\"external_link\" target=\"_blank\">Thomas Graham (chemist)<\/a>, the founder of dialysis and father of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colloid_chemistry\" class=\"mw-redirect\" title=\"Colloid chemistry\" rel=\"external_link\" target=\"_blank\">colloid chemistry<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis_tubing\" title=\"Dialysis tubing\" rel=\"external_link\" target=\"_blank\">Dialysis tubing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_US_dialysis_providers\" title=\"List of US dialysis providers\" rel=\"external_link\" target=\"_blank\">List of US dialysis providers<\/a><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Medical_applications\">Medical applications<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apheresis\" title=\"Apheresis\" rel=\"external_link\" target=\"_blank\">Apheresis<\/a>, also known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasmapheresis\" title=\"Plasmapheresis\" rel=\"external_link\" target=\"_blank\">plasmapheresis<\/a>, is another <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracorporeal\" title=\"Extracorporeal\" rel=\"external_link\" target=\"_blank\">extracorporeal<\/a> technique that selectively removes specific constituents from blood<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">Hemodialysis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">Peritoneal dialysis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_failure\" class=\"mw-redirect\" title=\"Acute kidney failure\" rel=\"external_link\" target=\"_blank\">Acute kidney failure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_failure\" title=\"Kidney failure\" rel=\"external_link\" target=\"_blank\">Kidney failure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrology\" title=\"Nephrology\" rel=\"external_link\" target=\"_blank\">Nephrology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_kidney_disease\" title=\"Chronic kidney disease\" rel=\"external_link\" target=\"_blank\">Chronic kidney disease<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatorenal_syndrome\" title=\"Hepatorenal syndrome\" rel=\"external_link\" target=\"_blank\">Hepatorenal syndrome<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Pendse-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Pendse_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Pendse_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Pendse S, Singh A, Zawada E. Initiation of Dialysis. In: <i>Handbook of Dialysis<\/i>. 4th ed. New York, NY; 2008:14\u201321<\/span>\n<\/li>\n<li id=\"cite_note-Garrett-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Garrett_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Garrett, Reginald H.; Grisham, Charles M. (2013). <i>Biochemistry<\/i> (5th ed.). p. 107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-133-10629-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biochemistry&rft.pages=107&rft.edition=5th&rft.date=2013&rft.isbn=978-1-133-10629-6&rft.aulast=Garrett&rft.aufirst=Reginald+H.&rft.au=Grisham%2C+Charles+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Ninfa, Alexander J.; Ballou, David P.; Benore, Marilee (2009). <i>Fundamental Laboratory Approaches for Biochemistry and Biotechnology<\/i> (2nd ed.). p. 45. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-470-08766-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Fundamental+Laboratory+Approaches+for+Biochemistry+and+Biotechnology&rft.pages=45&rft.edition=2nd&rft.date=2009&rft.isbn=978-0-470-08766-4&rft.aulast=Ninfa&rft.aufirst=Alexander+J.&rft.au=Ballou%2C+David+P.&rft.au=Benore%2C+Marilee&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Brundage D. <i>Renal Disorders<\/i>. St. Louis, MO: Mosby; 1992<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kidneyatlas.org\/book5\/adk5-01.ccc.QXD.pdf\" target=\"_blank\">\"Atlas of Diseases of the Kidney, Volume 5, Principles of Dialysis: Diffusion, Convection, and Dialysis Machines\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-09-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Atlas+of+Diseases+of+the+Kidney%2C+Volume+5%2C+Principles+of+Dialysis%3A+Diffusion%2C+Convection%2C+and+Dialysis+Machines&rft_id=http%3A%2F%2Fwww.kidneyatlas.org%2Fbook5%2Fadk5-01.ccc.QXD.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.davita.com\/treatment-options\/hemodialysis\/home-hemodialysis\/home-hemodialysis-and-water-treatment\/t\/5581\" target=\"_blank\">\"Home Hemodialysis and Water Treatment\"<\/a>. <i>Davita<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">3 June<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Davita&rft.atitle=Home+Hemodialysis+and+Water+Treatment&rft_id=https%3A%2F%2Fwww.davita.com%2Ftreatment-options%2Fhemodialysis%2Fhome-hemodialysis%2Fhome-hemodialysis-and-water-treatment%2Ft%2F5581&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mosby-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Mosby_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Mosby_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><i>Mosby\u2019s Dictionary of Medicine, Nursing, & Health Professions<\/i>. 7th ed. St. Louis, MO; Mosby: 2006<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ahmad S, Misra Hemodialysis Apparatus. In: <i>Handbook of Dialysis<\/i>. 4th ed. New York, NY; 2008:59-78.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usrds.org\/2007\/pdf\/04_modalities_07.pdf\" target=\"_blank\">\"USRDS Treatment Modalities\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>United States Renal Data System<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-09-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=United+States+Renal+Data+System&rft.atitle=USRDS+Treatment+Modalities&rft_id=http%3A%2F%2Fwww.usrds.org%2F2007%2Fpdf%2F04_modalities_07.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid17603969-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid17603969_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rocco, MV (July 2007). \"More Frequent Hemodialysis: Back to the Future?\". <i>Advances in Chronic Kidney Disease<\/i>. <b>14<\/b> (3): e1\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fj.ackd.2007.04.006\" target=\"_blank\">10.1053\/j.ackd.2007.04.006<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17603969\" target=\"_blank\">17603969<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Chronic+Kidney+Disease&rft.atitle=More+Frequent+Hemodialysis%3A+Back+to+the+Future%3F&rft.volume=14&rft.issue=3&rft.pages=e1-9&rft.date=2007-07&rft_id=info%3Adoi%2F10.1053%2Fj.ackd.2007.04.006&rft_id=info%3Apmid%2F17603969&rft.aulast=Rocco&rft.aufirst=MV&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.homedialysis.org\/learn\/types\/\" target=\"_blank\">Daily therapy study results compared<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110305085319\/http:\/\/www.homedialysis.org\/learn\/types\/\" target=\"_blank\">Archived<\/a> March 5, 2011, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. <a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.hcup-us.ahrq.gov\/reports\/statbriefs\/sb165.jsp\" target=\"_blank\">[1]<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/medline\/abstract\/15293039\" target=\"_blank\">\"Access\"<\/a>. Medscape<span class=\"reference-accessdate\">. 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Wang, Fang; Wang, Li; Wang, Wenke; Liu, Bicheng; Liu, Jian; Chen, Menghua; He, Qiang; Liao, Yunhua (2012-03-03). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0140673612600336\" target=\"_blank\">\"Prevalence of chronic kidney disease in China: a cross-sectional survey\"<\/a>. <i>The Lancet<\/i>. <b>379<\/b> (9818): 815\u2013822. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0140-6736%2812%2960033-6\" target=\"_blank\">10.1016\/S0140-6736(12)60033-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22386035\" target=\"_blank\">22386035<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Lancet&rft.atitle=Prevalence+of+chronic+kidney+disease+in+China%3A+a+cross-sectional+survey&rft.volume=379&rft.issue=9818&rft.pages=815-822&rft.date=2012-03-03&rft_id=info%3Adoi%2F10.1016%2FS0140-6736%2812%2960033-6&rft_id=info%3Apmid%2F22386035&rft.aulast=Zhang&rft.aufirst=Luxia&rft.au=Wang%2C+Fang&rft.au=Wang%2C+Li&rft.au=Wang%2C+Wenke&rft.au=Liu%2C+Bicheng&rft.au=Liu%2C+Jian&rft.au=Chen%2C+Menghua&rft.au=He%2C+Qiang&rft.au=Liao%2C+Yunhua&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0140673612600336&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Li, Philip Kam-Tao; Lui, Sing Leung; Ng, Jack Kit-Chung; Cai, Guan Yan; Chan, Christopher T; Chen, Hung Chun; Cheung, Alfred K; Choi, Koon Shing; Choong, Hui Lin (2017-12-01). \"Addressing the burden of dialysis around the world: A summary of the roundtable discussion on dialysis economics at the First International Congress of Chinese Nephrologists 2015\". <i>Nephrology<\/i>. <b>22<\/b>: 3\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fnep.13143\" target=\"_blank\">10.1111\/nep.13143<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1440-1797\" target=\"_blank\">1440-1797<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29155495\" target=\"_blank\">29155495<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nephrology&rft.atitle=Addressing+the+burden+of+dialysis+around+the+world%3A+A+summary+of+the+roundtable+discussion+on+dialysis+economics+at+the+First+International+Congress+of+Chinese+Nephrologists+2015&rft.volume=22&rft.pages=3-8&rft.date=2017-12-01&rft.issn=1440-1797&rft_id=info%3Apmid%2F29155495&rft_id=info%3Adoi%2F10.1111%2Fnep.13143&rft.aulast=Li&rft.aufirst=Philip+Kam-Tao&rft.au=Lui%2C+Sing+Leung&rft.au=Ng%2C+Jack+Kit-Chung&rft.au=Cai%2C+Guan+Yan&rft.au=Chan%2C+Christopher+T&rft.au=Chen%2C+Hung+Chun&rft.au=Cheung%2C+Alfred+K&rft.au=Choi%2C+Koon+Shing&rft.au=Choong%2C+Hui+Lin&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NYT-31\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NYT_31-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NYT_31-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Blakeslee, Sandra (12 February 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2009\/02\/13\/health\/13kolff.html?pagewanted=all\" target=\"_blank\">\"Willem Kolff, Doctor Who Invented Kidney and Heart Machines, Dies at 97\"<\/a>. <i>The New York Times<\/i>. New York Times.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Willem+Kolff%2C+Doctor+Who+Invented+Kidney+and+Heart+Machines%2C+Dies+at+97&rft.date=2009-02-12&rft.aulast=Blakeslee&rft.aufirst=Sandra&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2009%2F02%2F13%2Fhealth%2F13kolff.html%3Fpagewanted%3Dall&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Bibliography\">Bibliography<\/span><\/h2>\n<div class=\"refbegin columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em;\">\n<ul><li><cite class=\"citation journal\">Al-Mosawi A. J. 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A.; Ali K. E.; Fadlalla A. E.; Khalid K. E. (2008). \"The effects of gum arabic oral treatment on the metabolic profile of chronic renal failure patients under regular haemodialysis in Central Sudan\". <i>Natural Product Research<\/i>. <b>22<\/b> (1): 12\u201321. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F14786410500463544\" target=\"_blank\">10.1080\/14786410500463544<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17999333\" target=\"_blank\">17999333<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Natural+Product+Research&rft.atitle=The+effects+of+gum+arabic+oral+treatment+on+the+metabolic+profile+of+chronic+renal+failure+patients+under+regular+haemodialysis+in+Central+Sudan&rft.volume=22&rft.issue=1&rft.pages=12-21&rft.date=2008&rft_id=info%3Adoi%2F10.1080%2F14786410500463544&rft_id=info%3Apmid%2F17999333&rft.au=Ali+A.+A.&rft.au=Ali+K.+E.&rft.au=Fadlalla+A.+E.&rft.au=Khalid+K.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Miskowiak J (1991). \"Continuous Intestinal Dialysis for Uraemia by Intermittent Oral Intake of Non-Absorbable Solutions: An Experimental Study\". <i>Scandinavian Journal of Urology and Nephrology<\/i>. <b>25<\/b> (1): 71\u201374. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F00365599109024532\" target=\"_blank\">10.3109\/00365599109024532<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scandinavian+Journal+of+Urology+and+Nephrology&rft.atitle=Continuous+Intestinal+Dialysis+for+Uraemia+by+Intermittent+Oral+Intake+of+Non-Absorbable+Solutions%3A+An+Experimental+Study&rft.volume=25&rft.issue=1&rft.pages=71-74&rft.date=1991&rft_id=info%3Adoi%2F10.3109%2F00365599109024532&rft.au=Miskowiak+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite id=\"rdp-ebb-CITEREFStefania_CrowtherLois_ReynoldsTilli_Tansey2009\" class=\"citation\">Stefania Crowther; Lois Reynolds; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tilli_Tansey\" title=\"Tilli Tansey\" rel=\"external_link\" target=\"_blank\">Tilli Tansey<\/a>, eds. (2009), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.histmodbiomed.org\/witsem\/vol37\" target=\"_blank\"><i>History of Dialysis in the UK: c. 1950-1980<\/i><\/a>, Wellcome Witnesses to Contemporary Medicine, <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_Modern_Biomedicine_Research_Group\" title=\"History of Modern Biomedicine Research Group\" rel=\"external_link\" target=\"_blank\">History of Modern Biomedicine Research Group<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-85484-122-6<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=History+of+Dialysis+in+the+UK%3A+c.+1950-1980&rft.series=Wellcome+Witnesses+to+Contemporary+Medicine&rft.pub=History+of+Modern+Biomedicine+Research+Group&rft.date=2009&rft.isbn=978-0-85484-122-6&rft_id=http%3A%2F%2Fwww.histmodbiomed.org%2Fwitsem%2Fvol37&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikidata\" title=\"Wikidata\" rel=\"external_link\" target=\"_blank\">Wikidata<\/a> <a href=\"https:\/\/www.wikidata.org\/wiki\/Q29581768\" class=\"extiw\" title=\"d:Q29581768\" rel=\"external_link\" target=\"_blank\">Q29581768<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=ZyEDAAAAMBAJ&pg=PA103#v=onepage&f=true\" target=\"_blank\">Machine Cleans Blood While You Wait<\/a>\u20141950 article on early use of dialysis machine at Bellevue Hospital New York City\u2014i.e. example of how complex and large early dialysis machines were<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.homedialysis.org\/home-dialysis-basics\/machines-and-supplies\/dialysis-museum\" target=\"_blank\">Home Dialysis Museum<\/a>\u2014History and pictures of dialysis machines through time<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.maximintegrated.com\/app-notes\/index.mvp\/id\/4698\" target=\"_blank\">Introduction to Dialysis Machines<\/a>\u2014Tutorial describing the main subfunctions of dialysis systems.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cbc.ca\/news\/canada\/thunder-bay\/home-dialysis-1.3873291\" target=\"_blank\">First Nations man conducts own dialysis treatments to avoid move to the city<\/a>\u2014<a href=\"https:\/\/en.wikipedia.org\/wiki\/CBC_News\" title=\"CBC News\" rel=\"external_link\" target=\"_blank\">CBC News<\/a> (November 30, 2016)<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181212175009\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.584 seconds\nReal time usage: 0.765 seconds\nPreprocessor visited node count: 2569\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 85124\/2097152 bytes\nTemplate argument size: 1165\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 80204\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.303\/10.000 seconds\nLua memory usage: 6.66 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 628.836 1 -total\n<\/p>\n<pre>38.75% 243.674 1 Template:Reflist\n21.64% 136.086 1 Template:Cite_Q\n14.84% 93.333 13 Template:Cite_journal\n11.17% 70.220 3 Template:Cite_book\n10.37% 65.201 1 Template:Infobox_interventions\n 9.47% 59.574 1 Template:Infobox\n 7.61% 47.876 1 Template:About\n 6.80% 42.792 1 Template:Citation_needed\n 5.78% 36.327 1 Template:Fix\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:56511-1!canonical and timestamp 20181212175008 and revision id 873325604\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214659\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.044 seconds\nReal time usage: 0.210 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 200.255 1 - wikipedia:Dialysis\n100.00% 200.255 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8565-0!*!*!*!*!*!* and timestamp 20181217214659 and revision id 24993\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Dialysis\">https:\/\/www.limswiki.org\/index.php\/Dialysis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1015376d34b6db14e7bd61c81d508dc0_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Patient_receiving_dialysis_03.jpg\/560px-Patient_receiving_dialysis_03.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Hemodialysismachine.jpg\/440px-Hemodialysismachine.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ae\/Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\/440px-Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Hemodialysis-en.svg\/1308px-Hemodialysis-en.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/4e\/Peritoneal_dialysis.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d0\/Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg\/440px-Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg\/440px-Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Dialysis_-_arm_-_01.jpg\/300px-Dialysis_-_arm_-_01.jpg"],"1015376d34b6db14e7bd61c81d508dc0_timestamp":1545083219,"6f55d1dae5110a6096abf37240670631_type":"article","6f55d1dae5110a6096abf37240670631_title":"Computer-assisted surgery","6f55d1dae5110a6096abf37240670631_url":"https:\/\/www.limswiki.org\/index.php\/Computer-assisted_surgery","6f55d1dae5110a6096abf37240670631_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tComputer-assisted surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tComputer-assisted surgeryICD-9-CM00.3[edit on Wikidata]\nComputer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.\n\nContents \n\n1 General principles \n\n1.1 Creating a virtual image of the patient \n1.2 Image analysis and processing \n1.3 Diagnostic, preoperative planning, surgical simulation \n1.4 Surgical navigation \n1.5 Robotic surgery \n\n\n2 Applications \n\n2.1 Computer-assisted neurosurgery \n2.2 Computer-assisted oral and maxillofacial surgery \n\n2.2.1 Guided Implantology \n\n\n2.3 Computer-assisted ENT surgery \n2.4 Computer-assisted orthopedic surgery (CAOS) \n2.5 Computer-assisted visceral surgery \n2.6 Computer-assisted cardiac interventions \n2.7 Computer-assisted radiosurgery \n\n\n3 Advantages \n4 Disadvantages \n5 See also \n6 References \n7 External links \n\n\nGeneral principles \n Image gathering (\"segmentation\") on the LUCAS workstation\nCreating a virtual image of the patient \nThe most important component for CAS is the development of an accurate model of the patient. This can be conducted through a number of medical imaging technologies including CT, MRI, x-rays, ultrasound plus many more. For the generation of this model, the anatomical region to be operated has to be scanned and uploaded into the computer system. It is possible to employ a number of scanning methods, with the datasets combined through data fusion techniques. The final objective is the creation of a 3D dataset that reproduces the exact geometrical situation of the normal and pathological tissues and structures of that region. Of the available scanning methods, the CT is preferred,[1] because MRI data sets are known to have volumetric deformations that may lead to inaccuracies. An example data set can include the collection of data compiled with 180 CT slices, that are 1 mm apart, each having 512 by 512 pixels. The contrasts of the 3D dataset (with its tens of millions of pixels) provide the detail of soft vs hard tissue structures, and thus allow a computer to differentiate, and visually separate for a human, the different tissues and structures. The image data taken from a patient will often include intentional landmark features, in order to be able to later realign the virtual dataset against the actual patient during surgery. See patient registration.\n\nImage analysis and processing \nImage analysis involves the manipulation of the patients 3D model to extract relevant information from the data. Using the differing contrast levels of the different tissues within the imagery, as examples, a model can be changed to show just hard structures such as bone, or view the flow of arteries and veins through the brain.\n\n Diagnostic, preoperative planning, surgical simulation \nUsing specialized software the gathered dataset can be rendered as a virtual 3D model of the patient, this model can be easily manipulated by a surgeon to provide views from any angle and at any depth within the volume. Thus the surgeon can better assess the case and establish a more accurate diagnostic. Furthermore, the surgical intervention will be planned and simulated virtually, before actual surgery takes place (computer-aided surgical simulation [CASS]). Using dedicated software, the surgical robot will be programmed to carry out the planned actions during the actual surgical intervention.\n\nSurgical navigation \nIn computer-assisted surgery, the actual intervention is defined as surgical navigation. Using the surgical navigation system the surgeon uses special instruments, which are tracked by the navigation system. The position of a tracked instrument in relation to the patient's anatomy is shown on images of the patient, as the surgeon moves the instrument. The surgeon thus uses the system to 'navigate' the location of an instrument. The feedback the system provides of the instrument location is particularly useful in situations where the surgeon cannot actually see the tip of the instrument, such as in minimally invasive surgeries.\n\nRobotic surgery \nMain article: Robotic surgery\nRobotic surgery is a term used for correlated actions of a surgeon and a surgical robot (that has been programmed to carry out certain actions during the preoperative planning procedure). A surgical robot is a mechanical device (generally looking like a robotic arm) that is computer-controlled.\nRobotic surgery can be divided into three types, depending on the degree of surgeon interaction during the procedure: supervisory-controlled, telesurgical, and shared-control.[2] In a supervisory-controlled system, the procedure is executed solely by the robot, which will perform the pre-programmed actions. A telesurgical system, also known as remote surgery, requires the surgeon to manipulate the robotic arms during the procedure rather than allowing the robotic arms to work from a predetermined program. With shared-control systems, the surgeon carries out the procedure with the use of a robot that offers steady-hand manipulations of the instrument. In most robots, the working mode can be chosen for each separate intervention, depending on the surgical complexity and the particularities of the case.\n\nApplications \nComputer-assisted surgery is the beginning of a revolution in surgery. It already makes a great difference in high-precision surgical domains, but it is also used in standard surgical procedures.\n\nComputer-assisted neurosurgery \nTelemanipulators have been used for the first time in neurosurgery, in the 1980s. This allowed a greater development in brain microsurgery (compensating surgeon\u2019s physiological tremor by 10-fold), increased accuracy and precision of the intervention. It also opened a new gate to minimally invasive brain surgery, furthermore reducing the risk of post-surgical morbidity by avoiding accidental damage to adjacent centers.\n\nComputer-assisted oral and maxillofacial surgery \nBone segment navigation is the modern surgical approach in orthognathic surgery (correction of the anomalies of the jaws and skull), in temporo-mandibular joint (TMJ) surgery, or in the reconstruction of the mid-face and orbit.[3]\nIt is also used in implantology where the available bone can be seen and the position, angulation and depth of the implants can be simulated before the surgery. During the operation surgeon is guided visually and by sound alerts. IGI (Image Guided Implantology) is one of the navigation systems which uses this technology.\n\nGuided Implantology \nNew therapeutic concepts as guided surgery are being developed and applied in the placement of dental implants. The prosthetic rehabilitation is also planned and performed parallel to the surgical procedures. The planning steps are at the foreground and carried out in a cooperation of the surgeon, the dentist and the dental technician. Edentulous patients, either one or both jaws, benefit as the time of treatment is reduced.\nRegarding the edentulous patients, conventional denture support is often compromised due to moderate bone atrophy, even if the dentures are constructed based on correct anatomic morphology.\nUsing cone beam computed tomography, the patient and the existing prosthesis are being scanned. Furthermore, the prosthesis alone is also scanned. Glass pearls of defined diameter are placed in the prosthesis and used as reference points for the upcoming planning. The resulting data is processed and the position of the implants determined. The surgeon, using special developed software, plans the implants based on prosthetic concepts considering the anatomic morphology. After the planning of the surgical part is completed, a CAD\/CAM surgical guide for dental placement is constructed. The mucosal-supported surgical splint ensures the exact placement of the implants in the patient. Parallel to this step, the new implant supported prosthesis is constructed.\nThe dental technician, using the data resulting from the previous scans, manufactures a model representing the situation after the implant placement. The prosthetic compounds, abutments, are already prefabricated. The length and the inclination can be chosen. The abutments are connected to the model at a position in consideration of the prosthetic situation. The exact position of the abutments is registered. The dental technician can now manufacture the prosthesis.\nThe fit of the surgical splint is clinically proved. After that, the splint is attached using a three-point support pin system. Prior to the attachment, irrigation with a chemical disinfectant is advised. The pins are driven through defined sheaths from the vestibular to the oral side of the jaw. Ligaments anatomy should be considered, and if necessary decompensation can be achieved with minimal surgical interventions. The proper fit of the template is crucial and should be maintained throughout the whole treatment. Regardless of the mucosal resilience, a correct and stable attachment is achieved through the bone fixation.\nThe access to the jaw can now only be achieved through the sleeves embedded in the surgical template. Using specific burs through the sleeves the mucosa is removed. Every bur used, carries a sleeve compatible to the sleeves in the template, which ensures that the final position is achieved but no further progress in the alveolar ridge can take place. Further procedure is very similar to the traditional implant placement. The pilot hole is drilled and then expanded. With the aid of the splint, the implants are finally placed. After that, the splint can be removed.\n\n<\/p>With the aid of a registration template, the abutments can be attached and connected to the implants at the defined position. No less than a pair of abutments should be connected simultaneously to avoid any discrepancy. An important advantage of this technique is the parallel positioning of the abutments. A radiological control is necessary to verify the correct placement and connection of implant and abutment.\nIn a further step, abutments are covered by gold cone caps, which represent the secondary crowns. Where necessary, the transition of the gold cone caps to the mucosa can be isolated with rubber dam rings.\nThe new prosthesis corresponds to a conventional total prosthesis but the basis contains cavities so that the secondary crowns can be incorporated. The prosthesis is controlled at the terminal position and corrected if needed. The cavities are filled with a self-curing cement and the prosthesis is placed in the terminal position. After the self-curing process, the gold caps are definitely cemented in the prosthesis cavities and the prosthesis can now be detached. Excess cement may be removed and some corrections like polishing or under filling around the secondary crowns may be necessary.\nThe new prosthesis is fitted using a construction of telescope double cone crowns. At the end position, the prosthesis buttons down on the abutments to ensure an adequate hold.\n\n<\/p>At the same sitting, the patient receives the implants and the prosthesis. An interim prosthesis is not necessary. The extent of the surgery is kept to minimum. Due to the application of the splint, a reflection of soft tissues in not needed. The patient experiences less bleeding, swelling and discomfort. Complications such as injuring of neighbouring structures are also avoided. \nUsing 3D imaging during the planning phase, the communication between the surgeon, dentist and dental technician is highly supported and any problems can easily detected and eliminated. Each specialist accompanies the whole treatment and interaction can be made. As the end result is already planned and all surgical intervention is carried according to the initial plan, the possibility of any deviation is kept to a minimum. Given the effectiveness of the initial planning the whole treatment duration is shorter than any other treatment procedures.\n\n<\/p>\nComputer-assisted ENT surgery \nImage-guided surgery and CAS in ENT commonly consists of navigating preoperative image data such as CT or cone beam CT to assist with locating or avoiding anatomically important regions such as the optical nerve or the opening to the frontal sinuses.[4] For use in middle-ear surgery there has been some application of robotic surgery due to the requirement for high-precision actions.[5]\n\n Computer-assisted orthopedic surgery (CAOS) \nThe application of robotic surgery is widespread in orthopedics, especially in routine interventions, like total hip replacement [6] or pedicle screw insertion.[7] It is also useful in pre-planning and guiding the correct anatomical position of displaced bone fragments in fractures, allowing a good fixation by osteosynthesis. Early CAOS systems include the HipNav, OrthoPilot, and Praxim.\n\nComputer-assisted visceral surgery \nWith the advent of computer-assisted surgery, great progresses have been made in general surgery towards minimal invasive approaches. Laparoscopy in abdominal and gynecologic surgery is one of the beneficiaries, allowing surgical robots to perform routine operations, like colecystectomies, or even hysterectomies. In cardiac surgery, shared control systems can perform mitral valve replacement or ventricular pacing by small thoracotomies. In urology, surgical robots contributed in laparoscopic approaches for pyeloplasty or nephrectomy or prostatic interventions.[8][9]\n\nComputer-assisted cardiac interventions \nApplications include atrial fibrillation and cardiac resynchronization therapy. Pre-operative MRI or CT is used to plan the procedure. Pre-operative images, models or planning information can be registered to intra-operative fluoroscopic image to guide procedures. \n\nComputer-assisted radiosurgery \nRadiosurgery is also incorporating advanced robotic systems. CyberKnife is such a system that has a lightweight linear accelerator mounted on the robotic arm. It is guided towards tumor processes, using the skeletal structures as a reference system (Stereotactic Radiosurgery System). During the procedure, real time X-ray is used to accurately position the device before delivering radiation beam. The robot can compensate for respiratory motion of the tumor in real-time.[10]\n\nAdvantages \nCAS starts with the premise of a much better visualization of the operative field, thus allowing a more accurate preoperative diagnostic and a well-defined surgical planning, by using surgical planning in a preoperative virtual environment. This way, the surgeon can easily assess most of the surgical difficulties and risks and have a clear idea about how to optimize the surgical approach and decrease surgical morbidity. During the operation, the computer guidance improves the geometrical accuracy of the surgical gestures and also reduce the redundancy of the surgeon\u2019s acts. This significantly improves ergonomy in the operating theatre, decreases the risk of surgical errors and reduces the operating time.\n\nDisadvantages \nThere are several disadvantages of computer-assisted surgery. A major disadvantage of this system is their cost. With a price tag of a million dollars[citation needed ], their cost is nearly prohibitive. Some people believe that improvements in technology, such as haptics, increased processor speeds, and more complex and capable software will increase the cost of these systems.[11] Another disadvantage is the size of these systems. These systems have relatively large footprints and relatively cumbersome robotic arms. This is an important disadvantage in today's already crowded-operating rooms. It may be difficult for both the surgical team and the robot to fit into the operating room.[11] Another factor that is stunting the development of robotic surgery is that of \u201clatency\u201d which is the time delay between the instructions issued by the surgeon and the movement of the robot which responds to the instructions. With the current level of technology, the surgeon must be in close proximity.[12]\n\nSee also \n\n\n Medicine portal \n Robotics portal \nAdvanced Simulation Library[13] is a hardware accelerated multiphysics simulation software\nReferences \n\n\n^ Mischkowski RA, Zinser MJ, Ritter L, Neugebauer J, Keeve E, Zoeller JE (2007b) Intraoperative navigation in the maxillofacial area based on 3D imaging obtained by a cone-beam device. Int J Oral Maxillofac Surg 36:687-694 \n\n^ Bale RJ, Melzer A et al.: Robotics for interventional procedures. Cardiovascular and Interventional Radiological Society of Europe Newsletter, 2006 \n\n^ Marmulla R, Niederdellmann H: Computer-assisted bone segment navigation. J Cranio-Maxillofac Surg 26:347-359, 1998 \n\n^ Surgical minimally-invasive endonasal tumor resection \n\n^ Berlinger NT:Robotic Surgery - Squeezing into Tight Places. New England Journal of Medicine 354:2099-2101, 2006 \n\n^ Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A: Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152-9, 2005 \n\n^ Manbachi A, Cobbold RS, Ginsberg HJ: \"Guided pedicle screw insertion: techniques and training.\" Spine J. 2014 Jan;14(1):165-79. \n\n^ Muntener M, Ursu D, Patriciu A, Petrisor D, Stoianovici D: Robotic prostate surgery. Expert Rev Med Devices 3(5):575-84 \n\n^ Guillonneau, Bertrand: What Robotics in Urology? A Current Point of View. European Urology. 43: 103-105 2003 \n\n^ Schweikard, A., Shiomi, H., & Adler, J. (2004). Respiration tracking in radiosurgery. Medical physics, 31(10), 2738-2741. \n\n^ a b Lanfranco, Anthony. \"Robotic Surgery: A Current Perspective\". \n\n^ \"Robotic Surgery \u2013 Advantages and Disadvantages\". \n\n^ \"ASL: Intraoperative Brain Shift Simulation\". \n\n\nExternal links \n Media related to Computer assisted surgery at Wikimedia Commons\n\nvteHealth softwareBarcoding\nBar Code Medication Administration\nDatabases\nEpocrates\nLexicomp\nMedscape\nMicromedex\nDiagnosticsBioimagingDICOMGeneral\n3DSlicer\nDrishti\nGIMIAS\nGinkgo CADx\nInVesalius\nITK-SNAP\nOsiriX\nVistA imaging\nVoreen\nXebra\nServers\nOrthanc\nXebra\nHeuristics\nBestbets\nCommonGround\nEuResist\nOdontologic\nCybermed\nFlorida Probe\nElectronic\r\nhealth recordsPlatforms\nApache cTAKES\nAHLTA\nathenaClinicals\nCentricity EMR\nCertify HealthLogix\nCerner EHR\nCottageMed\nCOSTAR\nDatix\nDocNetwork\nEMIAS\nEMIS Web\nEpicCare EMR\nFreeMED\nGaiaEHR\nGNUmed\nGPASS\nHOSxP\nINPS Vision\nKareo EHR\nMedcomSoft Record\nMTBC WebEHR2.0\nNextGen Healthcare\nNHS 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:28.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,086 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6f55d1dae5110a6096abf37240670631_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Computer-assisted_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Computer-assisted surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Computer-assisted surgery<\/b> (<b>CAS<\/b>) represents a surgical concept and set of methods, that use computer technology for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_planning\" title=\"Surgical planning\" rel=\"external_link\" target=\"_blank\">surgical planning<\/a>, and for guiding or performing surgical interventions. CAS is also known as <b>computer-aided surgery<\/b>, <b>computer-assisted intervention<\/b>, <b>image-guided surgery<\/b> and <b>surgical navigation<\/b>, but these are terms that are more or less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synonym\" title=\"Synonym\" rel=\"external_link\" target=\"_blank\">synonymous<\/a> with CAS. CAS has been a leading factor in the development of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">robotic surgery<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"General_principles\">General principles<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:LUCASSegmentation1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/LUCASSegmentation1.jpg\/220px-LUCASSegmentation1.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:LUCASSegmentation1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Image gathering (\"segmentation\") on the LUCAS workstation<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Creating_a_virtual_image_of_the_patient\">Creating a virtual image of the patient<\/span><\/h3>\n<p>The most important component for CAS is the development of an accurate model of the patient. This can be conducted through a number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">medical imaging<\/a> technologies including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-rays\" class=\"mw-redirect\" title=\"X-rays\" rel=\"external_link\" target=\"_blank\">x-rays<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasound<\/a> plus many more. For the generation of this model, the anatomical region to be operated has to be scanned and uploaded into the computer system. It is possible to employ a number of scanning methods, with the datasets combined through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_fusion\" title=\"Data fusion\" rel=\"external_link\" target=\"_blank\">data fusion<\/a> techniques. The final objective is the creation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Three-dimensional_space\" title=\"Three-dimensional space\" rel=\"external_link\" target=\"_blank\">3D<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dataset\" class=\"mw-redirect\" title=\"Dataset\" rel=\"external_link\" target=\"_blank\">dataset<\/a> that reproduces the exact geometrical situation of the normal and pathological tissues and structures of that region. Of the available scanning methods, the CT is preferred,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> because MRI data sets are known to have volumetric deformations that may lead to inaccuracies. An example data set can include the collection of data compiled with 180 CT slices, that are 1 mm apart, each having 512 by 512 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pixels\" class=\"mw-redirect\" title=\"Pixels\" rel=\"external_link\" target=\"_blank\">pixels<\/a>. The contrasts of the 3D dataset (with its tens of millions of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pixels\" class=\"mw-redirect\" title=\"Pixels\" rel=\"external_link\" target=\"_blank\">pixels<\/a>) provide the detail of soft vs hard tissue structures, and thus allow a computer to differentiate, and visually separate for a human, the different tissues and structures. The image data taken from a patient will often include intentional landmark features, in order to be able to later realign the virtual dataset against the actual patient during surgery. See <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">patient registration<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Image_analysis_and_processing\">Image analysis and processing<\/span><\/h3>\n<p>Image analysis involves the manipulation of the patients 3D model to extract relevant information from the data. Using the differing contrast levels of the different tissues within the imagery, as examples, a model can be changed to show just hard structures such as bone, or view the flow of arteries and veins through the brain.\n<\/p>\n<h3><span id=\"rdp-ebb-Diagnostic.2C_preoperative_planning.2C_surgical_simulation\"><\/span><span class=\"mw-headline\" id=\"Diagnostic,_preoperative_planning,_surgical_simulation\">Diagnostic, preoperative planning, surgical simulation<\/span><\/h3>\n<p>Using specialized software the gathered dataset can be rendered as a virtual 3D model of the patient, this model can be easily manipulated by a surgeon to provide views from any angle and at any depth within the volume. Thus the surgeon can better assess the case and establish a more accurate diagnostic. Furthermore, the surgical intervention will be planned and simulated virtually, before actual surgery takes place (computer-aided surgical simulation [CASS]). Using dedicated software, the surgical robot will be programmed to carry out the planned actions during the actual surgical intervention.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Surgical_navigation\">Surgical navigation<\/span><\/h3>\n<p>In computer-assisted surgery, the actual intervention is defined as surgical navigation. Using the surgical navigation system the surgeon uses special instruments, which are tracked by the navigation system. The position of a tracked instrument in relation to the patient's anatomy is shown on images of the patient, as the surgeon moves the instrument. The surgeon thus uses the system to 'navigate' the location of an instrument. The feedback the system provides of the instrument location is particularly useful in situations where the surgeon cannot actually see the tip of the instrument, such as in minimally invasive surgeries.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Robotic_surgery\">Robotic surgery<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery<\/a><\/div>\n<p>Robotic surgery is a term used for correlated actions of a surgeon and a surgical robot (that has been programmed to carry out certain actions during the preoperative planning procedure). A surgical robot is a mechanical device (generally looking like a robotic arm) that is computer-controlled.\nRobotic surgery can be divided into three types, depending on the degree of surgeon interaction during the procedure: supervisory-controlled, telesurgical, and shared-control.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> In a supervisory-controlled system, the procedure is executed solely by the robot, which will perform the pre-programmed actions. A telesurgical system, also known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">remote surgery<\/a>, requires the surgeon to manipulate the robotic arms during the procedure rather than allowing the robotic arms to work from a predetermined program. With shared-control systems, the surgeon carries out the procedure with the use of a robot that offers steady-hand manipulations of the instrument. In most robots, the working mode can be chosen for each separate intervention, depending on the surgical complexity and the particularities of the case.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Computer-assisted surgery is the beginning of a revolution in surgery. It already makes a great difference in high-precision surgical domains, but it is also used in standard surgical procedures.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_neurosurgery\">Computer-assisted neurosurgery<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_manipulator\" title=\"Remote manipulator\" rel=\"external_link\" target=\"_blank\">Telemanipulators<\/a> have been used for the first time in neurosurgery, in the 1980s. This allowed a greater development in brain microsurgery (compensating surgeon\u2019s physiological tremor by 10-fold), increased accuracy and precision of the intervention. It also opened a new gate to minimally invasive brain surgery, furthermore reducing the risk of post-surgical morbidity by avoiding accidental damage to adjacent centers.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_oral_and_maxillofacial_surgery\">Computer-assisted oral and maxillofacial surgery<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">Bone segment navigation<\/a> is the modern surgical approach in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthognathic_surgery\" title=\"Orthognathic surgery\" rel=\"external_link\" target=\"_blank\">orthognathic surgery<\/a> (correction of the anomalies of the jaws and skull), in <a href=\"https:\/\/en.wikipedia.org\/wiki\/TMJ\" class=\"mw-redirect\" title=\"TMJ\" rel=\"external_link\" target=\"_blank\">temporo-mandibular joint (TMJ)<\/a> surgery, or in the reconstruction of the mid-face and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbit_(anatomy)\" title=\"Orbit (anatomy)\" rel=\"external_link\" target=\"_blank\">orbit<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>It is also used in implantology where the available bone can be seen and the position, angulation and depth of the implants can be simulated before the surgery. During the operation surgeon is guided visually and by sound alerts. IGI (Image Guided Implantology) is one of the navigation systems which uses this technology.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Guided_Implantology\">Guided Implantology<\/span><\/h4>\n<p>New therapeutic concepts as guided surgery are being developed and applied in the placement of dental implants. The prosthetic rehabilitation is also planned and performed parallel to the surgical procedures. The planning steps are at the foreground and carried out in a cooperation of the surgeon, the dentist and the dental technician. Edentulous patients, either one or both jaws, benefit as the time of treatment is reduced.\n<\/p><p>Regarding the edentulous patients, conventional denture support is often compromised due to moderate bone atrophy, even if the dentures are constructed based on correct anatomic morphology.\n<\/p><p>Using cone beam computed tomography, the patient and the existing prosthesis are being scanned. Furthermore, the prosthesis alone is also scanned. Glass pearls of defined diameter are placed in the prosthesis and used as reference points for the upcoming planning. The resulting data is processed and the position of the implants determined. The surgeon, using special developed software, plans the implants based on prosthetic concepts considering the anatomic morphology. After the planning of the surgical part is completed, a CAD\/CAM surgical guide for dental placement is constructed. The mucosal-supported surgical splint ensures the exact placement of the implants in the patient. Parallel to this step, the new implant supported prosthesis is constructed.\n<\/p><p>The dental technician, using the data resulting from the previous scans, manufactures a model representing the situation after the implant placement. The prosthetic compounds, abutments, are already prefabricated. The length and the inclination can be chosen. The abutments are connected to the model at a position in consideration of the prosthetic situation. The exact position of the abutments is registered. The dental technician can now manufacture the prosthesis.\n<\/p><p>The fit of the surgical splint is clinically proved. After that, the splint is attached using a three-point support pin system. Prior to the attachment, irrigation with a chemical disinfectant is advised. The pins are driven through defined sheaths from the vestibular to the oral side of the jaw. Ligaments anatomy should be considered, and if necessary decompensation can be achieved with minimal surgical interventions. The proper fit of the template is crucial and should be maintained throughout the whole treatment. Regardless of the mucosal resilience, a correct and stable attachment is achieved through the bone fixation.\n<p>The access to the jaw can now only be achieved through the sleeves embedded in the surgical template. Using specific burs through the sleeves the mucosa is removed. Every bur used, carries a sleeve compatible to the sleeves in the template, which ensures that the final position is achieved but no further progress in the alveolar ridge can take place. Further procedure is very similar to the traditional implant placement. The pilot hole is drilled and then expanded. With the aid of the splint, the implants are finally placed. After that, the splint can be removed.\n<\/p>\n<\/p><p>With the aid of a registration template, the abutments can be attached and connected to the implants at the defined position. No less than a pair of abutments should be connected simultaneously to avoid any discrepancy. An important advantage of this technique is the parallel positioning of the abutments. A radiological control is necessary to verify the correct placement and connection of implant and abutment.\n<\/p><p>In a further step, abutments are covered by gold cone caps, which represent the secondary crowns. Where necessary, the transition of the gold cone caps to the mucosa can be isolated with rubber dam rings.\n<\/p><p>The new prosthesis corresponds to a conventional total prosthesis but the basis contains cavities so that the secondary crowns can be incorporated. The prosthesis is controlled at the terminal position and corrected if needed. The cavities are filled with a self-curing cement and the prosthesis is placed in the terminal position. After the self-curing process, the gold caps are definitely cemented in the prosthesis cavities and the prosthesis can now be detached. Excess cement may be removed and some corrections like polishing or under filling around the secondary crowns may be necessary.\n<p>The new prosthesis is fitted using a construction of telescope double cone crowns. At the end position, the prosthesis buttons down on the abutments to ensure an adequate hold.\n<\/p>\n<\/p><p>At the same sitting, the patient receives the implants and the prosthesis. An interim prosthesis is not necessary. The extent of the surgery is kept to minimum. Due to the application of the splint, a reflection of soft tissues in not needed. The patient experiences less bleeding, swelling and discomfort. Complications such as injuring of neighbouring structures are also avoided. \n<p>Using 3D imaging during the planning phase, the communication between the surgeon, dentist and dental technician is highly supported and any problems can easily detected and eliminated. Each specialist accompanies the whole treatment and interaction can be made. As the end result is already planned and all surgical intervention is carried according to the initial plan, the possibility of any deviation is kept to a minimum. Given the effectiveness of the initial planning the whole treatment duration is shorter than any other treatment procedures.\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_ENT_surgery\">Computer-assisted ENT surgery<\/span><\/h3>\n<p>Image-guided surgery and CAS in ENT commonly consists of navigating preoperative image data such as CT or cone beam CT to assist with locating or avoiding anatomically important regions such as the optical nerve or the opening to the frontal sinuses.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> For use in middle-ear surgery there has been some application of robotic surgery due to the requirement for high-precision actions.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Computer-assisted_orthopedic_surgery_.28CAOS.29\"><\/span><span class=\"mw-headline\" id=\"Computer-assisted_orthopedic_surgery_(CAOS)\">Computer-assisted orthopedic surgery (CAOS)<\/span><\/h3>\n<p>The application of robotic surgery is widespread in orthopedics, especially in routine interventions, like total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a> <sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pedicle_of_vertebral_arch\" class=\"mw-redirect\" title=\"Pedicle of vertebral arch\" rel=\"external_link\" target=\"_blank\">pedicle<\/a> screw insertion.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> It is also useful in pre-planning and guiding the correct anatomical position of displaced bone fragments in fractures, allowing a good fixation by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosynthesis\" title=\"Osteosynthesis\" rel=\"external_link\" target=\"_blank\">osteosynthesis<\/a>. Early CAOS systems include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/HipNav\" title=\"HipNav\" rel=\"external_link\" target=\"_blank\">HipNav<\/a>, , and Praxim.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_visceral_surgery\">Computer-assisted visceral surgery<\/span><\/h3>\n<p>With the advent of computer-assisted surgery, great progresses have been made in general surgery towards minimal invasive approaches. Laparoscopy in abdominal and gynecologic surgery is one of the beneficiaries, allowing surgical robots to perform routine operations, like colecystectomies, or even hysterectomies. In cardiac surgery, shared control systems can perform mitral valve replacement or ventricular pacing by small thoracotomies. In urology, surgical robots contributed in laparoscopic approaches for pyeloplasty or nephrectomy or prostatic interventions.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_cardiac_interventions\">Computer-assisted cardiac interventions<\/span><\/h3>\n<p>Applications include atrial fibrillation and cardiac resynchronization therapy. Pre-operative MRI or CT is used to plan the procedure. Pre-operative images, models or planning information can be registered to intra-operative fluoroscopic image to guide procedures. \n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_radiosurgery\">Computer-assisted radiosurgery<\/span><\/h3>\n<p>Radiosurgery is also incorporating advanced robotic systems. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CyberKnife\" class=\"mw-redirect\" title=\"CyberKnife\" rel=\"external_link\" target=\"_blank\">CyberKnife<\/a> is such a system that has a lightweight linear accelerator mounted on the robotic arm. It is guided towards tumor processes, using the skeletal structures as a reference system (Stereotactic Radiosurgery System). During the procedure, real time X-ray is used to accurately position the device before delivering radiation beam. The robot can compensate for respiratory motion of the tumor in real-time.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h2>\n<p>CAS starts with the premise of a much better visualization of the operative field, thus allowing a more accurate preoperative diagnostic and a well-defined surgical planning, by using surgical planning in a preoperative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_environment\" title=\"Virtual environment\" rel=\"external_link\" target=\"_blank\">virtual environment<\/a>. This way, the surgeon can easily assess most of the surgical difficulties and risks and have a clear idea about how to optimize the surgical approach and decrease surgical morbidity. During the operation, the computer guidance improves the geometrical accuracy of the surgical gestures and also reduce the redundancy of the surgeon\u2019s acts. This significantly improves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ergonomy\" class=\"mw-redirect\" title=\"Ergonomy\" rel=\"external_link\" target=\"_blank\">ergonomy<\/a> in the operating theatre, decreases the risk of surgical errors and reduces the operating time.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Disadvantages\">Disadvantages<\/span><\/h2>\n<p>There are several disadvantages of computer-assisted surgery. A major disadvantage of this system is their cost. With a price tag of a million dollars<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>, their cost is nearly prohibitive. Some people believe that improvements in technology, such as haptics, increased processor speeds, and more complex and capable software will increase the cost of these systems.<sup id=\"rdp-ebb-cite_ref-test_11-0\" class=\"reference\"><a href=\"#cite_note-test-11\" rel=\"external_link\">[11]<\/a><\/sup> Another disadvantage is the size of these systems. These systems have relatively large footprints and relatively cumbersome robotic arms. This is an important disadvantage in today's already crowded-operating rooms. It may be difficult for both the surgical team and the robot to fit into the operating room.<sup id=\"rdp-ebb-cite_ref-test_11-1\" class=\"reference\"><a href=\"#cite_note-test-11\" rel=\"external_link\">[11]<\/a><\/sup> Another factor that is stunting the development of robotic surgery is that of \u201clatency\u201d which is the time delay between the instructions issued by the surgeon and the movement of the robot which responds to the instructions. With the current level of technology, the surgeon must be in close proximity.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/12px-WHO_Rod.svg.png\" width=\"12\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine\" title=\"Portal:Medicine\" rel=\"external_link\" target=\"_blank\">Medicine portal<\/a><\/span><\/li>\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Animation2.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/17px-Animation2.gif\" width=\"17\" height=\"28\" class=\"noviewer\" \/><\/a><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Robotics\" title=\"Portal:Robotics\" rel=\"external_link\" target=\"_blank\">Robotics portal<\/a><\/span><\/li><\/ul><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Advanced_Simulation_Library\" title=\"Advanced Simulation Library\" rel=\"external_link\" target=\"_blank\">Advanced Simulation Library<\/a><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> is a hardware accelerated multiphysics simulation software<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mischkowski RA, Zinser MJ, Ritter L, Neugebauer J, Keeve E, Zoeller JE (2007b) Intraoperative navigation in the maxillofacial area based on 3D imaging obtained by a cone-beam device. Int J Oral Maxillofac Surg 36:687-694<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bale RJ, Melzer A et al.: <i>Robotics for interventional procedures.<\/i> Cardiovascular and Interventional Radiological Society of Europe Newsletter, 2006<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Marmulla R, Niederdellmann H: <i>Computer-assisted bone segment navigation.<\/i> J Cranio-Maxillofac Surg 26:347-359, 1998<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.scopis.com\/en\/news\/navigation-in-practice\/details\/archive\/2013\/january\/22\/article\/scopisR-navigation-in-der-praxis-minimal-invasive-endonasale-tumorentfernung\/\" target=\"_blank\">Surgical minimally-invasive endonasal tumor resection<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Berlinger NT:<i>Robotic Surgery - Squeezing into Tight Places<\/i>. New England Journal of Medicine 354:2099-2101, 2006<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A: <i>Computer-assisted navigation increases precision of component placement in total knee arthroplasty.<\/i> Clin Orthop Relat Res 433:152-9, 2005<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Manbachi A, Cobbold RS, Ginsberg HJ: \"Guided pedicle screw insertion: techniques and training.\" Spine J. 2014 Jan;14(1):165-79.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Muntener M, Ursu D, Patriciu A, Petrisor D, Stoianovici D: <i>Robotic prostate surgery.<\/i> Expert Rev Med Devices 3(5):575-84<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Guillonneau, Bertrand: <i>What Robotics in Urology? A Current Point of View.<\/i> European Urology. 43: 103-105 2003<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Schweikard, A., Shiomi, H., & Adler, J. (2004). Respiration tracking in radiosurgery. Medical physics, 31(10), 2738-2741.<\/span>\n<\/li>\n<li id=\"cite_note-test-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-test_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-test_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Lanfranco, Anthony. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/viewarticle\/466691_5\" target=\"_blank\">\"Robotic Surgery: A Current Perspective\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Robotic+Surgery%3A+A+Current+Perspective&rft.aulast=Lanfranco&rft.aufirst=Anthony&rft_id=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F466691_5&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComputer-assisted+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.futuretechnology500.com\/index.php\/future-medical-technology\/robotic-surgery-advantages-and-disadvantages\/\" target=\"_blank\">\"Robotic Surgery \u2013 Advantages and Disadvantages\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Robotic+Surgery+%E2%80%93+Advantages+and+Disadvantages&rft_id=http%3A%2F%2Fwww.futuretechnology500.com%2Findex.php%2Ffuture-medical-technology%2Frobotic-surgery-advantages-and-disadvantages%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComputer-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/asl.org.il\/2015\/08\/30\/ASL_assists_neurosurgeons\/\" target=\"_blank\">\"ASL: Intraoperative Brain Shift Simulation\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ASL%3A+Intraoperative+Brain+Shift+Simulation&rft_id=http%3A%2F%2Fasl.org.il%2F2015%2F08%2F30%2FASL_assists_neurosurgeons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComputer-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Computer_assisted_surgery\" class=\"extiw\" title=\"commons:Category:Computer assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer assisted surgery <\/a> at Wikimedia Commons\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181217045410\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.332 seconds\nReal time usage: 0.455 seconds\nPreprocessor visited node count: 973\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 58702\/2097152 bytes\nTemplate argument size: 863\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11289\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.151\/10.000 seconds\nLua memory usage: 5.1 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 365.561 1 -total\n<\/p>\n<pre>26.45% 96.695 1 Template:Reflist\n23.65% 86.440 1 Template:Infobox_interventions\n21.37% 78.105 1 Template:Infobox\n20.62% 75.375 3 Template:Cite_web\n17.12% 62.575 1 Template:Commons_category-inline\n14.13% 51.667 1 Template:Citation_needed\n13.69% 50.043 7 Template:Navbox\n12.41% 45.352 1 Template:Fix\n 8.75% 31.978 1 Template:Health_software\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:15945619-1!canonical and timestamp 20181217045410 and revision id 825174313\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214658\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.345 1 - wikipedia:Computer-assisted_surgery\n100.00% 144.345 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8301-0!*!*!*!*!*!* and timestamp 20181217214658 and revision id 27023\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Computer-assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Computer-assisted_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6f55d1dae5110a6096abf37240670631_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/4a\/LUCASSegmentation1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/34px-Animation2.gif","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png"],"6f55d1dae5110a6096abf37240670631_timestamp":1545083218,"7dae9d41420f015e1fc21b33951b5110_type":"article","7dae9d41420f015e1fc21b33951b5110_title":"Coronary catheterization","7dae9d41420f015e1fc21b33951b5110_url":"https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization","7dae9d41420f015e1fc21b33951b5110_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCoronary catheterization\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCoronary catheterizationA coronary angiogram (an X-ray with radiocontrast agent in the coronary arteries) that shows the left coronary circulation. The distal left main coronary artery (LMCA) is in the left upper quadrant of the image. Its main branches (also visible) are the left circumflex artery (LCX), which courses top-to-bottom initially and then toward the centre\/bottom, and the left anterior descending (LAD) artery, which courses from left-to-right on the image and then down the middle of the image to project underneath the distal LCX. The LAD, as is usual, has two large diagonal branches, which arise at the centre-top of the image and course toward the centre\/right of the image.[edit on Wikidata]\nA coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes.\nCoronary catheterization is one of the several cardiology diagnostic tests and procedures. Specifically, coronary catheterization is a visually interpreted test performed to recognize occlusion, stenosis, restenosis, thrombosis or aneurysmal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance; and some aspects of heart valve function. Important internal heart and lung blood pressures, not measurable from outside the body, can be accurately measured during the test. The relevant problems that the test deals with most commonly occur as a result of advanced atherosclerosis \u2013 atheroma activity within the wall of the coronary arteries. Less frequently, valvular, heart muscle, or arrhythmia issues are the primary focus of the test.\nCoronary artery luminal narrowing reduces the flow reserve for oxygenated blood to the heart, typically producing intermittent angina. Very advanced luminal occlusion usually produces a heart attack. However, it has been increasingly recognized, since the late 1980s, that coronary catheterization does not allow the recognition of the presence or absence of coronary atherosclerosis itself, only significant luminal changes which have occurred as a result of end stage complications of the atherosclerotic process. See IVUS and atheroma for a better understanding of this issue.\n\nContents \n\n1 History \n2 Indications \n3 Patient participation \n4 Equipment \n5 Diagnostic procedures \n6 Therapeutic procedures \n7 Advances in catheter based physical treatments \n8 Alternative approaches \n9 See also \n10 References \n\n10.1 Notes \n10.2 General \n\n\n\n\nHistory \nMain article: History of invasive and interventional cardiology\nThe technique of angiography itself was first developed in 1927 by the Portuguese physician Egas Moniz at the University of Lisbon for cerebral angiography, the viewing of brain vasculature by X-ray radiation with the aid of a contrast medium introduced by catheter.\nHeart catheterization was first performed in 1929 when the German physician Werner Forssmann inserted a plastic tube in his cubital vein and guided it to the right chamber of the heart. He took an x-ray to prove his success and published it on November 5, 1929 with the title \"\u00dcber die Sondierung des rechten Herzens\" (About probing of the right heart).\nIn the early 1940s, Andr\u00e9 Cournand, in collaboration with Dickinson Richards, performed more systematic measurements of the hemodynamics of the heart. For their work in the discovery of cardiac catheterization and hemodynamic measurements, Cournand, Forssmann, and Richards shared the Nobel Prize in Physiology or Medicine in 1956. The first radial access for angiography can be traced back to 1953, where Eduardo Pereira, in Lisbon, Portugal, first cannulated the radial artery to perform a coronary angiogram. \nIn 1960 F. Mason Sones, a pediatric cardiologist at the Cleveland Clinic, accidentally injected radiocontrast in a coronary artery instead of the left ventricle. Although the patient had a reversible cardiac arrest, Sones and Shirey developed the procedure further, and are credited with the discovery (Connolly 2002); they published a series of 1,000 patents in 1966 (Proudfit et al.).\nSince the late 1970s, building on the pioneering work of Charles Dotter in 1964 and especially Andreas Gruentzig starting in 1977, coronary catheterization has been extended to therapeutic uses: (a) the performance of less invasive physical treatment for angina and some of the complications of severe atherosclerosis, (b) treating heart attacks before complete damage has occurred and (c) research for better understanding of the pathology of coronary artery disease and atherosclerosis.\nIn the early 1960s, cardiac catheterization frequently took several hours and involved significant complications for as many as 2\u20133% of patients. With multiple incremental improvements over time, simple coronary catheterization examinations are now commonly done more rapidly and with significantly improved outcomes.\n\nIndications \nIndications for cardiac catheterization include the following:\n\nHeart Attack (includes ST elevation MI, Non-ST Elevation MI, Unstable Angina)\nAbnormal Stress Test\nNew-onset unexplained heart failure\nSurvival of sudden cardiac death or dangerous cardiac arrhythmia\nPersistent chest pain despite optimal medical therapy\nWorkup of suspected Prinzmetal Angina (coronary vasospasm)[1]\nPatient participation \n Coronary Angiography.\nThe patient being examined or treated is usually awake during catheterization, ideally with only local anaesthesia such as lidocaine and minimal general sedation, throughout the procedure. Performing the procedure with the patient awake is safer as the patient can immediately report any discomfort or problems and thereby facilitate rapid correction of any undesirable events. Medical monitors fail to give a comprehensive view of the patient's immediate well-being; how the patient feels is often a most reliable indicator of procedural safety.\nDeath, myocardial infarction, stroke, serious ventricular arrhythmia, and major vascular complications each occur in less than 1% of patients undergoing catheterization.[2] However, though the imaging portion of the examination is often brief, because of setup and safety issues the patient is often in the lab for 20\u201345 minutes. Any of multiple technical difficulties, while not endangering the patient (indeed added to protect the patient's interests) can significantly increase the examination time.\n\nEquipment \nCoronary catheterization is performed in a catheterization lab, usually located within a hospital. With current designs, the patient must lie relatively flat on a narrow, minimally padded, radiolucent (transparent to X-ray) table. The X-ray source and imaging camera equipment are on opposite sides of the patient's chest and freely move, under motorized control, around the patient's chest so images can be taken quickly from multiple angles. More advanced equipment, termed a bi-plane cath lab, uses two sets of X-ray source and imaging cameras, each free to move independently, which allows two sets of images to be taken with each injection of radiocontrast agent. The equipment and installation setup to perform such testing typically represents a capital expenditure of US$2\u20135 million (2004), sometimes more, partially repeated every few years.\n\nDiagnostic procedures \n Coronary angiography of a critical sub-occlusion of the common trunk of the left coronary artery and the circumflex artery. (See arrows)\nDuring coronary catheterization (often referred to as a cath by physicians), blood pressures are recorded and X-ray motion picture shadow-grams of the blood inside the coronary arteries are recorded. In order to create the X-ray pictures, a physician guides a small tube-like device called a catheter, typically ~2.0 mm (6-French) in diameter, through the large arteries of the body until the tip is just within the opening of one of the coronary arteries. By design, the catheter is smaller than the lumen of the artery it is placed in; internal (intra-arterial) blood pressures are monitored through the catheter to verify that the catheter does not block blood flow.\nThe catheter is itself designed to be radiodense for visibility and it allows a clear, watery, blood compatible radiocontrast agent, commonly called an X-ray dye, to be selectively injected and mixed with the blood flowing within the artery. Typically 3\u20138 cc of the radiocontrast agent is injected for each image to make the blood flow visible for about 3\u20135 seconds as the radiocontrast agent is rapidly washed away into the coronary capillaries and then coronary veins. Without the X-ray dye injection, the blood and surrounding heart tissues appear, on X-ray, as only a mildly-shape-changing, otherwise uniform water density mass; no details of the blood and internal organ structure are discernible. The radiocontrast within the blood allows visualization of the blood flow within the arteries or heart chambers, depending on where it is injected.\nIf atheroma, or clots, are protruding into the lumen, producing narrowing, the narrowing may be seen instead as increased haziness within the X-ray shadow images of the blood\/dye column within that portion of the artery; this is as compared to adjacent, presumed healthier, less stenotic areas. See the single frame illustration of a coronary angiogram image on the angioplasty page.\nFor guidance regarding catheter positions during the examination, the physician mostly relies on detailed knowledge of internal anatomy, guide wire and catheter behavior and intermittently, briefly uses fluoroscopy and a low X-ray dose to visualize when needed. This is done without saving recordings of these brief looks. When the physician is ready to record diagnostic views, which are saved and can be more carefully scrutinized later, he activates the equipment to apply a significantly higher X-ray dose, termed cine, in order to create better quality motion picture images, having sharper radiodensity contrast, typically at 30 frames per second. The physician controls both the contrast injection, fluoroscopy and cine application timing so as to minimize the total amount of radiocontrast injected and times the X-Ray to the injection so as to minimize the total amount of X-ray used. Doses of radiocontrast agents and X-ray exposure times are routinely recorded in an effort to maximize safety.\nThough not the focus of the test, calcification within the artery walls, located in the outer edges of atheroma within the artery walls, is sometimes recognizable on fluoroscopy (without contrast injection) as radiodense halo rings partially encircling, and separated from the blood filled lumen by the interceding radiolucent atheroma tissue and endothelial lining. Calcification, even though usually present, is usually only visible when quite advanced and calcified sections of the artery wall happen to be viewed on end tangentially through multiple rings of calcification, so as to create enough radiodensity to be visible on fluoroscopy.\n\nTherapeutic procedures \nMain article: Percutaneous coronary intervention\nBy changing the diagnostic catheter to a guiding catheter, physicians can also pass a variety of instruments through the catheter and into the artery to a lesion site. The most commonly used are 0.014-inch-diameter (0.36 mm) guide wires and the balloon dilation catheters.\nBy injecting radiocontrast agent through a tiny passage extending down the balloon catheter and into the balloon, the balloon is progressively expanded. The hydraulic pressures are chosen and applied by the physician, according to how the balloon within the stenosis (abnormal narrowing in a blood vessel) responds. The radiocontrast filled balloon is watched under fluoroscopy (it typically assumes a \"dog bone\" shape imposed on the outside of the balloon by the stenosis as the balloon is expanded), as it opens. As much hydraulic brute force is applied as judged needed and visualized to be effective to make the stenosis of the artery lumen visibly enlarge.\nTypical normal coronary artery pressures are in the <200 mmHg range (27 kPa). The hydraulic pressures applied within the balloon may extend to as high as 19000 mmHg (2,500 kPa). Prevention of over-enlargement is achieved by choosing balloons manufactured out of high tensile strength clear plastic membranes. The balloon is initially folded around the catheter, near the tip, to create a small cross-sectional profile to facilitate passage though luminal stenotic areas, and is designed to inflate to a specific pre-designed diameter. If over inflated, the balloon material simply tears and allows the inflating radiocontrast agent to simply escape into the blood.\nAdditionally, several other devices can be advanced into the artery via a guiding catheter. These include laser catheters, stent catheters, IVUS catheters, Doppler catheter, pressure or temperature measurement catheter and various clot and grinding or removal devices. Most of these devices have turned out to be niche devices, only useful in a small percentage of situations or for research.\nStents, which are specially manufactured expandable stainless steel mesh tubes, mounted on a balloon catheter, are the most commonly used device beyond the balloon catheter. When the stent\/balloon device is positioned within the stenosis, the balloon is inflated which, in turn, expands the stent and the artery. The balloon is removed and the stent remains in place, supporting the inner artery walls in the more open, dilated position. Current stents generally cost around $1,000 to 3,000 each (US 2004 dollars), the drug coated ones being the more expensive.\n\nAdvances in catheter based physical treatments \nInterventional procedures have been plagued by restenosis due to the formation of endothelial tissue overgrowth at the lesion site. Restenosis is the body's response to the injury of the vessel wall from angioplasty and to the stent as a foreign body. As assessed in clinical trials during the late 1980 and 1990s, using only balloon angioplasty (POBA, plain old balloon angioplasty), up to 50% of patients suffered significant restenosis; but that percentage has dropped to the single to lower two digit range with the introduction of drug-eluting stents. Sirolimus, paclitaxel, and everolimus are the three drugs used in coatings which are currently FDA approved in the United States. As opposed to bare metal, drug eluting stents are covered with a medicine that is slowly dispersed with the goal of suppressing the restenosis reaction. The key to the success of drug coating has been (a) choosing effective agents, (b) developing ways of adequately binding the drugs to the stainless surface of the stent struts (the coating must stay bound despite marked handling and stent deformation stresses), and (c) developing coating controlled release mechanisms that release the drug slowly over about 30 days. One of the newest innovations in coronary stents is the development of a dissolving stent. Abbott Laboratories has used a dissolvable material, polylactic acid, that will completely absorb within 2 years of being implanted.\n\nAlternative approaches \n Angiography (left) and CT (middle and right) of chronic total occlusion lesions at the left anterior descending coronary artery (LAD) and right coronary artery (RCA).\nCT angiography can act as a less invasive alternative to Catheter angiography. Instead of a catheter being inserted into a vein or artery, CT angiography involves only the injection of a CT-visible dye into the arm or hand via an IV line. CT angiography lowers the risk of arterial perforation and catheter site infection. It provides 3D images that can be studied on computer, and also allows measurement of heart ventricle size. Infarct area and arterial calcium can also be observed (however those require a somewhat higher radiation exposure). That said, one advantage retained by Catheter angiography is the ability of the physician to perform procedure such as balloon angioplasty or insertion of a stent to improve blood flow to the artery.[3]\n\nSee also \nAngiography\nInterventional cardiology\nFractional flow reserve\nReferences \nNotes \n\n\n^ Sabatine, edited by Marc S. (2011). Pocket medicine (4th ed.). Philadelphia: Wolters Kluwer Health\/Lippincott Williams & Wilkins. ISBN 1608319059. CS1 maint: Extra text: authors list (link) \n\n^ Hurst, J. Willis; Fuster, Valentin; O'Rourke, Robert A. (2004). Hurst's The Heart. New York: McGraw-Hill, Medical Publishing Division. pp. 489\u201390. ISBN 0-07-142264-1. \n\n^ \"Angiogram vs. CT Catscan Angiogram\". Archived from the original on May 11, 2013. Retrieved July 19, 2013 . \n\n\nGeneral \nConnolly JE. The development of coronary artery surgery: personal recollections. Tex Heart Inst J 2002;29:10-4. PMID 11995842.\nProudfit WL, Shirey EK, Sones FM Jr. Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. Circulation 1966;33:901-10. PMID 5942973.\nSones FM, Shirey EK. Cine coronary arteriography. Mod Concepts Cardiovasc Dis 1962;31:735-8. PMID 13915182.\n[1] Coronary CT angiography by Eugene Lin\n[2] Abbott Dissolving Stent May Be \u2018Next Revolution\u2019 by Michelle Fay Cortez\nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization\">https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7dae9d41420f015e1fc21b33951b5110_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Coronary_catheterization skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Coronary catheterization<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>coronary catheterization<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive\" class=\"mw-redirect\" title=\"Minimally invasive\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a> procedure to access the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_circulation\" title=\"Coronary circulation\" rel=\"external_link\" target=\"_blank\">coronary circulation<\/a> and blood filled chambers of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a>. It is performed for both diagnostic and interventional (treatment) purposes.\n<\/p><p>Coronary catheterization is one of the several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiology_diagnostic_tests_and_procedures\" title=\"Cardiology diagnostic tests and procedures\" rel=\"external_link\" target=\"_blank\">cardiology diagnostic tests and procedures<\/a>. Specifically, coronary catheterization is a visually interpreted test performed to recognize <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_occlusion\" title=\"Vascular occlusion\" rel=\"external_link\" target=\"_blank\">occlusion<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restenosis\" title=\"Restenosis\" rel=\"external_link\" target=\"_blank\">restenosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombosis\" title=\"Thrombosis\" rel=\"external_link\" target=\"_blank\">thrombosis<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysmal<\/a> enlargement of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">coronary artery<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumen_(anatomy)\" title=\"Lumen (anatomy)\" rel=\"external_link\" target=\"_blank\">lumens<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_chamber\" class=\"mw-redirect\" title=\"Heart chamber\" rel=\"external_link\" target=\"_blank\">heart chamber<\/a> size; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_muscle\" class=\"mw-redirect\" title=\"Heart muscle\" rel=\"external_link\" target=\"_blank\">heart muscle<\/a> contraction performance; and some aspects of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valve\" title=\"Heart valve\" rel=\"external_link\" target=\"_blank\">heart valve<\/a> function. Important internal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lung<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressures<\/a>, not measurable from outside the body, can be accurately measured during the test. The relevant problems that the test deals with most commonly occur as a result of advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a> \u2013 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a> activity within the wall of the coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">arteries<\/a>. Less frequently, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valve\" title=\"Heart valve\" rel=\"external_link\" target=\"_blank\">valvular<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_muscle\" class=\"mw-redirect\" title=\"Heart muscle\" rel=\"external_link\" target=\"_blank\">heart muscle<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_arrhythmia\" title=\"Heart arrhythmia\" rel=\"external_link\" target=\"_blank\">arrhythmia<\/a> issues are the primary focus of the test.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">Coronary artery<\/a> luminal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">narrowing<\/a> reduces the flow reserve for oxygenated blood to the heart, typically producing intermittent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angina_pectoris\" class=\"mw-redirect\" title=\"Angina pectoris\" rel=\"external_link\" target=\"_blank\">angina<\/a>. Very advanced luminal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_occlusion\" title=\"Vascular occlusion\" rel=\"external_link\" target=\"_blank\">occlusion<\/a> usually produces a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">heart attack<\/a>. However, it has been increasingly recognized, since the late 1980s, that coronary catheterization does not allow the recognition of the presence or absence of coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a> itself, only significant luminal changes which have occurred as a result of end stage complications of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerotic<\/a> process. See <a href=\"https:\/\/en.wikipedia.org\/wiki\/IVUS\" class=\"mw-redirect\" title=\"IVUS\" rel=\"external_link\" target=\"_blank\">IVUS<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a> for a better understanding of this issue.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_invasive_and_interventional_cardiology\" title=\"History of invasive and interventional cardiology\" rel=\"external_link\" target=\"_blank\">History of invasive and interventional cardiology<\/a><\/div>\n<p>The technique of angiography itself was first developed in 1927 by the Portuguese physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egas_Moniz\" class=\"mw-redirect\" title=\"Egas Moniz\" rel=\"external_link\" target=\"_blank\">Egas Moniz<\/a> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Lisbon\" title=\"University of Lisbon\" rel=\"external_link\" target=\"_blank\">University of Lisbon<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_angiography\" title=\"Cerebral angiography\" rel=\"external_link\" target=\"_blank\">cerebral angiography<\/a>, the viewing of brain vasculature by X-ray radiation with the aid of a contrast medium introduced by catheter.\n<\/p><p>Heart catheterization was first performed in 1929 when the German physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Werner_Forssmann\" title=\"Werner Forssmann\" rel=\"external_link\" target=\"_blank\">Werner Forssmann<\/a> inserted a plastic tube in his cubital vein and guided it to the right chamber of the heart. He took an x-ray to prove his success and published it on November 5, 1929 with the title \"\u00dcber die Sondierung des rechten Herzens\" (About probing of the right heart).\n<\/p><p>In the early 1940s, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Andr%C3%A9_Cournand\" class=\"mw-redirect\" title=\"Andr\u00e9 Cournand\" rel=\"external_link\" target=\"_blank\">Andr\u00e9 Cournand<\/a>, in collaboration with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dickinson_Richards\" class=\"mw-redirect\" title=\"Dickinson Richards\" rel=\"external_link\" target=\"_blank\">Dickinson Richards<\/a>, performed more systematic measurements of the hemodynamics of the heart. For their work in the discovery of cardiac catheterization and hemodynamic measurements, Cournand, Forssmann, and Richards shared the Nobel Prize in Physiology or Medicine in 1956. The first radial access for angiography can be traced back to 1953, where <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eduardo_Pereira\" title=\"Eduardo Pereira\" rel=\"external_link\" target=\"_blank\">Eduardo Pereira<\/a>, in Lisbon, Portugal, first cannulated the radial artery to perform a coronary angiogram. \n<\/p><p>In 1960 <a href=\"https:\/\/en.wikipedia.org\/wiki\/F._Mason_Sones\" title=\"F. Mason Sones\" rel=\"external_link\" target=\"_blank\">F. Mason Sones<\/a>, a pediatric cardiologist at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleveland_Clinic\" title=\"Cleveland Clinic\" rel=\"external_link\" target=\"_blank\">Cleveland Clinic<\/a>, accidentally injected radiocontrast in a coronary artery instead of the left ventricle. Although the patient had a reversible cardiac arrest, Sones and Shirey developed the procedure further, and are credited with the discovery (Connolly 2002); they published a series of 1,000 patents in 1966 (Proudfit <i>et al.<\/i>).\n<\/p><p>Since the late 1970s, building on the pioneering work of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Dotter\" class=\"mw-redirect\" title=\"Charles Dotter\" rel=\"external_link\" target=\"_blank\">Charles Dotter<\/a> in 1964 and especially <a href=\"https:\/\/en.wikipedia.org\/wiki\/Andreas_Gruentzig\" title=\"Andreas Gruentzig\" rel=\"external_link\" target=\"_blank\">Andreas Gruentzig<\/a> starting in 1977, coronary catheterization has been extended to therapeutic uses: (a) the performance of less invasive physical treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angina_pectoris\" class=\"mw-redirect\" title=\"Angina pectoris\" rel=\"external_link\" target=\"_blank\">angina<\/a> and some of the complications of severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>, (b) treating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">heart attacks<\/a> before complete damage has occurred and (c) research for better understanding of the pathology of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_disease\" title=\"Coronary artery disease\" rel=\"external_link\" target=\"_blank\">coronary artery disease<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>.\n<\/p><p>In the early 1960s, cardiac catheterization frequently took several hours and involved significant complications for as many as 2\u20133% of patients. With multiple incremental improvements over time, simple coronary catheterization examinations are now commonly done more rapidly and with significantly improved outcomes.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>Indications for cardiac catheterization include the following:\n<\/p>\n<ul><li>Heart Attack (includes ST elevation MI, Non-ST Elevation MI, Unstable Angina)<\/li>\n<li>Abnormal Stress Test<\/li>\n<li>New-onset unexplained heart failure<\/li>\n<li>Survival of sudden cardiac death or dangerous cardiac arrhythmia<\/li>\n<li>Persistent chest pain despite optimal medical therapy<\/li>\n<li>Workup of suspected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prinzmetal%27s_angina\" class=\"mw-redirect\" title=\"Prinzmetal's angina\" rel=\"external_link\" target=\"_blank\">Prinzmetal Angina<\/a> (coronary vasospasm)<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Patient_participation\">Patient participation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_Angiography.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Coronary_Angiography.png\/220px-Coronary_Angiography.png\" width=\"220\" height=\"110\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_Angiography.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Coronary Angiography.<\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient\" title=\"Patient\" rel=\"external_link\" target=\"_blank\">patient<\/a> being examined or treated is usually awake during catheterization, ideally with only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anaesthesia\" class=\"mw-redirect\" title=\"Local anaesthesia\" rel=\"external_link\" target=\"_blank\">local anaesthesia<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lidocaine\" title=\"Lidocaine\" rel=\"external_link\" target=\"_blank\">lidocaine<\/a> and minimal general <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedation\" title=\"Sedation\" rel=\"external_link\" target=\"_blank\">sedation<\/a>, throughout the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_procedure\" class=\"mw-redirect\" title=\"Surgical procedure\" rel=\"external_link\" target=\"_blank\">procedure<\/a>. Performing the procedure with the patient awake is safer as the patient can immediately report any discomfort or problems and thereby facilitate rapid correction of any undesirable events. Medical monitors fail to give a comprehensive view of the patient's immediate well-being; how the patient feels is often a most reliable indicator of procedural safety.\n<\/p><p>Death, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">myocardial infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>, serious <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_arrhythmia\" class=\"mw-redirect\" title=\"Ventricular arrhythmia\" rel=\"external_link\" target=\"_blank\">ventricular arrhythmia<\/a>, and major vascular complications each occur in less than 1% of patients undergoing catheterization.<sup id=\"rdp-ebb-cite_ref-isbn0-07-142264-1_2-0\" class=\"reference\"><a href=\"#cite_note-isbn0-07-142264-1-2\" rel=\"external_link\">[2]<\/a><\/sup> However, though the imaging portion of the examination is often brief, because of setup and safety issues the patient is often in the lab for 20\u201345 minutes. Any of multiple technical difficulties, while not endangering the patient (indeed added to protect the patient's interests) can significantly increase the examination time.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Equipment\">Equipment<\/span><\/h2>\n<p>Coronary catheterization is performed in a catheterization lab, usually located within a hospital. With current designs, the patient must lie relatively flat on a narrow, minimally padded, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiodensity\" title=\"Radiodensity\" rel=\"external_link\" target=\"_blank\">radiolucent<\/a> (transparent to <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a>) table. The X-ray source and imaging camera equipment are on opposite sides of the patient's chest and freely move, under motorized control, around the patient's chest so images can be taken quickly from multiple angles. More advanced equipment, termed a bi-plane cath lab, uses two sets of X-ray source and imaging cameras, each free to move independently, which allows two sets of images to be taken with each injection of radiocontrast agent. The equipment and installation setup to perform such testing typically represents a capital expenditure of US$2\u20135 million (2004), sometimes more, partially repeated every few years.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Diagnostic_procedures\">Diagnostic procedures<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Angiography_coronary_stenosis_01.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8b\/Angiography_coronary_stenosis_01.jpg\/220px-Angiography_coronary_stenosis_01.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Angiography_coronary_stenosis_01.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Coronary angiography of a critical sub-occlusion of the common trunk of the left coronary artery and the circumflex artery. (See arrows)<\/div><\/div><\/div>\n<p>During coronary catheterization (often referred to as a <b>cath<\/b> by physicians), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressures<\/a> are recorded and <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motion_picture\" class=\"mw-redirect\" title=\"Motion picture\" rel=\"external_link\" target=\"_blank\">motion picture<\/a> shadow-grams of the blood inside the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_arteries\" title=\"Coronary arteries\" rel=\"external_link\" target=\"_blank\">coronary arteries<\/a> are recorded. In order to create the X-ray pictures, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physician<\/a> guides a small tube-like device called a catheter, typically ~2.0 mm (6-French) in diameter, through the large arteries of the body until the tip is just within the opening of one of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_arteries\" title=\"Coronary arteries\" rel=\"external_link\" target=\"_blank\">coronary arteries<\/a>. By design, the catheter is smaller than the lumen of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> it is placed in; internal (intra-arterial) blood pressures are monitored through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> to verify that the catheter does not block blood flow.\n<\/p><p>The catheter is itself designed to be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiodensity\" title=\"Radiodensity\" rel=\"external_link\" target=\"_blank\">radiodense<\/a> for visibility and it allows a clear, watery, blood compatible radiocontrast agent, commonly called an X-ray dye, to be selectively injected and mixed with the blood flowing within the artery. Typically 3\u20138 cc of the radiocontrast agent is injected for each image to make the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_flow\" class=\"mw-redirect\" title=\"Blood flow\" rel=\"external_link\" target=\"_blank\">blood flow<\/a> visible for about 3\u20135 seconds as the radiocontrast agent is rapidly washed away into the coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capillaries\" class=\"mw-redirect\" title=\"Capillaries\" rel=\"external_link\" target=\"_blank\">capillaries<\/a> and then coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">veins<\/a>. Without the X-ray dye injection, the blood and surrounding heart <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_tissue\" class=\"mw-redirect\" title=\"Biological tissue\" rel=\"external_link\" target=\"_blank\">tissues<\/a> appear, on X-ray, as only a mildly-shape-changing, otherwise uniform water density mass; no details of the blood and internal organ structure are discernible. The radiocontrast within the blood allows visualization of the blood flow within the arteries or heart chambers, depending on where it is injected.\n<\/p><p>If <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clot\" class=\"mw-redirect\" title=\"Clot\" rel=\"external_link\" target=\"_blank\">clots<\/a>, are protruding into the lumen, producing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">narrowing<\/a>, the narrowing may be seen instead as increased haziness within the X-ray shadow images of the blood\/dye column within that portion of the artery; this is as compared to adjacent, presumed healthier, less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenotic<\/a> areas. See the single frame illustration of a coronary angiogram image on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">angioplasty<\/a> page.\n<\/p><p>For guidance regarding catheter positions during the examination, the physician mostly relies on detailed knowledge of internal anatomy, guide wire and catheter behavior and intermittently, briefly uses <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> and a low X-ray dose to visualize when needed. This is done without saving recordings of these brief looks. When the physician is ready to record , which are saved and can be more carefully scrutinized later, he activates the equipment to apply a significantly higher X-ray dose, termed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cine\" class=\"mw-redirect\" title=\"Cine\" rel=\"external_link\" target=\"_blank\">cine<\/a>, in order to create better quality motion picture images, having sharper radiodensity contrast, typically at 30 frames per second. The physician controls both the contrast injection, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> and cine application timing so as to minimize the total amount of radiocontrast injected and times the X-Ray to the injection so as to minimize the total amount of X-ray used. Doses of radiocontrast agents and X-ray exposure times are routinely recorded in an effort to maximize safety.\n<\/p><p>Though not the focus of the test, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcification\" title=\"Calcification\" rel=\"external_link\" target=\"_blank\">calcification<\/a> within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> walls, located in the outer edges of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a> within the artery walls, is sometimes recognizable on fluoroscopy (without contrast injection) as radiodense halo rings partially encircling, and separated from the blood filled lumen by the interceding radiolucent atheroma tissue and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endothelium\" title=\"Endothelium\" rel=\"external_link\" target=\"_blank\">endothelial<\/a> lining. Calcification, even though usually present, is usually only visible when quite advanced and calcified sections of the artery wall happen to be viewed on end <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tangent\" title=\"Tangent\" rel=\"external_link\" target=\"_blank\">tangentially<\/a> through multiple rings of calcification, so as to create enough radiodensity to be visible on fluoroscopy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Therapeutic_procedures\">Therapeutic procedures<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_coronary_intervention\" title=\"Percutaneous coronary intervention\" rel=\"external_link\" target=\"_blank\">Percutaneous coronary intervention<\/a><\/div>\n<p>By changing the diagnostic catheter to a guiding catheter, physicians can also pass a variety of instruments through the catheter and into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lesion\" title=\"Lesion\" rel=\"external_link\" target=\"_blank\">lesion<\/a> site. The most commonly used are 0.014-inch-diameter (0.36 mm) guide wires and the balloon dilation catheters.\n<\/p><p>By injecting radiocontrast agent through a tiny passage extending down the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Balloon_catheter\" title=\"Balloon catheter\" rel=\"external_link\" target=\"_blank\">balloon catheter<\/a> and into the balloon, the balloon is progressively expanded. The hydraulic pressures are chosen and applied by the physician, according to how the balloon within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a> (abnormal narrowing in a blood vessel) responds. The radiocontrast filled balloon is watched under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> (it typically assumes a \"dog bone\" shape imposed on the outside of the balloon by the stenosis as the balloon is expanded), as it opens. As much <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydraulic\" class=\"mw-redirect\" title=\"Hydraulic\" rel=\"external_link\" target=\"_blank\">hydraulic<\/a> brute force is applied as judged needed and visualized to be effective to make the stenosis of the artery lumen visibly enlarge.\n<\/p><p>Typical normal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">coronary artery<\/a> pressures are in the <200 mmHg range (27 kPa). The hydraulic pressures applied within the balloon may extend to as high as 19000 mmHg (2,500 kPa). Prevention of over-enlargement is achieved by choosing balloons manufactured out of high tensile strength clear plastic membranes. The balloon is initially folded around the catheter, near the tip, to create a small cross-sectional profile to facilitate passage though luminal stenotic areas, and is designed to inflate to a specific pre-designed diameter. If over inflated, the balloon material simply tears and allows the inflating radiocontrast agent to simply escape into the blood.\n<\/p><p>Additionally, several other devices can be advanced into the artery via a guiding catheter. These include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser\" title=\"Laser\" rel=\"external_link\" target=\"_blank\">laser<\/a> catheters, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> catheters, <a href=\"https:\/\/en.wikipedia.org\/wiki\/IVUS\" class=\"mw-redirect\" title=\"IVUS\" rel=\"external_link\" target=\"_blank\">IVUS<\/a> catheters, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Doppler_echocardiography\" title=\"Doppler echocardiography\" rel=\"external_link\" target=\"_blank\">Doppler<\/a> catheter, pressure or temperature measurement catheter and various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clot\" class=\"mw-redirect\" title=\"Clot\" rel=\"external_link\" target=\"_blank\">clot<\/a> and grinding or removal devices. Most of these devices have turned out to be niche devices, only useful in a small percentage of situations or for research.\n<\/p><p>Stents, which are specially manufactured expandable stainless steel mesh tubes, mounted on a balloon catheter, are the most commonly used device beyond the balloon catheter. When the stent\/balloon device is positioned within the stenosis, the balloon is inflated which, in turn, expands the stent and the artery. The balloon is removed and the stent remains in place, supporting the inner artery walls in the more open, dilated position. Current stents generally cost around $1,000 to 3,000 each (US 2004 dollars), the drug coated ones being the more expensive.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Advances_in_catheter_based_physical_treatments\">Advances in catheter based physical treatments<\/span><\/h2>\n<p>Interventional procedures have been plagued by restenosis due to the formation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endothelium\" title=\"Endothelium\" rel=\"external_link\" target=\"_blank\">endothelial<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_tissue\" class=\"mw-redirect\" title=\"Biological tissue\" rel=\"external_link\" target=\"_blank\">tissue<\/a> overgrowth at the lesion site. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restenosis\" title=\"Restenosis\" rel=\"external_link\" target=\"_blank\">Restenosis<\/a> is the body's response to the injury of the vessel wall from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">angioplasty<\/a> and to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body\" title=\"Foreign body\" rel=\"external_link\" target=\"_blank\">foreign body<\/a>. As assessed in clinical trials during the late 1980 and 1990s, using only balloon angioplasty (POBA, plain old balloon angioplasty), up to 50% of patients suffered significant restenosis; but that percentage has dropped to the single to lower two digit range with the introduction of drug-eluting stents. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sirolimus\" title=\"Sirolimus\" rel=\"external_link\" target=\"_blank\">Sirolimus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paclitaxel\" title=\"Paclitaxel\" rel=\"external_link\" target=\"_blank\">paclitaxel<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Everolimus\" title=\"Everolimus\" rel=\"external_link\" target=\"_blank\">everolimus<\/a> are the three drugs used in coatings which are currently FDA approved in the United States. As opposed to bare metal, drug eluting stents are covered with a medicine that is slowly dispersed with the goal of suppressing the restenosis reaction. The key to the success of drug coating has been (a) choosing effective agents, (b) developing ways of adequately binding the drugs to the stainless surface of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> struts (the coating must stay bound despite marked handling and stent deformation stresses), and (c) developing coating controlled release mechanisms that release the drug slowly over about 30 days. One of the newest innovations in coronary stents is the development of a dissolving stent. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abbott_Laboratories\" title=\"Abbott Laboratories\" rel=\"external_link\" target=\"_blank\">Abbott Laboratories<\/a> has used a dissolvable material, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, that will completely absorb within 2 years of being implanted.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternative_approaches\">Alternative approaches<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_revascularization.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Coronary_revascularization.png\/220px-Coronary_revascularization.png\" width=\"220\" height=\"185\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_revascularization.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Angiography (left) and CT (middle and right) of chronic total occlusion lesions at the left anterior descending coronary artery (LAD) and right coronary artery (RCA).<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_computed_tomography\" class=\"mw-redirect\" title=\"X-ray computed tomography\" rel=\"external_link\" target=\"_blank\">CT angiography<\/a> can act as a less invasive alternative to Catheter angiography. Instead of a catheter being inserted into a vein or artery, CT angiography involves only the injection of a CT-visible dye into the arm or hand via an IV line. CT angiography lowers the risk of arterial perforation and catheter site infection. It provides 3D images that can be studied on computer, and also allows measurement of heart ventricle size. Infarct area and arterial calcium can also be observed (however those require a somewhat higher radiation exposure). That said, one advantage retained by Catheter angiography is the ability of the physician to perform procedure such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">balloon angioplasty<\/a> or insertion of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> to improve blood flow to the artery.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Angiography\" title=\"Angiography\" rel=\"external_link\" target=\"_blank\">Angiography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_cardiology\" title=\"Interventional cardiology\" rel=\"external_link\" target=\"_blank\">Interventional cardiology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractional_flow_reserve\" title=\"Fractional flow reserve\" rel=\"external_link\" target=\"_blank\">Fractional flow reserve<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h3>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Sabatine, edited by Marc S. (2011). <i>Pocket medicine<\/i> (4th ed.). Philadelphia: Wolters Kluwer Health\/Lippincott Williams & Wilkins. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1608319059.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pocket+medicine&rft.place=Philadelphia&rft.edition=4th&rft.pub=Wolters+Kluwer+Health%2FLippincott+Williams+%26+Wilkins&rft.date=2011&rft.isbn=1608319059&rft.aulast=Sabatine&rft.aufirst=edited+by+Marc+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACoronary+catheterization\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Extra text: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Extra_text:_authors_list\" title=\"Category:CS1 maint: Extra text: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/span>\n<\/li>\n<li id=\"cite_note-isbn0-07-142264-1-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-isbn0-07-142264-1_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Hurst, J. Willis; Fuster, Valentin; O'Rourke, Robert A. (2004). <a rel=\"external_link\" class=\"external text\" href=\"#PRA2-PA489\"><i>Hurst's The Heart<\/i><\/a>. New York: McGraw-Hill, Medical Publishing Division. pp. 489\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-07-142264-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Hurst%27s+The+Heart&rft.place=New+York&rft.pages=489-90&rft.pub=McGraw-Hill%2C+Medical+Publishing+Division&rft.date=2004&rft.isbn=0-07-142264-1&rft.au=Hurst%2C+J.+Willis&rft.au=Fuster%2C+Valentin&rft.au=O%27Rourke%2C+Robert+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D5Yl1LNe69lwC%26pg%3DRA2-PA481%23PRA2-PA489&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACoronary+catheterization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130511054812\/http:\/\/www.ct-angiogram.com\/Angiogram_vs._CT_Catscan_Angiogram_2273.htm\" target=\"_blank\">\"Angiogram vs. CT Catscan Angiogram\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ct-angiogram.com\/Angiogram_vs._CT_Catscan_Angiogram_2273.htm\" target=\"_blank\">the original<\/a> on May 11, 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">July 19,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Angiogram+vs.+CT+Catscan+Angiogram&rft_id=http%3A%2F%2Fwww.ct-angiogram.com%2FAngiogram_vs._CT_Catscan_Angiogram_2273.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACoronary+catheterization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"General\">General<\/span><\/h3>\n<ul><li>Connolly JE. The development of coronary artery surgery: personal recollections. <i>Tex Heart Inst J<\/i> 2002;29:10-4. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11995842\" target=\"_blank\">11995842<\/a>.<\/li>\n<li>Proudfit WL, Shirey EK, Sones FM Jr. Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. <i>Circulation<\/i> 1966;33:901-10. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/5942973\" target=\"_blank\">5942973<\/a>.<\/li>\n<li>Sones FM, Shirey EK. Cine coronary arteriography. <i>Mod Concepts Cardiovasc Dis<\/i> 1962;31:735-8. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/13915182\" target=\"_blank\">13915182<\/a>.<\/li>\n<li><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/emedicine.medscape.com\/article\/1603072-overview\" target=\"_blank\">[1]<\/a> Coronary CT angiography by Eugene Lin<\/li>\n<li><a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/web.archive.org\/web\/20101018180232\/http:\/\/www.businessweek.com\/news\/2010-09-09\/abbott-dissolving-stent-may-be-next-revolution-.html\" target=\"_blank\">[2]<\/a> Abbott Dissolving Stent May Be \u2018Next Revolution\u2019 by Michelle Fay Cortez<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181205151601\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.300 seconds\nReal time usage: 0.397 seconds\nPreprocessor visited node count: 984\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 42969\/2097152 bytes\nTemplate argument size: 1183\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 14805\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.125\/10.000 seconds\nLua memory usage: 4.2 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 302.909 1 -total\n<\/p>\n<pre>31.57% 95.634 1 Template:Infobox_medical_intervention\n30.45% 92.242 1 Template:Reflist\n29.12% 88.204 1 Template:Infobox\n23.10% 69.968 2 Template:Cite_book\n14.62% 44.295 1 Template:Convert\n10.92% 33.089 2 Template:Navbox\n 8.93% 27.053 1 Template:Cardiac_procedures\n 6.79% 20.553 3 Template:PMID\n 6.15% 18.636 2 Template:Main\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:582832-1!canonical and timestamp 20181205151600 and revision id 859336064\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_catheterization\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214658\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.030 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 165.348 1 - wikipedia:Coronary_catheterization\n100.00% 165.348 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8564-0!*!*!*!*!*!* and timestamp 20181217214658 and revision id 24992\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization\">https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7dae9d41420f015e1fc21b33951b5110_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Ha1.jpg\/560px-Ha1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Coronary_Angiography.png\/440px-Coronary_Angiography.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8b\/Angiography_coronary_stenosis_01.jpg\/440px-Angiography_coronary_stenosis_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Coronary_revascularization.png\/440px-Coronary_revascularization.png"],"7dae9d41420f015e1fc21b33951b5110_timestamp":1545083218,"a861e2413242a1a61c199e0a714946fe_type":"article","a861e2413242a1a61c199e0a714946fe_title":"Corneal pachymetry","a861e2413242a1a61c199e0a714946fe_url":"https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry","a861e2413242a1a61c199e0a714946fe_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCorneal pachymetry\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2015) (Learn how and when to remove this template message)\nCorneal pachymetryMedical diagnosticsA typical ultrasound pachymeter\nCorneal pachymetry is the process of measuring the thickness of the cornea. A pachymeter is a medical device used to measure the thickness of the eye's cornea. It is used to perform corneal pachymetry prior to refractive surgery, for Keratoconus screening, LRI surgery [1] and is useful in screening for patients suspected of developing glaucoma among other uses.\n\nContents \n\n1 Process \n2 Pachymeters \n3 Indications \n4 Technology \n5 References \n\n\nProcess \nIt can be done using either ultrasonic or optical methods . The contact methods, such as ultrasound and optical such as confocal microscopy (CONFOSCAN), or noncontact methods such as optical biometry with a single Scheimpflug camera (such as SIRIUS or PENTACAM), or a Dual Scheimpflug camera (such as GALILEI), or Optical Coherence Tomography (OCT, such as Visante) and online Optical Coherence Pachymetry (OCP, such as ORBSCAN). Corneal Pachymetry is essential prior to a refractive surgery procedure for ensuring sufficient corneal thickness to prevent abnormal bulging of the cornea, a side effect known as ectasia.\n\nPachymeters \nThe instrument used for this purpose is known as a pachymeter. Conventional pachymeters are devices that display the thickness of the cornea, usually in micrometres, when the ultrasonic transducer touches the cornea. Newer generations of ultrasonic pachymeters work by way of Corneal Waveform (CWF). Using this technology the user can capture an ultra-high definition echogram of the cornea, somewhat like a corneal A-scan. Pachymetry using the corneal waveform process allows the user to more accurately measure the corneal thickness, verify the reliability of the measurements that were obtained, superimpose corneal waveforms to monitor changes in a patient's cornea over time, and measure structures within the cornea such as micro bubbles created during femto-second laser flap cuts.[2]\n\nIndications \nCorneal pachymetry is essential for other corneal surgeries such as Limbal Relaxing Incisions. LRI[3] is used to reduce corneal astigmatism by placing a pair of incisions of a particular depth and arc length at a steep axis of corneal astigmatism. By using the corneal pachymetry the surgeon will reduce the chances of perforation of the eye and improves surgical outcome. Newer generations of pachymeters will help surgeons by providing graphical surgical plans to eliminate astigmatism.\nCorneal pachymetry is also considered an important test in the early detection of glaucoma. In 2002, the five-year report of the Ocular Hypertension Study (OHTS) was released. The study reported that corneal thickness as measured by corneal pachymetry was an accurate predictor of glaucoma development when combined with standard measurements of intraocular pressure. As a result of this study and others that followed, corneal pachymetry is now widely used by both glaucoma researchers and glaucoma specialists to better diagnose and detect early cases. Newer generation pachymeters have the ability to adjust the intraocular pressure that is measured according to the corneal thickness.\n\nTechnology \nModern devices use ultrasound technology, while earlier models were based on optical principles. The ultrasonic Pachymeters traditionally have been devices that provide the thickness of the human cornea in the form of a number in micrometres that is displayed to the user. The newer generation of ultrasonic pachymeters work by way of Corneal Waveform (CWF). Using this technology the user can capture an ultra high definition echogram of cornea, think of it as a corneal A-scan. Pachymetry using the corneal waveform allows the user to more accurately measure the corneal thickness, have the ability to check the reliability of the measurements that were obtained, have the ability to superimpose corneal waveform to monitor the change of patients cornea over time, and ability to measure structures within the cornea such as micro bubbles created in the cornea during femto-second laser flap cut.[2]\n\nReferences \n\n\n^ [1][dead link ] \n\n^ a b Eisner, R; Israel, R (November 1, 2006). \"Corneal waveform measurements has advantages in pachymetry\". Ocular Surgery News. 24 (21). \n\n^ \"Limbal Relaxing Incisions Made Simple | OphthalmologyWeb: The Ultimate Online Resource for Ophthalmologists\". Ophthalmologyweb.com. 2008-08-27. Retrieved 2015-02-22 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry\">https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:33.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 643 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a861e2413242a1a61c199e0a714946fe_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Corneal_pachymetry skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Corneal pachymetry<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Corneal pachymetry<\/b> is the process of measuring the thickness of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a>. A <b>pachymeter<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> used to measure the thickness of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a>. It is used to perform corneal pachymetry prior to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_surgery\" title=\"Refractive surgery\" rel=\"external_link\" target=\"_blank\">refractive surgery<\/a>, for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keratoconus\" title=\"Keratoconus\" rel=\"external_link\" target=\"_blank\">Keratoconus<\/a> screening, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Limbal_relaxing_incisions\" title=\"Limbal relaxing incisions\" rel=\"external_link\" target=\"_blank\">LRI surgery<\/a> <sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> and is useful in screening for patients suspected of developing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a> among other uses.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Process\">Process<\/span><\/h2>\n<p>It can be done using either ultrasonic or optical methods . The contact methods, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasound<\/a> and optical such as confocal microscopy (CONFOSCAN), or noncontact methods such as optical biometry with a single Scheimpflug camera (such as SIRIUS or PENTACAM), or a Dual Scheimpflug camera (such as GALILEI), or Optical Coherence Tomography (OCT, such as Visante) and online Optical Coherence Pachymetry (OCP, such as ORBSCAN). Corneal Pachymetry is essential prior to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_surgery\" title=\"Refractive surgery\" rel=\"external_link\" target=\"_blank\">refractive surgery<\/a> procedure for ensuring sufficient corneal thickness to prevent abnormal bulging of the cornea, a side effect known as ectasia.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Pachymeters\">Pachymeters<\/span><\/h2>\n<p>The instrument used for this purpose is known as a <i>pachymeter<\/i>. Conventional pachymeters are devices that display the thickness of the cornea, usually in micrometres, when the ultrasonic transducer touches the cornea. Newer generations of ultrasonic pachymeters work by way of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_Waveform_(CWF)\" class=\"mw-redirect\" title=\"Corneal Waveform (CWF)\" rel=\"external_link\" target=\"_blank\">Corneal Waveform (CWF)<\/a>. Using this technology the user can capture an ultra-high definition echogram of the cornea, somewhat like a corneal A-scan. Pachymetry using the corneal waveform process allows the user to more accurately measure the corneal thickness, verify the reliability of the measurements that were obtained, superimpose corneal waveforms to monitor changes in a patient's cornea over time, and measure structures within the cornea such as micro bubbles created during femto-second laser flap cuts.<sup id=\"rdp-ebb-cite_ref-Eisner2006_2-0\" class=\"reference\"><a href=\"#cite_note-Eisner2006-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>Corneal pachymetry is essential for other corneal surgeries such as Limbal Relaxing Incisions. LRI<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> is used to reduce corneal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Astigmatism\" title=\"Astigmatism\" rel=\"external_link\" target=\"_blank\">astigmatism<\/a> by placing a pair of incisions of a particular depth and arc length at a steep axis of corneal astigmatism. By using the corneal pachymetry the surgeon will reduce the chances of perforation of the eye and improves surgical outcome. Newer generations of pachymeters will help surgeons by providing graphical surgical plans to eliminate astigmatism.\n<\/p><p>Corneal pachymetry is also considered an important test in the early detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a>. In 2002, the five-year report of the Ocular Hypertension Study (OHTS) was released. The study reported that corneal thickness as measured by corneal pachymetry was an accurate predictor of glaucoma development when combined with standard measurements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraocular_pressure\" title=\"Intraocular pressure\" rel=\"external_link\" target=\"_blank\">intraocular pressure<\/a>. As a result of this study and others that followed, corneal pachymetry is now widely used by both glaucoma researchers and glaucoma specialists to better diagnose and detect early cases. Newer generation pachymeters have the ability to adjust the intraocular pressure that is measured according to the corneal thickness.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technology\">Technology<\/span><\/h2>\n<p>Modern devices use ultrasound technology, while earlier models were based on optical principles. The ultrasonic Pachymeters traditionally have been devices that provide the thickness of the human cornea in the form of a number in micrometres that is displayed to the user. The newer generation of ultrasonic pachymeters work by way of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_Waveform_(CWF)\" class=\"mw-redirect\" title=\"Corneal Waveform (CWF)\" rel=\"external_link\" target=\"_blank\">Corneal Waveform (CWF)<\/a>. Using this technology the user can capture an ultra high definition echogram of cornea, think of it as a corneal A-scan. Pachymetry using the corneal waveform allows the user to more accurately measure the corneal thickness, have the ability to check the reliability of the measurements that were obtained, have the ability to superimpose corneal waveform to monitor the change of patients cornea over time, and ability to measure structures within the cornea such as micro bubbles created in the cornea during femto-second laser flap cut.<sup id=\"rdp-ebb-cite_ref-Eisner2006_2-1\" class=\"reference\"><a href=\"#cite_note-Eisner2006-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.micromedinc.com\/docs\/LRI.pps?phpMyAdmin=Fcl1OjyGwOwdRVEgAYHUz%2CRRli1\" target=\"_blank\">[1]<\/a><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since June 2016\">dead link<\/span><\/a><\/i>]<\/span><\/sup><\/span>\n<\/li>\n<li id=\"cite_note-Eisner2006-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Eisner2006_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Eisner2006_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Eisner, R; Israel, R (November 1, 2006). \"Corneal waveform measurements has advantages in pachymetry\". <i>Ocular Surgery News<\/i>. <b>24<\/b> (21).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ocular+Surgery+News&rft.atitle=Corneal+waveform+measurements+has+advantages+in+pachymetry&rft.volume=24&rft.issue=21&rft.date=2006-11-01&rft.aulast=Eisner&rft.aufirst=R&rft.au=Israel%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACorneal+pachymetry\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ophthalmologyweb.com\/Tech-Spotlights\/26497-Limbal-Relaxing-Incisions-Made-Simple\/\" target=\"_blank\">\"Limbal Relaxing Incisions Made Simple | OphthalmologyWeb: The Ultimate Online Resource for Ophthalmologists\"<\/a>. Ophthalmologyweb.com. 2008-08-27<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-02-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Limbal+Relaxing+Incisions+Made+Simple+%26%23124%3B+OphthalmologyWeb%3A+The+Ultimate+Online+Resource+for+Ophthalmologists&rft.pub=Ophthalmologyweb.com&rft.date=2008-08-27&rft_id=http%3A%2F%2Fwww.ophthalmologyweb.com%2FTech-Spotlights%2F26497-Limbal-Relaxing-Incisions-Made-Simple%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACorneal+pachymetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181130000029\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.200 seconds\nReal time usage: 0.266 seconds\nPreprocessor visited node count: 540\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 10458\/2097152 bytes\nTemplate argument size: 713\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 5935\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.108\/10.000 seconds\nLua memory usage: 2.38 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 239.285 1 -total\n<\/p>\n<pre>54.42% 130.229 1 Template:Reflist\n33.23% 79.508 1 Template:Cite_news\n29.75% 71.177 1 Template:Refimprove\n18.74% 44.837 1 Template:Ambox\n14.01% 33.514 1 Template:Infobox_diagnostic\n12.16% 29.095 1 Template:Infobox\n 8.38% 20.059 1 Template:Dead_link\n 6.65% 15.908 1 Template:Fix\n 4.46% 10.676 2 Template:Category_handler\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:17212274-1!canonical and timestamp 20181130000029 and revision id 865950838\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_pachymetry\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214657\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.146 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 140.973 1 - wikipedia:Corneal_pachymetry\n100.00% 140.973 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8563-0!*!*!*!*!*!* and timestamp 20181217214657 and revision id 24991\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry\">https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a861e2413242a1a61c199e0a714946fe_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/Pachymeter_%28by_itucker_at_Flickr%29.jpg\/580px-Pachymeter_%28by_itucker_at_Flickr%29.jpg"],"a861e2413242a1a61c199e0a714946fe_timestamp":1545083217,"5e264bde9598d2c256a0d8b5cebe251a_type":"article","5e264bde9598d2c256a0d8b5cebe251a_title":"Augmented reality assisted surgery","5e264bde9598d2c256a0d8b5cebe251a_url":"https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery","5e264bde9598d2c256a0d8b5cebe251a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAugmented reality assisted surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAugmented reality-assisted surgery (ARAS) is a surgical tool utilizing technology that superimposes a computer-generated image on a surgeon\u2019s view of the operative field, thus providing a composite view for the surgeon of the patient with a computer generated overlay enhancing the operative experience. It can be used for training, preparation for an operation, or performance of an operation. ARAS can be performed using a wide array of technology, including an optical head-mounted display (OHMD)\u2014such as the Google Glass XE 22.1 or Vuzix STAR 1200 XL[1]\u2014and a digital overlay from robotic and laparoscopic surgery feeds.[2] The technique has been primarily been tested in the urological and cardiovascular domains.[1][3][4]\n\nSpecialized uses \nA subset of ARAS called augmented reality-assisted urologic surgery (ARAUS) specifically aids with urological surgery. This intraoperative training tool was first described and utilized by Tariq S. Hakky, Ryan M. Dickey, and Larry I. Lipshultz within the Scott Department of Urology, Baylor College of Medicine, and Daniel R. Martinez, Rafael E. Carrion, and Philippe E. Spiess within the Sexual Medicine Program in the Department of Urology, at the University of South Florida.[1] It was initially used to teach medical residents how to place a penile prosthesis from start to finish via an application downloaded onto the OHMD. Intraoperatively, an optical display camera output feed combined with software allowing for the detection of points of interest enabled faculty to interact with residents during the placement of the penile prosthesis. Both faculty and residents demonstrated a high degree of satisfaction of the ARAUS experience, and it was shown to be an effective tool in training urological surgical technique. Advantages of ARAUS include real-time feedback of residents during surgery and superior visibility and interaction between faculty and residents.[1][3]\nARAS has also been applied to the cardiovascular realm. Terry Peters of the University of Western Ontario in London, Canada has teamed up with other researchers at the Robarts Research Institute to implement ARAS towards the goal of improving repairs to the heart's mitral valve and replacement of the aortic valve.[4] In an interview for the Medical Augmented Reality Blog, Peters stated that his research team could not only use ARAS to \"[improve] the speed and safety of the cardiac valve repair procedure\"; they also conducted \"the evaluation of an AR environment to plan brain-tumor removal, and the development of an ARF-enhanced system for ultrasound-guided spinal injections.\"[5]\n\nReferences \n\n\n^ a b c d Hakky, Tariq; Martinez, Daniel; Lipshultz, Larry; Spiess, Philippe; Carrion, Rafael (2015). \"Augmented Reality Assisted Urologic Surgery (ARAUS): A surgical training tool\". The Journal of Urology. 193 (4): e271. doi:10.1016\/j.juro.2015.02.1254. \n\n^ Scopis Surgical Navigation (23 November 2012). Scopis Augmented Reality: Path guidance to craniopharyngioma. YouTube. Retrieved 16 February 2016 . \n\n^ a b Dickey, R.M.; Srikishen, N.; Lipshultz, L.I.; et al. \"Augmented reality assisted surgery: A urologic training tool\". Asian Journal of Andrology. 0 (0): 0. doi:10.4103\/1008-682X.166436. PMID 26620455. \n\n^ a b Peters, Terry (21 May 2015). \"Augmented-Reality Assisted Surgery on the Beating Heart\". IEEE Toronto. Retrieved 16 February 2016 . \n\n^ Bichlmeier, Christoph (8 November 2014). \"Interview with Terry Peters \u2013 Bringing Research to Clinical Practice\". Medical Augmented Reality Blog. Retrieved 16 February 2016 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 20:06.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 506 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5e264bde9598d2c256a0d8b5cebe251a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Augmented_reality_assisted_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Augmented reality assisted surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Augmented reality-assisted surgery<\/b> (<b>ARAS<\/b>) is a surgical tool utilizing technology that superimposes a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-generated_image\" class=\"mw-redirect\" title=\"Computer-generated image\" rel=\"external_link\" target=\"_blank\">computer-generated image<\/a> on a surgeon\u2019s view of the operative field, thus providing a composite view for the surgeon of the patient with a computer generated overlay enhancing the operative experience. It can be used for training, preparation for an operation, or performance of an operation. ARAS can be performed using a wide array of technology, including an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_head-mounted_display\" title=\"Optical head-mounted display\" rel=\"external_link\" target=\"_blank\">optical head-mounted display<\/a> (OHMD)\u2014such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Google_Glass\" title=\"Google Glass\" rel=\"external_link\" target=\"_blank\">Google Glass<\/a> XE 22.1 or Vuzix STAR 1200 XL<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-0\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup>\u2014and a digital overlay from robotic and laparoscopic surgery feeds.<sup id=\"rdp-ebb-cite_ref-Scopis12_2-0\" class=\"reference\"><a href=\"#cite_note-Scopis12-2\" rel=\"external_link\">[2]<\/a><\/sup> The technique has been primarily been tested in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urology\" title=\"Urology\" rel=\"external_link\" target=\"_blank\">urological<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiovascular_system\" class=\"mw-redirect\" title=\"Cardiovascular system\" rel=\"external_link\" target=\"_blank\">cardiovascular<\/a> domains.<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-1\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DickeyAug15_3-0\" class=\"reference\"><a href=\"#cite_note-DickeyAug15-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-PetersAug15_4-0\" class=\"reference\"><a href=\"#cite_note-PetersAug15-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Specialized_uses\">Specialized uses<\/span><\/h2>\n<p>A subset of ARAS called augmented reality-assisted urologic surgery (ARAUS) specifically aids with urological <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. This intraoperative training tool was first described and utilized by Tariq S. Hakky, Ryan M. Dickey, and Larry I. Lipshultz within the Scott Department of Urology, Baylor College of Medicine, and Daniel R. Martinez, Rafael E. Carrion, and Philippe E. Spiess within the Sexual Medicine Program in the Department of Urology, at the University of South Florida.<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-2\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup> It was initially used to teach medical residents how to place a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penile_prosthesis\" title=\"Penile prosthesis\" rel=\"external_link\" target=\"_blank\">penile prosthesis<\/a> from start to finish via an application downloaded onto the OHMD. Intraoperatively, an optical display camera output feed combined with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Software\" title=\"Software\" rel=\"external_link\" target=\"_blank\">software<\/a> allowing for the detection of points of interest enabled faculty to interact with residents during the placement of the penile prosthesis. Both faculty and residents demonstrated a high degree of satisfaction of the ARAUS experience, and it was shown to be an effective tool in training urological surgical technique. Advantages of ARAUS include real-time feedback of residents during surgery and superior visibility and interaction between faculty and residents.<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-3\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DickeyAug15_3-1\" class=\"reference\"><a href=\"#cite_note-DickeyAug15-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>ARAS has also been applied to the cardiovascular realm. Terry Peters of the University of Western Ontario in London, Canada has teamed up with other researchers at the Robarts Research Institute to implement ARAS towards the goal of improving repairs to the heart's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve\" title=\"Mitral valve\" rel=\"external_link\" target=\"_blank\">mitral valve<\/a> and replacement of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve\" title=\"Aortic valve\" rel=\"external_link\" target=\"_blank\">aortic valve<\/a>.<sup id=\"rdp-ebb-cite_ref-PetersAug15_4-1\" class=\"reference\"><a href=\"#cite_note-PetersAug15-4\" rel=\"external_link\">[4]<\/a><\/sup> In an interview for the Medical Augmented Reality Blog, Peters stated that his research team could not only use ARAS to \"[improve] the speed and safety of the cardiac valve repair procedure\"; they also conducted \"the evaluation of an AR environment to plan <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_tumor\" title=\"Brain tumor\" rel=\"external_link\" target=\"_blank\">brain-tumor<\/a> removal, and the development of an ARF-enhanced system for ultrasound-guided <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia#Spinal,_epidural_and_caudal_anesthesia\" title=\"Anesthesia\" rel=\"external_link\" target=\"_blank\">spinal injections<\/a>.\"<sup id=\"rdp-ebb-cite_ref-BichlmeierInt14_5-0\" class=\"reference\"><a href=\"#cite_note-BichlmeierInt14-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-HakkyAug15-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-HakkyAug15_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HakkyAug15_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HakkyAug15_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HakkyAug15_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hakky, Tariq; Martinez, Daniel; Lipshultz, Larry; Spiess, Philippe; Carrion, Rafael (2015). \"Augmented Reality Assisted Urologic Surgery (ARAUS): A surgical training tool\". <i>The Journal of Urology<\/i>. <b>193<\/b> (4): e271. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.juro.2015.02.1254\" target=\"_blank\">10.1016\/j.juro.2015.02.1254<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Urology&rft.atitle=Augmented+Reality+Assisted+Urologic+Surgery+%28ARAUS%29%3A+A+surgical+training+tool&rft.volume=193&rft.issue=4&rft.pages=e271&rft.date=2015&rft_id=info%3Adoi%2F10.1016%2Fj.juro.2015.02.1254&rft.aulast=Hakky&rft.aufirst=Tariq&rft.au=Martinez%2C+Daniel&rft.au=Lipshultz%2C+Larry&rft.au=Spiess%2C+Philippe&rft.au=Carrion%2C+Rafael&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Scopis12-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Scopis12_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation audio-visual\">Scopis Surgical Navigation (23 November 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=i4emmCcBb4s\" target=\"_blank\"><i>Scopis Augmented Reality: Path guidance to craniopharyngioma<\/i><\/a>. YouTube<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Scopis+Augmented+Reality%3A+Path+guidance+to+craniopharyngioma&rft.pub=YouTube&rft.date=2012-11-23&rft.au=Scopis+Surgical+Navigation&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3Di4emmCcBb4s&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-DickeyAug15-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-DickeyAug15_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DickeyAug15_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dickey, R.M.; Srikishen, N.; Lipshultz, L.I.; et al. \"Augmented reality assisted surgery: A urologic training tool\". <i>Asian Journal of Andrology<\/i>. <b>0<\/b> (0): 0. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F1008-682X.166436\" target=\"_blank\">10.4103\/1008-682X.166436<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26620455\" target=\"_blank\">26620455<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Asian+Journal+of+Andrology&rft.atitle=Augmented+reality+assisted+surgery%3A+A+urologic+training+tool&rft.volume=0&rft.issue=0&rft.pages=0&rft_id=info%3Adoi%2F10.4103%2F1008-682X.166436&rft_id=info%3Apmid%2F26620455&rft.au=Dickey%2C+R.M.&rft.au=Srikishen%2C+N.&rft.au=Lipshultz%2C+L.I.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PetersAug15-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-PetersAug15_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PetersAug15_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Peters, Terry (21 May 2015). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ewh.ieee.org\/r7\/toronto\/events\/may2115.html\" target=\"_blank\">\"Augmented-Reality Assisted Surgery on the Beating Heart\"<\/a>. IEEE Toronto<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Augmented-Reality+Assisted+Surgery+on+the+Beating+Heart&rft.pub=IEEE+Toronto&rft.date=2015-05-21&rft.au=Peters%2C+Terry&rft_id=http%3A%2F%2Fewh.ieee.org%2Fr7%2Ftoronto%2Fevents%2Fmay2115.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BichlmeierInt14-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BichlmeierInt14_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Bichlmeier, Christoph (8 November 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medicalaugmentedreality.com\/2014\/11\/interview-with-terry-peters-bringing-research-to-clinical-practice\/\" target=\"_blank\">\"Interview with Terry Peters \u2013 Bringing Research to Clinical Practice\"<\/a>. <i>Medical Augmented Reality Blog<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Medical+Augmented+Reality+Blog&rft.atitle=Interview+with+Terry+Peters+%E2%80%93+Bringing+Research+to+Clinical+Practice&rft.date=2014-11-08&rft.au=Bichlmeier%2C+Christoph&rft_id=http%3A%2F%2Fmedicalaugmentedreality.com%2F2014%2F11%2Finterview-with-terry-peters-bringing-research-to-clinical-practice%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181209115931\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.148 seconds\nReal time usage: 0.180 seconds\nPreprocessor visited node count: 313\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9054\/2097152 bytes\nTemplate argument size: 98\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 14906\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.095\/10.000 seconds\nLua memory usage: 2.46 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.681 1 Template:Reflist\n100.00% 158.681 1 -total\n<\/p>\n<pre>74.38% 118.029 2 Template:Cite_journal\n 9.26% 14.686 2 Template:Cite_web\n 4.66% 7.396 1 Template:Cite_AV_media\n 2.00% 3.169 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:45395430-1!canonical and timestamp 20181209115931 and revision id 869146706\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Augmented_Reality_Assisted_Surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214657\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 153.562 1 - wikipedia:Augmented_Reality_Assisted_Surgery\n100.00% 153.562 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8224-0!*!*!*!*!*!* and timestamp 20181217214657 and revision id 24374\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5e264bde9598d2c256a0d8b5cebe251a_images":[],"5e264bde9598d2c256a0d8b5cebe251a_timestamp":1545083217,"3d2911d947dc7db295e5285b62f25b90_type":"article","3d2911d947dc7db295e5285b62f25b90_title":"Trephine","3d2911d947dc7db295e5285b62f25b90_url":"https:\/\/www.limswiki.org\/index.php\/Trephine","3d2911d947dc7db295e5285b62f25b90_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTrephine\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t A trephine with a center pin can be seen on the left.\n Dr. John Clarke trepanning a skull, ca. 1664, in one of the earliest American portraits. Clarke has a trephine in his right hand. The painting is in Harvard Medical School.[1]\nA trephine (\/t r \u026a \u02c8 f a\u026a n \/ ; from Greek trypanon, meaning an instrument for boring)[2] is a surgical instrument with a cylindrical blade. It can be of one of several dimensions and designs depending on what it is meant to be used for. They may be specially designed for obtaining a cylindrically shaped core of bone that can be used for tests and bone studies, cutting holes in bones (i.e., the skull) or for cutting out a round piece of the cornea for eye surgery.\nA cylindrically shaped core of bone (or bone biopsy) obtained with a bone marrow trephine is usually examined in the histopathology department of a hospital under a microscope. It shows the pattern and cellularity of the bone marrow as it lay in the bone and is a useful diagnostic tool in certain circumstances such as bone marrow cancer and leukemia.[citation needed ]\n\nSee also \nTrepanning\nTrepanation in Mesoamerica\nInstruments used in general surgery\nReferences \n\n\n^ Holmes, Oliver Wendell (September 18, 2008). Medical Essays. \n\n^ \u03c4\u03c1\u03cd\u03c0\u03b1\u03bd\u03bf\u03bd . Liddell, Henry George; Scott, Robert; A Greek\u2013English Lexicon at the Perseus Project. \n\n\nExternal links \n \"Trepan\". The American Cyclop\u00e6dia. 1879. \n\r\n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Trephine\">https:\/\/www.limswiki.org\/index.php\/Trephine<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:00.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 287 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3d2911d947dc7db295e5285b62f25b90_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Trephine skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Trephine<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ancientgreek_surgical.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Ancientgreek_surgical.jpg\/220px-Ancientgreek_surgical.jpg\" width=\"220\" height=\"184\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ancientgreek_surgical.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A trephine with a center pin can be seen on the left.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_John_Clarke_trepanning_a_skull_operation.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4b\/Dr_John_Clarke_trepanning_a_skull_operation.jpg\/220px-Dr_John_Clarke_trepanning_a_skull_operation.jpg\" width=\"220\" height=\"271\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_John_Clarke_trepanning_a_skull_operation.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dr._John_Clarke\" class=\"mw-redirect\" title=\"Dr. John Clarke\" rel=\"external_link\" target=\"_blank\">Dr. John Clarke<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trepanning\" title=\"Trepanning\" rel=\"external_link\" target=\"_blank\">trepanning<\/a> a skull, ca. 1664, in one of the earliest American portraits. Clarke has a trephine in his right hand. The painting is in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvard_Medical_School\" title=\"Harvard Medical School\" rel=\"external_link\" target=\"_blank\">Harvard Medical School<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/div><\/div><\/div>\n<p>A <b>trephine<\/b> (<span class=\"nowrap\"><span class=\"IPA nopopups noexcerpt\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Help:IPA\/English\" title=\"Help:IPA\/English\" rel=\"external_link\" target=\"_blank\">\/<span style=\"border-bottom:1px dotted\"><span title=\"'t' in 'tie'\">t<\/span><span title=\"'r' in 'rye'\">r<\/span><span title=\"\/\u026a\/: 'i' in 'kit'\">\u026a<\/span><span title=\"\/\u02c8\/: primary stress follows\">\u02c8<\/span><span title=\"'f' in 'find'\">f<\/span><span title=\"\/a\u026a\/: 'i' in 'tide'\">a\u026a<\/span><span title=\"'n' in 'nigh'\">n<\/span><\/span>\/<\/a><\/span><\/span>; from Greek <i>trypanon<\/i>, meaning an instrument for boring)<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instrument<\/a> with a cylindrical blade. It can be of one of several dimensions and designs depending on what it is meant to be used for. They may be specially designed for obtaining a cylindrically shaped core of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> that can be used for tests and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_histomorphometry#Bone_histomorphometry\" class=\"mw-redirect\" title=\"Bone histomorphometry\" rel=\"external_link\" target=\"_blank\">bone studies<\/a>, cutting holes in bones (i.e., the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_skull\" class=\"mw-redirect\" title=\"Human skull\" rel=\"external_link\" target=\"_blank\">skull<\/a>) or for cutting out a round piece of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eye_surgery\" title=\"Eye surgery\" rel=\"external_link\" target=\"_blank\">eye surgery<\/a>.\n<\/p><p>A cylindrically shaped core of bone (or bone <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biopsy\" title=\"Biopsy\" rel=\"external_link\" target=\"_blank\">biopsy<\/a>) obtained with a bone marrow trephine is usually examined in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Histopathology\" title=\"Histopathology\" rel=\"external_link\" target=\"_blank\">histopathology<\/a> department of a hospital under a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microscope\" title=\"Microscope\" rel=\"external_link\" target=\"_blank\">microscope<\/a>. It shows the pattern and cellularity of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_marrow\" title=\"Bone marrow\" rel=\"external_link\" target=\"_blank\">bone marrow<\/a> as it lay in the bone and is a useful diagnostic tool in certain circumstances such as bone marrow cancer and leukemia.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trepanning\" title=\"Trepanning\" rel=\"external_link\" target=\"_blank\">Trepanning<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trepanation_in_Mesoamerica\" title=\"Trepanation in Mesoamerica\" rel=\"external_link\" target=\"_blank\">Trepanation in Mesoamerica<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Holmes,_Oliver_Wendell\" class=\"mw-redirect\" title=\"Holmes, Oliver Wendell\" rel=\"external_link\" target=\"_blank\">Holmes, Oliver Wendell<\/a> (September 18, 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gutenberg.org\/ebooks\/2700\" target=\"_blank\"><i>Medical Essays<\/i><\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus:text:1999.04.0057:entry=tru\/panon\" target=\"_blank\"><span lang=\"grc\" title=\"Ancient Greek language text\">\u03c4\u03c1\u03cd\u03c0\u03b1\u03bd\u03bf\u03bd<\/span><\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Liddell\" title=\"Henry Liddell\" rel=\"external_link\" target=\"_blank\">Liddell, Henry George<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Scott_(philologist)\" title=\"Robert Scott (philologist)\" rel=\"external_link\" target=\"_blank\">Scott, Robert<\/a>; <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/A_Greek%E2%80%93English_Lexicon\" title=\"A Greek\u2013English Lexicon\" rel=\"external_link\" target=\"_blank\">A Greek\u2013English Lexicon<\/a><\/i> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perseus_Project\" title=\"Perseus Project\" rel=\"external_link\" target=\"_blank\">Perseus Project<\/a>.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><img alt=\"Wikisource\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4c\/Wikisource-logo.svg\/12px-Wikisource-logo.svg.png\" width=\"12\" height=\"13\" \/> <cite class=\"citation encyclopaedia\">\"<a href=\"https:\/\/en.wikisource.org\/wiki\/The_American_Cyclop%C3%A6dia_(1879)\/Trepan\" class=\"extiw\" title=\"s:The American Cyclop\u00e6dia (1879)\/Trepan\" rel=\"external_link\" target=\"_blank\">Trepan<\/a>\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_American_Cyclop%C3%A6dia\" class=\"mw-redirect\" title=\"The American Cyclop\u00e6dia\" rel=\"external_link\" target=\"_blank\">The American Cyclop\u00e6dia<\/a><\/i>. 1879.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Trepan&rft.btitle=The+American+Cyclop%C3%A6dia&rft.date=1879&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATrephine\" class=\"Z3988\"><\/span><\/li><\/ul>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181215205531\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.276 seconds\nReal time usage: 0.390 seconds\nPreprocessor visited node count: 450\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9312\/2097152 bytes\nTemplate argument size: 623\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 2510\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.207\/10.000 seconds\nLua memory usage: 10.33 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 361.919 1 -total\n<\/p>\n<pre>47.89% 173.335 1 Template:Reflist\n44.66% 161.633 1 Template:LSJ\n43.70% 158.145 1 Template:Lang\n20.93% 75.738 1 Template:Cite_AmCyc\n19.34% 70.002 1 Template:Cite_encyclopedia\n15.32% 55.456 1 Template:IPAc-en\n10.24% 37.070 1 Template:Citation_needed\n 8.48% 30.689 1 Template:Fix\n 5.33% 19.307 1 Template:Medical-equipment-stub\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1669789-1!canonical and timestamp 20181215205531 and revision id 856477753\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trephine\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214657\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.034 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 168.050 1 - wikipedia:Trephine\n100.00% 168.050 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8562-0!*!*!*!*!*!* and timestamp 20181217214656 and revision id 24990\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Trephine\">https:\/\/www.limswiki.org\/index.php\/Trephine<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3d2911d947dc7db295e5285b62f25b90_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Ancientgreek_surgical.jpg\/440px-Ancientgreek_surgical.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4b\/Dr_John_Clarke_trepanning_a_skull_operation.jpg\/440px-Dr_John_Clarke_trepanning_a_skull_operation.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png"],"3d2911d947dc7db295e5285b62f25b90_timestamp":1545083216,"4ecb22262c78bf2dca1ad28cc1bfec99_type":"article","4ecb22262c78bf2dca1ad28cc1bfec99_title":"Surgical stapler","4ecb22262c78bf2dca1ad28cc1bfec99_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_staple","4ecb22262c78bf2dca1ad28cc1bfec99_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical staple\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (April 2016) (Learn how and when to remove this template message)\n 34 surgical staples closing scalp following craniotomy\n Projectional radiograph of surgical staples\nSurgical staples are specialized staples used in surgery in place of sutures to close skin wounds, connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, and the time it takes to close.[1]\nA more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.[2]\n\nContents \n\n1 History \n2 Types and applications \n3 Removal of skin staples \n4 See also \n5 References \n\n\nHistory \nThe technique was pioneered by \"father of surgical stapling\", Hungarian surgeon Humor Hultl.[3][4] Hultl's prototype stapler of 1908 weighed 8 pounds (3.6 kg), and required two hours to assemble and load.\nThe technology was refined in the 1950s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and vascular anastomoses.[5] Mark M. Ravitch, brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur Leon C. Hirsch, who founded the United States Surgical Corporation in 1964 to manufacture surgical staplers under its Auto Suture brand.[6] Until the late 1970s USSC had the market essentially to itself, but in 1977 Johnson & Johnson's Ethicon brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by Tyco Healthcare in 1998, which became Covidien on June 29, 2007.\nSafety and patency of mechanical (stapled) bowel anastomoses has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.[7] It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than catgut, silk and linen, which were the main suture materials used up to the 1990s.\nOne key feature of intestinal staplers is that the edges of the stapler act as a haemostat, compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.[8][2]\nIn patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leaks.[9] Alternative techniques to seal lung tissue are currently investigated.[10]\n\nTypes and applications \nThis section may be too long to read and navigate comfortably. Please consider splitting content into sub-articles, condensing it, or adding or removing subheadings. (June 2014)\n Laparoscopic cholecystectomy.\n Close-up demonstration of a surgical skin stapler.\nThe first commercial staplers were made of stainless steel with titanium staples loaded into reloadable staple cartridges.\nModern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.\nThe staple line may be straight, curved or circular. Circular staplers are used for end-to-end anastomosis after bowel resection or, somewhat more controversially, in esophagogastric surgery.[11] The instruments may be used in either open or laparoscopic surgery, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of trocar ports.\nSome staplers incorporate a knife, to complete excision and anastomosis in a single operation. \nStaplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in vertical banded gastroplasty surgery (popularly known as \"stomach stapling\").\n\n<\/p>\n Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion \u226430\u00b0. Activating guide-wire is connected just immediately before firing (video)\nWhile devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research [12][13][14] circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler.\nAlthough most surgical staples are made of titanium, stainless steel is more often used in some skin staples and clips. Titanium produces less reaction with the immune system and, being non-ferrous, does not interfere significantly with MRI scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on polyglycolic acid, as with many synthetic absorbable sutures.\nTitanium staples are not suspected of causing nickel reactions because nickel is rarely if ever used in titanium alloys.[dubious   – discuss ]\n\nRemoval of skin staples \nWhere skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that when hand-pressure is exerted it pushes down on the staple and pushes it through a slot in the shoe and deforms the staple into an 'M' shape to facilitate its removal, although in an emergency it is possible to remove them with a pair of artery forceps.[15]\nSkin staple removers are manufactured in many shapes and forms,[16] some disposable and some reusable.\n\nSee also \nInstruments used in general surgery\nReferences \n\n\n^ Iavazzo, Christos; Gkegkes, Ioannis D.; Vouloumanou, Evridiki K.; Mamais, Ioannis; Peppas, George; Falagas, Matthew E. (September 2011). \"Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials\". The American Surgeon. 77 (9): 1206\u20131221. ISSN 1555-9823. PMID 21944632. \n\n^ a b Chughtai, T.; Chen, L. Q.; Salasidis, G.; Nguyen, D.; Tchervenkov, C.; Morin, J. F. (November 2000). \"Clips versus suture technique: is there a difference?\". The Canadian Journal of Cardiology. 16 (11): 1403\u20131407. ISSN 0828-282X. PMID 11109037. \n\n^ Non-suture methods of vascular anastomosis, British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271 \n\n^ Circular vascular stapling in coronary surgery,\nKonstantinov, Annals of Thoracic Surgery, 2004; 78: 369-373 \n\n^ [1] \n\n^ History of United States Surgical Corporation \n\n^ Brundage Susan I (2001). \"Stapled versus Sutured Gastrointestinal Anastomoses in the Trauma Patient: A Multicenter Trial\". Journal of Trauma-Injury Infection & Critical Care. 51 (6): 1054\u20131061. doi:10.1097\/00005373-200112000-00005. \n\n^ Surgery Today, Volume 34, Number 2 \/ February, 2004 \n\n^ Venuta, F; Rendina, EA; De Giacomo, T; Flaishman, I; Guarino, E; Ciccone, AM; Ricci, C (April 1998). \"Technique to reduce air leaks after pulmonary lobectomy\". European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 13 (4): 361\u20134. PMID 9641332. \n\n^ Guedes, Rog\u00e9rio Luizari; H\u00f6glund, Odd Viking; Brum, Juliana Sperotto; Borg, Niklas; Dornbusch, Peterson Triches (3 January 2018). \"Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application\". Surgical Innovation. 25 (2): 158\u2013164. doi:10.1177\/1553350617751293. \n\n^ European Journal of Cardio-Thoracic Surgery, Volume 25, Issue 6, June 2004, Pages 1097-1101 \n\n^ Nazari S et al. A new vascular stapler for pulmonary artery anastomosis in experimental single lung trasnplantation.Video, Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990 \n\n^ \"Evaluation of an aortic stapler for an open aortic anastomosis\". The Journal of Cardiovascular Surgery (Torino). 48 (5): 659\u201365. Oct 2007 – via Minerva Medica. \n\n^ \"Intravascular Stapler for \"Open\" Aortic Surgery: Preliminary Results\". European Journal of Vascular and Endovascular Surgery. 33 (4): 408\u201311. Apr 2007. doi:10.1016\/j.ejvs.2006.10.019 – via Science Direct. \n\n^ Teoh, MK; Bird, DA (1 September 1987), \"Removal of skin staples in an emergency\", Ann R Coll Surg Engl, Annals of the Royal College of Surgeons of England, 69: 222\u20134, PMC 2498551 , PMID 3314634 \n\n^ https:\/\/www.google.co.uk\/search?q=skin+staple+removers&biw=1173&bih=813&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAmoVChMI8_nK9aTsxgIViXI-Ch21EAPc#imgrc=EgdRfi49foQSwM%3A \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_staple\">https:\/\/www.limswiki.org\/index.php\/Surgical_staple<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4ecb22262c78bf2dca1ad28cc1bfec99_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_staple skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical staple<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:34_surgical_staples,_craniotomy.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/41\/34_surgical_staples%2C_craniotomy.jpg\/220px-34_surgical_staples%2C_craniotomy.jpg\" width=\"220\" height=\"141\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:34_surgical_staples,_craniotomy.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>34 surgical staples closing scalp following <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniotomy\" title=\"Craniotomy\" rel=\"external_link\" target=\"_blank\">craniotomy<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Medical-staples.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a3\/Medical-staples.jpg\/220px-Medical-staples.jpg\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Medical-staples.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiograph\" class=\"mw-redirect\" title=\"Projectional radiograph\" rel=\"external_link\" target=\"_blank\">Projectional radiograph<\/a> of surgical staples<\/div><\/div><\/div>\n<p><b>Surgical staples<\/b> are specialized <a href=\"https:\/\/en.wikipedia.org\/wiki\/Staple_(fastener)\" title=\"Staple (fastener)\" rel=\"external_link\" target=\"_blank\">staples<\/a> used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> in place of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a> to close <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> wounds, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">connect<\/a> or remove parts of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel\" class=\"mw-redirect\" title=\"Bowel\" rel=\"external_link\" target=\"_blank\">bowels<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lungs<\/a>. The use of staples over sutures reduces the local inflammatory response, width of the wound, and the time it takes to close.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.<sup id=\"rdp-ebb-cite_ref-:0_2-0\" class=\"reference\"><a href=\"#cite_note-:0-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The technique was pioneered by \"father of surgical stapling\", Hungarian surgeon .<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Hultl's prototype stapler of 1908 weighed 8 pounds (3.6 kg), and required two hours to assemble and load.\n<\/p><p>The technology was refined in the 1950s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and vascular anastomoses.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Mark M. Ravitch, brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur , who founded the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Surgical_Corporation\" class=\"mw-redirect\" title=\"United States Surgical Corporation\" rel=\"external_link\" target=\"_blank\">United States Surgical Corporation<\/a> in 1964 to manufacture surgical staplers under its Auto Suture brand.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Until the late 1970s USSC had the market essentially to itself, but in 1977 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johnson_%26_Johnson\" title=\"Johnson & Johnson\" rel=\"external_link\" target=\"_blank\">Johnson & Johnson<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethicon_Inc.\" title=\"Ethicon Inc.\" rel=\"external_link\" target=\"_blank\">Ethicon<\/a> brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tyco_Healthcare\" class=\"mw-redirect\" title=\"Tyco Healthcare\" rel=\"external_link\" target=\"_blank\">Tyco Healthcare<\/a> in 1998, which became <a href=\"https:\/\/en.wikipedia.org\/wiki\/Covidien\" title=\"Covidien\" rel=\"external_link\" target=\"_blank\">Covidien<\/a> on June 29, 2007.\n<\/p><p>Safety and patency of mechanical (stapled) bowel <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomoses<\/a> has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut\" title=\"Catgut\" rel=\"external_link\" target=\"_blank\">catgut<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linen\" title=\"Linen\" rel=\"external_link\" target=\"_blank\">linen<\/a>, which were the main suture materials used up to the 1990s.\n<\/p><p>One key feature of intestinal staplers is that the edges of the stapler act as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Haemostat\" class=\"mw-redirect\" title=\"Haemostat\" rel=\"external_link\" target=\"_blank\">haemostat<\/a>, compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:0_2-1\" class=\"reference\"><a href=\"#cite_note-:0-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leaks.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Alternative techniques to seal lung tissue are currently investigated.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_and_applications\">Types and applications<\/span><\/h2>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/220px-Gallbladderop.jpg\" width=\"220\" height=\"204\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a>.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Skin_stapler_closeup.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/31\/Skin_stapler_closeup.jpg\/220px-Skin_stapler_closeup.jpg\" width=\"220\" height=\"104\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Skin_stapler_closeup.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Close-up demonstration of a surgical skin stapler.<\/div><\/div><\/div>\n<p>The first commercial staplers were made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> with titanium staples loaded into reloadable staple cartridges.\n<\/p><p>Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.\n<\/p><p>The staple line may be straight, curved or circular. Circular staplers are used for end-to-end <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis#Medicine\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomosis<\/a> after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel_resection\" title=\"Bowel resection\" rel=\"external_link\" target=\"_blank\">bowel resection<\/a> or, somewhat more controversially, in esophagogastric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> The instruments may be used in either open or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a>, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocar<\/a> ports.\n<\/p><p>Some staplers incorporate a knife, to complete <a href=\"https:\/\/en.wiktionary.org\/wiki\/excision\" class=\"extiw\" title=\"wikt:excision\" rel=\"external_link\" target=\"_blank\">excision<\/a> and anastomosis in a single operation. \n<p>Staplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_banded_gastroplasty_surgery\" title=\"Vertical banded gastroplasty surgery\" rel=\"external_link\" target=\"_blank\">vertical banded gastroplasty surgery<\/a> (popularly known as \"stomach stapling\").\n<\/p>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vascular_stapler.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/61\/Vascular_stapler.jpg\/220px-Vascular_stapler.jpg\" width=\"220\" height=\"116\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vascular_stapler.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion \u226430\u00b0. Activating guide-wire is connected just immediately before firing <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fondazionecarrel.org\/carrel\/vasc\/files\/stapler\/stapler.htm\" target=\"_blank\">(video)<\/a><\/div><\/div><\/div>\n<p>While devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research <sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler.\n<\/p><p>Although most surgical staples are made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> is more often used in some skin staples and clips. Titanium produces less reaction with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune\" class=\"mw-redirect\" title=\"Immune\" rel=\"external_link\" target=\"_blank\">immune<\/a> system and, being non-ferrous, does not interfere significantly with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI<\/a> scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, as with many synthetic absorbable sutures.\n<\/p><p>Titanium staples are not suspected of causing nickel reactions because nickel is rarely if ever used in titanium alloys.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Accuracy_dispute#Disputed_statement\" title=\"Wikipedia:Accuracy dispute\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag is possibly inaccurate or nonfactual. (June 2014)\">dubious<\/span><\/a> <span class=\"metadata\"> – <a href=\"https:\/\/en.wikipedia.org\/wiki\/Talk:Surgical_staple#Dubious\" title=\"Talk:Surgical staple\" rel=\"external_link\" target=\"_blank\">discuss<\/a><\/span><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Removal_of_skin_staples\">Removal of skin staples<\/span><\/h2>\n<p>Where skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that when hand-pressure is exerted it pushes down on the staple and pushes it through a slot in the shoe and deforms the staple into an 'M' shape to facilitate its removal, although in an emergency it is possible to remove them with a pair of artery forceps.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\nSkin staple removers are manufactured in many shapes and forms,<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> some disposable and some reusable.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Iavazzo, Christos; Gkegkes, Ioannis D.; Vouloumanou, Evridiki K.; Mamais, Ioannis; Peppas, George; Falagas, Matthew E. (September 2011). \"Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials\". <i>The American Surgeon<\/i>. <b>77<\/b> (9): 1206\u20131221. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1555-9823\" target=\"_blank\">1555-9823<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21944632\" target=\"_blank\">21944632<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Surgeon&rft.atitle=Sutures+versus+staples+for+the+management+of+surgical+wounds%3A+a+meta-analysis+of+randomized+controlled+trials&rft.volume=77&rft.issue=9&rft.pages=1206-1221&rft.date=2011-09&rft_id=info%3Apmid%2F21944632&rft.issn=1555-9823&rft.aulast=Iavazzo&rft.aufirst=Christos&rft.au=Gkegkes%2C+Ioannis+D.&rft.au=Vouloumanou%2C+Evridiki+K.&rft.au=Mamais%2C+Ioannis&rft.au=Peppas%2C+George&rft.au=Falagas%2C+Matthew+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-:0-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chughtai, T.; Chen, L. Q.; Salasidis, G.; Nguyen, D.; Tchervenkov, C.; Morin, J. F. (November 2000). \"Clips versus suture technique: is there a difference?\". <i>The Canadian Journal of Cardiology<\/i>. <b>16<\/b> (11): 1403\u20131407. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0828-282X\" target=\"_blank\">0828-282X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11109037\" target=\"_blank\">11109037<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Canadian+Journal+of+Cardiology&rft.atitle=Clips+versus+suture+technique%3A+is+there+a+difference%3F&rft.volume=16&rft.issue=11&rft.pages=1403-1407&rft.date=2000-11&rft_id=info%3Apmid%2F11109037&rft.issn=0828-282X&rft.aulast=Chughtai&rft.aufirst=T.&rft.au=Chen%2C+L.+Q.&rft.au=Salasidis%2C+G.&rft.au=Nguyen%2C+D.&rft.au=Tchervenkov%2C+C.&rft.au=Morin%2C+J.+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Non-suture methods of vascular anastomosis<\/i>, British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Circular vascular stapling in coronary surgery<\/i>,\nKonstantinov, Annals of Thoracic Surgery, 2004; 78: 369-373<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/ats.ctsnetjournals.org\/cgi\/content\/full\/78\/1\/369\" target=\"_blank\">[1]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fundinguniverse.com\/company-histories\/United-States-Surgical-Corporation-Company-History.html\" target=\"_blank\">History of United States Surgical Corporation<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brundage Susan I (2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jtrauma.com\/pt\/re\/jtrauma\/abstract.00005373-200112000-00005.htm;jsessionid=HGcPqDY6ny12TtcpJwhGzx4hymlFGkJn1hpPvntqS1J2C1GLL2w3!1458925248!181195629!8091!-1\" target=\"_blank\">\"Stapled versus Sutured Gastrointestinal Anastomoses in the Trauma Patient: A Multicenter Trial\"<\/a>. <i>Journal of Trauma-Injury Infection & Critical Care<\/i>. <b>51<\/b> (6): 1054\u20131061. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00005373-200112000-00005\" target=\"_blank\">10.1097\/00005373-200112000-00005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Trauma-Injury+Infection+%26+Critical+Care&rft.atitle=Stapled+versus+Sutured+Gastrointestinal+Anastomoses+in+the+Trauma+Patient%3A+A+Multicenter+Trial&rft.volume=51&rft.issue=6&rft.pages=1054-1061&rft.date=2001&rft_id=info%3Adoi%2F10.1097%2F00005373-200112000-00005&rft.au=Brundage+Susan+I&rft_id=http%3A%2F%2Fwww.jtrauma.com%2Fpt%2Fre%2Fjtrauma%2Fabstract.00005373-200112000-00005.htm%3Bjsessionid%3DHGcPqDY6ny12TtcpJwhGzx4hymlFGkJn1hpPvntqS1J2C1GLL2w3%211458925248%21181195629%218091%21-1&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.springerlink.com\/content\/yycjvdad177gwet8\/\" target=\"_blank\"><i>Surgery Today<\/i>, Volume 34, Number 2 \/ February, 2004<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Venuta, F; 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H\u00f6glund, Odd Viking; Brum, Juliana Sperotto; Borg, Niklas; Dornbusch, Peterson Triches (3 January 2018). \"Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application\". <i>Surgical Innovation<\/i>. <b>25<\/b> (2): 158\u2013164. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1553350617751293\" target=\"_blank\">10.1177\/1553350617751293<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+Innovation&rft.atitle=Resorbable+Self-Locking+Implant+for+Lung+Lobectomy+Through+Video-Assisted+Thoracoscopic+Surgery%3A+First+Live+Animal+Application&rft.volume=25&rft.issue=2&rft.pages=158-164&rft.date=2018-01-03&rft_id=info%3Adoi%2F10.1177%2F1553350617751293&rft.aulast=Guedes&rft.aufirst=Rog%C3%A9rio+Luizari&rft.au=H%C3%B6glund%2C+Odd+Viking&rft.au=Brum%2C+Juliana+Sperotto&rft.au=Borg%2C+Niklas&rft.au=Dornbusch%2C+Peterson+Triches&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science?_ob=ArticleURL&_udi=B6T35-4C0TN7T-B&_user=10&_coverDate=06%2F30%2F2004&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=bdeaf02b388cd206dfc979b56f1d0b8d\" target=\"_blank\">European Journal of Cardio-Thoracic Surgery, Volume 25, Issue 6, June 2004, Pages 1097-1101<\/a><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Nazari S et al. A new vascular stapler for pulmonary artery anastomosis in experimental single lung trasnplantation.Video, Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.minervamedica.it\/en\/journals\/cardiovascular-surgery\/article.php?cod=R37Y2007N05A0659\" target=\"_blank\">\"Evaluation of an aortic stapler for an open aortic anastomosis\"<\/a>. <i>The Journal of Cardiovascular Surgery (Torino)<\/i>. <b>48<\/b> (5): 659\u201365. Oct 2007 – via Minerva Medica.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Cardiovascular+Surgery+%28Torino%29.&rft.atitle=Evaluation+of+an+aortic+stapler+for+an+open+aortic+anastomosis&rft.volume=48&rft.issue=5&rft.pages=659-65&rft.date=2007-10&rft_id=http%3A%2F%2Fwww.minervamedica.it%2Fen%2Fjournals%2Fcardiovascular-surgery%2Farticle.php%3Fcod%3DR37Y2007N05A0659&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1078588406006058\" target=\"_blank\">\"Intravascular Stapler for \"Open\" Aortic Surgery: Preliminary Results\"<\/a>. <i>European Journal of Vascular and Endovascular Surgery<\/i>. <b>33<\/b> (4): 408\u201311. Apr 2007. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ejvs.2006.10.019\" target=\"_blank\">10.1016\/j.ejvs.2006.10.019<\/a> – via Science Direct.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Vascular+and+Endovascular+Surgery&rft.atitle=Intravascular+Stapler+for+%22Open%22+Aortic+Surgery%3A+Preliminary+Results&rft.volume=33&rft.issue=4&rft.pages=408-11&rft.date=2007-04&rft_id=info%3Adoi%2F10.1016%2Fj.ejvs.2006.10.019&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1078588406006058&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFTeohBird1987\" class=\"citation\">Teoh, MK; Bird, DA (1 September 1987), \"Removal of skin staples in an emergency\", <i>Ann R Coll Surg Engl<\/i>, Annals of the Royal College of Surgeons of England, <b>69<\/b>: 222\u20134, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2498551\" target=\"_blank\">2498551<\/a><\/span>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3314634\" target=\"_blank\">3314634<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+R+Coll+Surg+Engl&rft.atitle=Removal+of+skin+staples+in+an+emergency&rft.volume=69&rft.pages=222-4&rft.date=1987-09-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2498551&rft_id=info%3Apmid%2F3314634&rft.aulast=Teoh&rft.aufirst=MK&rft.au=Bird%2C+DA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"#imgrc=EgdRfi49foQSwM%3A\">https:\/\/www.google.co.uk\/search?q=skin+staple+removers&biw=1173&bih=813&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAmoVChMI8_nK9aTsxgIViXI-Ch21EAPc#imgrc=EgdRfi49foQSwM%3A<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1319\nCached time: 20181129135400\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.292 seconds\nReal time usage: 0.388 seconds\nPreprocessor visited node count: 1096\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 52509\/2097152 bytes\nTemplate argument size: 821\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 27462\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.165\/10.000 seconds\nLua memory usage: 5.56 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 322.786 1 -total\n<\/p>\n<pre>50.05% 161.562 1 Template:Reflist\n39.82% 128.523 7 Template:Cite_journal\n22.24% 71.775 1 Template:More_footnotes\n16.03% 51.727 2 Template:Ambox\n10.61% 34.253 1 Template:Convert\n 7.08% 22.864 1 Template:Dubious\n 6.15% 19.864 1 Template:Fix\n 5.48% 17.694 3 Template:Navbox\n 5.23% 16.883 1 Template:Surgical_instruments\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:9487577-1!canonical and timestamp 20181129135400 and revision id 843083595\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_staple\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214656\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.152 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.133 1 - wikipedia:Surgical_staple\n100.00% 145.133 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8561-0!*!*!*!*!*!* and timestamp 20181217214656 and revision id 24989\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_staple\">https:\/\/www.limswiki.org\/index.php\/Surgical_staple<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4ecb22262c78bf2dca1ad28cc1bfec99_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/41\/34_surgical_staples%2C_craniotomy.jpg\/440px-34_surgical_staples%2C_craniotomy.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a3\/Medical-staples.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/440px-Gallbladderop.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/31\/Skin_stapler_closeup.jpg\/440px-Skin_stapler_closeup.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/61\/Vascular_stapler.jpg\/440px-Vascular_stapler.jpg"],"4ecb22262c78bf2dca1ad28cc1bfec99_timestamp":1545083216,"17d73fcb12dc52873dd739f6359e8c4b_type":"article","17d73fcb12dc52873dd739f6359e8c4b_title":"Surgical scissors","17d73fcb12dc52873dd739f6359e8c4b_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_scissors","17d73fcb12dc52873dd739f6359e8c4b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical scissors\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article does not cite any sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2010) (Learn how and when to remove this template message)\nSurgical scissors are surgical instruments usually used for cutting. They include bandage scissors, dissecting scissors, iris scissors, operating scissors, stitch scissors, tenotomy scissors, Metzenbaum scissors, plastic surgery scissors, and Mayo scissors. Surgical scissors are usually made of very hard stainless steel for ongoing toughness. Some scissors have tungsten carbide reinforcements along their cutting edges. The hardness of this material allows the manufacturers to create sharper edges, which allows for easier and smoother cuts and keeps the scissors sharp for longer.\n\nContents \n\n1 Types \n2 Material \n3 Gallery \n4 See also \n5 References \n\n\nTypes \nThere are two types of scissors used in surgeries. \n\nRing scissors look much like standard utility scissors with two finger loops.\nSpring forceps are small scissors used mostly in eye surgery or microsurgery. The handles end in flat springs connected with a pivot joint. The cutting action is achieved by pressing the handles together. As the pressure is released, the spring action opens the jaws.\nScissors are available in various configurations like\n\nBlunt\/blunt blades\nBlunt\/sharp blades\nSharp\/sharp blades\nMaterial \nUsually material of surgical scissor are stainless steel, zirconia ceramic, nitinol and titanium.\n\nGallery \n\n\t\t\n\t\t\t\n\t\t\t\nMetzenbaum scissors\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nMayo scissors\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBandage Scissors\n\n\t\t\t\n\t\t\n\nSee also \n\n\n\nWikimedia Commons has media related to Surgical scissors.\nTrauma shears\nBandage scissors\nHemostat, a surgical clamp resembling scissors\nNeedle holder, an instrument resembling scissors used to hold a suturing needle\nReferences \n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_scissors\">https:\/\/www.limswiki.org\/index.php\/Surgical_scissors<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:57.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 433 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","17d73fcb12dc52873dd739f6359e8c4b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_scissors skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical scissors<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Surgical scissors<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instruments<\/a> usually used for cutting. They include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage_scissors\" title=\"Bandage scissors\" rel=\"external_link\" target=\"_blank\">bandage scissors<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iris_scissors\" title=\"Iris scissors\" rel=\"external_link\" target=\"_blank\">iris scissors<\/a>, , , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tenotomy_scissors\" title=\"Tenotomy scissors\" rel=\"external_link\" target=\"_blank\">tenotomy scissors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metzenbaum_scissors\" title=\"Metzenbaum scissors\" rel=\"external_link\" target=\"_blank\">Metzenbaum scissors<\/a>, , and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_scissors\" title=\"Mayo scissors\" rel=\"external_link\" target=\"_blank\">Mayo scissors<\/a>. Surgical scissors are usually made of very hard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> for ongoing toughness. Some scissors have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten_carbide\" title=\"Tungsten carbide\" rel=\"external_link\" target=\"_blank\">tungsten carbide<\/a> reinforcements along their cutting edges. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a> of this material allows the manufacturers to create sharper edges, which allows for easier and smoother cuts and keeps the scissors sharp for longer.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>There are two types of scissors used in surgeries. \n<\/p>\n<ul><li>Ring scissors look much like standard utility scissors with two finger loops.<\/li>\n<li>Spring forceps are small scissors used mostly in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eye_surgery\" title=\"Eye surgery\" rel=\"external_link\" target=\"_blank\">eye surgery<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microsurgery\" title=\"Microsurgery\" rel=\"external_link\" target=\"_blank\">microsurgery<\/a>. The handles end in flat springs connected with a pivot joint. The cutting action is achieved by pressing the handles together. As the pressure is released, the spring action opens the jaws.<\/li><\/ul>\n<p>Scissors are available in various configurations like\n<\/p>\n<ul><li>Blunt\/blunt blades<\/li>\n<li>Blunt\/sharp blades<\/li>\n<li>Sharp\/sharp blades<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Material\">Material<\/span><\/h2>\n<p>Usually material of surgical scissor are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_stainless_steel\" title=\"Surgical stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, zirconia ceramic, nitinol and titanium.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Gallery\">Gallery<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:35px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Metzenbaum_scissors_04.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Metzenbaum_scissors_04.jpg\/120px-Metzenbaum_scissors_04.jpg\" width=\"120\" height=\"80\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Metzenbaum_scissors\" title=\"Metzenbaum scissors\" rel=\"external_link\" target=\"_blank\">Metzenbaum scissors<\/a>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_scissors_07.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Surgical_scissors_07.JPG\/120px-Surgical_scissors_07.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_scissors\" title=\"Mayo scissors\" rel=\"external_link\" target=\"_blank\">Mayo scissors<\/a>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bandage_Scissors.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Bandage_Scissors.JPG\/120px-Bandage_Scissors.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Bandage Scissors\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_shears\" title=\"Trauma shears\" rel=\"external_link\" target=\"_blank\">Trauma shears<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage_scissors\" title=\"Bandage scissors\" rel=\"external_link\" target=\"_blank\">Bandage scissors<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">Hemostat<\/a>, a surgical clamp resembling scissors<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_holder\" title=\"Needle holder\" rel=\"external_link\" target=\"_blank\">Needle holder<\/a>, an instrument resembling scissors used to hold a suturing needle<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181205031100\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.144 seconds\nReal time usage: 0.235 seconds\nPreprocessor visited node count: 334\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9621\/2097152 bytes\nTemplate argument size: 340\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 2274\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.074\/10.000 seconds\nLua memory usage: 2.75 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 210.637 1 -total\n<\/p>\n<pre>45.32% 95.466 1 Template:Commons_category\n39.28% 82.732 1 Template:Commons\n37.84% 79.699 1 Template:Sister_project\n35.79% 75.392 1 Template:Side_box\n32.47% 68.404 1 Template:Unreferenced\n31.92% 67.239 2 Template:If_then_show\n23.24% 48.946 1 Template:Ambox\n 8.54% 17.980 1 Template:Medical-equipment-stub\n 7.45% 15.700 1 Template:Asbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:30040768-1!canonical and timestamp 20181205031100 and revision id 859102756\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_scissors\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214656\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.144 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.639 1 - wikipedia:Surgical_scissors\n100.00% 138.639 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8560-0!*!*!*!*!*!* and timestamp 20181217214656 and revision id 24988\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_scissors\">https:\/\/www.limswiki.org\/index.php\/Surgical_scissors<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","17d73fcb12dc52873dd739f6359e8c4b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Metzenbaum_scissors_04.jpg\/240px-Metzenbaum_scissors_04.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Surgical_scissors_07.JPG\/240px-Surgical_scissors_07.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Bandage_Scissors.JPG\/240px-Bandage_Scissors.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png"],"17d73fcb12dc52873dd739f6359e8c4b_timestamp":1545083216,"a0bea2b6776e6a13c6234028907149c5_type":"article","a0bea2b6776e6a13c6234028907149c5_title":"Surgical mask","a0bea2b6776e6a13c6234028907149c5_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_mask","a0bea2b6776e6a13c6234028907149c5_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical mask\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Respirator.\n OR personnel wearing surgical mask at California Pacific Medical Center.\nA surgical mask, also known as a procedure mask, is intended to be worn by health professionals during surgery and during nursing to catch the bacteria shed in liquid droplets and aerosols from the wearer's mouth and nose. They are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, such as N95 or NIOSH masks, which provide better protection due to their material, shape and tight seal.\nSurgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading airborne diseases.\n\nContents \n\n1 Definition \n2 Usage \n\n2.1 Health care workers \n2.2 General public \n\n\n3 Design \n4 See also \n5 References \n\n\nDefinition \nA surgical mask, or procedure mask, is intended to be worn by health professionals during surgery and certain health care procedures[1] to catch microorganisms shed in liquid droplets and aerosols from the wearer's mouth and nose. Its first recorded use was by the French surgeon Paul Berger during an 1897 operation in Paris.[citation needed ]\nModern surgical masks are made from paper or other non-woven material and should be discarded after each use.[2]\nA surgical mask is not to be confused with a respirator and is not certified as such. Surgical masks are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, which are designed for this purpose.[3]\n\nUsage \n Without the manifold buffers afforded by a surgical mask, airborne diseases can be easily transferred via respiratory droplets\nHealth care workers \n A Kimberly-Clark procedure mask.[4] Note the full facial shielding and the Droplet Isolation protocol signage.\nSimple surgical masks protect wearers from being splashed in the mouth with body fluids, and prevent transmission of body fluids from the wearer to others, e.g. the patient. They also remind wearers not to touch their mouth or nose, which could otherwise transfer viruses and bacteria after having touched a contaminated surface (fomite). They can also reduce the spread of infectious liquid droplets (carrying bacteria or viruses) that are created when the wearer coughs or sneezes[citation needed ]. There is no clear evidence that disposable face masks worn by members of the surgical team would reduce the risk of wound infections after clean surgical procedures.[5] Cotton and gauze masks do not serve as surgical masks as they do not offer adequate filtration of microbes.[citation needed ]\nEvidence supports the effectiveness of surgical masks in reducing the risk of infection among other healthcare workers and in the community.[6] In community settings, facemasks must be coupled with other measures such as avoiding close contact and maintaining good hand hygiene to reduce the risk of getting influenza according to the Centers for Disease Control and Prevention in its guidance regarding the 2009 swine flu outbreak.[2]\nFor healthcare workers, safety guidelines recommend the wearing of a face-fit tested respirator mask conforming to United States standard NIOSH N95 or European standard EN 149 FFP3 in the vicinity of pandemic-flu patients, to reduce the exposure of the wearer to potentially infectious aerosols and airborne liquid droplets.[7][8]\nThe U.S Centers for Disease Control and Prevention (CDC) provides information on manufacturers' products, and the importance of correct fitting of such masks (respirators). A printable factsheet has been designed for issue to those unaccustomed to respirator use.[9]\n\n<\/p>\n A man wearing a surgical mask in public in Japan.\nGeneral public \n During the 1918 flu pandemic, a street car conductor in Seattle, USA refuses a person who attempts to board without wearing a mask.\nSurgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading airborne diseases; in Japan, it is common to wear a face mask whilst ill to avoid infecting others in public settings.[10] In Japan and Taiwan, it is common to see these masks worn while ill, as a show of consideration for others and social responsibility.[11]\nSurgical masks were widely used in China, Hong Kong, Vietnam, and Toronto, Ontario, Canada during outbreaks of the SARS, during the 2007 bird flu pandemic in Japan, and during the 2009 flu pandemic featuring swine flu and the H1N1 virus in the United States and Mexico City.[citation needed ]\n\nDesign \n Typical 3-ply surgical masks. The top one has the right side up and the bottom one up side down. The edge with double stitches is designed to cover the nose, and a metal wire is concealed within so the mask could be fitted to the contour of the nasal bridge.\nThe design of the surgical masks depends on the mode; usually the masks are 3 ply\/3 layers. This 3 ply material is made up from a melt-blown material placed between non-woven fabric. The melt-blown material acts as the filter that stops microbes from entering or exiting the mask. Most surgical masks feature pleats or folds. Commonly, 3 pleats are used allowing the user to expand the mask so it covers the area from the nose to the chin.\nThere are 3 different ways to secure the masks. The most popular is the ear loop, where a string like material is attached to the mask and placed behind the ears. The other is the tie-on and the head band. The tie-on straps consist of four non-woven straps that are tied behind the head. The head band is an elastic strap that is placed behind the head.[citation needed ]\nSurgical masks with decorative designs are popular in countries in which they are worn in public.[citation needed ]\n\nSee also \nDust mask\nReferences \n\n\n^ Procedure mask. nursingcenter.com \n\n^ a b \"Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission\". Centers for Disease Control and Prevention. May 27, 2009. Unless otherwise specified, the term \"facemasks\" refers to disposable facemasks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks... Facemasks should be used once and then thrown away in the trash. \n\n^ \"Respiratory Protection Against Airborne Infectious Agents for Health Care Workers: Do surgical masks protect workers?\" (OSH Answers Fact Sheets). Canadian Centre for Occupational Health and Safety. 2017-02-28. Retrieved 2017-02-28 . \n\n^ \/2014\/12\/08\/dr-mark-dowell-urges-flu-shots-despite-mutated-h3n2-strain\/ \n\n^ Vincent, Marina; Edwards, Peggy (26 April 2016). \"Disposable surgical face masks for preventing surgical wound infection in clean surgery\". Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. 4: CD002929. doi:10.1002\/14651858.cd002929.pub3. PMID 27115326. Retrieved 29 April 2016 . \n\n^ MacIntyre, CR; Chughtai, AA (9 April 2015). \"Facemasks for the prevention of infection in healthcare and community settings\". BMJ (Clinical research ed.). 350: h694. doi:10.1136\/bmj.h694. PMID 25858901. \n\n^ \"Interim guidance on planning for the use of surgical masks and respirators in health care settings during an influenza pandemic\" (PDF) . U.S. Department of Health & Human Services. October 2006. Archived from the original (PDF) on 2016-03-04. \n\n^ \"Working with highly pathogenic avian influenza virus\". UK Health and Safety Executive. Retrieved August 2, 2014 . \n\n^ \"N95 Factsheet\". Centers for Disease Control and Prevention. Archived from the original on November 11, 2009. \n\n^ Juliet Hindell (May 30, 1999). \"Japan's war on germs and smells\". BBC Online. \n\n^ Negrin, Matt (2009-04-26). \"For allergy and flu season, the Japanese turn to surgical masks\". Winnipeg Free Press. Retrieved 2017-09-29 . \n\n\n\n\n\nWikimedia Commons has media related to Surgical masks.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_mask\">https:\/\/www.limswiki.org\/index.php\/Surgical_mask<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 612 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a0bea2b6776e6a13c6234028907149c5_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_mask skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical mask<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respirator\" title=\"Respirator\" rel=\"external_link\" target=\"_blank\">Respirator<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CPMC_Surgery_(412142792).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/CPMC_Surgery_%28412142792%29.jpg\/220px-CPMC_Surgery_%28412142792%29.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CPMC_Surgery_(412142792).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>OR personnel wearing surgical mask at <a href=\"https:\/\/en.wikipedia.org\/wiki\/California_Pacific_Medical_Center\" title=\"California Pacific Medical Center\" rel=\"external_link\" target=\"_blank\">California Pacific Medical Center<\/a>.<\/div><\/div><\/div>\n<p>A <b>surgical mask<\/b>, also known as a <b>procedure mask<\/b>, is intended to be worn by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_professional\" title=\"Health professional\" rel=\"external_link\" target=\"_blank\">health professionals<\/a> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> and during nursing to catch the bacteria shed in liquid droplets and aerosols from the wearer's mouth and nose. They are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/NIOSH_air_filtration_rating\" title=\"NIOSH air filtration rating\" rel=\"external_link\" target=\"_blank\">N95<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/NIOSH\" class=\"mw-redirect\" title=\"NIOSH\" rel=\"external_link\" target=\"_blank\">NIOSH<\/a> masks, which provide better protection due to their material, shape and tight seal.\nSurgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airborne_disease\" title=\"Airborne disease\" rel=\"external_link\" target=\"_blank\">airborne diseases<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Definition\">Definition<\/span><\/h2>\n<p>A surgical mask, or procedure mask, is intended to be worn by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_professional\" title=\"Health professional\" rel=\"external_link\" target=\"_blank\">health professionals<\/a> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> and certain health care procedures<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> to catch microorganisms shed in liquid droplets and aerosols from the wearer's mouth and nose. Its first recorded use was by the French surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_Berger\" title=\"Paul Berger\" rel=\"external_link\" target=\"_blank\">Paul Berger<\/a> during an 1897 operation in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paris\" title=\"Paris\" rel=\"external_link\" target=\"_blank\">Paris<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\nModern surgical masks are made from paper or other non-woven material and should be discarded after each use.<sup id=\"rdp-ebb-cite_ref-h1n1masks_2-0\" class=\"reference\"><a href=\"#cite_note-h1n1masks-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>A surgical mask is not to be confused with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respirator\" title=\"Respirator\" rel=\"external_link\" target=\"_blank\">respirator<\/a> and is not certified as such. Surgical masks are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, which are designed for this purpose.<sup id=\"rdp-ebb-cite_ref-canada_3-0\" class=\"reference\"><a href=\"#cite_note-canada-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Usage\">Usage<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sneeze.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Sneeze.JPG\/220px-Sneeze.JPG\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sneeze.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Without the manifold buffers afforded by a surgical mask, airborne diseases can be easily transferred via respiratory droplets<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Health_care_workers\">Health care workers<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\/170px-KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\" width=\"170\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kimberly-Clark\" title=\"Kimberly-Clark\" rel=\"external_link\" target=\"_blank\">Kimberly-Clark<\/a> procedure mask.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Note the full facial shielding and the Droplet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isolation_(health_care)\" title=\"Isolation (health care)\" rel=\"external_link\" target=\"_blank\">Isolation<\/a> protocol signage.<\/div><\/div><\/div>\n<p>Simple surgical masks protect wearers from being splashed in the mouth with body fluids, and prevent transmission of body fluids from the wearer to others, e.g. the patient. They also remind wearers not to touch their mouth or nose, which could otherwise transfer viruses and bacteria after having touched a contaminated surface (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Fomite_(term)\" class=\"mw-redirect\" title=\"Fomite (term)\" rel=\"external_link\" target=\"_blank\">fomite<\/a>). They can also reduce the spread of infectious liquid droplets (carrying bacteria or viruses) that are created when the wearer coughs or sneezes<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>. There is no clear evidence that disposable face masks worn by members of the surgical team would reduce the risk of wound infections after clean surgical procedures.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Cotton and gauze masks do not serve as surgical masks as they do not offer adequate filtration of microbes.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Evidence supports the effectiveness of surgical masks in reducing the risk of infection among other healthcare workers and in the community.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> In community settings, facemasks must be coupled with other measures such as avoiding close contact and maintaining good hand hygiene to reduce the risk of getting influenza according to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a> in its guidance regarding the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2009_swine_flu_outbreak\" class=\"mw-redirect\" title=\"2009 swine flu outbreak\" rel=\"external_link\" target=\"_blank\">2009 swine flu outbreak<\/a>.<sup id=\"rdp-ebb-cite_ref-h1n1masks_2-1\" class=\"reference\"><a href=\"#cite_note-h1n1masks-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>For healthcare workers, safety guidelines recommend the wearing of a face-fit tested <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respirator\" title=\"Respirator\" rel=\"external_link\" target=\"_blank\">respirator<\/a> mask conforming to United States standard <a href=\"https:\/\/en.wikipedia.org\/wiki\/NIOSH\" class=\"mw-redirect\" title=\"NIOSH\" rel=\"external_link\" target=\"_blank\">NIOSH<\/a> N95 or European standard EN 149 FFP3 in the vicinity of pandemic-flu patients, to reduce the exposure of the wearer to potentially infectious aerosols and airborne liquid droplets.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<p>The U.S <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a> (CDC) provides information on manufacturers' products, and the importance of correct fitting of such masks (respirators). A printable factsheet has been designed for issue to those unaccustomed to respirator use.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Maninamedicanmask-tokyoarea-nov6-2018.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/32\/Maninamedicanmask-tokyoarea-nov6-2018.jpg\/220px-Maninamedicanmask-tokyoarea-nov6-2018.jpg\" width=\"220\" height=\"191\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Maninamedicanmask-tokyoarea-nov6-2018.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A man wearing a surgical mask in public in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Japan\" title=\"Japan\" rel=\"external_link\" target=\"_blank\">Japan<\/a>.<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"General_public\">General public<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:165-WW-269B-11-trolley-l.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/06\/165-WW-269B-11-trolley-l.jpg\/170px-165-WW-269B-11-trolley-l.jpg\" width=\"170\" height=\"235\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:165-WW-269B-11-trolley-l.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>During the <a href=\"https:\/\/en.wikipedia.org\/wiki\/1918_flu_pandemic\" class=\"mw-redirect\" title=\"1918 flu pandemic\" rel=\"external_link\" target=\"_blank\">1918 flu pandemic<\/a>, a street car conductor in Seattle, USA refuses a person who attempts to board without wearing a mask.<\/div><\/div><\/div>\n<p>Surgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airborne_disease\" title=\"Airborne disease\" rel=\"external_link\" target=\"_blank\">airborne diseases<\/a>; in Japan, it is common to wear a face mask whilst ill to avoid infecting others in public settings.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In Japan and Taiwan, it is common to see these masks worn while ill, as a show of consideration for others and social responsibility.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Surgical masks were widely used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hong_Kong\" title=\"Hong Kong\" rel=\"external_link\" target=\"_blank\">Hong Kong<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vietnam\" title=\"Vietnam\" rel=\"external_link\" target=\"_blank\">Vietnam<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toronto,_Ontario\" class=\"mw-redirect\" title=\"Toronto, Ontario\" rel=\"external_link\" target=\"_blank\">Toronto, Ontario<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canada\" title=\"Canada\" rel=\"external_link\" target=\"_blank\">Canada<\/a> during outbreaks of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Severe_acute_respiratory_syndrome\" title=\"Severe acute respiratory syndrome\" rel=\"external_link\" target=\"_blank\">SARS<\/a>, during the 2007 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Influenza_A_virus_subtype_H5N1\" title=\"Influenza A virus subtype H5N1\" rel=\"external_link\" target=\"_blank\">bird flu<\/a> pandemic in Japan, and during the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2009_flu_pandemic\" title=\"2009 flu pandemic\" rel=\"external_link\" target=\"_blank\">2009 flu pandemic<\/a> featuring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swine_flu\" class=\"mw-redirect\" title=\"Swine flu\" rel=\"external_link\" target=\"_blank\">swine flu<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/H1N1\" class=\"mw-redirect\" title=\"H1N1\" rel=\"external_link\" target=\"_blank\">H1N1<\/a> virus in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mexico_City\" title=\"Mexico City\" rel=\"external_link\" target=\"_blank\">Mexico City<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\/220px-Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\" width=\"220\" height=\"208\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Typical 3-ply surgical masks. The top one has the right side up and the bottom one up side down. The edge with double stitches is designed to cover the nose, and a metal wire is concealed within so the mask could be fitted to the contour of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasal_bridge\" title=\"Nasal bridge\" rel=\"external_link\" target=\"_blank\">nasal bridge<\/a>.<\/div><\/div><\/div>\n<p>The design of the surgical masks depends on the mode; usually the masks are 3 ply\/3 layers. This 3 ply material is made up from a melt-blown material placed between non-woven fabric. The melt-blown material acts as the filter that stops microbes from entering or exiting the mask. Most surgical masks feature pleats or folds. Commonly, 3 pleats are used allowing the user to expand the mask so it covers the area from the nose to the chin.\nThere are 3 different ways to secure the masks. The most popular is the ear loop, where a string like material is attached to the mask and placed behind the ears. The other is the tie-on and the head band. The tie-on straps consist of four non-woven straps that are tied behind the head. The head band is an elastic strap that is placed behind the head.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Surgical masks with decorative designs are popular in countries in which they are worn in public.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dust_mask\" title=\"Dust mask\" rel=\"external_link\" target=\"_blank\">Dust mask<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nursingcenter.com\/lnc\/static?pageid=811924\" target=\"_blank\">Procedure mask.<\/a> nursingcenter.com<\/span>\n<\/li>\n<li id=\"cite_note-h1n1masks-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-h1n1masks_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-h1n1masks_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/h1n1flu\/masks.htm\" target=\"_blank\">\"Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a>. May 27, 2009. <q>Unless otherwise specified, the term \"facemasks\" refers to <b>disposable<\/b> facemasks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks... <b>Facemasks should be used once and then thrown away in the trash.<\/b><\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Interim+Recommendations+for+Facemask+and+Respirator+Use+to+Reduce+Novel+Influenza+A+%28H1N1%29+Virus+Transmission&rft.pub=Centers+for+Disease+Control+and+Prevention&rft.date=2009-05-27&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fh1n1flu%2Fmasks.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-canada-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-canada_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ccohs.ca\/oshanswers\/prevention\/respiratory_protection.html\" target=\"_blank\">\"Respiratory Protection Against Airborne Infectious Agents for Health Care Workers: Do surgical masks protect workers?\"<\/a> (OSH Answers Fact Sheets). Canadian Centre for Occupational Health and Safety. 2017-02-28<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-02-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Respiratory+Protection+Against+Airborne+Infectious+Agents+for+Health+Care+Workers%3A+Do+surgical+masks+protect+workers%3F&rft.pub=Canadian+Centre+for+Occupational+Health+and+Safety&rft.date=2017-02-28&rft_id=http%3A%2F%2Fwww.ccohs.ca%2Foshanswers%2Fprevention%2Frespiratory_protection.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wyomingmedicalcenter.org\/pulse\/2014\/12\/08\/dr-mark-dowell-urges-flu-shots-despite-mutated-h3n2-strain\/\" target=\"_blank\">\/2014\/12\/08\/dr-mark-dowell-urges-flu-shots-despite-mutated-h3n2-strain\/<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vincent, Marina; Edwards, Peggy (26 April 2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD002929.pub3\/full\" target=\"_blank\">\"Disposable surgical face masks for preventing surgical wound infection in clean surgery\"<\/a>. <i>Cochrane Database of Systematic Reviews<\/i>. John Wiley & Sons, Ltd. <b>4<\/b>: CD002929. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.cd002929.pub3\" target=\"_blank\">10.1002\/14651858.cd002929.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27115326\" target=\"_blank\">27115326<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+of+Systematic+Reviews&rft.atitle=Disposable+surgical+face+masks+for+preventing+surgical+wound+infection+in+clean+surgery&rft.volume=4&rft.pages=CD002929&rft.date=2016-04-26&rft_id=info%3Adoi%2F10.1002%2F14651858.cd002929.pub3&rft_id=info%3Apmid%2F27115326&rft.aulast=Vincent&rft.aufirst=Marina&rft.au=Edwards%2C+Peggy&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1002%2F14651858.CD002929.pub3%2Ffull&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">MacIntyre, CR; Chughtai, AA (9 April 2015). \"Facemasks for the prevention of infection in healthcare and community settings\". <i>BMJ (Clinical research ed.)<\/i>. <b>350<\/b>: h694. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.h694\" target=\"_blank\">10.1136\/bmj.h694<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25858901\" target=\"_blank\">25858901<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+%28Clinical+research+ed.%29&rft.atitle=Facemasks+for+the+prevention+of+infection+in+healthcare+and+community+settings.&rft.volume=350&rft.pages=h694&rft.date=2015-04-09&rft_id=info%3Adoi%2F10.1136%2Fbmj.h694&rft_id=info%3Apmid%2F25858901&rft.aulast=MacIntyre&rft.aufirst=CR&rft.au=Chughtai%2C+AA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160304190243\/http:\/\/home.nyc.gov\/html\/doh\/downloads\/pdf\/bhpp\/bhpp-interrim-maskguide120106.pdf\" target=\"_blank\">\"Interim guidance on planning for the use of surgical masks and respirators in health care settings during an influenza pandemic\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Department_of_Health_%26_Human_Services\" class=\"mw-redirect\" title=\"U.S. Department of Health & Human Services\" rel=\"external_link\" target=\"_blank\">U.S. Department of Health & Human Services<\/a>. October 2006. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/home.nyc.gov\/html\/doh\/downloads\/pdf\/bhpp\/bhpp-interrim-maskguide120106.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2016-03-04.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Interim+guidance+on+planning+for+the+use+of+surgical+masks+and+respirators+in+health+care+settings+during+an+influenza+pandemic&rft.pub=U.S.+Department+of+Health+%26+Human+Services&rft.date=2006-10&rft_id=http%3A%2F%2Fhome.nyc.gov%2Fhtml%2Fdoh%2Fdownloads%2Fpdf%2Fbhpp%2Fbhpp-interrim-maskguide120106.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hse.gov.uk\/biosafety\/diseases\/avianflu.htm\" target=\"_blank\">\"Working with highly pathogenic avian influenza virus\"<\/a>. UK Health and Safety Executive<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 2,<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Working+with+highly+pathogenic+avian+influenza+virus&rft.pub=UK+Health+and+Safety+Executive&rft_id=http%3A%2F%2Fwww.hse.gov.uk%2Fbiosafety%2Fdiseases%2Favianflu.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20091111221111\/http:\/\/www.cdc.gov\/h1n1flu\/eua\/summary-factsheet.htm\" target=\"_blank\">\"N95 Factsheet\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/h1n1flu\/eua\/summary-factsheet.htm\" target=\"_blank\">the original<\/a> on November 11, 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=N95+Factsheet&rft.pub=Centers+for+Disease+Control+and+Prevention&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fh1n1flu%2Feua%2Fsummary-factsheet.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Juliet Hindell (May 30, 1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/2\/hi\/programmes\/from_our_own_correspondent\/354321.stm\" target=\"_blank\">\"Japan's war on germs and smells\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/BBC_Online\" title=\"BBC Online\" rel=\"external_link\" target=\"_blank\">BBC Online<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Japan%27s+war+on+germs+and+smells&rft.pub=BBC+Online&rft.date=1999-05-30&rft.au=Juliet+Hindell&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F2%2Fhi%2Fprogrammes%2Ffrom_our_own_correspondent%2F354321.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Negrin, Matt (2009-04-26). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.winnipegfreepress.com\/arts-and-life\/life\/health\/For-allergy-and-flu-season_-the-Japanese-turn-to-surgical-masks-43738507.html\" target=\"_blank\">\"For allergy and flu season, the Japanese turn to surgical masks\"<\/a>. Winnipeg Free Press<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-09-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=For+allergy+and+flu+season%2C+the+Japanese+turn+to+surgical+masks&rft.date=2009-04-26&rft.aulast=Negrin&rft.aufirst=Matt&rft_id=https%3A%2F%2Fwww.winnipegfreepress.com%2Farts-and-life%2Flife%2Fhealth%2FFor-allergy-and-flu-season_-the-Japanese-turn-to-surgical-masks-43738507.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181212004335\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.336 seconds\nReal time usage: 0.454 seconds\nPreprocessor visited node count: 1365\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 30596\/2097152 bytes\nTemplate argument size: 3158\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 26006\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.213\/10.000 seconds\nLua memory usage: 4.44 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 404.983 1 -total\n<\/p>\n<pre>48.55% 196.620 1 Template:Reflist\n28.21% 114.247 6 Template:Cite_web\n25.29% 102.401 6 Template:Citation_needed\n22.29% 90.270 6 Template:Fix\n14.87% 60.226 1 Template:Commons_category\n12.54% 50.776 12 Template:Category_handler\n11.74% 47.565 2 Template:Cite_journal\n 9.33% 37.796 1 Template:Other_uses\n 8.26% 33.456 6 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:821829-1!canonical and timestamp 20181212004335 and revision id 873241440\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_mask\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214655\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.027 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 167.906 1 - wikipedia:Surgical_mask\n100.00% 167.906 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8559-0!*!*!*!*!*!* and timestamp 20181217214655 and revision id 24987\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_mask\">https:\/\/www.limswiki.org\/index.php\/Surgical_mask<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a0bea2b6776e6a13c6234028907149c5_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/CPMC_Surgery_%28412142792%29.jpg\/440px-CPMC_Surgery_%28412142792%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Sneeze.JPG\/440px-Sneeze.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a7\/KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/32\/Maninamedicanmask-tokyoarea-nov6-2018.jpg\/440px-Maninamedicanmask-tokyoarea-nov6-2018.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/06\/165-WW-269B-11-trolley-l.jpg\/340px-165-WW-269B-11-trolley-l.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\/440px-Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg"],"a0bea2b6776e6a13c6234028907149c5_timestamp":1545083215,"3633b9ae4a7a31327d7d10b337925b43_type":"article","3633b9ae4a7a31327d7d10b337925b43_title":"Speculum (medical)","3633b9ae4a7a31327d7d10b337925b43_url":"https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)","3633b9ae4a7a31327d7d10b337925b43_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSpeculum (medical)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMedical device for investigating body orifices by direct vision\n The disposable bivalved plastic vaginal speculum is used in office gynecology\nA speculum (Latin for \"mirror\"; plural specula or speculums) is a medical tool for investigating body orifices, with a form dependent on the orifice for which it is designed. In old texts, the speculum may also be referred to as a diopter or dioptra.[1] Like an endoscope, a speculum allows a view inside the body; endoscopes, however, tend to have optics while a speculum is intended for direct vision.\n\nContents \n\n1 History \n2 Construction \n3 Types \n\n3.1 Vaginal use \n3.2 Rectal use \n3.3 Nasal use \n3.4 Aural use \n3.5 Oral use \n\n\n4 BDSM \n5 See also \n6 References \n\n\nHistory \n 14th, 15th and 16th century specula\nVaginal and anal specula were used by the ancient Greeks and Romans,[2] and speculum artifacts have been found in Pompeii.[3] A vaginal speculum, developed by J. Marion Sims, consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the beak of a duck. The speculum is inserted into the vagina to dilate it for examination of the vagina and cervix.\n\nConstruction \nSpecula were formerly made of stainless steel, and sterilized after use. However, many, especially those used in emergency departments and doctor's offices, are now made of plastic, and are disposable, single-use items. Those used in surgical suites are still commonly made of metal.\n\nTypes \n Two cylindrical-shaped glass specula\nSpecula come in a variety of shapes based on their purpose, and a variety of sizes;[4] in any case the cylinder or blade(s) of the instrument allow the operator a direct vision of the area of interest and the possibility to introduce instruments for further interventions such as a biopsy.\n\nVaginal use \nThe best-known speculum is the bivalved vaginal speculum; the two blades are hinged and are \"closed\" when the speculum is inserted to facilitate its entry and \"opened\" in its final position where they can be arrested by a screw mechanism, so that the operator is freed from keeping the blades apart.\n\nA cylindrical-shaped speculum, introduced in 2001, the dilating vaginal speculum (also known as the Veda-scope[5]) invented by Clemens van der Weegen,[6] inflates the vagina with filtered air.[7] (see diagram) The device has two main functions: a) to take a normal Pap smear with a cervical brush or a cytology brush; and b) as an internal colposcope so that the operator can pivot the Veda-scope to view any part of the vagina barrel and cervix facilitated by an internal light source that can illuminate the vaginal wall and cervix with multi-coloured light filters, which can detect pre-cancerous cells with the aid of acetic acid solution and iodine solution. It also has a facility to attach a digital camera for viewing and recording.[8] Dilating vaginal speculum inflating vagina and light illuminating (cervical brush inserts through top inlet)\nA specialized form of vaginal speculum is the weighted speculum, which consists of a broad half tube which is bent at about a 90 degree angle, with the channel of the tube on the exterior side of the angle. One end of the tube has a roughly spherical metal weight surrounding the channel of the speculum. A weighted speculum is placed in the vagina during vaginal surgery with the patient in the lithotomy position. The weight holds the speculum in place and frees the surgeon's hands for other tasks.\nA vaginal speculum is also used in fertility treatments, particularly artificial insemination, and allows the vaginal cavity to be opened and observed thereby facilitating the deposit of semen into the vagina.\n\nCylindrical shape\nFerguson\nGlass speculum\nVeda-scope (dilating vaginal speculum)\nOne blade\n The single-bladed Sims speculum is still in use today.\n\n\n\n\nAuvard\nBreisky\nDoyen\nEastman\nJackson\nKallmorgen\nKristeller\n\n\nLandau\nMartin\nMathieu\nPolansky\nSamuel\nScherbak\nSims\nWeissbarth\n\nTwo blades (bivalved)\n Medical instrument\n Duckbill shape of a two-bladed speculum\n\n\n\n\nCollin\nCusco\nDeVilbiss\nGrave\n\n\nPederson\nSemm\nSeyffert\nTrelat\nWinterton\n\nThree blades\n\n\n\n\nGuttmann\nNott\n\n\nO\u00b4Sullivan-O\u00b4Connor\nPolansky (veterinary use)\n\nRectal use \nVaginal specula are also used for anal surgery, although several other forms of anal specula exist. One form, the anoscope, resembles a tube that has a removable bullet-shaped insert. When the anoscope is inserted into the anus, the insert dilates the anus to the diameter of the tube. The insert is then removed, leaving the tube to allow examination of the lower rectum and anus.\nThis style of anal speculum is one of the oldest designs for surgical instruments still in use, with examples dating back many centuries. The sigmoidoscope can be further advanced into the lower intestinal tract and requires an endoscopic set-up.\n\nTubal shape\nAniscope\nOne blade\nCzerny\nTwo blades\n\n\n\n\nBarr\nBodenhammer\nKillian\nPratt\n\n\nRicord\nRoschke\nSims\nSmith-Buie\n\nThree blades\nAlan Park\nCook\nMathieu\nNasal use \nNasal specula have two relatively flat blades with handle. The instrument is hinged so that when the handles are squeezed together the blades spread laterally, allowing examination.\n\n\n\n\n\nKillian\nVienna\n\n\nVoltolini\nYankauer\n\nAdditionally, the Thudichum nasal speculum is commonly used in the outpatient examination of the nose.\n\nAural use \n Ear specula are funnel-shaped.\nEar or aural specula resemble a funnel, and come in a variety of sizes.\n\n\n\n\n\nAural speculum\n\n\n\nOral use \nIn veterinary medicine, a McPherson Speculum can be used for oral examination. The speculum helps keep the mouth open during the exam and helps avoid biting injuries.\n\nBDSM \nSpeculum is used for Speculum Play under BDSM for spreading the vagina or the anus.[9]\n\nSee also \n Endoscope\n Colposcope\n Vaginal dilator\nReferences \n\n\n\nWikimedia Commons has media related to speculums.\n\n\n^ \"diopter\" in The Compact Edition of the Oxford English Dictionary, Oxford University Press, 1971 \n\n^ Univ. of Virginia. \"Surgical Instruments from Ancient Rome (with pictures)\". Retrieved 2009-06-12 . \n\n^ Cecilia Mettler. History of Medicine. The Blakiston Co (1947). \n\n^ \"Comparison chart of speculum types, with line images\". Retrieved 2014-05-03 . \n\n^ Longmore, P. G. (2004). \"Veda-scope: More comfortable than the bivalve speculum and cytologically equivalent\". The Australian and New Zealand Journal of Obstetrics and Gynaecology. 44 (2): 140\u20135. doi:10.1111\/j.1479-828X.2004.00180.x. PMID 15089838. \n\n^ van der Weegen, Clemens (2000) \"Vaginal speculum with seal\" U.S. Patent 6,719,687 \n\n^ Thomas, A; Weisberg, E; Lieberman, D; Fraser, I. S. (2001). \"A randomised controlled trial comparing a dilating vaginal speculum with a conventional bivalve speculum\". The Australian & New Zealand journal of obstetrics & gynaecology. 41 (4): 379\u201386. PMID 11787909. \n\n^ How it works. pacificei.com \n\n^ Speculum Play by www.kinkly.com \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)\">https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 742 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3633b9ae4a7a31327d7d10b337925b43_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Speculum_medical skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Speculum (medical)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">Medical device for investigating body orifices by direct vision<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sp%C3%A9culum_en_plastique.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Sp%C3%A9culum_en_plastique.jpg\/250px-Sp%C3%A9culum_en_plastique.jpg\" width=\"250\" height=\"184\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sp%C3%A9culum_en_plastique.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The disposable bivalved plastic vaginal speculum is used in office gynecology<\/div><\/div><\/div>\n<p>A <b>speculum<\/b> (Latin for \"mirror\"; plural <b>specula<\/b> or speculums) is a medical tool for investigating body <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orifices\" class=\"mw-redirect\" title=\"Orifices\" rel=\"external_link\" target=\"_blank\">orifices<\/a>, with a form dependent on the orifice for which it is designed. In old texts, the speculum may also be referred to as a <b>diopter<\/b> or <b>dioptra<\/b>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Like an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a>, a speculum allows a view inside the body; endoscopes, however, tend to have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optics\" title=\"Optics\" rel=\"external_link\" target=\"_blank\">optics<\/a> while a speculum is intended for direct vision.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:5_Speculum,_14th_15th_and_16th_century._Wellcome_M0008374.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg\/220px-5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg\" width=\"220\" height=\"172\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:5_Speculum,_14th_15th_and_16th_century._Wellcome_M0008374.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>14th, 15th and 16th century specula<\/div><\/div><\/div>\n<p>Vaginal and anal specula were used by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greece\" title=\"Ancient Greece\" rel=\"external_link\" target=\"_blank\">ancient Greeks<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Rome\" title=\"Ancient Rome\" rel=\"external_link\" target=\"_blank\">Romans<\/a>,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> and speculum <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artifact_(archaeology)\" title=\"Artifact (archaeology)\" rel=\"external_link\" target=\"_blank\">artifacts<\/a> have been found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pompeii\" title=\"Pompeii\" rel=\"external_link\" target=\"_blank\">Pompeii<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> A vaginal speculum, developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/J._Marion_Sims\" title=\"J. Marion Sims\" rel=\"external_link\" target=\"_blank\">J. Marion Sims<\/a>, consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beak\" title=\"Beak\" rel=\"external_link\" target=\"_blank\">beak<\/a> of a duck. The speculum is inserted into the vagina to dilate it for examination of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagina\" title=\"Vagina\" rel=\"external_link\" target=\"_blank\">vagina<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Construction\">Construction<\/span><\/h2>\n<p>Specula were formerly made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, and sterilized after use. However, many, especially those used in emergency departments and doctor's offices, are now made of plastic, and are disposable, single-use items. Those used in surgical suites are still commonly made of metal.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Glasspekula.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Glasspekula.jpg\/170px-Glasspekula.jpg\" width=\"170\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Glasspekula.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Two cylindrical-shaped glass specula<\/div><\/div><\/div>\n<p>Specula come in a variety of shapes based on their purpose, and a variety of sizes;<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> in any case the cylinder or blade(s) of the instrument allow the operator a direct vision of the area of interest and the possibility to introduce instruments for further interventions such as a biopsy.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Vaginal_use\">Vaginal use<\/span><\/h3>\n<p>The best-known speculum is the bivalved vaginal speculum; the two blades are hinged and are \"closed\" when the speculum is inserted to facilitate its entry and \"opened\" in its final position where they can be arrested by a screw mechanism, so that the operator is freed from keeping the blades apart.\n<\/p><p>\nA cylindrical-shaped speculum, introduced in 2001, the dilating vaginal speculum (also known as the Veda-scope<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>) invented by Clemens van der Weegen,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> inflates the vagina with filtered air.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> (see diagram) The device has two main functions: a) to take a normal Pap smear with a cervical brush or a cytology brush; and b) as an internal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colposcope\" class=\"mw-redirect\" title=\"Colposcope\" rel=\"external_link\" target=\"_blank\">colposcope<\/a> so that the operator can pivot the Veda-scope to view any part of the vagina barrel and cervix facilitated by an internal light source that can illuminate the vaginal wall and cervix with multi-coloured light filters, which can detect pre-cancerous cells with the aid of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetic_acid\" title=\"Acetic acid\" rel=\"external_link\" target=\"_blank\">acetic acid<\/a> solution and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iodine\" title=\"Iodine\" rel=\"external_link\" target=\"_blank\">iodine<\/a> solution. It also has a facility to attach a digital camera for viewing and recording.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> <\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:200px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/b\/b7\/Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg\" width=\"198\" height=\"132\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Dilating vaginal speculum inflating vagina and light illuminating (cervical brush inserts through top inlet)<\/div><\/div><\/div>\n<p>A specialized form of vaginal speculum is the weighted speculum, which consists of a broad half tube which is bent at about a 90 degree angle, with the channel of the tube on the exterior side of the angle. One end of the tube has a roughly spherical metal weight surrounding the channel of the speculum. A weighted speculum is placed in the vagina during vaginal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> with the patient in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithotomy_position\" title=\"Lithotomy position\" rel=\"external_link\" target=\"_blank\">lithotomy position<\/a>. The weight holds the speculum in place and frees the surgeon's hands for other tasks.\nA vaginal speculum is also used in fertility treatments, particularly artificial insemination, and allows the vaginal cavity to be opened and observed thereby facilitating the deposit of semen into the vagina.\n<\/p>\n<dl><dt>Cylindrical shape<\/dt><\/dl>\n<ul><li>Ferguson<\/li>\n<li>Glass speculum<\/li>\n<li>Veda-scope (dilating vaginal speculum)<\/li><\/ul>\n<dl><dt>One blade<\/dt><\/dl>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sims.Speculum.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Sims.Speculum.jpg\/170px-Sims.Speculum.jpg\" width=\"170\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sims.Speculum.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The single-bladed Sims speculum is still in use today.<\/div><\/div><\/div>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Auvard<\/li>\n<li>Breisky<\/li>\n<li>Doyen<\/li>\n<li>Eastman<\/li>\n<li>Jackson<\/li>\n<li>Kallmorgen<\/li>\n<li>Kristeller<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Landau<\/li>\n<li>Martin<\/li>\n<li>Mathieu<\/li>\n<li>Polansky<\/li>\n<li>Samuel<\/li>\n<li>Scherbak<\/li>\n<li>Sims<\/li>\n<li>Weissbarth<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<dl><dt>Two blades (bivalved)<\/dt><\/dl>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_of_Polansky.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Speculum_of_Polansky.jpg\/220px-Speculum_of_Polansky.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_of_Polansky.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Medical instrument<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_en_m%C3%A9tal.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Speculum_en_m%C3%A9tal.jpg\/170px-Speculum_en_m%C3%A9tal.jpg\" width=\"170\" height=\"213\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_en_m%C3%A9tal.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Duckbill shape of a two-bladed speculum<\/div><\/div><\/div>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Collin<\/li>\n<li>Cusco<\/li>\n<li>DeVilbiss<\/li>\n<li>Grave<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Pederson<\/li>\n<li>Semm<\/li>\n<li>Seyffert<\/li>\n<li>Trelat<\/li>\n<li>Winterton<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<dl><dt>Three blades<\/dt><\/dl>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Guttmann<\/li>\n<li>Nott<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>O\u00b4Sullivan-O\u00b4Connor<\/li>\n<li>Polansky (veterinary use)<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Rectal_use\">Rectal use<\/span><\/h3>\n<p>Vaginal specula are also used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anus\" title=\"Anus\" rel=\"external_link\" target=\"_blank\">anal<\/a> surgery, although several other forms of anal specula exist. One form, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anoscopy\" title=\"Anoscopy\" rel=\"external_link\" target=\"_blank\">anoscope<\/a>, resembles a tube that has a removable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bullet\" title=\"Bullet\" rel=\"external_link\" target=\"_blank\">bullet<\/a>-shaped insert. When the anoscope is inserted into the anus, the insert dilates the anus to the diameter of the tube. The insert is then removed, leaving the tube to allow examination of the lower rectum and anus.\n<\/p><p>This style of anal speculum is one of the oldest designs for surgical instruments still in use, with examples dating back many centuries. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sigmoidoscopy\" title=\"Sigmoidoscopy\" rel=\"external_link\" target=\"_blank\">sigmoidoscope<\/a> can be further advanced into the lower intestinal tract and requires an endoscopic set-up.\n<\/p>\n<dl><dt>Tubal shape<\/dt><\/dl>\n<ul><li>Aniscope<\/li><\/ul>\n<dl><dt>One blade<\/dt><\/dl>\n<ul><li>Czerny<\/li><\/ul>\n<dl><dt>Two blades<\/dt><\/dl>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Barr<\/li>\n<li>Bodenhammer<\/li>\n<li>Killian<\/li>\n<li>Pratt<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Ricord<\/li>\n<li>Roschke<\/li>\n<li>Sims<\/li>\n<li>Smith-Buie<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<dl><dt>Three blades<\/dt><\/dl>\n<ul><li>Alan Park<\/li>\n<li>Cook<\/li>\n<li>Mathieu<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Nasal_use\">Nasal use<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_nose\" title=\"Human nose\" rel=\"external_link\" target=\"_blank\">Nasal<\/a> specula have two relatively flat blades with handle. The instrument is hinged so that when the handles are squeezed together the blades spread laterally, allowing examination.\n<\/p>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Killian<\/li>\n<li>Vienna<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Voltolini<\/li>\n<li>Yankauer<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<p>Additionally, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johann_Ludwig_Wilhelm_Thudichum\" title=\"Johann Ludwig Wilhelm Thudichum\" rel=\"external_link\" target=\"_blank\">Thudichum<\/a> nasal speculum is commonly used in the outpatient examination of the nose.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Aural_use\">Aural use<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aural_Speculum_ENT_Instrument_Medical.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/11\/Aural_Speculum_ENT_Instrument_Medical.jpg\/220px-Aural_Speculum_ENT_Instrument_Medical.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aural_Speculum_ENT_Instrument_Medical.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Ear specula are funnel-shaped.<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">Ear<\/a> or aural specula resemble a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Funnel\" title=\"Funnel\" rel=\"external_link\" target=\"_blank\">funnel<\/a>, and come in a variety of sizes.\n<\/p>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Aural speculum<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Oral_use\">Oral use<\/span><\/h3>\n<p>In veterinary medicine, a McPherson Speculum can be used for oral examination. The speculum helps keep the mouth open during the exam and helps avoid biting injuries.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"BDSM\">BDSM<\/span><\/h2>\n<p>Speculum is used for <i>Speculum Play<\/i> under <a href=\"https:\/\/en.wikipedia.org\/wiki\/BDSM\" title=\"BDSM\" rel=\"external_link\" target=\"_blank\">BDSM<\/a> for spreading the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagina\" title=\"Vagina\" rel=\"external_link\" target=\"_blank\">vagina<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anus\" title=\"Anus\" rel=\"external_link\" target=\"_blank\">anus<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\"> Endoscope<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Colposcopy\" title=\"Colposcopy\" rel=\"external_link\" target=\"_blank\"> Colposcope<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vaginal_dilator\" title=\"Vaginal dilator\" rel=\"external_link\" target=\"_blank\"> Vaginal dilator<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"diopter\" in <i>The Compact Edition of the Oxford English Dictionary<\/i>, Oxford University Press, 1971<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Univ. of Virginia. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hsl.virginia.edu\/historical\/artifacts\/roman_surgical\/\" target=\"_blank\">\"Surgical Instruments from Ancient Rome (with pictures)\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-06-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Surgical+Instruments+from+Ancient+Rome++%28with+pictures%29&rft.au=Univ.+of+Virginia&rft_id=http%3A%2F%2Fwww.hsl.virginia.edu%2Fhistorical%2Fartifacts%2Froman_surgical%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cecilia_Mettler\" title=\"Cecilia Mettler\" rel=\"external_link\" target=\"_blank\">Cecilia Mettler<\/a>. <i>History of Medicine<\/i>. The Blakiston Co (1947).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=History+of+Medicine&rft.pub=The+Blakiston+Co+%281947%29&rft.au=Cecilia+Mettler&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.m-e-dical.com\/english\/vs.htm\" target=\"_blank\">\"Comparison chart of speculum types, with line images\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-05-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Comparison+chart+of+speculum+types%2C+with+line+images&rft_id=http%3A%2F%2Fwww.m-e-dical.com%2Fenglish%2Fvs.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Longmore, P. G. (2004). \"Veda-scope: More comfortable than the bivalve speculum and cytologically equivalent\". <i>The Australian and New Zealand Journal of Obstetrics and Gynaecology<\/i>. <b>44<\/b> (2): 140\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1479-828X.2004.00180.x\" target=\"_blank\">10.1111\/j.1479-828X.2004.00180.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15089838\" target=\"_blank\">15089838<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Australian+and+New+Zealand+Journal+of+Obstetrics+and+Gynaecology&rft.atitle=Veda-scope%3A+More+comfortable+than+the+bivalve+speculum+and+cytologically+equivalent&rft.volume=44&rft.issue=2&rft.pages=140-5&rft.date=2004&rft_id=info%3Adoi%2F10.1111%2Fj.1479-828X.2004.00180.x&rft_id=info%3Apmid%2F15089838&rft.aulast=Longmore&rft.aufirst=P.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">van der Weegen, Clemens (2000) \"Vaginal speculum with seal\" <span><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US6719687\" target=\"_blank\">U.S. Patent 6,719,687<\/a><\/span><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomas, A; Weisberg, E; Lieberman, D; Fraser, I. S. (2001). \"A randomised controlled trial comparing a dilating vaginal speculum with a conventional bivalve speculum\". <i>The Australian & New Zealand journal of obstetrics & gynaecology<\/i>. <b>41<\/b> (4): 379\u201386. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11787909\" target=\"_blank\">11787909<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Australian+%26+New+Zealand+journal+of+obstetrics+%26+gynaecology&rft.atitle=A+randomised+controlled+trial+comparing+a+dilating+vaginal+speculum+with+a+conventional+bivalve+speculum&rft.volume=41&rft.issue=4&rft.pages=379-86&rft.date=2001&rft_id=info%3Apmid%2F11787909&rft.aulast=Thomas&rft.aufirst=A&rft.au=Weisberg%2C+E&rft.au=Lieberman%2C+D&rft.au=Fraser%2C+I.+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pacificei.com\/how_work.html\" target=\"_blank\">How it works<\/a>. pacificei.com<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.kinkly.com\/definition\/14516\/speculum-play\" target=\"_blank\">Speculum Play by www.kinkly.com<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181207063749\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.280 seconds\nReal time usage: 0.398 seconds\nPreprocessor visited node count: 792\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 35336\/2097152 bytes\nTemplate argument size: 615\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 14407\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.145\/10.000 seconds\nLua memory usage: 4.01 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 321.208 1 -total\n<\/p>\n<pre>43.36% 139.267 1 Template:Reflist\n22.05% 70.834 1 Template:Commons_category\n20.48% 65.770 2 Template:Cite_web\n15.42% 49.546 1 Template:Short_description\n14.31% 45.974 1 Template:Pagetype\n13.39% 43.017 2 Template:Cite_journal\n 9.92% 31.878 3 Template:Annotated_link\n 8.17% 26.238 6 Template:Template_parameter_value\n 6.76% 21.706 3 Template:Navbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:320320-1!canonical and timestamp 20181207063749 and revision id 867410457\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Speculum_%28medical%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214655\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.160 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 153.088 1 - wikipedia:Speculum_(medical)\n100.00% 153.088 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8558-0!*!*!*!*!*!* and timestamp 20181217214655 and revision id 24986\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)\">https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3633b9ae4a7a31327d7d10b337925b43_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Sp%C3%A9culum_en_plastique.jpg\/500px-Sp%C3%A9culum_en_plastique.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg\/440px-5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Glasspekula.jpg\/340px-Glasspekula.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/b\/b7\/Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Sims.Speculum.jpg\/340px-Sims.Speculum.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Speculum_of_Polansky.jpg\/440px-Speculum_of_Polansky.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Speculum_en_m%C3%A9tal.jpg\/340px-Speculum_en_m%C3%A9tal.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/11\/Aural_Speculum_ENT_Instrument_Medical.jpg\/440px-Aural_Speculum_ENT_Instrument_Medical.jpg"],"3633b9ae4a7a31327d7d10b337925b43_timestamp":1545083215,"739645b065bcad0f5a9e9e65c6d95099_type":"article","739645b065bcad0f5a9e9e65c6d95099_title":"Scalpel","739645b065bcad0f5a9e9e65c6d95099_url":"https:\/\/www.limswiki.org\/index.php\/Scalpel","739645b065bcad0f5a9e9e65c6d95099_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tScalpel\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Scalpel (disambiguation).\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2008) (Learn how and when to remove this template message)\nScalpelVarious scalpels. The first (from left), second, and fourth have replaceable bladesClassificationCutting toolUsed withStencil, surgeryRelatedLancet, utility knife, laser scalpel\nA scalpel, or lancet, is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (called a hobby knife). Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a utility knife) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile. Double-edged scalpels are referred to as \"lancets\".\nScalpel blades are usually made of hardened and tempered steel, stainless steel, or high carbon steel; in addition, titanium, ceramic, diamond and even obsidian knives are not uncommon. For example, when performing surgery under MRI guidance, steel blades are unusable (the blades would be drawn to the magnets, or may cause image artifacts). Historically, the preferred material for surgical scalpels was silver. Scalpel blades are also offered by select manufacturers with a zirconium nitride-coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut. Alternatives to scalpels in surgical applications include electrocautery and lasers.\n\nContents \n\n1 Surgical scalpels \n\n1.1 Gripping a medical scalpel \n\n1.1.1 Palmar grip \n1.1.2 Pencil grip \n\n\n\n\n2 Graphic design and arts and crafts blades \n3 Ancient scalpels \n4 Scalpel injuries \n\n4.1 Safety scalpels \n4.2 Blade removers \n4.3 Safety \n\n\n5 See also \n6 References \n7 External links \n\n\nSurgical scalpels \nReusable handle (top) and disposable scalpels (bottom)\nSurgical scalpels consist of two parts, a blade and a handle. The handles are often reusable, with the blades being replaceable. In medical applications, each blade is only used once (even if just for a single, small cut).\nThe handle is also known as a \"B.P. handle\", named after Charles Russell Bard and Morgan Parker, founders of the Bard-Parker Company. Morgan Parker patented the 2-piece scalpel design in 1915 and Bard-Parker developed a method of cold sterilization that would not dull the blades, as did the heat-based method that was previously used.[1]\nThe handle of medical scalpels come in two basic types. The first is a flat handle used in the #3 and #4 handles. The #7 handle is more like a long writing pen, rounded at the front and flat at the back. A #4 handle is larger than a #3. Blades are manufactured with a corresponding fitment size so that they fit on only one size handle. The following table of blades is incomplete and some blades listed may work with handles not specified here.\n\n\nTypes of surgical scalpel blades\n\n\nBlade No.\nPicture\nCompatible Handles\nBlade Description\nUses\n\n\nNo. 6\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 9\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 10\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nCurved cutting edge with an unsharpened back edge. A more traditional blade shape.\nGenerally for making incisions in skin and muscle. Commonly used to cut the skin in abdominal operations.\n\n\nNo. 10a\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nThis blade is a small and straight\n\n\n\nNo. 11\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nTriangular blade with sharp point, flat cutting edge parallel to the handle and flat back\nFor precision cutting, stripping, sharp angle cuts and also stencil cutting due to its similarity to the X-Acto artknife blade\n\n\nNo. 11P\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. E11\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. E\/11\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\nDebriding hard skin for example callus by Podiatrists.\n\n\nNo. 12\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA small, pointed, crescent-shaped blade sharpened on the inside edge of the curve\n\n\n\nNo. 12D\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA small, pointed, crescent-shaped blade sharpened on both sides of the curve\n\n\n\nNo. 13\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 14\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 15\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA smaller version of the #10\nFor the same general use as the #10 blade\n\n\nNo. 15A\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA front-facing straight blade with flat back\n\n\n\nNo. 15C\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nThe #15 with a downward angle, flatter and thinner than the #15\nThe downward angle makes this the preferred blade for working within the chest during cardiac surgery, and is commonly used to make the distal arteriotomy during coronary artery bypass grafting.\n\n\nNo. 15T\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\nEnucleation of lesions such as corns.\n\n\nNo. D\/15\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 16\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA narrow chisel-like blade with flat, angled cutting edge, positioned higher than the axis of the handle\nFor cutting stencils, scoring and etching\n\n\nNo. 17\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA flat face 1.6 mm chisel blade\nFor narrow cuts\n\n\nNo. 18\n\n4, 4 Graduated, 4 Long, 6\nA 12.7 mm chisel blade\nFor deep cuts and scraping\n\n\nNo. 19\n\n4, 4 Graduated, 4 Long, 6\nA similar blade to the #15\n\n\n\nNo. 20\n\n4, 4 Graduated, 4 Long, 6\nA larger version of the #10 blade, with a curved cutting edge and a flat, unsharpened back edge.\nUsed in general surgery and orthopaedic surgery.\n\n\nNo. 21\n\n4, 4 Graduated, 4 Long, 6\n\n\n\n\nNo. 22\n\n2, 4, 5, 6\nA slightly larger version of the #20, with a curved cutting edge and a flat, unsharpened back edge.\nUsed for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung resection surgery.\n\n\nNo. 22A\n\n4, 4 Graduated, 4 Long, 6\n\n\n\n\nNo. 23\n\n4, 4 Graduated, 4 Long, 6\nSimilar to #22, leaf-shaped\nFor long incisions.\n\n\nNo. 24\n\n4, 4 Graduated, 4 Long, 6\nA wide, flat, angled cutting edge\nFor corner cuts, trimming, stripping, and cutting mats and gaskets\n\n\nNo. 25\n\n4, 4 Graduated, 4 Long, 6\nA front-facing straight blade with flat back (similar to #15a)\n\n\n\nNo. 25a\n\n4, 4 Graduated, 4 Long, 6\nA triangular straight blade with flat back edge taking a downwards angle (similar to #10a, shorter than #26)\n\n\n\nNo. 26\n\n4, 4 Graduated, 4 Long, 6\nA triangular straight blade with flat back edge taking a downwards angle (similar to the #15a, longer than #25a)\n\n\n\nNo. 27\n\n4, 4 Graduated, 4 Long, 6\n\n\n\n\nNo. 34\n\n4, 4 Graduated, 4 Long, 6\nA triangular blade similar to the #11\n\n\n\nNo. 36\n\n4, 4 Graduated, 4 Long, 6\nA larger blade\nUsed in general surgery but also within a Laboratory setting for Histology and Histopathology\n\n\nNo. 40\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. PM40\n\nStainless PM Handle\n\n\n\n\nNo. PM40B\n\nStainless PM Handle\n\n\n\n\nNo. 60\n\n4, 4 Graduated, 4 Long, 6\nA long blade resembling the #10 with a long cutting edge, rounded tip and flat back.\n\n\n\nNo. PM60\n\nPM8\n\n\n\n\nNo. PM60B\n\nPM8\n\n\n\nGripping a medical scalpel \n Palmar grip\nPalmar grip \nAlso called the \"dinner knife\" grip. The handle is held with the second through fourth fingers and secured along the base of the thumb, with the index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts.\n\nPencil grip \n Pencil grip\nBest used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle. The scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of the index finger and thumb. Care should be taken not to allow the handle to rest too far along the index finger as this promotes an unstable grip and cramped fingers.\n\nGraphic design and arts and crafts blades \n X-Acto knife\nGraphical and model-making scalpels tend to have round handles, with textured grips (either knurled metal or soft plastic). The blade is usually flat and straight, allowing it to be run easily against a straightedge to produce straight cuts.\nThere are many kinds of graphic arts blades; the most common around the graphic design studio is the #11 blade which is very similar to a #11 surgical blade (q.v.). Other blade shapes are used for wood carving, cutting leather and heavy fabric, etc.\n\nAncient scalpels \nObsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.[2] Skulls from the same time and place show signs of brain surgery.[3]\nAncient Egyptians made incisions for embalming with scalpels of sharpened obsidian, a material that is still in use.\nThe first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC.[4]\nAncient Romans used more than 150 different surgical instruments, including scalpels.[5]\nIndian Ayurvedic medicine mentions the use of sharp bamboo splinters.[citation needed ]\nScalpel injuries \nSee also: Needlestick injury\nIn the last decade,[when? ] a rising awareness of the dangers of sharps in a medical environment has led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the Centers for Disease Control and Prevention, as many as 1,000 people each day are subject to accidental needle sticks and lacerations while providing medical care. Scalpel blade injuries are among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries make up 7 percent to 8 percent of all sharps injuries.[6][7]\n\"Scalpel Safety\" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury.[8]\n\nSafety scalpels \nSafety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as the Needle Stick Prevention Act.[clarification needed ]\nThere are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, DeRoyal, Jai Surgicals, Swann Morton, and PenBlade are more intuitive to use due to their similarities to a standard box-cutter. Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as Aditya Dispomed, Aspen Surgical and Southmedic.\nA few companies[who? ] have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges is considerably more than for conventional surgical blades.\nHowever, CDC studies shows that up to 87% of active medical devices are not activated.[clarification needed ] Safety scalpels are active devices and therefore the risk of not activating is still significant.[9] There is a study that indicated there were actually four times more injuries with safety scalpels than reusable scalpels.[10][full citation needed ]\n\nBlade removers \nThere are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than a safety scalpel.[11] Companies like Qlicksmart offers a single-handed scalpel blade remover that complies with regulatory requirements such as US Occupational Safety and Health Administration Standards.[12]\n\nSafety \nThe usage of both safety scalpels and a single-handed blade remover, combined with a hands-free passing technique, are potentially effective in reducing scalpel blade injuries.[11] It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.\n\nSee also \nLaser scalpel\nMedical device\nThe Lancet\nReferences \n\n\n^ Ochsner, J (2009). \"Surgical knife\". Texas Heart Institute Journal. 36 (5): 441\u2013443. PMC 2763477 . PMID 19876423. \n\n^ Jo Marchant. \"Scalpels and skulls point to Bronze Age brain surgery\". New Scientist. \n\n^ \"ARTS-CULTURE \u2013 Excavations restarting at \u0130kiztepe in northern Turkey\". \n\n^ Ochsner J (2009). \"Surgical Knife\". Tex Heart Inst J. 36 (5): 441\u20133. PMC 2763477 . PMID 19876423. \n\n^ \"Roman ruins cast new light on a trip to doctor\". Telegraph.co.uk. December 9, 2007. \n\n^ Perry J, Parker G, Jagger J (2003). \"EPINet Report: 2001 Percutaneous Injury Rates\". Advances in Exposure Prevention. 6 (3): 32\u201336. \n\n^ \"Sharps Injury Prevention Workbook\". Cdc.gov (Centre for Disease Control and Prevention). \n\n^ Sinnott M.; Wall D. (2007). \"' SCALPEL SAFETY': How safe (or dangerous) are safety scalpels?\". International Journal of Surgery. 6 (2): 176\u2013177. doi:10.1016\/j.ijsu.2007.01.010. \n\n^ Alvarado-Ramy F, Beltrami EM, Short LJ, et al. (2003). \"A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicentre study, 1993\u20131995\". Infect Control Hosp Epidemiol. 24 (2): 97\u2013104. \n\n^ \"Needlestick and Sharp-Object Injury Report. US EPINet Network\". Advances in Exposure Prevention. 7 (4): 44\u201345. 2005. \n\n^ a b Fuentes, H., et al. (2008). \"Scalpel Safety\": Modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries.\" The International Journal of Risk & Safety in Medicine 20(1\u20132):83\u201389. \n\n^ \"OSHA Standard Interpretations \u2013 Use of passing trays and single-handed scalpel blade remover in a surgical setting\". Osha.gov. December 22, 2005. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Scalpels.\nvteCutting and abrasive tools\nAbrasive saw\nAxe\nBlade\nBandsaw\nBolt cutter\nBroach\nCeramic tile cutter\nChainsaw\nCircular saw\nChisel\nCoping saw\nCountersink\nCutting tool\nDiagonal pliers\nDiamond blade\nDiamond tool\nDrawknife\nDrill bit\nEmery cloth\nFile\nFretsaw\nFroe\nGlass cutter\nGrater\nGrinding wheel\nHacksaw\nHand saw\nHole saw\nIncisor\nKnife\nLaser\nLawn mower\nMachete\nMeat slicer\nMezzaluna\nMilling cutter\nMiter saw\nNail clipper\nNibbler\nPencil sharpener\nPipecutter\nPizza cutter\nPlasma cutter\nPlane\nPocket knife\nRasp\nRazor\nReamer\nSandpaper\nSaw\nScalpel\nScissors\nSnips\nSteel wool\nSurform\nSwitchblade\nTool bit\nUtility knife\nWater jet cutter\nWire brush\nWire stripper\n\nTypes of tools\nCleaning\nCutting and abrasive\nForestry\nGarden\nHand\nMachine and metalworking\nMeasuring and alignment\nPower\n\nvteKnives and daggers\nList of daggers\nList of blade materials\nTypes of knives\nAircrew Survival Egress Knife\nAthame\nBalisong\/Butterfly\nBallistic\nBallpoint pen knife\nBayonet\nBoline\nBolo\nBoning\nBoot knife\nBowie\nBread knife\nCane knife\nCheese knife\nChef's knife\nCleaver\nClip point\nCombat knife\nCommander\nCorvo\nCQC-6\nDeba b\u014dch\u014d\nDiving knife\nDrop point\nElectric knife\nFairbairn\u2013Sykes fighting knife\nGerber Mark II\nGinsu\nGrapefruit knife\nGravity knife\nGunong\nHunting knife\nJacob's ladder\nKarambit\nKard\nK\u012bla\nKirpan\nKitchen knife\nKukri\nLaguiole knife\nMachete\nMandau\nMezzaluna\nMisericorde\nMora knife\nMulti-tool\nNakiri b\u014dch\u014d\nNavaja\nNeck knife\nNontron knife\nOpinel knife\nPalette knife\nPantographic knife\nParang\nPenknife\nPenny knife\nPocket knife\nPutty knife\nPuukko\nRampuri\nResolza\nSabatier\nSami knife\nSantoku\nSARK\nScalpel\nSeax\nSgian dubh\nSharpfinger\nShiv\nSliding knife\nSmatchet\nSOG Knife\nStraight razor\nStrider SMF\nSurvival knife\nSwiss Army knife\nSwitchblade\nTaping knife\nThrowing knife\nTomato knife\nTrench knife\nTsakat\nTumi\nUlu\nUtility knife\nWarrior knife\nX-Acto\nYanagi ba\nYatagan\nTypes of daggers\nAnelace\nApplegate\u2013Fairbairn fighting knife\nArkansas toothpick\nBC-41\nBagh naka\nBaselard\nBichuwa\nBollock dagger\nCinquedea\nDirk\nEar dagger\nEmeici\nFac\u00f3n\nFrench Nail\nHachiwara\nHunting dagger\nJanbiya\nKaiken\nKalis\nKatar\nKhanjali\nKhanjar\nKris\nKunai\nMark I trench knife\nOcean Edge Knife\nParrying dagger\nPoignard\nQolxad\/Jile dagger\nPush dagger\nRondel dagger\nSeme\nShobo\nSica\nStiletto\nTant\u014d\nMarine Raider stiletto\nV-42 stiletto\nYarar\u00e1 Parachute Knife\nYoroid\u014dshi\nKnife manufacturers\nAitor\nAl Mar Knives\nAmerican Tomahawk Company\nBear MCG\nBenchmade\nB\u00f6ker\nBuck Knives\nCaber\nCamillus Cutlery Company\nCattaraugus Cutlery Company\nChris Reeve Knives\nCold Steel\nColumbia River Knife & Tool\nCuisinart\nCutco Cutlery\nDOVO Solingen\nDexter-Russell\nDirte Knives\nEikhorn\nEk Commando Knife Co.\nEmerson Knives\nErizo\nF. Dick\nF\u00e4llkniven\nFAMAE\nFiskars\nF\u00fcritechnics\nGerber Legendary Blades\nGlobal\nGolok\nHanwei\nImperial Schrade\nJ. A. Henckels\nKa-Bar\nKershaw Knives\nKitchenAid\nKorin Japanese Trading Company\nKyocera\nLeatherman\nMad Dog Knives\nMercWorx\nMicrotech Knives\nMorseth\nMurphy Knives\nOntario Knife Company\nOpinel\nRandall Made Knives\nRanz\nRigid Knives\nR\u00f6sle\nSOG Specialty Knives\nSabatier A\u00een\u00e9 & Perrier\nShun Cutlery\nSpyderco\nStrider Knives\nSurvival Aids\nTEKNA\nThiers Issard\nTramontina\nVictorinox\nVox Knives\nW. R. Case & Sons Cutlery Co.\nWalther arms\nWenger\nWestern Knife Company\nWilkinson Sword\nWindlass Steelcrafts\nW\u00fcsthof\nYarara Ltd\nZero Tolerance Knives\nKnifemakers\nA.G. Russell\nAmerican Bladesmith Society\nRex Applegate\nJames Black\nBlackie Collins\nJohn Nelson Cooper\nErnest Emerson\nJerry Fisk\nPhill Hartsfield\nBill Harsey Jr.\nGil Hibben\nKnifemakers' Guild\nZanjan Knifemakers\nJimmy Lile\nBob Loveless\nBob Lum\nWilliam F. 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Russell\nJody Samson\nWilliam Scagel\nMike Snody\nRobert Terzuola\nMichael Walker\nBuster Warenski\nDaniel Winkler\n\n Book:Knives and daggers\n Category:Knives \/ Daggers\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Scalpel\">https:\/\/www.limswiki.org\/index.php\/Scalpel<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:53.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 383 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","739645b065bcad0f5a9e9e65c6d95099_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Scalpel skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Scalpel<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel_(disambiguation)\" class=\"mw-disambig\" title=\"Scalpel (disambiguation)\" rel=\"external_link\" target=\"_blank\">Scalpel (disambiguation)<\/a>.<\/div>\n\n\n<p>A <b>scalpel<\/b>, or <b>lancet<\/b>, is a small and extremely sharp bladed instrument used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>, anatomical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dissection\" title=\"Dissection\" rel=\"external_link\" target=\"_blank\">dissection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Podiatry\" title=\"Podiatry\" rel=\"external_link\" target=\"_blank\">podiatry<\/a> and various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Handicraft\" title=\"Handicraft\" rel=\"external_link\" target=\"_blank\">arts and crafts<\/a> (called a <b>hobby knife<\/b>). Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Utility_knife\" title=\"Utility knife\" rel=\"external_link\" target=\"_blank\">utility knife<\/a>) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile. Double-edged scalpels are referred to as \"lancets\".\n<\/p><p>Scalpel blades are usually made of hardened and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tempered_steel\" class=\"mw-redirect\" title=\"Tempered steel\" rel=\"external_link\" target=\"_blank\">tempered steel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_carbon_steel\" class=\"mw-redirect\" title=\"High carbon steel\" rel=\"external_link\" target=\"_blank\">high carbon steel<\/a>; in addition, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_knife\" title=\"Ceramic knife\" rel=\"external_link\" target=\"_blank\">ceramic<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamond\" title=\"Diamond\" rel=\"external_link\" target=\"_blank\">diamond<\/a> and even <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obsidian\" title=\"Obsidian\" rel=\"external_link\" target=\"_blank\">obsidian<\/a> knives are not uncommon. For example, when performing surgery under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI<\/a> guidance, steel blades are unusable (the blades would be drawn to the magnets, or may cause image <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artifact_(medical_imaging)\" class=\"mw-redirect\" title=\"Artifact (medical imaging)\" rel=\"external_link\" target=\"_blank\">artifacts<\/a>). Historically, the preferred material for surgical scalpels was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">silver<\/a>. Scalpel blades are also offered by select manufacturers with a zirconium nitride-coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut. Alternatives to scalpels in surgical applications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cauterization#Electrocautery\" title=\"Cauterization\" rel=\"external_link\" target=\"_blank\">electrocautery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser\" title=\"Laser\" rel=\"external_link\" target=\"_blank\">lasers<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Surgical_scalpels\">Surgical scalpels<\/span><\/h2>\n<div class=\"thumb tmulti tright\"><div class=\"thumbinner\" style=\"width:224px;max-width:224px\"><div class=\"tsingle\" style=\"margin:1px;width:222px;max-width:222px\"><div class=\"thumbimage\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel_handle_3.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Scalpel_handle_3.jpg\/220px-Scalpel_handle_3.jpg\" width=\"220\" height=\"124\" \/><\/a><\/div><\/div><div class=\"tsingle\" style=\"margin:1px;width:222px;max-width:222px\"><div class=\"thumbimage\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Disposable_scalpels-small_and_large.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Disposable_scalpels-small_and_large.jpg\/220px-Disposable_scalpels-small_and_large.jpg\" width=\"220\" height=\"76\" \/><\/a><\/div><div class=\"thumbcaption\" style=\"clear:left\">Reusable handle (top) and disposable scalpels (bottom)<\/div><\/div><\/div><\/div>\n<p>Surgical scalpels consist of two parts, a blade and a handle. The handles are often reusable, with the blades being replaceable. In medical applications, each blade is only used once (even if just for a single, small cut).\n<\/p><p>The handle is also known as a \"B.P. handle\", named after Charles Russell Bard and Morgan Parker, founders of the Bard-Parker Company. Morgan Parker patented the 2-piece scalpel design in 1915 and Bard-Parker developed a method of cold sterilization that would not dull the blades, as did the heat-based method that was previously used.<sup id=\"rdp-ebb-cite_ref-THIJ_Ochsner_1-0\" class=\"reference\"><a href=\"#cite_note-THIJ_Ochsner-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The handle of medical scalpels come in two basic types. The first is a flat handle used in the #3 and #4 handles. The #7 handle is more like a long writing pen, rounded at the front and flat at the back. A #4 handle is larger than a #3. Blades are manufactured with a corresponding fitment size so that they fit on only one size handle. The following table of blades is incomplete and some blades listed may work with handles not specified here.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n<caption>Types of surgical scalpel blades\n<\/caption>\n<tbody><tr>\n<th>Blade No.<\/th>\n<th>Picture<\/th>\n<th>Compatible Handles<\/th>\n<th>Blade Description<\/th>\n<th>Uses\n<\/th><\/tr>\n<tr>\n<td>No. 6<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 9<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 10<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>Curved cutting edge with an unsharpened back edge. A more traditional blade shape.<\/td>\n<td>Generally for making incisions in skin and muscle. Commonly used to cut the skin in <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_surgery\" title=\"General surgery\" rel=\"external_link\" target=\"_blank\">abdominal operations<\/a>.\n<\/td><\/tr>\n<tr>\n<td>No. 10a<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>This blade is a small and straight<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 11<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel11.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel11.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fd\/Scalpel11.jpg\/120px-Scalpel11.jpg\" width=\"120\" height=\"61\" \/><\/a><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>Triangular blade with sharp point, flat cutting edge parallel to the handle and flat back<\/td>\n<td>For precision cutting, stripping, sharp angle cuts and also <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stencil\" title=\"Stencil\" rel=\"external_link\" target=\"_blank\">stencil<\/a> cutting due to its similarity to the X-Acto artknife blade\n<\/td><\/tr>\n<tr>\n<td>No. 11P<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. E11<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. E\/11<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>Debriding hard skin for example <a href=\"https:\/\/en.wikipedia.org\/wiki\/Callus\" title=\"Callus\" rel=\"external_link\" target=\"_blank\">callus<\/a> by Podiatrists.\n<\/td><\/tr>\n<tr>\n<td>No. 12<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel12.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel12.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Scalpel12.jpg\/120px-Scalpel12.jpg\" width=\"120\" height=\"55\" \/><\/a><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A small, pointed, crescent-shaped blade sharpened on the inside edge of the curve<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 12D<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A small, pointed, crescent-shaped blade sharpened on both sides of the curve<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 13<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 14<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 15<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_Blade.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Surgical Blade.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Surgical_Blade.jpg\/120px-Surgical_Blade.jpg\" width=\"120\" height=\"67\" \/><\/a><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A smaller version of the #10<\/td>\n<td>For the same general use as the #10 blade\n<\/td><\/tr>\n<tr>\n<td>No. 15A<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A front-facing straight blade with flat back<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 15C<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>The #15 with a downward angle, flatter and thinner than the #15<\/td>\n<td>The downward angle makes this the preferred blade for working within the chest during cardiac surgery, and is commonly used to make the distal arteriotomy during coronary artery bypass grafting.\n<\/td><\/tr>\n<tr>\n<td>No. 15T<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>Enucleation of lesions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corn_(medicine)\" title=\"Corn (medicine)\" rel=\"external_link\" target=\"_blank\">corns<\/a>.\n<\/td><\/tr>\n<tr>\n<td>No. D\/15<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 16<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A narrow chisel-like blade with flat, angled cutting edge, positioned higher than the axis of the handle<\/td>\n<td>For cutting stencils, scoring and etching\n<\/td><\/tr>\n<tr>\n<td>No. 17<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A flat face 1.6 mm chisel blade<\/td>\n<td>For narrow cuts\n<\/td><\/tr>\n<tr>\n<td>No. 18<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A 12.7 mm chisel blade<\/td>\n<td>For deep cuts and scraping\n<\/td><\/tr>\n<tr>\n<td>No. 19<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A similar blade to the #15<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 20<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel20.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel20.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0c\/Scalpel20.jpg\/120px-Scalpel20.jpg\" width=\"120\" height=\"72\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A larger version of the #10 blade, with a curved cutting edge and a flat, unsharpened back edge.<\/td>\n<td>Used in general surgery and orthopaedic surgery.\n<\/td><\/tr>\n<tr>\n<td>No. 21<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel21.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel21.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Scalpel21.jpg\/120px-Scalpel21.jpg\" width=\"120\" height=\"69\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 22<\/td>\n<td><\/td>\n<td>2, 4, 5, 6<\/td>\n<td>A slightly larger version of the #20, with a curved cutting edge and a flat, unsharpened back edge.<\/td>\n<td>Used for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung resection surgery.\n<\/td><\/tr>\n<tr>\n<td>No. 22A<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 23<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel23.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel23.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Scalpel23.jpg\/120px-Scalpel23.jpg\" width=\"120\" height=\"74\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>Similar to #22, leaf-shaped<\/td>\n<td>For long incisions.\n<\/td><\/tr>\n<tr>\n<td>No. 24<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A wide, flat, angled cutting edge<\/td>\n<td>For corner cuts, trimming, stripping, and cutting mats and gaskets\n<\/td><\/tr>\n<tr>\n<td>No. 25<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A front-facing straight blade with flat back (similar to #15a)<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 25a<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A triangular straight blade with flat back edge taking a downwards angle (similar to #10a, shorter than #26)<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 26<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel26.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel26.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Scalpel26.jpg\/120px-Scalpel26.jpg\" width=\"120\" height=\"74\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A triangular straight blade with flat back edge taking a downwards angle (similar to the #15a, longer than #25a)<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 27<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 34<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A triangular blade similar to the #11<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 36<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A larger blade<\/td>\n<td>Used in general surgery but also within a Laboratory setting for Histology and Histopathology\n<\/td><\/tr>\n<tr>\n<td>No. 40<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM40<\/td>\n<td><\/td>\n<td>Stainless PM Handle<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM40B<\/td>\n<td><\/td>\n<td>Stainless PM Handle<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 60<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A long blade resembling the #10 with a long cutting edge, rounded tip and flat back.<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM60<\/td>\n<td><\/td>\n<td>PM8<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM60B<\/td>\n<td><\/td>\n<td>PM8<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Gripping_a_medical_scalpel\">Gripping a medical scalpel<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Palmar-Plain.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1d\/ScalpelGrip_Palmar-Plain.svg\/150px-ScalpelGrip_Palmar-Plain.svg.png\" width=\"150\" height=\"105\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Palmar-Plain.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Palmar grip<\/div><\/div><\/div>\n<h4><span class=\"mw-headline\" id=\"Palmar_grip\">Palmar grip<\/span><\/h4>\n<p>Also called the \"dinner knife\" grip. The handle is held with the second through fourth fingers and secured along the base of the thumb, with the index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Pencil_grip\">Pencil grip<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Pencil-Plain.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/ScalpelGrip_Pencil-Plain.svg\/150px-ScalpelGrip_Pencil-Plain.svg.png\" width=\"150\" height=\"105\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Pencil-Plain.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Pencil grip<\/div><\/div><\/div>\n<p>Best used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle. The scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of the index finger and thumb. Care should be taken not to allow the handle to rest too far along the index finger as this promotes an unstable grip and cramped fingers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Graphic_design_and_arts_and_crafts_blades\">Graphic design and arts and crafts blades<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:192px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Exacto_knife.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Exacto_knife.jpg\/190px-Exacto_knife.jpg\" width=\"190\" height=\"143\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Exacto_knife.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>X-Acto knife<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Graphic_design\" title=\"Graphic design\" rel=\"external_link\" target=\"_blank\">Graphical<\/a> and model-making scalpels tend to have round handles, with textured grips (either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knurling\" title=\"Knurling\" rel=\"external_link\" target=\"_blank\">knurled<\/a> metal or soft plastic). The blade is usually flat and straight, allowing it to be run easily against a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Straightedge\" title=\"Straightedge\" rel=\"external_link\" target=\"_blank\">straightedge<\/a> to produce straight cuts.\n<\/p><p>There are many kinds of graphic arts blades; the most common around the graphic design studio is the #11 blade which is very similar to a #11 surgical blade (q.v.). Other blade shapes are used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wood_carving\" title=\"Wood carving\" rel=\"external_link\" target=\"_blank\">wood carving<\/a>, cutting leather and heavy fabric, etc.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Ancient_scalpels\">Ancient scalpels<\/span><\/h2>\n<ul><li>Obsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Skulls from the same time and place show signs of brain surgery.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Egyptian_medicine\" title=\"Ancient Egyptian medicine\" rel=\"external_link\" target=\"_blank\">Ancient Egyptians<\/a> made incisions for embalming with scalpels of sharpened <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obsidian\" title=\"Obsidian\" rel=\"external_link\" target=\"_blank\">obsidian<\/a>, a material that is still in use.<\/li>\n<li>The first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine_in_ancient_Rome\" title=\"Medicine in ancient Rome\" rel=\"external_link\" target=\"_blank\">Ancient Romans<\/a> used more than 150 different surgical instruments, including scalpels.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><\/li>\n<li>Indian <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ayurveda\" title=\"Ayurveda\" rel=\"external_link\" target=\"_blank\">Ayurvedic<\/a> medicine mentions the use of sharp <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bamboo\" title=\"Bamboo\" rel=\"external_link\" target=\"_blank\">bamboo<\/a> splinters.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2010)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Scalpel_injuries\">Scalpel injuries<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needlestick_injury\" title=\"Needlestick injury\" rel=\"external_link\" target=\"_blank\">Needlestick injury<\/a><\/div>\n<p>In the last decade,<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (June 2012)\">when?<\/span><\/a><\/i>]<\/sup> a rising awareness of the dangers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle\" title=\"Hypodermic needle\" rel=\"external_link\" target=\"_blank\">sharps<\/a> in a medical environment has led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a>, as many as 1,000 people each day are subject to accidental needle sticks and lacerations while providing medical care. Scalpel blade injuries are among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries make up 7 percent to 8 percent of all sharps injuries.<sup id=\"rdp-ebb-cite_ref-Perry2003_6-0\" class=\"reference\"><a href=\"#cite_note-Perry2003-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-CDC_7-0\" class=\"reference\"><a href=\"#cite_note-CDC-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>\"Scalpel Safety\" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury.<sup id=\"rdp-ebb-cite_ref-Sinnott2007_8-0\" class=\"reference\"><a href=\"#cite_note-Sinnott2007-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Safety_scalpels\">Safety scalpels<\/span><\/h3>\n<p>Safety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as the Needle Stick Prevention Act.<sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag may need clarification or removal of jargon. (April 2013)\">clarification needed<\/span><\/a><\/i>]<\/sup>\nThere are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, <a href=\"https:\/\/en.wikipedia.org\/wiki\/DeRoyal\" title=\"DeRoyal\" rel=\"external_link\" target=\"_blank\">DeRoyal<\/a>, Jai Surgicals, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swann_Morton\" title=\"Swann Morton\" rel=\"external_link\" target=\"_blank\">Swann Morton<\/a>, and <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/penblade.net\" target=\"_blank\">PenBlade<\/a> are more intuitive to use due to their similarities to a standard box-cutter. Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as , and .\nA few companies<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\" title=\"Wikipedia:Manual of Style\/Words to watch\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag possibly uses too-vague attribution or weasel words. (December 2016)\">who?<\/span><\/a><\/i>]<\/sup> have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges is considerably more than for conventional surgical blades.\n<\/p><p>However, CDC studies shows that up to 87% of active medical devices are not activated.<sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag may need clarification or removal of jargon. (May 2013)\">clarification needed<\/span><\/a><\/i>]<\/sup> Safety scalpels are active devices and therefore the risk of not activating is still significant.<sup id=\"rdp-ebb-cite_ref-Alvarado-Ramy_9-0\" class=\"reference\"><a href=\"#cite_note-Alvarado-Ramy-9\" rel=\"external_link\">[9]<\/a><\/sup> There is a study that indicated there were actually four times more injuries with safety scalpels than reusable scalpels.<sup id=\"rdp-ebb-cite_ref-EPInet2005_10-0\" class=\"reference\"><a href=\"#cite_note-EPInet2005-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"A complete citation is needed (July 2016)\">full citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Blade_removers\">Blade removers<\/span><\/h3>\n<p>There are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than a safety scalpel.<sup id=\"rdp-ebb-cite_ref-Fuentes2008_11-0\" class=\"reference\"><a href=\"#cite_note-Fuentes2008-11\" rel=\"external_link\">[11]<\/a><\/sup> Companies like offers a single-handed scalpel blade remover that complies with regulatory requirements such as US <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_Safety_and_Health_Administration\" title=\"Occupational Safety and Health Administration\" rel=\"external_link\" target=\"_blank\">Occupational Safety and Health Administration<\/a> Standards.<sup id=\"rdp-ebb-cite_ref-OSHA2005_12-0\" class=\"reference\"><a href=\"#cite_note-OSHA2005-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Safety\">Safety<\/span><\/h3>\n<p>The usage of both safety scalpels and a single-handed blade remover, combined with a hands-free passing technique, are potentially effective in reducing scalpel blade injuries.<sup id=\"rdp-ebb-cite_ref-Fuentes2008_11-1\" class=\"reference\"><a href=\"#cite_note-Fuentes2008-11\" rel=\"external_link\">[11]<\/a><\/sup> It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser_scalpel\" class=\"mw-redirect\" title=\"Laser scalpel\" rel=\"external_link\" target=\"_blank\">Laser scalpel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Medical device<\/a><\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Lancet\" title=\"The Lancet\" rel=\"external_link\" target=\"_blank\">The Lancet<\/a><\/i><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-THIJ_Ochsner-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-THIJ_Ochsner_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ochsner, J (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">\"Surgical knife\"<\/a>. <i>Texas Heart Institute Journal<\/i>. <b>36<\/b> (5): 441\u2013443. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">2763477<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19876423\" target=\"_blank\">19876423<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Texas+Heart+Institute+Journal&rft.atitle=Surgical+knife&rft.volume=36&rft.issue=5&rft.pages=441-443&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rft_id=info%3Apmid%2F19876423&rft.aulast=Ochsner&rft.aufirst=J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Jo Marchant. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.newscientist.com\/article\/mg20727750-200-scalpels-and-skulls-point-to-bronze-age-brain-surgery\/\" target=\"_blank\">\"Scalpels and skulls point to Bronze Age brain surgery\"<\/a>. <i>New Scientist<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=New+Scientist&rft.atitle=Scalpels+and+skulls+point+to+Bronze+Age+brain+surgery&rft.au=Jo+Marchant&rft_id=https%3A%2F%2Fwww.newscientist.com%2Farticle%2Fmg20727750-200-scalpels-and-skulls-point-to-bronze-age-brain-surgery%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hurriyetdailynews.com\/default.aspx?pageid=438&n=0717104921378-2010-07-19\" target=\"_blank\">\"ARTS-CULTURE \u2013 Excavations restarting at \u0130kiztepe in northern Turkey\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ARTS-CULTURE+%E2%80%93+Excavations+restarting+at+%C4%B0kiztepe+in+northern+Turkey&rft_id=http%3A%2F%2Fwww.hurriyetdailynews.com%2Fdefault.aspx%3Fpageid%3D438%26n%3D0717104921378-2010-07-19&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ochsner J (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">\"Surgical Knife\"<\/a>. <i>Tex Heart Inst J<\/i>. <b>36<\/b> (5): 441\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">2763477<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19876423\" target=\"_blank\">19876423<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tex+Heart+Inst+J&rft.atitle=Surgical+Knife&rft.volume=36&rft.issue=5&rft.pages=441-3&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rft_id=info%3Apmid%2F19876423&rft.au=Ochsner+J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.telegraph.co.uk\/news\/worldnews\/1572030\/Roman-ruins-cast-new-light-on-a-trip-to-doctor.html\" target=\"_blank\">\"Roman ruins cast new light on a trip to doctor\"<\/a>. <i>Telegraph.co.uk<\/i>. December 9, 2007.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Telegraph.co.uk&rft.atitle=Roman+ruins+cast+new+light+on+a+trip+to+doctor&rft.date=2007-12-09&rft_id=https%3A%2F%2Fwww.telegraph.co.uk%2Fnews%2Fworldnews%2F1572030%2FRoman-ruins-cast-new-light-on-a-trip-to-doctor.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Perry2003-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Perry2003_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Perry J, Parker G, Jagger J (2003). \"EPINet Report: 2001 Percutaneous Injury Rates\". <i>Advances in Exposure Prevention<\/i>. <b>6<\/b> (3): 32\u201336.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Exposure+Prevention&rft.atitle=EPINet+Report%3A+2001+Percutaneous+Injury+Rates&rft.volume=6&rft.issue=3&rft.pages=32-36&rft.date=2003&rft.aulast=Perry&rft.aufirst=J&rft.au=Parker%2C+G&rft.au=Jagger%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CDC-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CDC_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/SharpsSafety\/workbook.html\" target=\"_blank\">\"Sharps Injury Prevention Workbook\"<\/a>. Cdc.gov (Centre for Disease Control and Prevention).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Sharps+Injury+Prevention+Workbook&rft.pub=Cdc.gov+%28Centre+for+Disease+Control+and+Prevention%29&rft_id=https%3A%2F%2Fwww.cdc.gov%2FSharpsSafety%2Fworkbook.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Sinnott2007-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Sinnott2007_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sinnott M.; Wall D. (2007). \"<span class=\"cs1-kern-left\">'<\/span>SCALPEL SAFETY': How safe (or dangerous) are safety scalpels?\". <i>International Journal of Surgery<\/i>. <b>6<\/b> (2): 176\u2013177. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ijsu.2007.01.010\" target=\"_blank\">10.1016\/j.ijsu.2007.01.010<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Surgery&rft.atitle=%27SCALPEL+SAFETY%27%3A+How+safe+%28or+dangerous%29+are+safety+scalpels%3F&rft.volume=6&rft.issue=2&rft.pages=176-177&rft.date=2007&rft_id=info%3Adoi%2F10.1016%2Fj.ijsu.2007.01.010&rft.au=Sinnott+M.&rft.au=Wall+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Alvarado-Ramy-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Alvarado-Ramy_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alvarado-Ramy F, Beltrami EM, Short LJ, et al. (2003). \"A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicentre study, 1993\u20131995\". <i>Infect Control Hosp Epidemiol<\/i>. <b>24<\/b> (2): 97\u2013104.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Infect+Control+Hosp+Epidemiol&rft.atitle=A+comprehensive+approach+to+percutaneous+injury+prevention+during+phlebotomy%3A+results+of+a+multicentre+study%2C+1993%E2%80%931995&rft.volume=24&rft.issue=2&rft.pages=97-104&rft.date=2003&rft.aulast=Alvarado-Ramy&rft.aufirst=F&rft.au=Beltrami%2C+EM&rft.au=Short%2C+LJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-EPInet2005-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-EPInet2005_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Needlestick and Sharp-Object Injury Report. US EPINet Network\". <i>Advances in Exposure Prevention<\/i>. <b>7<\/b> (4): 44\u201345. 2005.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Exposure+Prevention&rft.atitle=Needlestick+and+Sharp-Object+Injury+Report.+US+EPINet+Network&rft.volume=7&rft.issue=4&rft.pages=44-45&rft.date=2005&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Fuentes2008-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Fuentes2008_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fuentes2008_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Fuentes, H., et al. (2008). \"Scalpel Safety\": Modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries.\" The International Journal of Risk & Safety in Medicine 20(1\u20132):83\u201389.<\/span>\n<\/li>\n<li id=\"cite_note-OSHA2005-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-OSHA2005_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.osha.gov\/pls\/oshaweb\/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25339\" target=\"_blank\">\"OSHA Standard Interpretations \u2013 Use of passing trays and single-handed scalpel blade remover in a surgical setting\"<\/a>. Osha.gov. December 22, 2005.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=OSHA+Standard+Interpretations+%E2%80%93+Use+of+passing+trays+and+single-handed+scalpel+blade+remover+in+a+surgical+setting&rft.pub=Osha.gov&rft.date=2005-12-22&rft_id=https%3A%2F%2Fwww.osha.gov%2Fpls%2Foshaweb%2Fowadisp.show_document%3Fp_table%3DINTERPRETATIONS%26p_id%3D25339&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181207053247\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.552 seconds\nReal time usage: 0.757 seconds\nPreprocessor visited node count: 1908\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 93927\/2097152 bytes\nTemplate argument size: 3512\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 29774\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.240\/10.000 seconds\nLua memory usage: 5.71 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 535.825 1 -total\n<\/p>\n<pre>30.42% 162.975 1 Template:Reflist\n21.04% 112.732 6 Template:Cite_journal\n13.31% 71.310 1 Template:Commons_category\n 9.13% 48.933 5 Template:Navbox\n 8.79% 47.089 1 Template:Refimprove\n 8.38% 44.913 4 Template:Fix\n 7.02% 37.639 1 Template:Ambox\n 6.79% 36.404 1 Template:Other_uses\n 6.40% 34.269 1 Template:Infobox_Tool\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:263748-1!canonical and timestamp 20181207053246 and revision id 861590271\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214654\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.158 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.813 1 - wikipedia:Scalpel\n100.00% 149.813 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8557-0!*!*!*!*!*!* and timestamp 20181217214654 and revision id 24985\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Scalpel\">https:\/\/www.limswiki.org\/index.php\/Scalpel<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","739645b065bcad0f5a9e9e65c6d95099_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Various_scalpels.png\/350px-Various_scalpels.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Scalpel_handle_3.jpg\/440px-Scalpel_handle_3.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Disposable_scalpels-small_and_large.jpg\/440px-Disposable_scalpels-small_and_large.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fd\/Scalpel11.jpg\/240px-Scalpel11.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Scalpel12.jpg\/240px-Scalpel12.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Surgical_Blade.jpg\/240px-Surgical_Blade.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0c\/Scalpel20.jpg\/240px-Scalpel20.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Scalpel21.jpg\/240px-Scalpel21.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Scalpel23.jpg\/240px-Scalpel23.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Scalpel26.jpg\/240px-Scalpel26.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1d\/ScalpelGrip_Palmar-Plain.svg\/300px-ScalpelGrip_Palmar-Plain.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/ScalpelGrip_Pencil-Plain.svg\/300px-ScalpelGrip_Pencil-Plain.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Exacto_knife.jpg\/380px-Exacto_knife.jpg"],"739645b065bcad0f5a9e9e65c6d95099_timestamp":1545083214,"f1eaeb307bd9f4ff0eb6ba6223d56270_type":"article","f1eaeb307bd9f4ff0eb6ba6223d56270_title":"Retractor (medical)","f1eaeb307bd9f4ff0eb6ba6223d56270_url":"https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)","f1eaeb307bd9f4ff0eb6ba6223d56270_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRetractor (medical)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Surgical retractors\nA retractor is a surgical instrument used to separate the edges of a surgical incision or wound, or to hold back underlying organs and tissues so that body parts under the incision may be accessed. The general term retractor usually describes a simple handheld steel tool possessing a curved, hooked, or angled blade and fitted with a comfortable handle, that when in place maintains the desired position of a given region of tissue. These simple retractors may be handheld, clamped in place, or suspended at the end of a robotic arm. Retractors can also be self-retaining and not need to be held once inserted by having two or more opposing blades or hooks which are separated via spring, ratchet, worm gear or other method. The term retractor is also used to describe distinct, hand-cranked devices such as rib spreaders (also known as thoracic retractors, or distractors) with which surgeons may forcefully drive tissues apart to obtain exposure. For specialized situations such as spinal surgery, retractors have been fitted both with suction and with fiberoptic lights to keep a surgical wound dry and illuminated.\n\nContents \n\n1 History \n2 Current \n3 Gallery \n4 References \n\n\nHistory \nSurgical retractors probably originate with very basic tools used in the Stone Age.[1] Branches or antlers of various shapes were used to dig and extract food from the ground. As the use of tools evolved, a variety of instruments came about to substitute for the use of hooked or grasping fingers in the butchering of meat or dissection of bodies. The use of metals in tool making was of great importance. A variety of Roman metal instruments of the hook and retractor family have been found by archeologists. These instruments would generally be called hooks if the end was as narrow as the handle of the instrument. If the end was broad, it would be called a retractor. Also arising from this group of tools were other related tools for displacing (elevators and spatulas) and scooping (spoons and curettes).\nIn 4th century CE, Indian physician Susruta used surgical tools such as retractors. In a description of the procedure of tonsillectomy from the 7th century CE, Paul of Aegina documents the use of a tongue spatula to keep the tongue out of the way while a form of tonsil hook is used to bring the tonsil forward for excision. In 1000 CE Abu al-Qasim al-Zahrawi, also known as Albucasis or Abulcasis, described a variety of surgical instruments including retractors in his famous text Al-Tasrif.[citation needed ] Vesalius described a variety of hooks and retractors in the 16th century.[citation needed ] Jan Mikulicz-Radecki's invention of a hinged rib spreading retractor in 1904 prompted a flurry of development of retractors in the early 20th century, culminating in 1936 in our modern device based on the design of Enrique Finochietto.[2]\n\nCurrent \nThe following is an incomplete list of surgical retractors in use:[3]\n\n\nHAND HELD RETRACTORS\n\nHohmann Retractor\nLahey Retractor\nSenn Retractor\nBlair (Rollet) Retractor\nRigid Rake\nFlexible Rake\nRagnell Retractor\nLinde-Ragnell Retractor\nDavis Retractor\nVolkman Retractor\nKocher Retractor\nFarabeuf Retractor\nMathieu Retractor\nJackson Tracheal Hook\nCrile Retractor\nMeyerding Finger Retractor\nLittle Retractor\nLove Nerve Retractor\nGreen Retractor\nGoelet Retractor\nCushing Vein Retractor\nLangenbeck Retractor\nRichardson Retractor\nRichardson-Eastmann Retractor\nKelly Retractor\nDeaver Retractor\nDoyen Retractor\nParker Retractor\nParker-Mott Retractor\nRoux Retractor\nMayo-Collins Retractor\nU.S. Army Retractor\nRibbon Retractor\nSELF RETAINING RETRACTORS\n\nRultract Skyhook Retractor System\nAlm Retractor\nLone star retractor\nGelpi Retractor\nGutow Retractor\nWeitlaner Retractor\nBeckman-Weitlaner Retractor\nBeckman-Eaton Retractor\nBeckman Retractor\nAdson Retractor\nBalfour Retractor\nFinochietto Retractor or Rib Spreader\n\nGallery \n\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nDeaver retractor\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nArmy-Navy Retractor\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAmputation retractor\n\n\t\t\t\n\t\t\n\nReferences \n\n\n^ Kirkup, John (2006-05-15). The Evolution of Surgical Instruments \u2013 An Illustrated History from Ancient Times to the Twentieth Century. Norman Publishing. ISBN 978-0-930405-86-1. \n\n^ Bonfils-Roberts, E (May 1972). \"The Rib Spreader: A Chapter in the History of Thoracic Surgery\" (PDF) . Chest. 61 (5): 469\u2013474. doi:10.1378\/chest.61.5.469. PMID 4558402. Archived from the original (PDF) on 2008-12-17. Retrieved 2008-04-22 . \n\n^ \"General Instrument Sourcebook \u2013 KMedic\" (PDF) . Archived from the original (pdf) on November 12, 2006. Retrieved 2008-04-22 . \n\n\n\nFamous Canadian Physicians: Dr. Norman Bethune at Library and Archives Canada\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)\">https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:52.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 480 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","f1eaeb307bd9f4ff0eb6ba6223d56270_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Retractor_medical skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Retractor (medical)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor_Orem_2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Surgical_retractor_Orem_2.jpg\/220px-Surgical_retractor_Orem_2.jpg\" width=\"220\" height=\"222\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor_Orem_2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Surgical retractors<\/div><\/div><\/div>\n<p>A <b>retractor<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instrument<\/a> used to separate the edges of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_incision\" title=\"Surgical incision\" rel=\"external_link\" target=\"_blank\">surgical incision<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound\" title=\"Wound\" rel=\"external_link\" target=\"_blank\">wound<\/a>, or to hold back underlying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_(biology)\" class=\"mw-redirect\" title=\"Organ (biology)\" rel=\"external_link\" target=\"_blank\">organs<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">tissues<\/a> so that body parts under the incision may be accessed. The general term <i>retractor<\/i> usually describes a simple handheld steel tool possessing a curved, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hook\" title=\"Hook\" rel=\"external_link\" target=\"_blank\">hooked<\/a>, or angled blade and fitted with a comfortable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Handle_(grip)\" class=\"mw-redirect\" title=\"Handle (grip)\" rel=\"external_link\" target=\"_blank\">handle<\/a>, that when in place maintains the desired position of a given region of tissue. These simple retractors may be handheld, clamped in place, or suspended at the end of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_arm\" title=\"Robotic arm\" rel=\"external_link\" target=\"_blank\">robotic arm<\/a>. Retractors can also be self-retaining and not need to be held once inserted by having two or more opposing blades or hooks which are separated via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spring_(device)\" title=\"Spring (device)\" rel=\"external_link\" target=\"_blank\">spring<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ratchet_(device)\" title=\"Ratchet (device)\" rel=\"external_link\" target=\"_blank\">ratchet<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Worm_gear\" class=\"mw-redirect\" title=\"Worm gear\" rel=\"external_link\" target=\"_blank\">worm gear<\/a> or other method. The term <i>retractor<\/i> is also used to describe distinct, hand-cranked devices such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rib_spreader\" title=\"Rib spreader\" rel=\"external_link\" target=\"_blank\">rib spreaders<\/a> (also known as thoracic retractors, or distractors) with which surgeons may forcefully drive tissues apart to obtain exposure. For specialized situations such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_surgery\" class=\"mw-redirect\" title=\"Spinal surgery\" rel=\"external_link\" target=\"_blank\">spinal surgery<\/a>, retractors have been fitted both with suction and with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberoptic\" class=\"mw-redirect\" title=\"Fiberoptic\" rel=\"external_link\" target=\"_blank\">fiberoptic<\/a> lights to keep a surgical wound dry and illuminated.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Surgical retractors probably originate with very basic tools used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stone_Age\" title=\"Stone Age\" rel=\"external_link\" target=\"_blank\">Stone Age<\/a>.<sup id=\"rdp-ebb-cite_ref-ESI_1-0\" class=\"reference\"><a href=\"#cite_note-ESI-1\" rel=\"external_link\">[1]<\/a><\/sup> Branches or antlers of various shapes were used to dig and extract food from the ground. As the use of tools evolved, a variety of instruments came about to substitute for the use of hooked or grasping fingers in the butchering of meat or dissection of bodies. The use of metals in tool making was of great importance. A variety of Roman metal instruments of the hook and retractor family have been found by archeologists. These instruments would generally be called hooks if the end was as narrow as the handle of the instrument. If the end was broad, it would be called a retractor. Also arising from this group of tools were other related tools for displacing (elevators and spatulas) and scooping (spoons and curettes).\n<\/p><p>In 4th century CE, Indian physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Susruta\" class=\"mw-redirect\" title=\"Susruta\" rel=\"external_link\" target=\"_blank\">Susruta<\/a> used surgical tools such as retractors. In a description of the procedure of tonsillectomy from the 7th century CE, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_of_Aegina\" title=\"Paul of Aegina\" rel=\"external_link\" target=\"_blank\">Paul of Aegina<\/a> documents the use of a tongue spatula to keep the tongue out of the way while a form of tonsil hook is used to bring the tonsil forward for excision. In 1000 CE <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abu_al-Qasim_al-Zahrawi\" class=\"mw-redirect\" title=\"Abu al-Qasim al-Zahrawi\" rel=\"external_link\" target=\"_blank\">Abu al-Qasim al-Zahrawi<\/a>, also known as Albucasis or Abulcasis, described a variety of surgical instruments including retractors in his famous text <a href=\"https:\/\/en.wikipedia.org\/wiki\/Al-Tasrif\" title=\"Al-Tasrif\" rel=\"external_link\" target=\"_blank\">Al-Tasrif<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vesalius\" class=\"mw-redirect\" title=\"Vesalius\" rel=\"external_link\" target=\"_blank\">Vesalius<\/a> described a variety of hooks and retractors in the 16th century.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> Jan Mikulicz-Radecki's invention of a hinged rib spreading retractor in 1904 prompted a flurry of development of retractors in the early 20th century, culminating in 1936 in our modern device based on the design of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enrique_Finochietto\" title=\"Enrique Finochietto\" rel=\"external_link\" target=\"_blank\">Enrique Finochietto<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Current\">Current<\/span><\/h2>\n<p>The following is an incomplete list of surgical retractors in use:<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<p>HAND HELD RETRACTORS\n<\/p>\n<ul><li>Hohmann Retractor<\/li>\n<li>Lahey Retractor<\/li>\n<li>Senn Retractor<\/li>\n<li>Blair (Rollet) Retractor<\/li>\n<li>Rigid Rake<\/li>\n<li>Flexible Rake<\/li>\n<li>Ragnell Retractor<\/li>\n<li>Linde-Ragnell Retractor<\/li>\n<li>Davis Retractor<\/li>\n<li>Volkman Retractor<\/li>\n<li>Kocher Retractor<\/li>\n<li>Farabeuf Retractor<\/li>\n<li>Mathieu Retractor<\/li>\n<li>Jackson Tracheal Hook<\/li>\n<li>Crile Retractor<\/li>\n<li>Meyerding Finger Retractor<\/li>\n<li>Little Retractor<\/li>\n<li>Love Nerve Retractor<\/li>\n<li>Green Retractor<\/li>\n<li>Goelet Retractor<\/li>\n<li>Cushing Vein Retractor<\/li>\n<li>Langenbeck Retractor<\/li>\n<li>Richardson Retractor<\/li>\n<li>Richardson-Eastmann Retractor<\/li>\n<li>Kelly Retractor<\/li>\n<li>Deaver Retractor<\/li>\n<li>Doyen Retractor<\/li>\n<li>Parker Retractor<\/li>\n<li>Parker-Mott Retractor<\/li>\n<li>Roux Retractor<\/li>\n<li>Mayo-Collins Retractor<\/li>\n<li>U.S. Army Retractor<\/li>\n<li>Ribbon Retractor<\/li><\/ul>\n<p>SELF RETAINING RETRACTORS\n<\/p>\n<ul><li>Rultract Skyhook Retractor System<\/li>\n<li>Alm Retractor<\/li>\n<li>Lone star retractor<\/li>\n<li>Gelpi Retractor<\/li>\n<li>Gutow Retractor<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Franz_Weitlaner\" title=\"Franz Weitlaner\" rel=\"external_link\" target=\"_blank\">Weitlaner<\/a> Retractor<\/li>\n<li>Beckman-Weitlaner Retractor<\/li>\n<li>Beckman-Eaton Retractor<\/li>\n<li>Beckman Retractor<\/li>\n<li>Adson Retractor<\/li>\n<li>Balfour Retractor<\/li>\n<li>Finochietto Retractor or Rib Spreader<\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Gallery\">Gallery<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:35px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Surgical retractor.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a9\/Surgical_retractor.jpg\/120px-Surgical_retractor.jpg\" width=\"120\" height=\"80\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Deaver_retractor_01.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Deaver_retractor_01.JPG\/120px-Deaver_retractor_01.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Deaver retractor\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor_Orem.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d1\/Surgical_retractor_Orem.jpg\/120px-Surgical_retractor_Orem.jpg\" width=\"120\" height=\"68\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Army-Navy Retractor\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:39px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Amputation_retractor.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Amputation_retractor.svg\/120px-Amputation_retractor.svg.png\" width=\"120\" height=\"72\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Amputation retractor\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-ESI-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ESI_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kirkup, John (2006-05-15). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=eg_SpXBf4eIC&pg=PA279&lpg=PA279&dq=history+retractor\" target=\"_blank\"><i>The Evolution of Surgical Instruments \u2013 An Illustrated History from Ancient Times to the Twentieth Century<\/i><\/a>. Norman Publishing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-930405-86-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Evolution+of+Surgical+Instruments+%E2%80%93+An+Illustrated+History+from+Ancient+Times+to+the+Twentieth+Century&rft.pub=Norman+Publishing&rft.date=2006-05-15&rft.isbn=978-0-930405-86-1&rft.aulast=Kirkup&rft.aufirst=John&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Deg_SpXBf4eIC%26pg%3DPA279%26lpg%3DPA279%26dq%3Dhistory%2Bretractor&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetractor+%28medical%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bonfils-Roberts, E (May 1972). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081217025255\/http:\/\/www.chestjournal.org\/cgi\/reprint\/61\/5\/469.pdf\" target=\"_blank\">\"The Rib Spreader: A Chapter in the History of Thoracic Surgery\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Chest<\/i>. <b>61<\/b> (5): 469\u2013474. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1378%2Fchest.61.5.469\" target=\"_blank\">10.1378\/chest.61.5.469<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4558402\" target=\"_blank\">4558402<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chestjournal.org\/cgi\/reprint\/61\/5\/469.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2008-12-17<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-04-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chest&rft.atitle=The+Rib+Spreader%3A+A+Chapter+in+the+History+of+Thoracic+Surgery&rft.volume=61&rft.issue=5&rft.pages=469-474&rft.date=1972-05&rft_id=info%3Adoi%2F10.1378%2Fchest.61.5.469&rft_id=info%3Apmid%2F4558402&rft.aulast=Bonfils-Roberts&rft.aufirst=E&rft_id=http%3A%2F%2Fwww.chestjournal.org%2Fcgi%2Freprint%2F61%2F5%2F469.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetractor+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061112093646\/http:\/\/www.kmedicoem.com\/pdf\/GENERALS.PDF\" target=\"_blank\">\"General Instrument Sourcebook \u2013 KMedic\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kmedicoem.com\/pdf\/GENERALS.PDF\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(pdf)<\/span> on November 12, 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-04-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=General+Instrument+Sourcebook+%E2%80%93+KMedic&rft_id=http%3A%2F%2Fwww.kmedicoem.com%2Fpdf%2FGENERALS.PDF&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetractor+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<div class=\"refbegin\" style=\"\">\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.collectionscanada.ca\/physicians\/002032-210-e.html\" target=\"_blank\">Famous Canadian Physicians: Dr. Norman Bethune<\/a> at Library and Archives Canada<\/li><\/ul>\n<\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1247\nCached time: 20181128010333\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.216 seconds\nReal time usage: 0.300 seconds\nPreprocessor visited node count: 708\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 35128\/2097152 bytes\nTemplate argument size: 1086\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12441\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.107\/10.000 seconds\nLua memory usage: 2.47 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 253.901 1 -total\n<\/p>\n<pre>43.81% 111.223 1 Template:Reflist\n32.06% 81.404 2 Template:Citation_needed\n24.94% 63.311 2 Template:Fix\n24.83% 63.053 1 Template:Cite_book\n15.35% 38.972 4 Template:Category_handler\n11.82% 30.016 1 Template:Cite_journal\n 7.71% 19.573 3 Template:Navbox\n 7.68% 19.506 2 Template:Delink\n 7.28% 18.484 1 Template:Surgical_instruments\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2612628-1!canonical and timestamp 20181128010333 and revision id 836596222\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Retractor_%28medical%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214654\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.032 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 166.288 1 - wikipedia:Retractor_(medical)\n100.00% 166.288 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8556-0!*!*!*!*!*!* and timestamp 20181217214654 and revision id 24984\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)\">https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","f1eaeb307bd9f4ff0eb6ba6223d56270_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Surgical_retractor_Orem_2.jpg\/440px-Surgical_retractor_Orem_2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a9\/Surgical_retractor.jpg\/240px-Surgical_retractor.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Deaver_retractor_01.JPG\/240px-Deaver_retractor_01.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d1\/Surgical_retractor_Orem.jpg\/240px-Surgical_retractor_Orem.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Amputation_retractor.svg\/240px-Amputation_retractor.svg.png"],"f1eaeb307bd9f4ff0eb6ba6223d56270_timestamp":1545083214,"d3396438e09f98a8a1f26e591d7a278b_type":"article","d3396438e09f98a8a1f26e591d7a278b_title":"Forceps","d3396438e09f98a8a1f26e591d7a278b_url":"https:\/\/www.limswiki.org\/index.php\/Forceps","d3396438e09f98a8a1f26e591d7a278b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tForceps\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA handheld, hinged instrument used for grasping and holding objects\n Plastic forceps are intended to be disposable.\nForceps (plural forceps[1][2] or considered a plural noun without a singular, often a pair of forceps;[3][4] the Latin plural forcipes is no longer recorded in most dictionaries)[1][2][3][4] are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term \"forceps\" is used almost exclusively within the medical field. Outside medicine, people usually refer to forceps as tweezers, tongs, pliers, clips or clamps.\nMechanically, forceps employ the principle of the lever to grasp and apply pressure.\nDepending on their function, basic surgical forceps can be categorized into the following groups:\n\nNon-disposable forceps. They should withstand various kinds of physical and chemical effects of body fluids, secretions, cleaning agents, and sterilization methods.\nDisposable forceps. They are usually made of lower-quality materials or plastics which are disposed after use.\nSurgical forceps are commonly made of high-grade carbon steel, which ensures they can withstand repeated sterilization in high-temperature autoclaves. Some are made of other high-quality stainless steel, chromium and vanadium alloys to ensure durability of edges and restlessness. Lower-quality steel is used in forceps made for other uses. Some disposable forceps are made of plastic. The invention of surgical forceps is attributed to Stephen Hales.[5]\nThere are two basic types of forceps: non-locking (often called \"thumb forceps\" or \"pick-ups\") and locking, though these two types come in dozens of specialized forms for various uses. Non-locking forceps also come in two basic forms: hinged at one end, away from the grasping end (colloquially such forceps are called tweezers) and hinged in the middle, rather like scissors. Locking forceps are almost always hinged in the middle, though some forms place the hinge very close to the grasping end. Locking forceps use various means to lock the grasping surfaces in a closed position to facilitate manipulation or to independently clamp, grasp or hold an object.\n\nContents \n\n1 Thumb forceps \n2 Locking forceps \n\n2.1 Kelly forceps \n2.2 Other medical forceps \n\n\n3 See also \n4 References \n\n\nThumb forceps \n Blunt-nosed thumb forceps with serrated tips for increased grip\nSee also: Tweezers\nThumb forceps are commonly held between the thumb and two or three fingers of one hand, with the top end resting on the first dorsal interosseous muscle at the base of the thumb and index finger. Spring tension at one end holds the grasping ends apart until pressure is applied. This allows one to quickly and easily grasp small objects or tissue to move and release it or to grasp and hold tissue with easily variable pressure. Thumb forceps are used to hold tissue in place when applying sutures, to gently move tissues out of the way during exploratory surgery and to move dressings or draping without using the hands or fingers.\n\n Adson tissue forceps. Note the 1\u00d72 \"mouse's teeth\" on the lower tip.\nThumb forceps can have smooth tips, cross-hatched tips or serrated tips (often called \"mouse's teeth\"). Common arrangements of teeth are 1\u00d72 (two teeth on one side meshing with a single tooth on the other), 7\u00d77 and 9\u00d79. Serrated forceps are used on tissue; counter-intuitively, teeth will damage tissue less than a smooth surface because one can grasp with less overall pressure. Smooth or cross-hatched forceps are used to move dressings, remove sutures and similar tasks.\n\nLocking forceps \nLocking forceps, sometimes called clamps, are used to grasp and hold objects or tissue. When they are used to compress an artery to forestall bleeding, they are called hemostats. Another form of locking forceps is the needle holder, used to guide a suturing needle through tissue. Many locking forceps use finger loops to facilitate handling (see illustration, below, of Kelly forceps). The finger loops are usually grasped by the thumb and middle or ring fingers, while the index finger helps guide the instrument.\nThe most common locking mechanism is a series of interlocking teeth located near the finger loops. As the forceps are closed, the teeth engage and keep the instrument's grasping surfaces from separating. A simple shift of the fingers is all that is needed to disengage the teeth and allow the grasping ends to move apart. Forceps are also used for surgery.\n\nKelly forceps \n Kelly forceps, shown closed and open\nKelly forceps are a type of hemostat usually made of stainless steel. They resemble a pair of scissors with the blade replaced by a blunted grip. They also feature a locking mechanism to allow them to act as clamps.\nKelly forceps may be floor-grade (regular use) and as such not used for surgery. They may also be sterilized and used in operations, in both human and veterinary medicine. They may be either curved or straight. In surgery, they may be used for occluding blood vessels, manipulating tissues, or for assorted other purposes.\nThey are named for Howard Atwood Kelly, M.D., first professor of obstetrics and gynecology at the Johns Hopkins School of Medicine.\nThe \"mosquito\" variant of the tool is more delicate and has smaller, finer tips. Other varieties with similar, if more specialized, uses are Allis clamps, Babcocks, Kochers, Carmalts, and tonsils; all but the last bear the names of the surgeons who designed them.\n\nOther medical forceps \nOther types of forceps include:\n\n Magill forceps, which are angled forceps used to guide a tracheal tube into the larynx or a nasogastric tube into the esophagus under direct vision.[6] They are also used to remove foreign bodies.[6]\nAlligator forceps\nAnesthesia forceps\nArtery forceps\nAtraumatic forceps\nBiopsy forceps\nBone-cutting forceps\nBone-reduction forceps\nBone-holding forceps\nBulldogs forceps\nCatheter forceps\nCilia forceps\nCurettes forceps\nCushing forceps\nDebakey forceps\nDermal forceps & nippers\nDressing forceps\nEar forceps\nEye forceps\nGallbladder forceps\nGerald forceps\nHemostatic forceps\nHysterectomy forceps\nIntestinal forceps\nMicrosurgery forceps\nNasal forceps\nObstetrical forceps\nPostmortem forceps\nSplinter forceps\nSponge forceps\nSpreading forceps\nSterilizer forceps\nSuture sundries forceps\nTenaculum forceps\nThoracic forceps\nThoracic surgical forceps\nThumb forceps\nTissue forceps\nTongue forceps\nTooth extracting forceps\nTubing forceps\nUterine forceps\nVulsellum forceps\nWire cutting forceps\nSee also \n\n\n\nWikimedia Commons has media related to Forceps.\nReferences \n\n\n^ a b Company, Houghton Mifflin Harcourt Publishing. \"The American Heritage Dictionary entry: forceps\". www.ahdictionary.com. Retrieved 30 August 2018 . \n\n^ a b \"Definition of FORCEPS\". www.merriam-webster.com. Retrieved 30 August 2018 . \n\n^ a b \"forceps Meaning in the Cambridge English Dictionary\". dictionary.cambridge.org. Retrieved 30 August 2018 . \n\n^ a b \"forceps - Definition of forceps in English by Oxford Dictionaries\". Oxford Dictionaries - English. Retrieved 30 August 2018 . \n\n^ Scientific American inventions and discoveries By Rodney P. Carlisle. \n\n^ a b Magill forceps in Farlex medical dictionary, citing Mosby's Medical Dictionary, 8th edition. \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:51.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 491 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d3396438e09f98a8a1f26e591d7a278b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Forceps skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Forceps<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">A handheld, hinged instrument used for grasping and holding objects<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:177px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps_plastic.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Forceps_plastic.jpg\/175px-Forceps_plastic.jpg\" width=\"175\" height=\"79\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps_plastic.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Plastic forceps are intended to be disposable.<\/div><\/div><\/div>\n<p><i>Forceps<\/i> (plural <b>forceps<\/b><sup id=\"rdp-ebb-cite_ref-ahd_1-0\" class=\"reference\"><a href=\"#cite_note-ahd-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-mw_2-0\" class=\"reference\"><a href=\"#cite_note-mw-2\" rel=\"external_link\">[2]<\/a><\/sup> or considered a plural noun without a singular, often <b>a pair of forceps<\/b>;<sup id=\"rdp-ebb-cite_ref-cambridge_3-0\" class=\"reference\"><a href=\"#cite_note-cambridge-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-oxford_4-0\" class=\"reference\"><a href=\"#cite_note-oxford-4\" rel=\"external_link\">[4]<\/a><\/sup> the Latin plural <i>forcipes<\/i> is no longer recorded in most dictionaries)<sup id=\"rdp-ebb-cite_ref-ahd_1-1\" class=\"reference\"><a href=\"#cite_note-ahd-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-mw_2-1\" class=\"reference\"><a href=\"#cite_note-mw-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-cambridge_3-1\" class=\"reference\"><a href=\"#cite_note-cambridge-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-oxford_4-1\" class=\"reference\"><a href=\"#cite_note-oxford-4\" rel=\"external_link\">[4]<\/a><\/sup> are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term \"forceps\" is used almost exclusively within the medical field. Outside medicine, people usually refer to forceps as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tweezers\" title=\"Tweezers\" rel=\"external_link\" target=\"_blank\">tweezers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongs\" title=\"Tongs\" rel=\"external_link\" target=\"_blank\">tongs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pliers\" title=\"Pliers\" rel=\"external_link\" target=\"_blank\">pliers<\/a>, clips or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clamp_(tool)\" title=\"Clamp (tool)\" rel=\"external_link\" target=\"_blank\">clamps<\/a>.\n<\/p><p>Mechanically, forceps employ the principle of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lever\" title=\"Lever\" rel=\"external_link\" target=\"_blank\">lever<\/a> to grasp and apply pressure.\n<\/p><p>Depending on their function, basic surgical forceps can be categorized into the following groups:\n<\/p>\n<ol><li>Non-disposable forceps. They should withstand various kinds of physical and chemical effects of body fluids, secretions, cleaning agents, and sterilization methods.<\/li>\n<li>Disposable forceps. They are usually made of lower-quality materials or plastics which are disposed after use.<\/li><\/ol>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">Surgical<\/a> forceps are commonly made of high-grade <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_steel\" title=\"Carbon steel\" rel=\"external_link\" target=\"_blank\">carbon steel<\/a>, which ensures they can withstand repeated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> in high-temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclaves<\/a>. Some are made of other high-quality <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vanadium\" title=\"Vanadium\" rel=\"external_link\" target=\"_blank\">vanadium<\/a> alloys to ensure durability of edges and restlessness. Lower-quality steel is used in forceps made for other uses. Some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disposable\" class=\"mw-redirect\" title=\"Disposable\" rel=\"external_link\" target=\"_blank\">disposable<\/a> forceps are made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">plastic<\/a>. The invention of surgical forceps is attributed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stephen_Hales\" title=\"Stephen Hales\" rel=\"external_link\" target=\"_blank\">Stephen Hales<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>There are two basic types of forceps: non-locking (often called \"thumb forceps\" or \"pick-ups\") and locking, though these two types come in dozens of specialized forms for various uses. Non-locking forceps also come in two basic forms: hinged at one end, away from the grasping end (colloquially such forceps are called tweezers) and hinged in the middle, rather like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>. Locking forceps are almost always hinged in the middle, though some forms place the hinge very close to the grasping end. Locking forceps use various means to lock the grasping surfaces in a closed position to facilitate manipulation or to independently clamp, grasp or hold an object.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Thumb_forceps\">Thumb forceps<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a4\/Forceps.jpg\/220px-Forceps.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Blunt-nosed thumb forceps with serrated tips for increased grip<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tweezers\" title=\"Tweezers\" rel=\"external_link\" target=\"_blank\">Tweezers<\/a><\/div>\n<p>Thumb forceps are commonly held between the thumb and two or three fingers of one hand, with the top end resting on the first <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsal_interossei_of_the_hand\" title=\"Dorsal interossei of the hand\" rel=\"external_link\" target=\"_blank\">dorsal interosseous muscle<\/a> at the base of the thumb and index finger. Spring tension at one end holds the grasping ends apart until pressure is applied. This allows one to quickly and easily grasp small objects or tissue to move and release it or to grasp and hold tissue with easily variable pressure. Thumb forceps are used to hold tissue in place when applying sutures, to gently move tissues out of the way during exploratory surgery and to move dressings or draping without using the hands or fingers.\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Adson_forceps.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Adson_forceps.svg\/220px-Adson_forceps.svg.png\" width=\"220\" height=\"73\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Adson_forceps.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Adson tissue forceps. Note the 1\u00d72 \"mouse's teeth\" on the lower tip.<\/div><\/div><\/div>\n<p>Thumb forceps can have smooth tips, cross-hatched tips or serrated tips (often called \"mouse's teeth\"). Common arrangements of teeth are 1\u00d72 (two teeth on one side meshing with a single tooth on the other), 7\u00d77 and 9\u00d79. Serrated forceps are used on tissue; counter-intuitively, teeth will damage tissue less than a smooth surface because one can grasp with less overall pressure. Smooth or cross-hatched forceps are used to move dressings, remove sutures and similar tasks.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Locking_forceps\">Locking forceps<\/span><\/h2>\n<p>Locking forceps, sometimes called clamps, are used to grasp and hold objects or tissue. When they are used to compress an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> to forestall bleeding, they are called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">hemostats<\/a>. Another form of locking forceps is the needle holder, used to guide a suturing needle through tissue. Many locking forceps use finger loops to facilitate handling (see illustration, below, of Kelly forceps). The finger loops are usually grasped by the thumb and middle or ring fingers, while the index finger helps guide the instrument.\n<\/p><p>The most common locking mechanism is a series of interlocking teeth located near the finger loops. As the forceps are closed, the teeth engage and keep the instrument's grasping surfaces from separating. A simple shift of the fingers is all that is needed to disengage the teeth and allow the grasping ends to move apart. Forceps are also used for surgery.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Kelly_forceps\">Kelly forceps<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kelly_Forceps.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Kelly_Forceps.svg\/220px-Kelly_Forceps.svg.png\" width=\"220\" height=\"243\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kelly_Forceps.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Kelly forceps, shown closed and open<\/div><\/div><\/div>\n<p>Kelly forceps are a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">hemostat<\/a> usually made of stainless steel. They resemble a pair of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissor\" class=\"mw-redirect\" title=\"Scissor\" rel=\"external_link\" target=\"_blank\">scissors<\/a> with the blade replaced by a blunted grip. They also feature a locking mechanism to allow them to act as clamps.\nKelly forceps may be floor-grade (regular use) and as such not used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. They may also be sterilized and used in operations, in both human and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinary\" class=\"mw-redirect\" title=\"Veterinary\" rel=\"external_link\" target=\"_blank\">veterinary<\/a> medicine. They may be either curved or straight. In surgery, they may be used for occluding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessel\" title=\"Blood vessel\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a>, manipulating tissues, or for assorted other purposes.\nThey are named for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Howard_Atwood_Kelly\" title=\"Howard Atwood Kelly\" rel=\"external_link\" target=\"_blank\">Howard Atwood Kelly<\/a>, M.D., first professor of obstetrics and gynecology at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johns_Hopkins_School_of_Medicine\" title=\"Johns Hopkins School of Medicine\" rel=\"external_link\" target=\"_blank\">Johns Hopkins School of Medicine<\/a>.\nThe \"mosquito\" variant of the tool is more delicate and has smaller, finer tips. Other varieties with similar, if more specialized, uses are Allis clamps, Babcocks, Kochers, Carmalts, and tonsils; all but the last bear the names of the surgeons who designed them.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_medical_forceps\">Other medical forceps<\/span><\/h3>\n<p>Other types of forceps include:\n<\/p>\n<ul><li><span id=\"rdp-ebb-Magill\"><\/span><i>Magill forceps<\/i>, which are angled forceps used to guide a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheal_tube\" title=\"Tracheal tube\" rel=\"external_link\" target=\"_blank\">tracheal tube<\/a> into the larynx or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasogastric_tube\" class=\"mw-redirect\" title=\"Nasogastric tube\" rel=\"external_link\" target=\"_blank\">nasogastric tube<\/a> into the esophagus under direct vision.<sup id=\"rdp-ebb-cite_ref-magill_6-0\" class=\"reference\"><a href=\"#cite_note-magill-6\" rel=\"external_link\">[6]<\/a><\/sup> They are also used to remove <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_bodies\" class=\"mw-redirect\" title=\"Foreign bodies\" rel=\"external_link\" target=\"_blank\">foreign bodies<\/a>.<sup id=\"rdp-ebb-cite_ref-magill_6-1\" class=\"reference\"><a href=\"#cite_note-magill-6\" rel=\"external_link\">[6]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hartmann_alligator_forceps\" title=\"Hartmann alligator forceps\" rel=\"external_link\" target=\"_blank\">Alligator forceps<\/a><\/li>\n<li>Anesthesia forceps<\/li>\n<li>Artery forceps<\/li>\n<li>Atraumatic forceps<\/li>\n<li>Biopsy forceps<\/li>\n<li>Bone-cutting forceps<\/li>\n<li>Bone-reduction forceps<\/li>\n<li>Bone-holding forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bulldogs_forceps\" title=\"Bulldogs forceps\" rel=\"external_link\" target=\"_blank\">Bulldogs forceps<\/a><\/li>\n<li>Catheter forceps<\/li>\n<li>Cilia forceps<\/li>\n<li>Curettes forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvey_Williams_Cushing#Legacy\" class=\"mw-redirect\" title=\"Harvey Williams Cushing\" rel=\"external_link\" target=\"_blank\">Cushing forceps<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Debakey_forceps\" title=\"Debakey forceps\" rel=\"external_link\" target=\"_blank\">Debakey forceps<\/a><\/li>\n<li>Dermal forceps & nippers<\/li>\n<li>Dressing forceps<\/li>\n<li>Ear forceps<\/li>\n<li>Eye forceps<\/li>\n<li>Gallbladder forceps<\/li>\n<li>Gerald forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">Hemostatic forceps<\/a><\/li>\n<li>Hysterectomy forceps<\/li>\n<li>Intestinal forceps<\/li>\n<li>Microsurgery forceps<\/li>\n<li>Nasal forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps_in_childbirth\" class=\"mw-redirect\" title=\"Forceps in childbirth\" rel=\"external_link\" target=\"_blank\">Obstetrical forceps<\/a><\/li>\n<li>Postmortem forceps<\/li>\n<li>Splinter forceps<\/li>\n<li>Sponge forceps<\/li>\n<li>Spreading forceps<\/li>\n<li>Sterilizer forceps<\/li>\n<li>Suture sundries forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tenaculum\" title=\"Tenaculum\" rel=\"external_link\" target=\"_blank\">Tenaculum<\/a> forceps<\/li>\n<li>Thoracic forceps<\/li>\n<li>Thoracic surgical forceps<\/li>\n<li>Thumb forceps<\/li>\n<li>Tissue forceps<\/li>\n<li>Tongue forceps<\/li>\n<li>Tooth extracting forceps<\/li>\n<li>Tubing forceps<\/li>\n<li>Uterine forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vulsellum\" title=\"Vulsellum\" rel=\"external_link\" target=\"_blank\">Vulsellum forceps<\/a><\/li>\n<li>Wire cutting forceps<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-ahd-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ahd_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ahd_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Company, Houghton Mifflin Harcourt Publishing. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ahdictionary.com\/word\/search.html?q=forceps.\" target=\"_blank\">\"The American Heritage Dictionary entry: forceps\"<\/a>. <i>www.ahdictionary.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.ahdictionary.com&rft.atitle=The+American+Heritage+Dictionary+entry%3A+forceps.&rft.aulast=Company&rft.aufirst=Houghton+Mifflin+Harcourt+Publishing&rft_id=https%3A%2F%2Fwww.ahdictionary.com%2Fword%2Fsearch.html%3Fq%3Dforceps.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-mw-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-mw_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mw_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.merriam-webster.com\/dictionary\/forceps.\" target=\"_blank\">\"Definition of FORCEPS\"<\/a>. <i>www.merriam-webster.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.merriam-webster.com&rft.atitle=Definition+of+FORCEPS&rft_id=https%3A%2F%2Fwww.merriam-webster.com%2Fdictionary%2Fforceps.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-cambridge-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-cambridge_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-cambridge_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dictionary.cambridge.org\/dictionary\/english\/forceps?a=british.\" target=\"_blank\">\"forceps Meaning in the Cambridge English Dictionary\"<\/a>. <i>dictionary.cambridge.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=dictionary.cambridge.org&rft.atitle=forceps+Meaning+in+the+Cambridge+English+Dictionary&rft_id=http%3A%2F%2Fdictionary.cambridge.org%2Fdictionary%2Fenglish%2Fforceps%3Fa%3Dbritish.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-oxford-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-oxford_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-oxford_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.oxforddictionaries.com\/definition\/forceps.\" target=\"_blank\">\"forceps - Definition of forceps in English by Oxford Dictionaries\"<\/a>. <i>Oxford Dictionaries - English<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Oxford+Dictionaries+-+English&rft.atitle=forceps+-+Definition+of+forceps+in+English+by+Oxford+Dictionaries&rft_id=https%3A%2F%2Fen.oxforddictionaries.com%2Fdefinition%2Fforceps.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Scientific American inventions and discoveries By Rodney P. Carlisle.<\/span>\n<\/li>\n<li id=\"cite_note-magill-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-magill_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-magill_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medical-dictionary.thefreedictionary.com\/Magill+forceps\" target=\"_blank\">Magill forceps<\/a> in Farlex medical dictionary, citing Mosby's Medical Dictionary, 8th edition.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1270\nCached time: 20181213125525\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.308 seconds\nReal time usage: 0.409 seconds\nPreprocessor visited node count: 581\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 33219\/2097152 bytes\nTemplate argument size: 430\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11941\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.148\/10.000 seconds\nLua memory usage: 3.6 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 317.043 1 -total\n<\/p>\n<pre>43.28% 137.204 1 Template:Reflist\n36.22% 114.821 4 Template:Cite_web\n23.44% 74.326 1 Template:Commons_category\n13.66% 43.294 1 Template:Short_description\n12.51% 39.662 1 Template:Pagetype\n10.68% 33.866 3 Template:Navbox\n 9.61% 30.455 1 Template:Surgical_instruments\n 4.54% 14.403 1 Template:Commons\n 4.54% 14.393 1 Template:See_also\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:638969-1!canonical and timestamp 20181213125524 and revision id 873464072\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214654\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.163 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.804 1 - wikipedia:Forceps\n100.00% 156.804 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8555-0!*!*!*!*!*!* and timestamp 20181217214654 and revision id 24983\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Forceps\">https:\/\/www.limswiki.org\/index.php\/Forceps<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d3396438e09f98a8a1f26e591d7a278b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Forceps_plastic.jpg\/350px-Forceps_plastic.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a4\/Forceps.jpg\/440px-Forceps.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Adson_forceps.svg\/440px-Adson_forceps.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Kelly_Forceps.svg\/440px-Kelly_Forceps.svg.png"],"d3396438e09f98a8a1f26e591d7a278b_timestamp":1545083213,"053eab61e093aea2255f4b96741fb09f_type":"article","053eab61e093aea2255f4b96741fb09f_title":"Dermatome (instrument)","053eab61e093aea2255f4b96741fb09f_url":"https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)","053eab61e093aea2255f4b96741fb09f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDermatome (instrument)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Dermatome.\n Diagram of a dermatome\nA dermatome is a surgical instrument used to produce thin slices of skin from a donor area, in order to use them for making skin grafts. One of its main applications is for reconstituting skin areas damaged by grade 3 burns or trauma.\nDermatomes can be operated either manually or electrically. The first drum dermatomes, developed in the 1930s, were manually operated. Afterwards, dermatomes which were operated by air pressure, such as the Brown dermatome, achieved higher speed and precision. Electrical dermatomes are better for cutting out thinner and longer strips of skin with a more homogeneous thickness.\n\nContents \n\n1 Free-hand knives \n2 Types of dermatomes \n\n2.1 Knives \n2.2 Drum \n2.3 Electric \n2.4 Air \n\n\n3 See also \n4 References \n\n\nFree-hand knives \nThose are manual dermatomes and the term knife or scalpel is used to describe them. Their disadvantages are harvesting of grafts with irregular edges and grafts of variable thickness. Their operator has to be experienced in their use for optimal results.[1]\n\nTypes of dermatomes \n Side view of a drum dermatome blade (24) removing a slice of skin (38 and 40).\nThere are several types of dermatomes, usually named after their inventor.\n\nKnives \nBlair\/Brown knife.\nHumby knife, similar to the Blair knife with the addition of an adjustable roller which controls the thickness of the graft taken.[2]\nBraithwaite knife.\nWatson knife, another modified version of the Braithwaite knife.\nCobbett knife, a modified version of the Braithwaite knife.\nGoulian\/Weck knife.\nSilver knife, ideal for the harvesting of small grafts.\nDrum \nPadgett dermatome, was the first rotary drum manual dermatome to be devised.\nReese dermatome.\nElectric \nBrown dermatome, the first with powered rotation to be developed, used mostly for large skin grafts. It is electrically operated.\nCastroviejo dermatome, also electrically operated, is a precision dermatome with a small head and controllable thickness, which is most used for mucous membrane grafts.\nAir \nAir dermatome, the most commonly used dermatome used worldwide today, used mostly for large skin grafts.[3]\nSee also \nInstruments used in general surgery\nReferences \n\n\n^ David L. Brown, Gregory H. Borschel, Michigan Manual of Plastic Surgery \n\n^ Ian A. McGregor, Fundamental Techniques of Plastic Surgery and Their Surgical Applications \n\n^ \"Tiny Air Turbines Drive Surgical Instruments..\" Popular Science, September 1966, pp. 82-83. \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)\">https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 915 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","053eab61e093aea2255f4b96741fb09f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Dermatome_instrument skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Dermatome (instrument)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dermatome_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Dermatome (disambiguation)\" rel=\"external_link\" target=\"_blank\">Dermatome<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/09\/Dermatome.png\/170px-Dermatome.png\" width=\"170\" height=\"333\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Diagram of a dermatome<\/div><\/div><\/div>\n<p>A <b>dermatome<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instrument<\/a> used to produce thin slices of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> from a donor area, in order to use them for making <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin_graft\" class=\"mw-redirect\" title=\"Skin graft\" rel=\"external_link\" target=\"_blank\">skin grafts<\/a>. One of its main applications is for reconstituting skin areas damaged by grade 3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Burn_(injury)\" class=\"mw-redirect\" title=\"Burn (injury)\" rel=\"external_link\" target=\"_blank\">burns<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_trauma\" class=\"mw-redirect\" title=\"Physical trauma\" rel=\"external_link\" target=\"_blank\">trauma<\/a>.\n<\/p><p>Dermatomes can be operated either manually or electrically. The first drum dermatomes, developed in the 1930s, were manually operated. Afterwards, dermatomes which were operated by air pressure, such as the Brown dermatome, achieved higher speed and precision. Electrical dermatomes are better for cutting out thinner and longer strips of skin with a more homogeneous thickness.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Free-hand_knives\">Free-hand knives<\/span><\/h2>\n<p>Those are manual dermatomes and the term <i>knife<\/i> or <i>scalpel<\/i> is used to describe them. Their disadvantages are harvesting of grafts with irregular edges and grafts of variable thickness. Their operator has to be experienced in their use for optimal results.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_dermatomes\">Types of dermatomes<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome_usage.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Dermatome_usage.png\/200px-Dermatome_usage.png\" width=\"200\" height=\"108\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome_usage.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Side view of a drum dermatome blade (24) removing a slice of skin (38 and 40).<\/div><\/div><\/div>\n<p>There are several types of dermatomes, usually named after their inventor.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Knives\">Knives<\/span><\/h3>\n<ul><li><b>Blair\/Brown knife<\/b>.<\/li>\n<li><b>Humby knife<\/b>, similar to the Blair knife with the addition of an adjustable roller which controls the thickness of the graft taken.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li>\n<li><b>Braithwaite knife<\/b>.<\/li>\n<li><b>Watson knife<\/b>, another modified version of the Braithwaite knife.<\/li>\n<li><b>Cobbett knife<\/b>, a modified version of the Braithwaite knife.<\/li>\n<li><b>Goulian\/Weck knife<\/b>.<\/li>\n<li><b>Silver knife<\/b>, ideal for the harvesting of small grafts.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Drum\">Drum<\/span><\/h3>\n<ul><li><b>Padgett dermatome<\/b>, was the first rotary drum manual dermatome to be devised.<\/li>\n<li><b>Reese dermatome<\/b>.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Electric\">Electric<\/span><\/h3>\n<ul><li><b>Brown dermatome<\/b>, the first with powered rotation to be developed, used mostly for large skin grafts. It is electrically operated.<\/li>\n<li><b>Castroviejo dermatome<\/b>, also electrically operated, is a precision dermatome with a small head and controllable thickness, which is most used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mucous_membrane\" title=\"Mucous membrane\" rel=\"external_link\" target=\"_blank\">mucous membrane<\/a> grafts.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Air\">Air<\/span><\/h3>\n<ul><li><b>Air dermatome<\/b>, the most commonly used dermatome used worldwide today, used mostly for large skin grafts.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">David L. Brown, Gregory H. Borschel, <i>Michigan Manual of Plastic Surgery<\/i><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ian A. McGregor, <i>Fundamental Techniques of Plastic Surgery and Their Surgical Applications<\/i><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"> <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=true\">\"Tiny Air Turbines Drive Surgical Instruments..\"<\/a> <i>Popular Science<\/i>, September 1966, pp. 82-83.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181127220247\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.088 seconds\nReal time usage: 0.122 seconds\nPreprocessor visited node count: 268\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 25231\/2097152 bytes\nTemplate argument size: 86\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 1238\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.019\/10.000 seconds\nLua memory usage: 1,019 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 70.582 1 -total\n<\/p>\n<pre>41.16% 29.054 1 Template:Other_uses\n32.66% 23.054 3 Template:Navbox\n32.19% 22.720 1 Template:Surgical_instruments\n22.82% 16.108 1 Template:Reflist\n 5.33% 3.765 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1465659-1!canonical and timestamp 20181127220247 and revision id 768605767\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dermatome_%28instrument%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214653\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.158 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 152.074 1 - wikipedia:Dermatome_(instrument)\n100.00% 152.074 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8554-0!*!*!*!*!*!* and timestamp 20181217214653 and revision id 24982\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)\">https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","053eab61e093aea2255f4b96741fb09f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/0\/09\/Dermatome.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Dermatome_usage.png\/400px-Dermatome_usage.png"],"053eab61e093aea2255f4b96741fb09f_timestamp":1545083213,"5bd64ab04b9fb048ddfb3cd4ff215fac_type":"article","5bd64ab04b9fb048ddfb3cd4ff215fac_title":"Calipers","5bd64ab04b9fb048ddfb3cd4ff215fac_url":"https:\/\/www.limswiki.org\/index.php\/Calipers","5bd64ab04b9fb048ddfb3cd4ff215fac_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCalipers\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Caliper (disambiguation).\n Caliper detail view\nA caliper (British spelling also calliper, or in plurale tantum sense a pair of calipers) is a device used to measure the distance between two opposite sides of an object. Many types of calipers permit reading out a measurement on a ruled scale, a dial, or a digital display. But a caliper can be as simple as a compass with inward or outward-facing points. The tips of the caliper are adjusted to fit across the points to be measured and then the caliper is then removed and the distance read by measuring between the tips with a measuring tool, such as a ruler.\nIt is used in many fields such as mechanical engineering, metalworking, forestry, woodworking, science and medicine.\n\nContents \n\n1 Nomenclature variants \n2 History \n3 Types \n\n3.1 Inside caliper \n3.2 Outside caliper \n3.3 Divider caliper \n3.4 Oddleg caliper \n3.5 Vernier caliper \n3.6 Dial caliper \n3.7 Digital caliper \n3.8 Micrometer caliper \n\n\n4 Comparison \n5 Use \n6 Zero error \n7 See also \n8 References \n9 External links \n\n\nNomenclature variants \nA plurale tantum sense of the word \"calipers\" coexists in natural usage with the regular noun sense of \"caliper\". That is, sometimes a caliper is treated cognitively like a pair of glasses or a pair of scissors, resulting in a phrase such as \"hand me those calipers\" or \"those calipers are mine\" in reference to one unit.\nAlso existing colloquially but not in formal usage is referring to a vernier caliper as a \"vernier\" or a \"pair of verniers\". In imprecise colloquial usage, some speakers extend this even to dial calipers, although they involve no vernier scale.\nIn machine-shop usage, the term \"caliper\" is often used in contradistinction to \"micrometer\", even though outside micrometers are technically a form of caliper. In this usage, \"caliper\" implies only the form factor of the vernier or dial caliper (or its digital counterpart).\n\nHistory \nThe earliest caliper has been found in the Greek Giglio wreck near the Italian coast. The ship find dates to the 6th century BC. The wooden piece already featured a fixed and a movable jaw.[1][2] Although rare finds, caliper remained in use by the Greeks and Romans.[2][3]\nA bronze caliper, dating from 9 AD, was used for minute measurements during the Chinese Xin dynasty. The caliper had an inscription stating that it was \"made on a gui-you day at new moon of the first month of the first year of the Shijian guo period.\" The calipers included a \"slot and pin\" and \"graduated in inches and tenths of an inch.\"[4][5]\n\n Caliper with graduated bow 0\u201310 mm\nThe modern vernier caliper, reading to thousandths of an inch, was invented by American Joseph R. Brown in 1851. It was the first practical tool for exact measurements that could be sold at a price within the reach of ordinary machinists.[6]\n\nTypes \nInside caliper \n Two inside calipers\nThe inside calipers are used to measure the internal size of an object.\n\nThe upper caliper in the image (at the right) requires manual adjustment prior to fitting. Fine setting of this caliper type is performed by tapping the caliper legs lightly on a handy surface until they will almost pass over the object. A light push against the resistance of the central pivot screw then spreads the legs to the correct dimension and provides the required, consistent feel that ensures a repeatable measurement.\nThe lower caliper in the image has an adjusting screw that permits it to be carefully adjusted without removal of the tool from the workpiece. \nOutside caliper \n Three outside calipers.\nOutside calipers are used to measure the external size of an object.\nThe same observations and technique apply to this type of caliper, as for the above inside caliper. With some understanding of their limitations and usage, these instruments can provide a high degree of accuracy and repeatability. They are especially useful when measuring over very large distances; consider if the calipers are used to measure a large diameter pipe. A vernier caliper does not have the depth capacity to straddle this large diameter while at the same time reach the outermost points of the pipe's diameter. They are made from high carbon steel.\n\n\nDivider caliper \nMain article: Compass (drafting)\n A pair of dividers\nIn the metalworking field, a divider caliper, popularly called a compass, is used in the process of marking out locations. The points are sharpened so that they act as scribers, one leg can then be placed in the dimple created by a center or prick punch and the other leg pivoted so that it scribes a line on the workpiece's surface, thus forming an arc or circle.\nA divider caliper is also used to measure a distance between two points on a map. The two caliper's ends are brought to the two points whose distance is being measured. The caliper's opening is then either measured on a separate ruler and then converted to the actual distance, or it is measured directly on a scale drawn on the map. On a nautical chart the distance is often measured on the latitude scale appearing on the sides of the map: one minute of arc of latitude is approximately one nautical mile or 1852 metres.\nDividers are also used in the medical profession. An ECG (also EKG) caliper transfers distance on an electrocardiogram; in conjunction with the appropriate scale, the heart rate can be determined. A pocket caliper versions was invented by cardiologist Robert A. Mackin.[7]\n\nOddleg caliper \n Oddleg calipers\nOddleg calipers, Hermaphrodite calipers, or Oddleg jennys, as pictured on the left, are generally used to scribe a line at a set distance from the edge of a workpiece. The bent leg is used to run along the workpiece edge while the scriber makes its mark at a predetermined distance, this ensures a line parallel to the edge.\nIn the diagram at left, the uppermost caliper has a slight shoulder in the bent leg allowing it to sit on the edge more securely, the lower caliper lacks this feature but has a renewable scriber that can be adjusted for wear, as well as being replaced when excessively worn.\n\n\nVernier caliper \nMain article: Vernier scale\n Diagram of Vernier calipers. The labeled parts are Outside large jaws: used to measure external diameter or width of an objectInside small jaws: used to measure internal diameter of an objectDepth probe\/rod: used to measure depths of an object or a holeMain scale (Metric): scale marked every mmMain scale (Imperial): scale marked in inches and fractionsVernier scale (Metric) gives interpolated measurements to 0.1 mm or betterVernier scale (Imperial) gives interpolated measurements in fractions of an inchRetainer: used to block movable part to allow the easy transferring of a measurement The calipers in the diagram show a primary reading on the metric scale of about 2.475 cm (2.4 cm read from the main scale plus about 0.075 cm from the Vernier scale). Calipers often have a \"zero point error\", which is when the calipers do not read 0.000 cm when the jaws are closed. The zero point error must always be subtracted from the primary reading. Let us assume these calipers have a zero point error of 0.013 cm. This would give us a length reading of 2.462 cm. For any measurement, reporting the error on the measurement is also important. Both the primary reading and the zero point reading are bounded by plus\/minus half the length corresponding to the width of the smallest interval on the Vernier scale (0.0025 cm). These are \"absolute\" errors and absolute errors add, so the length reading is then bounded by plus\/minus the length corresponding to the full width of the smallest interval on the Vernier scale (0.005 cm). Assuming no systematics affect the measurement (the instrument works perfectly), a complete measurement would then read 2.462 cm \u00b1 0.005 cm.\nThe vernier, dial, and digital calipers give a direct reading of the distance measured with high accuracy and precision. They are functionally identical, with different ways of reading the result. These calipers comprise a calibrated scale with a fixed jaw, and another jaw, with a pointer, that slides along the scale. The distance between the jaws is then read in different ways for the three types.\nThe simplest method is to read the position of the pointer directly on the scale. When the pointer is between two markings, the user can mentally interpolate to improve the precision of the reading. This would be a simple calibrated caliper; but the addition of a vernier scale allows more accurate interpolation, and is the universal practice; this is the vernier caliper.\nVernier, dial, and digital calipers can measure internal dimensions (using the uppermost jaws in the picture at right), external dimensions using the pictured lower jaws, and in many cases depth by the use of a probe that is attached to the movable head and slides along the centre of the body. This probe is slender and can get into deep grooves that may prove difficult for other measuring tools.\nThe vernier scales may include metric measurements on the lower part of the scale and inch measurements on the upper, or vice versa, in countries that use inches. Vernier calipers commonly used in industry provide a precision to 0.01 mm (10 micrometres), or one thousandth of an inch. They are available in sizes that can measure up to 1,829 mm (72 in).[8]\n\n\nDial caliper \n Mitutoyo dial caliper\nInstead of using a vernier mechanism, which requires some practice to use, the dial caliper reads the final fraction of a millimeter or inch on a simple dial.\nIn this instrument, a small, precise rack and pinion drives a pointer on a circular dial, allowing direct reading without the need to read a vernier scale. Typically, the pointer rotates once every inch, tenth of an inch, or 1 millimeter. This measurement must be added to the coarse whole inches or centimeters read from the slide. The dial is usually arranged to be rotatable beneath the pointer, allowing for \"differential\" measurements (the measuring of the difference in size between two objects, or the setting of the dial using a master object and subsequently being able to read directly the plus-or-minus variance in size of subsequent objects relative to the master object).\nThe slide of a dial caliper can usually be locked at a setting using a small lever or screw; this allows simple go\/no-go checks of part sizes.\n\nDigital caliper \n Digital caliper\nA popular refinement replaces the analog dial with an electronic digital display that displays the reading as a numeric value. Rather than a rack and pinion, these calipers use a linear encoder. Some digital calipers can be switched between centimeters or millimeters, and inches. All provide for zeroing the display at any point along the slide, allowing the same sort of differential measurements as with the dial caliper. Digital calipers may contain a \"reading hold\" feature, allowing the reading of dimensions after use in awkward locations where the display cannot be seen.\nOrdinary 6-in\/150-mm digital calipers are made of stainless steel, have a rated accuracy of 0.001 in (0.02mm) and a resolution of 0.0005 in (0.01 mm).[9]\nThe same technology is used to make longer 8-in and 12-in calipers; the accuracy for longer measurements declines to 0.001 in (0.03 mm) for 100\u2013200 mm and 0.0015 in (0.04 mm) for 200\u2013300 mm.[10]\nIncreasingly, digital calipers offer a serial data output to allow them to be interfaced with a dedicated recorder or a personal computer. The digital interface significantly decreases the time to make and record a series of measurements, and it also improves the reliability of the records. A suitable device to convert the serial data output to common computer interfaces such as RS-232, Universal Serial Bus, or wireless can be built or purchased. With such a converter, measurements can be directly entered into a spreadsheet, a statistical process control program, or similar software.\nThe serial digital output varies among manufacturers. Common options are\n\nMitutoyo's Digimatic interface. This is the dominant name brand interface. Format is 52 bits arranged as 13 nibbles.[11][12][13]\nSylvac interface. This is the common protocol for inexpensive, non-name brand, calipers. Format is 24 bit 90 kHz synchronous.[14][15]\nStarrett[16]\nBrown & Sharpe[16]\nFederal\nTesa[16]\nAldi. Format is 7 BCD digits.[15]\nMahr (Digimatic, RS232C, Wireless FM Radio, Infrared and USB)[17]\nLike dial calipers, the slide of a digital caliper can usually be locked using a lever or thumb-screw.\nSome digital calipers contain a capacitive linear encoder. A pattern of bars is etched directly on the printed circuit board in the slider. Under the scale of the caliper another printed circuit board also contains an etched pattern of lines. The combination of these printed circuit boards forms two variable capacitors. The two capacitances are out of phase. As the slider moves the capacitance changes in a linear fashion and in a repeating pattern. The circuitry built into the slider counts the bars as the slider moves and does a linear interpolation based on the magnitudes of the capacitors to find the precise position of the slider. Other digital calipers contain an inductive linear encoder, which allows robust performance in the presence of contamination such as coolants.[18] Magnetic linear encoders are used in yet other digital calipers.\n\n\nMicrometer caliper \nMain article: Micrometer\nA caliper using a calibrated screw for measurement, rather than a slide, is called an external micrometer caliper gauge, a micrometer caliper or, more often, simply a micrometer. (Sometimes the term caliper, referring to any other type in this article, is held in contradistinction to micrometer.)\n\nComparison \nEach of the above types of calipers has its relative merits and faults.\nVernier calipers are rugged and have long lasting accuracy, are coolant proof, are not affected by magnetic fields, and are largely shock proof. They may have both centimeter and inch scales. However, vernier calipers require good eyesight or a magnifying glass to read and can be difficult to read from a distance or from awkward angles. It is relatively easy to misread the last digit. In production environments, reading vernier calipers all day long is error-prone and is annoying to the workers.\nDial calipers are comparatively easy to read, especially when seeking exact center by rocking and observing the needle movement. They can be set to 0 at any point for comparisons. They are usually fairly susceptible to shock damage. They are also very prone to getting dirt in the gears, which can cause accuracy problems.\nDigital calipers switch easily between centimeter and inch systems.They can be set to 0 easily at any point with full count in either direction, and can take measurements even if the display is completely hidden, either by using a \"hold\" key, or by zeroing the display and closing the jaws, showing the correct measurement, but negative. They can be mechanically and electronically fragile. Most also require batteries, and do not resist coolant well. They are also only moderately shockproof, and can be vulnerable to dirt.\nCalipers may read to a resolution of 0.01 mm or 0.0005 in, but accuracy may not be better than about \u00b10.02 mm or 0.001 in for 150 mm (6 in) calipers, and worse for longer ones.[19]\n\nUse \n Using the vernier caliper\nA caliper must be properly applied against the part in order to take the desired measurement. For example, when measuring the thickness of a plate a vernier caliper must be held at right angles to the piece. Some practice may be needed to measure round or irregular objects correctly.\nAccuracy of measurement when using a caliper is highly dependent on the skill of the operator. Regardless of type, a caliper's jaws must be forced into contact with the part being measured. As both part and caliper are always to some extent elastic, the amount of force used affects the indication. A consistent, firm touch is correct. Too much force results in an underindication as part and tool distort; too little force gives insufficient contact and an overindication. This is a greater problem with a caliper incorporating a wheel, which lends mechanical advantage. This is especially the case with digital calipers, calipers out of adjustment, or calipers with a poor quality beam.\nSimple calipers are uncalibrated; the measurement taken must be compared against a scale. Whether the scale is part of the caliper or not, all analog calipers\u2014verniers and dials\u2014require good eyesight in order to achieve the highest precision. Digital calipers have the advantage in this area.\nCalibrated calipers may be mishandled, leading to loss of zero. When a calipers' jaws are fully closed, it should, of course, indicate zero. If it does not, it must be recalibrated or repaired. A vernier caliper does not easily lose its calibration but a sharp impact or accidental damage to the measuring surface in the caliper jaw can be significant enough to displace zero.[20] Digital calipers have zero set buttons, for quick recalibration.\nVernier, dial and digital calipers can be used with accessories that extend their usefulness. Examples are a base that extends their usefulness as a depth gauge and a jaw attachment that allows measuring the center distance between holes. Since the 1970s a clever modification of the moveable jaw on the back side of any caliper allows for step or depth measurements in addition to external caliper measurements, in similar fashion to a universal micrometer (e.g., Starrett Mul-T-Anvil or Mitutoyo Uni-Mike).\n\nZero error \n When the jaws are closed and if the reading is 0.10 mm, the zero error is referred to as +0.10 mm. The method to use a vernier scale or caliper with zero error is to use the formula \"(actual reading) = (main scale) + (vernier scale) \u2212 (zero error)\", thus the actual reading is 19.00 + 0.54 \u2212 (0.10) = 19.44 mm. The resolution of the measurement, based on the width of the smallest sub-interval, is \u00b10.02 mm.\nThe method to use a vernier scale or caliper with zero error is to use the formula \"actual reading = main scale + vernier scale \u2212 (zero error)\". Zero error may arise due to knocks that affect the calibration at 0.00 mm when the jaws are perfectly closed or just touching each other. Positive zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a positive reading away from the actual reading of 0.00 mm. If the reading is 0.10 mm, the zero error is referred to as +0.10 mm. Negative zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a negative reading away from the actual reading of 0.00 mm. If the reading is \u22120.08 mm, the zero error is referred to as \u22120.08 mm.\n\nSee also \nDial indicator\nCruising rod\nLens clock\nReferences \n\n\n^ Mensun Bound: The Giglio wreck: a wreck of the Archaic period (c. 600 BC) off the Tuscany island of Giglio, Hellenic Institute of Marine Archaeology, Athens 1991, pp. 27 and 31 (Fig. 65) \n\n^ a b Roger B. Ulrich: Roman woodworking, Yale University Press, New Haven, Conn., 2007, ISBN 0-300-10341-7, p.52f. \n\n^ \"hand tool.\" Encyclop\u00e6dia Britannica from Encyclop\u00e6dia Britannica 2006 Ultimate Reference Suite DVD. [Accessed July 29, 2008] \n\n^ Colin A. Ronan; Joseph Needham (24 June 1994). The Shorter Science and Civilisation in China: 4. Cambridge University Press. p. 36. ISBN 978-0-521-32995-8. adjustable outside caliper gauge... self-dated at AD 9 . An abridged version. \n\n^ \"Archived copy\". Archived from the original on 2014-08-31. Retrieved 2013-11-26 . CS1 maint: Archived copy as title (link) \n\n^ Joseph Wickham Roe, English and American tool builders (1916) p. 203 \n\n^ http:\/\/www.mackinmfg.com\/ shows a picture of the calipers but does not support the RAM claim. \n\n^ \"Archived copy\" (PDF) . Archived from the original (PDF) on 2010-05-25. Retrieved 2010-06-25 . CS1 maint: Archived copy as title (link) \n\n^ \"Harbor Freight Tools \u2013 Quality Tools at Discount Prices Since 1977\". www.harborfreight.com. \n\n^ \"Archived copy\". Archived from the original on 2007-07-26. Retrieved 2009-06-12 . CS1 maint: Archived copy as title (link) \n\n^ DRO System: Linear Scales & Counters (PDF) , Mitutoyo, n.d., p. 22, Bulletin No. 1715, archived from the original (PDF) on 2013-11-03 \n\n^ Linear Gage (PDF) , Mitutoyo, n.d., p. 33, Catalog No. E4174-542\/572\/575, archived from the original (PDF) on 2013-11-03 \n\n^ Lancaster, Don (February 2000), \"Tech Musings\" (PDF) , Tech Musings, 145 \n\n^ \"Chinese Scales\". www.shumatech.com. \n\n^ a b Yadro archive-date=2013-12-09 archive-url=https:\/\/web.archive.org\/web\/20131209053512\/http:\/\/yadro.de\/digital-scale\/protocol.html \n\n^ a b c Lancaster, Don (November 1999), \"Tech Musings\" (PDF) , Tech Musings, 142: 142.3 \n\n^ \"New Mahr 2015 Catalogue\". www.Cutwel.co.uk. Cutwel. \n\n^ ABS Coolant Proof Caliper; Coolant Proof Micrometer (PDF) , Mitutoyo, January 2005, Bulletin No. 1813-293\/500, archived from the original (PDF) on 2013-11-03 \n\n^ \"Accuracy of Calipers\". www.tresnainstrument.com. \n\n^ Mitutoyo. E 12024 Check Points For Measuring Instruments. pp. 2, 3. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Calipers.\nRS-232 Interface Design Details For Digital Caliper\nvteMetalworkingvteToolsCutting machines\nBandsaw\nCold saw\nLaser\nMiter saw\nPlasma\nWater jet cutter\nCutting tools\nBroach\nBurr\nChisel\nCounterbore\nCountersink\nEnd mill\nFile\nHand scraper\nMilling cutter\nNibbler\nReamer\nShears\nTipped tool\nTool bit\nForming tools\nBrake\nDie\nEnglish wheel\nHydraulic press\nMachine press\nPunch press\nScrew press\nStamping press\nHand tools\nClamp\nCombination square\nDrift pin\nHacksaw\nHammer\nHand scraper\nMachinist square\nNeedlegun scaler\nPiercing saw\nPliers\nPunch\nScriber\nTap and die\nTongs\nVise\nWorkbench\nWrench\nMachine tooling\nAngle plate\nChuck\nCollet\nFixture\nIndexing head\nJig\nLathe center\nMachine taper\nMagnetic base\nMandrel\nRotary table\nWiggler\nMeasuring instruments\nBore gauge\nCaliper\nCenter gauge\nDial 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 680 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5bd64ab04b9fb048ddfb3cd4ff215fac_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Calipers skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Calipers<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caliper_(disambiguation)\" class=\"mw-disambig\" title=\"Caliper (disambiguation)\" rel=\"external_link\" target=\"_blank\">Caliper (disambiguation)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Caliper_detail_view.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/18\/Caliper_detail_view.jpeg\/220px-Caliper_detail_view.jpeg\" width=\"220\" height=\"137\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Caliper_detail_view.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Caliper detail view<\/div><\/div><\/div>\n<p>A <b>caliper<\/b> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/American_and_British_English_spelling_differences\" title=\"American and British English spelling differences\" rel=\"external_link\" target=\"_blank\">British spelling<\/a> also <b>calliper<\/b>, or in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plurale_tantum\" title=\"Plurale tantum\" rel=\"external_link\" target=\"_blank\">plurale tantum<\/a> sense <b>a pair of calipers<\/b>) is a device used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Measurement\" title=\"Measurement\" rel=\"external_link\" target=\"_blank\">measure<\/a> the distance between two opposite sides of an object. Many types of calipers permit reading out a measurement on a ruled scale, a dial, or a digital display. But a caliper can be as simple as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compass_(drafting)\" class=\"mw-redirect\" title=\"Compass (drafting)\" rel=\"external_link\" target=\"_blank\">compass<\/a> with inward or outward-facing points. The tips of the caliper are adjusted to fit across the points to be measured and then the caliper is then removed and the distance read by measuring between the tips with a measuring tool, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ruler\" title=\"Ruler\" rel=\"external_link\" target=\"_blank\">ruler<\/a>.\n<\/p><p>It is used in many fields such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_engineering\" title=\"Mechanical engineering\" rel=\"external_link\" target=\"_blank\">mechanical engineering<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metalworking\" title=\"Metalworking\" rel=\"external_link\" target=\"_blank\">metalworking<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forestry\" title=\"Forestry\" rel=\"external_link\" target=\"_blank\">forestry<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Woodworking\" title=\"Woodworking\" rel=\"external_link\" target=\"_blank\">woodworking<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Science\" title=\"Science\" rel=\"external_link\" target=\"_blank\">science<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Nomenclature_variants\">Nomenclature variants<\/span><\/h2>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plurale_tantum\" title=\"Plurale tantum\" rel=\"external_link\" target=\"_blank\">plurale tantum<\/a> sense of the word \"calipers\" coexists in natural usage with the regular noun sense of \"caliper\". That is, sometimes a caliper is treated cognitively like a pair of glasses or a pair of scissors, resulting in a phrase such as \"hand me those calipers\" or \"those calipers are mine\" in reference to one unit.\n<\/p><p>Also existing colloquially but not in formal usage is referring to a vernier caliper as a \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vernier_scale\" title=\"Vernier scale\" rel=\"external_link\" target=\"_blank\">vernier<\/a>\" or a \"pair of verniers\". In imprecise colloquial usage, some speakers extend this even to dial calipers, although they involve no vernier scale.\n<\/p><p>In machine-shop usage, the term \"caliper\" is often used in contradistinction to \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometer\" title=\"Micrometer\" rel=\"external_link\" target=\"_blank\">micrometer<\/a>\", even though outside micrometers are technically a form of caliper. In this usage, \"caliper\" implies only the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Design\" title=\"Design\" rel=\"external_link\" target=\"_blank\">form factor<\/a> of the vernier or dial caliper (or its digital counterpart).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The earliest caliper has been found in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greece\" title=\"Ancient Greece\" rel=\"external_link\" target=\"_blank\">Greek<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Giglio_Island\" class=\"mw-redirect\" title=\"Giglio Island\" rel=\"external_link\" target=\"_blank\">Giglio<\/a> wreck near the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Italy\" title=\"Italy\" rel=\"external_link\" target=\"_blank\">Italian<\/a> coast. The ship find dates to the 6th century BC. The wooden piece already featured a fixed and a movable jaw.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Roger_B._Ulrich_2-0\" class=\"reference\"><a href=\"#cite_note-Roger_B._Ulrich-2\" rel=\"external_link\">[2]<\/a><\/sup> Although rare finds, caliper remained in use by the Greeks and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Rome\" title=\"Ancient Rome\" rel=\"external_link\" target=\"_blank\">Romans<\/a>.<sup id=\"rdp-ebb-cite_ref-Roger_B._Ulrich_2-1\" class=\"reference\"><a href=\"#cite_note-Roger_B._Ulrich-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>A bronze caliper, dating from 9 AD, was used for minute measurements during the Chinese <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xin_dynasty\" title=\"Xin dynasty\" rel=\"external_link\" target=\"_blank\">Xin dynasty<\/a>. The caliper had an inscription stating that it was \"made on a <i>gui-you<\/i> day at new moon of the first month of the first year of the Shijian guo period.\" The calipers included a \"slot and pin\" and \"graduated in inches and tenths of an inch.\"<sup id=\"rdp-ebb-cite_ref-Ronan_4-0\" class=\"reference\"><a href=\"#cite_note-Ronan-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Calibro_archetto_graduato.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Calibro_archetto_graduato.JPG\/220px-Calibro_archetto_graduato.JPG\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Calibro_archetto_graduato.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Caliper with graduated bow 0\u201310 mm<\/div><\/div><\/div>\n<p>The modern vernier caliper, reading to thousandths of an inch, was invented by American Joseph R. Brown in 1851. It was the first practical tool for exact measurements that could be sold at a price within the reach of ordinary machinists.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Inside_caliper\">Inside caliper<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:InsideCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/InsideCalipers.jpg\/220px-InsideCalipers.jpg\" width=\"220\" height=\"157\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:InsideCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Two inside calipers<\/div><\/div><\/div>\n<p>The <b>inside calipers<\/b> are used to measure the internal size of an object.\n<\/p>\n<ul><li>The upper caliper in the image (at the right) requires manual adjustment prior to fitting. Fine setting of this caliper type is performed by tapping the caliper legs lightly on a handy surface until they will <i>almost<\/i> pass over the object. A light push against the resistance of the central pivot screw then spreads the legs to the correct dimension and provides the required, consistent <i>feel<\/i> that ensures a repeatable measurement.<\/li>\n<li>The lower caliper in the image has an adjusting screw that permits it to be carefully adjusted without removal of the tool from the workpiece. <div style=\"clear:both;\"><\/div><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Outside_caliper\">Outside caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OutsideCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/OutsideCalipers.jpg\/220px-OutsideCalipers.jpg\" width=\"220\" height=\"159\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OutsideCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Three outside calipers.<\/div><\/div><\/div>\n<p><b>Outside calipers<\/b> are used to measure the external size of an object.\n<\/p><p>The same observations and technique apply to this type of caliper, as for the above inside caliper. With some understanding of their limitations and usage, these instruments can provide a high degree of accuracy and repeatability. They are especially useful when measuring over very large distances; consider if the calipers are used to measure a large diameter pipe. A vernier caliper does not have the depth capacity to straddle this large diameter while at the same time reach the outermost points of the pipe's diameter. They are made from high carbon steel.\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Divider_caliper\">Divider caliper<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compass_(drafting)\" class=\"mw-redirect\" title=\"Compass (drafting)\" rel=\"external_link\" target=\"_blank\">Compass (drafting)<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DividerCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/DividerCalipers.jpg\/220px-DividerCalipers.jpg\" width=\"220\" height=\"122\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DividerCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A pair of dividers<\/div><\/div><\/div>\n<p>In the metalworking field, a <b>divider caliper,<\/b> popularly called a <b>compass,<\/b> is used in the process of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marking_out\" title=\"Marking out\" rel=\"external_link\" target=\"_blank\">marking out<\/a> locations. The points are sharpened so that they act as scribers, one leg can then be placed in the dimple created by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Punch_(engineering)\" class=\"mw-redirect\" title=\"Punch (engineering)\" rel=\"external_link\" target=\"_blank\">center or prick punch<\/a> and the other leg pivoted so that it scribes a line on the workpiece's surface, thus forming an arc or circle.\n<\/p><p>A divider caliper is also used to measure a distance between two points on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Map\" title=\"Map\" rel=\"external_link\" target=\"_blank\">map<\/a>. The two caliper's ends are brought to the two points whose distance is being measured. The caliper's opening is then either measured on a separate ruler and then converted to the actual distance, or it is measured directly on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scale_(map)\" title=\"Scale (map)\" rel=\"external_link\" target=\"_blank\">scale<\/a> drawn on the map. On a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nautical_chart\" title=\"Nautical chart\" rel=\"external_link\" target=\"_blank\">nautical chart<\/a> the distance is often measured on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Latitude\" title=\"Latitude\" rel=\"external_link\" target=\"_blank\">latitude<\/a> scale appearing on the sides of the map: one minute of arc of latitude is approximately one <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nautical_mile\" title=\"Nautical mile\" rel=\"external_link\" target=\"_blank\">nautical mile<\/a> or 1852 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metre\" title=\"Metre\" rel=\"external_link\" target=\"_blank\">metres<\/a>.\n<\/p><p>Dividers are also used in the medical profession. An ECG (also EKG) caliper transfers distance on an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiogram\" class=\"mw-redirect\" title=\"Electrocardiogram\" rel=\"external_link\" target=\"_blank\">electrocardiogram<\/a>; in conjunction with the appropriate scale, the heart rate can be determined. A pocket caliper versions was invented by cardiologist Robert A. Mackin.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Oddleg_caliper\">Oddleg caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OddlegCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/OddlegCalipers.jpg\/220px-OddlegCalipers.jpg\" width=\"220\" height=\"131\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OddlegCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Oddleg calipers<\/div><\/div><\/div>\n<p><b>Oddleg calipers<\/b>, <b>Hermaphrodite calipers<\/b>, or <b>Oddleg jennys<\/b>, as pictured on the left, are generally used to scribe a line at a set distance from the edge of a workpiece. The bent leg is used to run along the workpiece edge while the scriber makes its mark at a predetermined distance, this ensures a line parallel to the edge.\n<\/p><p>In the diagram at left, the uppermost caliper has a slight shoulder in the bent leg allowing it to sit on the edge more securely, the lower caliper lacks this feature but has a renewable scriber that can be adjusted for wear, as well as being replaced when excessively worn.\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Vernier_caliper\">Vernier caliper<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vernier_scale\" title=\"Vernier scale\" rel=\"external_link\" target=\"_blank\">Vernier scale<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:602px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_caliper.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Vernier_caliper.svg\/600px-Vernier_caliper.svg.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_caliper.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Diagram of Vernier calipers. The labeled parts are <div><ol><li><b>Outside large jaws<\/b>: used to measure external diameter or width of an object<\/li><li><b>Inside small jaws<\/b>: used to measure internal diameter of an object<\/li><li><b>Depth probe\/rod<\/b>: used to measure depths of an object or a hole<\/li><li><b>Main scale (Metric)<\/b>: scale marked every mm<\/li><li><b>Main scale (Imperial)<\/b>: scale marked in inches and fractions<\/li><li><b>Vernier scale (Metric)<\/b> gives interpolated measurements to 0.1 mm or better<\/li><li><b>Vernier scale (Imperial)<\/b> gives interpolated measurements in fractions of an inch<\/li><li><b>Retainer<\/b>: used to block movable part to allow the easy transferring of a measurement<\/li><\/ol><\/div> The calipers in the diagram show a primary reading on the metric scale of about 2.475 cm (2.4 cm read from the main scale plus about 0.075 cm from the Vernier scale). Calipers often have a \"zero point error\", which is when the calipers do not read 0.000 cm when the jaws are closed. The zero point error must always be subtracted from the primary reading. Let us assume these calipers have a zero point error of 0.013 cm. This would give us a length reading of 2.462 cm. For any measurement, reporting the error on the measurement is also important. Both the primary reading and the zero point reading are bounded by plus\/minus <i>half<\/i> the length corresponding to the width of the smallest interval on the Vernier scale (0.0025 cm). These are \"absolute\" errors and absolute errors add, so the length reading is then bounded by plus\/minus the length corresponding to the <i>full<\/i> width of the smallest interval on the Vernier scale (0.005 cm). Assuming no systematics affect the measurement (the instrument works perfectly), a complete measurement would then read 2.462 cm \u00b1 0.005 cm.<\/div><\/div><\/div>\n<p>The vernier, dial, and digital calipers give a direct reading of the distance measured with high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accuracy_and_precision\" title=\"Accuracy and precision\" rel=\"external_link\" target=\"_blank\">accuracy and precision<\/a>. They are functionally identical, with different ways of reading the result. These calipers comprise a calibrated scale with a fixed jaw, and another jaw, with a pointer, that slides along the scale. The distance between the jaws is then read in different ways for the three types.\n<\/p><p>The simplest method is to read the position of the pointer directly on the scale. When the pointer is between two markings, the user can mentally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interpolation\" title=\"Interpolation\" rel=\"external_link\" target=\"_blank\">interpolate<\/a> to improve the precision of the reading. This would be a simple calibrated caliper; but the addition of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vernier_scale\" title=\"Vernier scale\" rel=\"external_link\" target=\"_blank\">vernier scale<\/a> allows more accurate interpolation, and is the universal practice; this is the <b>vernier caliper<\/b>.\n<\/p><p>Vernier, dial, and digital calipers can measure internal dimensions (using the uppermost jaws in the picture at right), external dimensions using the pictured lower jaws, and in many cases depth by the use of a probe that is attached to the movable head and slides along the centre of the body. This probe is slender and can get into deep grooves that may prove difficult for other measuring tools.\n<\/p><p>The vernier scales may include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metric_system\" title=\"Metric system\" rel=\"external_link\" target=\"_blank\">metric<\/a> measurements on the lower part of the scale and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inch\" title=\"Inch\" rel=\"external_link\" target=\"_blank\">inch<\/a> measurements on the upper, or vice versa, in countries that use inches. Vernier calipers commonly used in industry provide a precision to 0.01 mm (10 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometre\" title=\"Micrometre\" rel=\"external_link\" target=\"_blank\">micrometres<\/a>), or one thousandth of an inch. They are available in sizes that can measure up to 1,829 mm (72 in).<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Dial_caliper\">Dial caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dial_calipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Dial_calipers.jpg\/220px-Dial_calipers.jpg\" width=\"220\" height=\"78\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dial_calipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitutoyo\" title=\"Mitutoyo\" rel=\"external_link\" target=\"_blank\">Mitutoyo<\/a> dial caliper<\/div><\/div><\/div>\n<p>Instead of using a vernier mechanism, which requires some practice to use, the <b>dial caliper<\/b> reads the final fraction of a millimeter or inch on a simple dial.\n<\/p><p>In this instrument, a small, precise <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rack_and_pinion\" title=\"Rack and pinion\" rel=\"external_link\" target=\"_blank\">rack and pinion<\/a> drives a pointer on a circular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dial_(measurement)\" title=\"Dial (measurement)\" rel=\"external_link\" target=\"_blank\">dial<\/a>, allowing direct reading without the need to read a vernier scale. Typically, the pointer rotates once every inch, tenth of an inch, or 1 millimeter. This measurement must be added to the coarse whole inches or centimeters read from the slide. The dial is usually arranged to be rotatable beneath the pointer, allowing for \"differential\" measurements (the measuring of the difference in size between two objects, or the setting of the dial using a master object and subsequently being able to read directly the plus-or-minus variance in size of subsequent objects relative to the master object).\n<\/p><p>The slide of a dial caliper can usually be locked at a setting using a small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lever\" title=\"Lever\" rel=\"external_link\" target=\"_blank\">lever<\/a> or screw; this allows simple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Go-NoGo_gauge\" class=\"mw-redirect\" title=\"Go-NoGo gauge\" rel=\"external_link\" target=\"_blank\">go\/no-go<\/a> checks of part sizes.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Digital_caliper\">Digital caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DigitalCaliperEuro.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/DigitalCaliperEuro.jpg\/220px-DigitalCaliperEuro.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DigitalCaliperEuro.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Digital caliper<\/div><\/div><\/div>\n<p>A popular refinement replaces the analog dial with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronics\" title=\"Electronics\" rel=\"external_link\" target=\"_blank\">electronic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Display_device\" title=\"Display device\" rel=\"external_link\" target=\"_blank\">digital display<\/a> that displays the reading as a numeric value. Rather than a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rack_and_pinion\" title=\"Rack and pinion\" rel=\"external_link\" target=\"_blank\">rack and pinion<\/a>, these calipers use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linear_encoder\" title=\"Linear encoder\" rel=\"external_link\" target=\"_blank\">linear encoder<\/a>. Some digital calipers can be switched between centimeters or millimeters, and inches. All provide for zeroing the display at any point along the slide, allowing the same sort of differential measurements as with the dial caliper. Digital calipers may contain a \"reading hold\" feature, allowing the reading of dimensions after use in awkward locations where the display cannot be seen.\nOrdinary 6-in\/150-mm digital calipers are made of stainless steel, have a rated accuracy of 0.001 in (0.02mm) and a resolution of 0.0005 in (0.01 mm).<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\nThe same technology is used to make longer 8-in and 12-in calipers; the accuracy for longer measurements declines to 0.001 in (0.03 mm) for 100\u2013200 mm and 0.0015 in (0.04 mm) for 200\u2013300 mm.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Increasingly, digital calipers offer a serial data output to allow them to be interfaced with a dedicated recorder or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personal_computer\" title=\"Personal computer\" rel=\"external_link\" target=\"_blank\">personal computer<\/a>. The digital interface significantly decreases the time to make and record a series of measurements, and it also improves the reliability of the records. A suitable device to convert the serial data output to common computer interfaces such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/RS-232\" title=\"RS-232\" rel=\"external_link\" target=\"_blank\">RS-232<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Universal_Serial_Bus\" class=\"mw-redirect\" title=\"Universal Serial Bus\" rel=\"external_link\" target=\"_blank\">Universal Serial Bus<\/a>, or wireless can be built or purchased. With such a converter, measurements can be directly entered into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spreadsheet\" title=\"Spreadsheet\" rel=\"external_link\" target=\"_blank\">spreadsheet<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Statistical_process_control\" title=\"Statistical process control\" rel=\"external_link\" target=\"_blank\">statistical process control<\/a> program, or similar software.\n<\/p><p>The serial digital output varies among manufacturers. Common options are\n<\/p>\n<ul><li>Mitutoyo's Digimatic interface. This is the dominant name brand interface. Format is 52 bits arranged as 13 nibbles.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Sylvac interface. This is the common protocol for inexpensive, non-name brand, calipers. Format is 24 bit 90 kHz synchronous.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-yadro_15-0\" class=\"reference\"><a href=\"#cite_note-yadro-15\" rel=\"external_link\">[15]<\/a><\/sup><\/li>\n<li>Starrett<sup id=\"rdp-ebb-cite_ref-muse142_16-0\" class=\"reference\"><a href=\"#cite_note-muse142-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li>\n<li>Brown & Sharpe<sup id=\"rdp-ebb-cite_ref-muse142_16-1\" class=\"reference\"><a href=\"#cite_note-muse142-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li>\n<li>Federal<\/li>\n<li>Tesa<sup id=\"rdp-ebb-cite_ref-muse142_16-2\" class=\"reference\"><a href=\"#cite_note-muse142-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li>\n<li>Aldi. Format is 7 BCD digits.<sup id=\"rdp-ebb-cite_ref-yadro_15-1\" class=\"reference\"><a href=\"#cite_note-yadro-15\" rel=\"external_link\">[15]<\/a><\/sup><\/li>\n<li>Mahr (Digimatic, RS232C, Wireless FM Radio, Infrared and USB)<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><\/li><\/ul>\n<p>Like dial calipers, the slide of a digital caliper can usually be locked using a lever or thumb-screw.\n<\/p><p>Some digital calipers contain a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linear_encoder#Capacitive\" title=\"Linear encoder\" rel=\"external_link\" target=\"_blank\">capacitive linear encoder<\/a>. A pattern of bars is etched directly on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Printed_circuit_board\" title=\"Printed circuit board\" rel=\"external_link\" target=\"_blank\">printed circuit board<\/a> in the slider. Under the scale of the caliper another printed circuit board also contains an etched pattern of lines. The combination of these printed circuit boards forms two variable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capacitor\" title=\"Capacitor\" rel=\"external_link\" target=\"_blank\">capacitors<\/a>. The two capacitances are out of phase. As the slider moves the capacitance changes in a linear fashion and in a repeating pattern. The circuitry built into the slider counts the bars as the slider moves and does a linear interpolation based on the magnitudes of the capacitors to find the precise position of the slider. Other digital calipers contain an inductive linear encoder, which allows robust performance in the presence of contamination such as coolants.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Magnetic linear encoders are used in yet other digital calipers.\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Micrometer_caliper\">Micrometer caliper<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometer\" title=\"Micrometer\" rel=\"external_link\" target=\"_blank\">Micrometer<\/a><\/div>\n<p>A caliper using a calibrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screw\" title=\"Screw\" rel=\"external_link\" target=\"_blank\">screw<\/a> for measurement, rather than a slide, is called an <i>external micrometer caliper gauge<\/i>, a <i>micrometer caliper<\/i> or, more often, simply a <i>micrometer<\/i>. (Sometimes the term <i>caliper<\/i>, referring to any other type in this article, is held in contradistinction to <i>micrometer<\/i>.)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Comparison\">Comparison<\/span><\/h2>\n<p>Each of the above types of calipers has its relative merits and faults.\n<\/p><p>Vernier calipers are rugged and have long lasting accuracy, are coolant proof, are not affected by magnetic fields, and are largely shock proof. They may have both centimeter and inch scales. However, vernier calipers require good eyesight or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnifying_glass\" title=\"Magnifying glass\" rel=\"external_link\" target=\"_blank\">magnifying glass<\/a> to read and can be difficult to read from a distance or from awkward angles. It is relatively easy to misread the last digit. In production environments, reading vernier calipers all day long is error-prone and is annoying to the workers.\n<\/p><p>Dial calipers are comparatively easy to read, especially when seeking exact center by rocking and observing the needle movement. They can be set to 0 at any point for comparisons. They are usually fairly susceptible to shock damage. They are also very prone to getting dirt in the gears, which can cause accuracy problems.\n<\/p><p>Digital calipers switch easily between centimeter and inch systems.They can be set to 0 easily at any point with full count in either direction, and can take measurements even if the display is completely hidden, either by using a \"hold\" key, or by zeroing the display and closing the jaws, showing the correct measurement, but negative. They can be mechanically and electronically fragile. Most also require batteries, and do not resist coolant well. They are also only moderately shockproof, and can be vulnerable to dirt.\n<\/p><p>Calipers may read to a resolution of 0.01 mm or 0.0005 in, but accuracy may not be better than about \u00b10.02 mm or 0.001 in for 150 mm (6 in) calipers, and worse for longer ones.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use\">Use<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Using_the_caliper_new_en.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Using_the_caliper_new_en.gif\/400px-Using_the_caliper_new_en.gif\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Using_the_caliper_new_en.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Using the vernier caliper<\/div><\/div><\/div>\n<p>A caliper must be properly applied against the part in order to take the desired measurement. For example, when measuring the thickness of a plate a vernier caliper must be held at right angles to the piece. Some practice may be needed to measure round or irregular objects correctly.\n<\/p><p>Accuracy of measurement when using a caliper is highly dependent on the skill of the operator. Regardless of type, a caliper's jaws must be forced into contact with the part being measured. As both part and caliper are always to some extent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elasticity_(physics)\" title=\"Elasticity (physics)\" rel=\"external_link\" target=\"_blank\">elastic<\/a>, the amount of force used affects the indication. A consistent, firm touch is correct. Too much force results in an underindication as part and tool distort; too little force gives insufficient contact and an overindication. This is a greater problem with a caliper incorporating a wheel, which lends <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_advantage\" title=\"Mechanical advantage\" rel=\"external_link\" target=\"_blank\">mechanical advantage<\/a>. This is especially the case with digital calipers, calipers out of adjustment, or calipers with a poor quality beam.\n<\/p><p>Simple calipers are uncalibrated; the measurement taken must be compared against a scale. Whether the scale is part of the caliper or not, all analog calipers\u2014verniers and dials\u2014require good eyesight in order to achieve the highest precision. Digital calipers have the advantage in this area.\n<\/p><p>Calibrated calipers may be mishandled, leading to loss of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calibration\" title=\"Calibration\" rel=\"external_link\" target=\"_blank\">zero<\/a>. When a calipers' jaws are fully closed, it should, of course, indicate zero. If it does not, it must be recalibrated or repaired. A vernier caliper does not easily lose its calibration but a sharp impact or accidental damage to the measuring surface in the caliper jaw can be significant enough to displace zero.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Digital calipers have zero set buttons, for quick recalibration.\n<\/p><p>Vernier, dial and digital calipers can be used with accessories that extend their usefulness. Examples are a base that extends their usefulness as a depth gauge and a jaw attachment that allows measuring the center distance between holes. Since the 1970s a clever modification of the moveable jaw on the back side of any caliper allows for step or depth measurements in addition to external caliper measurements, in similar fashion to a universal micrometer (e.g., Starrett Mul-T-Anvil or Mitutoyo Uni-Mike).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Zero_error\">Zero error<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_scale_zero_error_%2B0.10.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Vernier_scale_zero_error_%2B0.10.gif\/220px-Vernier_scale_zero_error_%2B0.10.gif\" width=\"220\" height=\"109\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_scale_zero_error_%2B0.10.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>When the jaws are closed and if the reading is 0.10 mm, the zero error is referred to as +0.10 mm. The method to use a vernier scale or caliper with zero error is to use the formula \"(actual reading) = (main scale) + (vernier scale) \u2212 (zero error)\", thus the actual reading is 19.00 + 0.54 \u2212 (0.10) = 19.44 mm. The resolution of the measurement, based on the width of the smallest sub-interval, is \u00b10.02 mm.<\/div><\/div><\/div>\n<p>The method to use a vernier scale or caliper with zero error is to use the formula \"actual reading = main scale + vernier scale \u2212 (zero error)\". Zero error may arise due to knocks that affect the calibration at 0.00 mm when the jaws are perfectly closed or just touching each other. Positive zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a positive reading away from the actual reading of 0.00 mm. If the reading is 0.10 mm, the zero error is referred to as +0.10 mm. Negative zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a negative reading away from the actual reading of 0.00 mm. If the reading is \u22120.08 mm, the zero error is referred to as \u22120.08 mm.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dial_indicator\" class=\"mw-redirect\" title=\"Dial indicator\" rel=\"external_link\" target=\"_blank\">Dial indicator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cruising_rod\" title=\"Cruising rod\" rel=\"external_link\" target=\"_blank\">Cruising rod<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_clock\" title=\"Lens clock\" rel=\"external_link\" target=\"_blank\">Lens clock<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mensun Bound: <i>The Giglio wreck: a wreck of the Archaic period (c. 600 BC) off the Tuscany island of Giglio<\/i>, Hellenic Institute of Marine Archaeology, Athens 1991, pp. 27 and 31 (Fig. 65)<\/span>\n<\/li>\n<li id=\"cite_note-Roger_B._Ulrich-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Roger_B._Ulrich_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roger_B._Ulrich_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Roger B. Ulrich: <i>Roman woodworking<\/i>, Yale University Press, New Haven, Conn., 2007, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-300-10341-7, p.52f.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"hand tool.\" Encyclop\u00e6dia Britannica from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Encyclop%C3%A6dia_Britannica_2006_Ultimate_Reference_Suite_DVD\" class=\"mw-redirect\" title=\"Encyclop\u00e6dia Britannica 2006 Ultimate Reference Suite DVD\" rel=\"external_link\" target=\"_blank\">Encyclop\u00e6dia Britannica 2006 Ultimate Reference Suite DVD<\/a>. [Accessed July 29, 2008]<\/span>\n<\/li>\n<li id=\"cite_note-Ronan-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ronan_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Colin A. Ronan; Joseph Needham (24 June 1994). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\"><i>The Shorter Science and Civilisation in China: 4<\/i><\/a>. Cambridge University Press. p. 36. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-521-32995-8. <q>adjustable outside caliper gauge... self-dated at AD 9<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Shorter+Science+and+Civilisation+in+China%3A+4&rft.pages=36&rft.pub=Cambridge+University+Press&rft.date=1994-06-24&rft.isbn=978-0-521-32995-8&rft.au=Colin+A.+Ronan&rft.au=Joseph+Needham&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPehoSnJfstUC%26pg%3DPA36%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>. An abridged version.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140831052938\/http:\/\/history.cultural-china.com\/en\/56H2758H7991.html\" target=\"_blank\">\"Archived copy\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/history.cultural-china.com\/en\/56H2758H7991.html\" target=\"_blank\">the original<\/a> on 2014-08-31<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fhistory.cultural-china.com%2Fen%2F56H2758H7991.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joseph_Wickham_Roe\" title=\"Joseph Wickham Roe\" rel=\"external_link\" target=\"_blank\">Joseph Wickham Roe<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/stream\/englishamericant00roej\/englishamericant00roej_djvu.txt\" target=\"_blank\"><i>English and American tool builders<\/i> (1916) p. 203<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.mackinmfg.com\/\" target=\"_blank\">http:\/\/www.mackinmfg.com\/<\/a> shows a picture of the calipers but does not support the RAM claim.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100525030431\/http:\/\/www.starrett.com\/download\/246_p108_114.pdf\" target=\"_blank\">\"Archived copy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.starrett.com\/download\/246_p108_114.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2010-05-25<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-06-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.starrett.com%2Fdownload%2F246_p108_114.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.harborfreight.com\/cpi\/ctaf\/displayitem.taf?Itemnumber=47257\" target=\"_blank\">\"Harbor Freight Tools \u2013 Quality Tools at Discount Prices Since 1977\"<\/a>. <i>www.harborfreight.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.harborfreight.com&rft.atitle=Harbor+Freight+Tools+%E2%80%93+Quality+Tools+at+Discount+Prices+Since+1977&rft_id=http%3A%2F%2Fwww.harborfreight.com%2Fcpi%2Fctaf%2Fdisplayitem.taf%3FItemnumber%3D47257&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070726053453\/http:\/\/www.msi-viking.com\/digital_caliper\/\" target=\"_blank\">\"Archived copy\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.msi-viking.com\/digital_caliper\/\" target=\"_blank\">the original<\/a> on 2007-07-26<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-06-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.msi-viking.com%2Fdigital_caliper%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131103082232\/http:\/\/www.mitutoyo.com\/pdf\/1715.pdf\" target=\"_blank\"><i>DRO System: Linear Scales & Counters<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>, Mitutoyo, n.d., p. 22, Bulletin No. 1715, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mitutoyo.com\/pdf\/1715.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2013-11-03<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=DRO+System%3A+Linear+Scales+%26amp%3B+Counters&rft.pages=22&rft.pub=Mitutoyo&rft_id=http%3A%2F%2Fwww.mitutoyo.com%2Fpdf%2F1715.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131103082151\/http:\/\/www.mitutoyo.com\/pdf\/E4174-542.pdf\" target=\"_blank\"><i>Linear Gage<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>, Mitutoyo, n.d., p. 33, Catalog No. E4174-542\/572\/575, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mitutoyo.com\/pdf\/E4174-542.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2013-11-03<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Linear+Gage&rft.pages=33&rft.pub=Mitutoyo&rft_id=http%3A%2F%2Fwww.mitutoyo.com%2Fpdf%2FE4174-542.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLancaster2000\" class=\"citation\">Lancaster, Don (February 2000), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tinaja.com\/glib\/muse145.pdf\" target=\"_blank\">\"Tech Musings\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>, <i>Tech Musings<\/i>, <b>145<\/b><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tech+Musings&rft.atitle=Tech+Musings&rft.volume=145&rft.date=2000-02&rft.aulast=Lancaster&rft.aufirst=Don&rft_id=http%3A%2F%2Fwww.tinaja.com%2Fglib%2Fmuse145.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.shumatech.com\/support\/chinese_scales.htm\" target=\"_blank\">\"Chinese Scales\"<\/a>. <i>www.shumatech.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.shumatech.com&rft.atitle=Chinese+Scales&rft_id=http%3A%2F%2Fwww.shumatech.com%2Fsupport%2Fchinese_scales.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-yadro-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-yadro_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-yadro_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.yadro.de\/digital-scale\/protocol.html\" target=\"_blank\">Yadro<\/a> archive-date=2013-12-09 archive-url=<a rel=\"external_link\" class=\"external free\" href=\"https:\/\/web.archive.org\/web\/20131209053512\/http:\/\/yadro.de\/digital-scale\/protocol.html\" target=\"_blank\">https:\/\/web.archive.org\/web\/20131209053512\/http:\/\/yadro.de\/digital-scale\/protocol.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-muse142-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-muse142_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-muse142_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-muse142_16-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLancaster1999\" class=\"citation\">Lancaster, Don (November 1999), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tinaja.com\/glib\/muse142.pdf\" target=\"_blank\">\"Tech Musings\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>, <i>Tech Musings<\/i>, <b>142<\/b>: 142.3<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tech+Musings&rft.atitle=Tech+Musings&rft.volume=142&rft.pages=142.3&rft.date=1999-11&rft.aulast=Lancaster&rft.aufirst=Don&rft_id=http%3A%2F%2Fwww.tinaja.com%2Fglib%2Fmuse142.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cutwel.co.uk\/new-mahr-2015-catalogue\" target=\"_blank\">\"New Mahr 2015 Catalogue\"<\/a>. <i>www.Cutwel.co.uk<\/i>. Cutwel.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.Cutwel.co.uk&rft.atitle=New+Mahr+2015+Catalogue&rft_id=http%3A%2F%2Fwww.cutwel.co.uk%2Fnew-mahr-2015-catalogue&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131103082314\/http:\/\/www.mitutoyo.com\/pdf\/ABS1813-293.pdf\" target=\"_blank\"><i>ABS Coolant Proof Caliper; Coolant Proof Micrometer<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>, Mitutoyo, January 2005, Bulletin No. 1813-293\/500, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mitutoyo.com\/pdf\/ABS1813-293.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2013-11-03<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=ABS+Coolant+Proof+Caliper%3B+Coolant+Proof+Micrometer&rft.pub=Mitutoyo&rft.date=2005-01&rft_id=http%3A%2F%2Fwww.mitutoyo.com%2Fpdf%2FABS1813-293.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tresnainstrument.com\/accuracy_of_calipers.html\" target=\"_blank\">\"Accuracy of Calipers\"<\/a>. <i>www.tresnainstrument.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.tresnainstrument.com&rft.atitle=Accuracy+of+Calipers&rft_id=http%3A%2F%2Fwww.tresnainstrument.com%2Faccuracy_of_calipers.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mitutoyo. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/details\/E12024CheckPointsForMeasuringInstruments\" target=\"_blank\"><i>E 12024 Check Points For Measuring Instruments<\/i><\/a>. pp. 2, 3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=E+12024+Check+Points+For+Measuring+Instruments&rft.pages=2%2C+3&rft.au=Mitutoyo&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2FE12024CheckPointsForMeasuringInstruments&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.compendiumarcana.com\/caliper\/\" target=\"_blank\">RS-232 Interface Design Details For Digital Caliper<\/a><\/li><\/ul>\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181217065651\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.504 seconds\nReal time usage: 0.673 seconds\nPreprocessor visited node count: 1553\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 97340\/2097152 bytes\nTemplate argument size: 473\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 40796\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.164\/10.000 seconds\nLua memory usage: 6.47 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 452.055 1 -total\n<\/p>\n<pre>47.31% 213.849 1 Template:Reflist\n15.07% 68.107 1 Template:ISBN\n12.37% 55.934 2 Template:Cite_book\n10.53% 47.583 1 Template:Convert\n 8.83% 39.922 1 Template:Catalog_lookup_link\n 8.29% 37.475 1 Template:Authority_control\n 7.80% 35.281 3 Template:Navbox\n 7.77% 35.115 1 Template:Other_uses\n 6.49% 29.318 7 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1635762-1!canonical and timestamp 20181217065650 and revision id 871937291\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Calipers\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214653\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.033 seconds\nReal time usage: 0.177 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 167.777 1 - wikipedia:Calipers\n100.00% 167.777 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8552-0!*!*!*!*!*!* and timestamp 20181217214653 and revision id 24980\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Calipers\">https:\/\/www.limswiki.org\/index.php\/Calipers<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5bd64ab04b9fb048ddfb3cd4ff215fac_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/18\/Caliper_detail_view.jpeg\/440px-Caliper_detail_view.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Calibro_archetto_graduato.JPG\/440px-Calibro_archetto_graduato.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/InsideCalipers.jpg\/440px-InsideCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/OutsideCalipers.jpg\/440px-OutsideCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/DividerCalipers.jpg\/440px-DividerCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/OddlegCalipers.jpg\/440px-OddlegCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Vernier_caliper.svg\/1200px-Vernier_caliper.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Dial_calipers.jpg\/440px-Dial_calipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/DigitalCaliperEuro.jpg\/440px-DigitalCaliperEuro.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/c2\/Using_the_caliper_new_en.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Vernier_scale_zero_error_%2B0.10.gif\/440px-Vernier_scale_zero_error_%2B0.10.gif","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/a\/ae\/Using_a_DTApe.JPG\/140px-Using_a_DTApe.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/42\/Pine_forest_in_Sweden.jpg\/31px-Pine_forest_in_Sweden.jpg"],"5bd64ab04b9fb048ddfb3cd4ff215fac_timestamp":1545083213,"5ff57cc066e5fb627487105a67a6f125_type":"article","5ff57cc066e5fb627487105a67a6f125_title":"Surgical segment navigator","5ff57cc066e5fb627487105a67a6f125_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator","5ff57cc066e5fb627487105a67a6f125_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical segment navigator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Surgical navigation for the orbit and zygoma on the SSN system (Color coding for the preoperative, predicted and goal position of the fragments, respectively)\nThe surgical segment navigator (SSN) is a computer-based system for use in surgical navigation. It is integrated into a common platform, together with the surgical tool navigator (STN), the surgical microscope navigator (SMN) and the 6DOF manipulator (MKM), developed by Carl Zeiss.\n\nContents \n\n1 SSN \n2 SSN++ \n3 References \n4 External links \n\n\nSSN \nThe SSN has been developed as a computer system for bone segment navigation in oral and maxillofacial surgery. It allows a very precise repositioning of bone fragments, with the advent of preoperative simulation and surgical planning.The system has been developed since 1997 at the University of Regensburg, Germany, with the support of the Carl Zeiss Company. Its principle is based on an infrared localisation system, composed of an infrared camera and at least three infrared transmitters attached to each bony fragment. The SSN is mainly used in orthognatic surgery (surgical correction of dysgnathia), but also for the surgical reconstruction of the orbit, or other surgical interventions to the midface.\n\n SSN++ \nSince 2001, at the University of Heidelberg, Germany, the SSN++ has been developed, a markerless-registration navigation system, based on a native (=markerless) CT or MRI. In this case, the patient registration is obtained on the operating table, using a surface scanner. The SSN++ correlates the surface scan data (gathered on the operating table) with the skin surface reconstruction from the dataset obtained preoperatively by CT or MRI. This principle complies with the terrain contour matching principle described for flying objects. The advantage of the new method is that the registration of the patient's position becomes a simple automated procedure; on the other hand, the radiation load for the patient is reduced, compared to the method using markers.\n\nReferences \nMarmulla R, Niederdellmann H: Computer-assisted Bone Segment Navigation, J Craniomaxillofac Surg 26: 347\u2013359, 1998\nMarmulla R, Niederdellmann H: Surgical Planning of Computer Assisted Repositioning Osteotomies, Plast Reconstr Surg 104 (4): 938\u2013944, 1999\nMarmulla R, M\u00fchling J, L\u00fcth T, Eggers G, Hassfeld S: Advanced surface-recording techniques for computer-assisted oral and maxillofacial surgery, Br J Oral Maxillofac Surg, 42: 511\u2013519, 2004\nExternal links \nSSN Homepage\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator\">https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator<\/a>\n\t\t\t\t\tCategory: Medical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical segment navigator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SSNNavigation.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/SSNNavigation.jpg\/220px-SSNNavigation.jpg\" width=\"220\" height=\"141\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SSNNavigation.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">Surgical navigation<\/a> for the orbit and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zygomatic_bone\" title=\"Zygomatic bone\" rel=\"external_link\" target=\"_blank\">zygoma<\/a> on the SSN system (Color coding for the preoperative, predicted and goal position of the fragments, respectively)<\/div><\/div><\/div>\n<p>The <b>surgical segment navigator (SSN)<\/b> is a computer-based system for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_navigation\" class=\"mw-redirect\" title=\"Surgical navigation\" rel=\"external_link\" target=\"_blank\">surgical navigation<\/a>. It is integrated into a common <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platform_(computing)\" class=\"mw-redirect\" title=\"Platform (computing)\" rel=\"external_link\" target=\"_blank\">platform<\/a>, together with the surgical tool navigator (STN), the surgical microscope navigator (SMN) and the 6<a href=\"https:\/\/en.wikipedia.org\/wiki\/Degrees_of_freedom_(engineering)\" class=\"mw-redirect\" title=\"Degrees of freedom (engineering)\" rel=\"external_link\" target=\"_blank\">DOF<\/a> manipulator (MKM), developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Zeiss_AG\" title=\"Carl Zeiss AG\" rel=\"external_link\" target=\"_blank\">Carl Zeiss<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"SSN\">SSN<\/span><\/h2>\n<p>The <b>SSN<\/b> has been developed as a computer system for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">bone segment navigation<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_and_maxillofacial_surgery\" title=\"Oral and maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">oral and maxillofacial surgery<\/a>. It allows a very precise repositioning of bone fragments, with the advent of preoperative simulation and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_planning\" title=\"Surgical planning\" rel=\"external_link\" target=\"_blank\">surgical planning<\/a>.The system has been developed since 1997 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Regensburg\" title=\"University of Regensburg\" rel=\"external_link\" target=\"_blank\">University of Regensburg, Germany<\/a>, with the support of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Zeiss_AG\" title=\"Carl Zeiss AG\" rel=\"external_link\" target=\"_blank\">Carl Zeiss Company<\/a>. Its principle is based on an infrared localisation system, composed of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a> camera and at least three infrared <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmitters\" class=\"mw-redirect\" title=\"Transmitters\" rel=\"external_link\" target=\"_blank\">transmitters<\/a> attached to each bony fragment. The SSN is mainly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthognatic_surgery\" class=\"mw-redirect\" title=\"Orthognatic surgery\" rel=\"external_link\" target=\"_blank\">orthognatic surgery<\/a> (surgical correction of dysgnathia), but also for the surgical reconstruction of the orbit, or other surgical interventions to the midface.\n<\/p>\n<h2><span id=\"rdp-ebb-SSN.2B.2B\"><\/span><span class=\"mw-headline\" id=\"SSN++\">SSN++<\/span><\/h2>\n<p>Since 2001, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Heidelberg\" class=\"mw-redirect\" title=\"University of Heidelberg\" rel=\"external_link\" target=\"_blank\">University of Heidelberg, Germany<\/a>, the <b>SSN++<\/b> has been developed, a markerless-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">registration<\/a> navigation system, based on a native (=markerless) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>. In this case, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">patient registration<\/a> is obtained on the operating table, using a surface scanner. The SSN++ correlates the surface scan data (gathered on the operating table) with the skin surface reconstruction from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dataset\" class=\"mw-redirect\" title=\"Dataset\" rel=\"external_link\" target=\"_blank\">dataset<\/a> obtained preoperatively by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>. This principle complies with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/TERCOM\" title=\"TERCOM\" rel=\"external_link\" target=\"_blank\">terrain contour matching<\/a> principle described for flying objects. The advantage of the new method is that the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">registration of the patient's position<\/a> becomes a simple automated procedure; on the other hand, the radiation load for the patient is reduced, compared to the method using markers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li>Marmulla R, Niederdellmann H: <i>Computer-assisted Bone Segment Navigation<\/i>, J Craniomaxillofac Surg 26: 347\u2013359, 1998<\/li>\n<li>Marmulla R, Niederdellmann H: <i>Surgical Planning of Computer Assisted Repositioning Osteotomies<\/i>, Plast Reconstr Surg 104 (4): 938\u2013944, 1999<\/li>\n<li>Marmulla R, M\u00fchling J, L\u00fcth T, Eggers G, Hassfeld S: <i>Advanced surface-recording techniques for computer-assisted oral and maxillofacial surgery<\/i>, Br J Oral Maxillofac Surg, 42: 511\u2013519, 2004<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/marmulla.com\/compengl.htm\" target=\"_blank\">SSN Homepage<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181126150205\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.018 seconds\nPreprocessor visited node count: 34\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 0\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 0.000 1 -total\n-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:15753093-1!canonical and timestamp 20181126150205 and revision id 862034115\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_segment_navigator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214652\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.100 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 95.123 1 - wikipedia:Surgical_segment_navigator\n100.00% 95.123 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8080-0!*!*!*!*!*!* and timestamp 20181217214652 and revision id 24198\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator\">https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5ff57cc066e5fb627487105a67a6f125_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/78\/SSNNavigation.jpg"],"5ff57cc066e5fb627487105a67a6f125_timestamp":1545083212,"459438aa577ac442814a6c6946908980_type":"article","459438aa577ac442814a6c6946908980_title":"Remote patient monitoring","459438aa577ac442814a6c6946908980_url":"https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring","459438aa577ac442814a6c6946908980_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRemote patient monitoring\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tRemote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings (e.g. in the home), which may increase access to care and decrease healthcare delivery costs.\nIncorporating RPM in chronic disease management can significantly improve an individual's quality of life. It allows patients to maintain independence, prevent complications, and minimize personal costs.[1] RPM facilitates these goals by delivering care right to the home. In addition, patients and their family members feel comfort knowing that they are being monitored and will be supported if a problem arises. This is particularly important when patients are managing complex self-care processes such as home hemodialysis.[2]\nKey features of RPM, like remote monitoring and trend analysis of physiological parameters, enable early detection of deterioration; thereby, reducing number of emergency department visits, hospitalizations, and duration of hospital stays.[3]\nThe need for wireless mobility in healthcare facilitates the adoption of RPM both in community and institutional settings. The time saved as a result of RPM implementation increases efficiency, and allows healthcare providers to allocate more time to remotely educate and communicate with patients.[4][5][6]\n\n<\/p>\nContents \n\n1 Technological components \n2 Applications \n\n2.1 Dementia and falls \n2.2 Diabetes \n2.3 Congestive heart failure \n2.4 Infertility \n2.5 Early adopter: Veterans Health Administration \n2.6 Whole System Demonstrator Trial in UK \n\n\n3 Limitations \n4 Controversy \n5 See also \n6 References \n\n\nTechnological components \nThe diverse applications of RPM lead to numerous variations of RPM technology architecture. However, most RPM technologies follow a general architecture that consists of four components.:[7]\n\nSensors on a device that is enabled by wireless communications to measure physiological parameters.\nLocal data storage at patients\u2019 site that interfaces between sensors and other centralized data repository and\/or healthcare providers.\nCentralized repository to store data sent from sensors, local data storage, diagnostic applications, and\/or healthcare providers.\nDiagnostic application software that develops treatment recommendations and intervention alerts based on the analysis of collected data.\nDepending on the disease and the parameters that are monitored, different combinations of sensors, storage, and applications may be deployed.[4][7]\n\nApplications \nPhysiological data such as blood pressure and subjective patient data are collected by sensors on peripheral devices. Examples of peripheral devices are: blood pressure cuff, pulse oximeter, and glucometer. The data are transmitted to healthcare providers or third parties via wireless telecommunication devices. The data are evaluated for potential problems by a healthcare professional or via a clinical decision support algorithm, and patient, caregivers, and health providers are immediately alerted if a problem is detected.[3] As a result, timely intervention ensures positive patient outcomes. The newer applications also provide education, test and medication reminder alerts, and a means of communication between the patient and the provider.[3] The following section illustrates examples of RPM applications, but RPM is not limited to those disease states.\n\nDementia and falls \n Telehealth Response Watch\nFor patients with dementia that are at risk for falls, RPM technology promotes safety and prevents harm through continuous surveillance.[3] RPM sensors can be affixed to the individual or their assistive mobility devices such as canes and walkers.[3] The sensors monitor an individual\u2019s location, gait, linear acceleration and angular velocity, and utilize a mathematical algorithm to predict the likelihood for falls, detect movement changes, and alert caregivers if the individual has fallen.[3] Furthermore, tracking capabilities via Wi-Fi, global positioning system (GPS) or radio frequency enables caregivers to locate wandering elders.[3]\n\nDiabetes \nDiabetes management requires control of multiple parameters: blood pressure, weight, and blood glucose. The real-time delivery of blood glucose and blood pressure readings enables immediate alerts for patient and healthcare providers to intervene when needed. There is evidence to show that daily diabetes management involving RPM is just as effective as usual clinic visit every 3 months.[8]\n\nCongestive heart failure \nA systematic review of the literature on home monitoring for heart failure patients indicates that RPM improves quality of life, improves patient-provider relationships, shortens duration of stay in hospitals, decreases mortality rate, and reduces costs to the healthcare system.[9]\n\nInfertility \nA recent study of a remote patient monitoring solution for infertility demonstrated that for appropriately screened patients who had been seeking In-Vitro Fertilization (IVF) treatment, a six-month remote monitoring program had the same pregnancy rate as a cycle of IVF.[10] The remote patient monitoring product and service used had a cost-per-patient of $800, compared to the average cost of a cycle of IVF of $15,000, suggesting a 95% reduction in the cost of care for the same outcome.\n\nEarly adopter: Veterans Health Administration \nThe Veterans Health Administration (VHA), United States\u2019 largest integrated healthcare system, is highly involved in the implementation and evaluation of RPM technologies. It has expanded use of RPM beyond common chronic disease applications, to post-traumatic stress disorder, cancer and palliative care.[5] VHA\u2019s findings indicate improvements in a wide range of metrics, including decrease in emergency department visits, hospitalizations, and nursing home admissions.[5] Findings from the VHA Care Coordination\/Home Telehealth program show that RPM deployment resulted in significant savings to the organization.[11]\n\nWhole System Demonstrator Trial in UK \nThe UK\u2019s Department of Health\u2019s Whole System Demonstrator (WSD)[12] launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall. The trials were evaluated by: City University London, University of Oxford, University of Manchester, Nuffield Trust, Imperial College London and London School of Economics.\n\n45% reduction in mortality rates\n20% reduction in emergency admissions\n15% reduction in A&E visits\n14% reduction in elective admissions\n14% reduction in bed days\n8% reduction in tariff costs\nIn the UK, the Government's Care Services minister, Paul Burstow, has stated that telehealth and telecare would be extended over the next five years (2012-2017) to reach three million people.[13]\n\nLimitations \nRPM is highly dependent on the individual\u2019s motivation to manage their health. Without the patient\u2019s willingness to be an active participant in their care, RPM implementation will likely fail. Cost is also a barrier to its widespread use. \nThere is a lack of reimbursement guidelines for RPM services, which may deter its incorporation into clinical practice.[7]\nThe shift of accountability associated with RPM brings up liability issues.[7] There are no clear guidelines in respect to whether clinicians have to intervene every time they receive an alert regardless of the urgency.\nThe continuous flow of patient data requires a dedicated team of health care providers to handle the information, which may, in fact, increase the workload. Although technology is introduced with the intent to increase efficiency, it can become a barrier to some healthcare providers that are not technological.\nThere are common obstacles that health informatics technologies encounter that applies to RPM. Depending on the comorbidities monitored, RPM involves a diverse selection of devices in its implementation. Standardization is required for data exchange and interoperability among multiple components. Furthermore, RPM deployment is highly dependent on an extensive wireless telecommunications infrastructure, which may not be available or feasible in rural areas. Since RPM involves transmission of sensitive patient data across telecommunication networks, information security is a concern.[7]\n\nControversy \nPublished by the New England Journal of Medicine, a randomized controlled trial involving congestive heart failure patients concluded that the use of telemonitoring failed to provide a benefit over usual care.[14] The telemonitoring patient group was instructed to call a designated number daily, and answer a series of questions about their symptoms using a keypad.[14] Clearly, the process described by Chaudhry et al. (2010) differs from the RPM methodology illustrated in the overview, which involves actual collection and transmission of physiological data through point-of-care devices. With articles[15][16] from Forbes associating RPM with the negative findings by Chaudhry et al. (2010), it may be difficult to clear the misconception that telemonitoring is synonymous with remote patient monitoring. The lack of standardization of RPM nomenclature and definition makes it difficult to differentiate between different forms of patient monitoring involving technology.\n\nSee also \nBiotelemetry\nTelehealth\neHealth\nmHealth\nReferences \n\n\n^ Bayliss, E.; Steiner, J.F.; Fernald, D.H.; Crane, L.A.; Main, D.S. (2003). \"Descriptions of barriers to self-care by persons with comorbid chronic diseases\". Ann Fam Med. 1 (1): 15\u201321. doi:10.1370\/afm.4. PMC 1466563 . \n\n^ Cafazzo, J.A., Leonard, K., Easty, A.C., Rossos, P.G., & Chan, C.T. (2009). Bridging the self-care deficit gap: remote patient monitoring and hospital at home. In Electronic Healthcare First International Conference, eHealth 2008. doi:10.1007\/978-3-642-00413-1_8 \n\n^ a b c d e f g Center for Technology and Aging. (2009, December). Technologies for remote patient monitoring in older adults discussion paper. Retrieved from http:\/\/www.techandaging.org\/RPMpositionpaperDraft.pdf \n\n^ a b O'Donoghue, John; Herbert, John (2012). \"Data Management within mHealth Environments: Patient Sensors, Mobile Devices, and Databases\". J. Data and Information Quality. 4: 1\u201320. doi:10.1145\/2378016.2378021. \n\n^ a b c Coye, M.; Haskelkorn, A.; Demello, S. (2009). \"Remote patient management: technology-enabled innovation and evolving business models for chronic disease care\". Health Affairs. 28 (1): 126\u2013135. doi:10.1377\/hlthaff.28.1.126. \n\n^ Vavilis, S., Petkovi\u0107, M., & Zannone, N. (2012). Impact of ICT on home healthcare . In ICT Critical Infrastructures and Society (pp. 111-122). Springer Berlin Heidelberg. \n\n^ a b c d e Smith, T. & Sweeney, R. (2010, September). Fusion trends and opportunities. Medical devices and communications. Retrieved from http:\/\/www.nerac.com\/nerac_insights.php?category=reports&id=279 \n\n^ Chase, H.P.; Pearson, J.A.; Wightman, C.; Roberts, M.D.; Oderberg, A.D.; Garg, S.K. \"Modem transmission of glucose values reduces the costs and need for clinic visits\". Diabetes Care. 26 (5): 1475\u20131479. doi:10.2337\/diacare.26.5.1475. \n\n^ Mart\u00ednez, A.; Everss, E.; Rojo-Alvarez, J.L.; Figal, D.P.; Garc\u00eda-Alberola, A. (2006). \"A systematic review of the literature on home monitoring for patients with heart failure\". J Telemed Telecare. 12 (5): 234\u201341. doi:10.1258\/135763306777889109. \n\n^ Chausiaux, O.; Hayes, J.; Long, C.; Morris, S.; Williams, G.; Husheer, S. (2011). \"Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation\/Intracytoplasmic Sperm Injection\". European Obstetrics & Gynaecology. 6 (2): 92\u20134. \n\n^ Darkins, A.; Ryan, P.; Kobb, R.; Foster, L; Edmonson, E.; Wakefield, B.; Lancaster, A.E. (2008). \"Care coordination\/home Telehealth: the systematic implementation of health informatics, home Telehealth, and disease management to support the care of Veteran patients with chronic conditions\". Telemed J E-Health. 14 (10): 1118\u20131126. doi:10.1089\/tmj.2008.0021. \n\n^ Whole Systems Demonstrators: An Overview of Telecare and Telehealth \n\n^ 3 Million Lives Announcement \n\n^ a b Chaudhry, S.I.; Mattera, J.A.; Curtis, J.P.; Spertus, J.A.; Herrin, J.; Lin, Z.; Phillips, C.O.; Hodshon, B.V.; Coopers, L.S.; Krumholz, H.M. (2010). \"Telemonitoring in patients with heart failure\". N Engl J Med. 363: 2301\u20132309. doi:10.1056\/nejmoa1010029. PMC 3237394 . \n\n^ Langreth, R. (2010, November 18). \"Why remote patient monitoring is overhyped\". Forbes. Retrieved from https:\/\/www.forbes.com\/sites\/robertlangreth\/2010\/11\/18\/why-telemedicine-is-overhyped\/2\/ \n\n^ Krumholz, H. (2010, November 19). \"A double whammy for remote patient monitoring\". Forbes. Retrieved from https:\/\/www.forbes.com\/sites\/sciencebiz\/2010\/11\/19\/a-double-whammy-for-remote-patient-monitoring\/ \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring\">https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring<\/a>\n\t\t\t\t\tCategories: Healthcare termsMedical devicesMedical monitoring and signal processingMedical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:19.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 938 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","459438aa577ac442814a6c6946908980_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Remote_patient_monitoring skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Remote patient monitoring<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Remote patient monitoring<\/b> (<b>RPM<\/b>) is a technology to enable monitoring of patients outside of conventional clinical settings (e.g. in the home), which may increase access to care and decrease healthcare delivery costs.\n<\/p><p>Incorporating RPM in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_disease\" class=\"mw-redirect\" title=\"Chronic disease\" rel=\"external_link\" target=\"_blank\">chronic disease<\/a> management can significantly improve an individual's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_life\" title=\"Quality of life\" rel=\"external_link\" target=\"_blank\">quality of life<\/a>. It allows patients to maintain independence, prevent complications, and minimize personal costs.<sup id=\"rdp-ebb-cite_ref-bayliss_1-0\" class=\"reference\"><a href=\"#cite_note-bayliss-1\" rel=\"external_link\">[1]<\/a><\/sup> RPM facilitates these goals by delivering care right to the home. In addition, patients and their family members feel comfort knowing that they are being monitored and will be supported if a problem arises. This is particularly important when patients are managing complex <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-care\" title=\"Self-care\" rel=\"external_link\" target=\"_blank\">self-care<\/a> processes such as home <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<p>Key features of RPM, like remote monitoring and trend analysis of physiological parameters, enable early detection of deterioration; thereby, reducing number of emergency department visits, hospitalizations, and duration of hospital stays.<sup id=\"rdp-ebb-cite_ref-center_3-0\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup>\nThe need for wireless mobility in healthcare facilitates the adoption of RPM both in community and institutional settings. The time saved as a result of RPM implementation increases efficiency, and allows healthcare providers to allocate more time to remotely educate and communicate with patients.<sup id=\"rdp-ebb-cite_ref-dx.doi.org_4-0\" class=\"reference\"><a href=\"#cite_note-dx.doi.org-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-coye_5-0\" class=\"reference\"><a href=\"#cite_note-coye-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ict_6-0\" class=\"reference\"><a href=\"#cite_note-ict-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Technological_components\">Technological components<\/span><\/h2>\n<p>The diverse applications of RPM lead to numerous variations of RPM technology architecture. However, most RPM technologies follow a general architecture that consists of four components.:<sup id=\"rdp-ebb-cite_ref-smith_7-0\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<ul><li>Sensors on a device that is enabled by wireless communications to measure physiological parameters.<\/li>\n<li>Local data storage at patients\u2019 site that interfaces between sensors and other centralized data repository and\/or healthcare providers.<\/li>\n<li>Centralized repository to store data sent from sensors, local data storage, diagnostic applications, and\/or healthcare providers.<\/li>\n<li>Diagnostic application software that develops treatment recommendations and intervention alerts based on the analysis of collected data.<\/li><\/ul>\n<p>Depending on the disease and the parameters that are monitored, different combinations of sensors, storage, and applications may be deployed.<sup id=\"rdp-ebb-cite_ref-dx.doi.org_4-1\" class=\"reference\"><a href=\"#cite_note-dx.doi.org-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-smith_7-1\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Physiological data such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a> and subjective patient data are collected by sensors on peripheral devices. Examples of peripheral devices are: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure_cuff\" class=\"mw-redirect\" title=\"Blood pressure cuff\" rel=\"external_link\" target=\"_blank\">blood pressure cuff<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_oximeter\" class=\"mw-redirect\" title=\"Pulse oximeter\" rel=\"external_link\" target=\"_blank\">pulse oximeter<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucometer\" class=\"mw-redirect\" title=\"Glucometer\" rel=\"external_link\" target=\"_blank\">glucometer<\/a>. The data are transmitted to healthcare providers or third parties via wireless telecommunication devices. The data are evaluated for potential problems by a healthcare professional or via a clinical decision support algorithm, and patient, caregivers, and health providers are immediately alerted if a problem is detected.<sup id=\"rdp-ebb-cite_ref-center_3-1\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> As a result, timely intervention ensures positive patient outcomes. The newer applications also provide education, test and medication reminder alerts, and a means of communication between the patient and the provider.<sup id=\"rdp-ebb-cite_ref-center_3-2\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> The following section illustrates examples of RPM applications, but RPM is not limited to those disease states.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dementia_and_falls\">Dementia and falls<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Telehealth_-_Response_Watch.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Telehealth_-_Response_Watch.jpg\/220px-Telehealth_-_Response_Watch.jpg\" width=\"220\" height=\"361\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Telehealth_-_Response_Watch.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Telehealth Response Watch<\/div><\/div><\/div>\n<p>For patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a> that are at risk for falls, RPM technology promotes safety and prevents harm through continuous surveillance.<sup id=\"rdp-ebb-cite_ref-center_3-3\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> RPM sensors can be affixed to the individual or their assistive mobility devices such as canes and walkers.<sup id=\"rdp-ebb-cite_ref-center_3-4\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> The sensors monitor an individual\u2019s location, gait, linear acceleration and angular velocity, and utilize a mathematical algorithm to predict the likelihood for falls, detect movement changes, and alert caregivers if the individual has fallen.<sup id=\"rdp-ebb-cite_ref-center_3-5\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> Furthermore, tracking capabilities via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wi-Fi\" title=\"Wi-Fi\" rel=\"external_link\" target=\"_blank\">Wi-Fi<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Global_positioning_system\" class=\"mw-redirect\" title=\"Global positioning system\" rel=\"external_link\" target=\"_blank\">global positioning system<\/a> (GPS) or radio frequency enables caregivers to locate wandering elders.<sup id=\"rdp-ebb-cite_ref-center_3-6\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Diabetes\">Diabetes<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes\" class=\"mw-redirect\" title=\"Diabetes\" rel=\"external_link\" target=\"_blank\">Diabetes<\/a> management requires control of multiple parameters: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a>, weight, and blood glucose. The real-time delivery of blood glucose and blood pressure readings enables immediate alerts for patient and healthcare providers to intervene when needed. There is evidence to show that daily diabetes management involving RPM is just as effective as usual clinic visit every 3 months.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Congestive_heart_failure\">Congestive heart failure<\/span><\/h3>\n<p>A systematic review of the literature on home monitoring for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_failure\" title=\"Heart failure\" rel=\"external_link\" target=\"_blank\">heart failure<\/a> patients indicates that RPM improves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_life\" title=\"Quality of life\" rel=\"external_link\" target=\"_blank\">quality of life<\/a>, improves patient-provider relationships, shortens duration of stay in hospitals, decreases mortality rate, and reduces costs to the healthcare system.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Infertility\">Infertility<\/span><\/h3>\n<p>A recent study of a remote patient monitoring solution for infertility demonstrated that for appropriately screened patients who had been seeking In-Vitro Fertilization (IVF) treatment, a six-month remote monitoring program had the same pregnancy rate as a cycle of IVF.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The remote patient monitoring product and service used had a cost-per-patient of $800, compared to the average cost of a cycle of IVF of $15,000, suggesting a 95% reduction in the cost of care for the same outcome.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Early_adopter:_Veterans_Health_Administration\">Early adopter: Veterans Health Administration<\/span><\/h3>\n<p>The Veterans Health Administration (VHA), United States\u2019 largest integrated healthcare system, is highly involved in the implementation and evaluation of RPM technologies. It has expanded use of RPM beyond common chronic disease applications, to post-traumatic stress disorder, cancer and palliative care.<sup id=\"rdp-ebb-cite_ref-coye_5-1\" class=\"reference\"><a href=\"#cite_note-coye-5\" rel=\"external_link\">[5]<\/a><\/sup> VHA\u2019s findings indicate improvements in a wide range of metrics, including decrease in emergency department visits, hospitalizations, and nursing home admissions.<sup id=\"rdp-ebb-cite_ref-coye_5-2\" class=\"reference\"><a href=\"#cite_note-coye-5\" rel=\"external_link\">[5]<\/a><\/sup> Findings from the VHA Care Coordination\/Home Telehealth program show that RPM deployment resulted in significant savings to the organization.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Whole_System_Demonstrator_Trial_in_UK\">Whole System Demonstrator Trial in UK<\/span><\/h3>\n<p>The UK\u2019s Department of Health\u2019s Whole System Demonstrator (WSD)<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> launched in May 2008. It is the largest randomised control trial of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telehealth\" title=\"Telehealth\" rel=\"external_link\" target=\"_blank\">telehealth<\/a> and telecare in the world, involving 6191 patients and 238 GP practices across three sites, <a href=\"https:\/\/en.wikipedia.org\/wiki\/London_Borough_of_Newham\" title=\"London Borough of Newham\" rel=\"external_link\" target=\"_blank\">Newham<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kent\" title=\"Kent\" rel=\"external_link\" target=\"_blank\">Kent<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornwall\" title=\"Cornwall\" rel=\"external_link\" target=\"_blank\">Cornwall<\/a>. The trials were evaluated by: <a href=\"https:\/\/en.wikipedia.org\/wiki\/City_University_London\" class=\"mw-redirect\" title=\"City University London\" rel=\"external_link\" target=\"_blank\">City University London<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Oxford\" title=\"University of Oxford\" rel=\"external_link\" target=\"_blank\">University of Oxford<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Manchester\" title=\"University of Manchester\" rel=\"external_link\" target=\"_blank\">University of Manchester<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuffield_Trust\" title=\"Nuffield Trust\" rel=\"external_link\" target=\"_blank\">Nuffield Trust<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Imperial_College_London\" title=\"Imperial College London\" rel=\"external_link\" target=\"_blank\">Imperial College London<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/London_School_of_Economics\" title=\"London School of Economics\" rel=\"external_link\" target=\"_blank\">London School of Economics<\/a>.\n<\/p>\n<ul><li>45% reduction in mortality rates<\/li>\n<li>20% reduction in emergency admissions<\/li>\n<li>15% reduction in A&E visits<\/li>\n<li>14% reduction in elective admissions<\/li>\n<li>14% reduction in bed days<\/li>\n<li>8% reduction in tariff costs<\/li><\/ul>\n<p>In the UK, the Government's Care Services minister, Paul Burstow, has stated that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telehealth\" title=\"Telehealth\" rel=\"external_link\" target=\"_blank\">telehealth<\/a> and telecare would be extended over the next five years (2012-2017) to reach three million people.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Limitations\">Limitations<\/span><\/h2>\n<p>RPM is highly dependent on the individual\u2019s motivation to manage their health. Without the patient\u2019s willingness to be an active participant in their care, RPM implementation will likely fail. Cost is also a barrier to its widespread use. \nThere is a lack of reimbursement guidelines for RPM services, which may deter its incorporation into clinical practice.<sup id=\"rdp-ebb-cite_ref-smith_7-2\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\nThe shift of accountability associated with RPM brings up liability issues.<sup id=\"rdp-ebb-cite_ref-smith_7-3\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup> There are no clear guidelines in respect to whether clinicians have to intervene every time they receive an alert regardless of the urgency.\nThe continuous flow of patient data requires a dedicated team of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care_providers\" class=\"mw-redirect\" title=\"Health care providers\" rel=\"external_link\" target=\"_blank\">health care providers<\/a> to handle the information, which may, in fact, increase the workload. Although technology is introduced with the intent to increase efficiency, it can become a barrier to some healthcare providers that are not technological.\nThere are common obstacles that health informatics technologies encounter that applies to RPM. Depending on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Comorbidities\" class=\"mw-redirect\" title=\"Comorbidities\" rel=\"external_link\" target=\"_blank\">comorbidities<\/a> monitored, RPM involves a diverse selection of devices in its implementation. Standardization is required for data exchange and interoperability among multiple components. Furthermore, RPM deployment is highly dependent on an extensive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wireless_telecommunications\" class=\"mw-redirect\" title=\"Wireless telecommunications\" rel=\"external_link\" target=\"_blank\">wireless telecommunications<\/a> infrastructure, which may not be available or feasible in rural areas. Since RPM involves transmission of sensitive patient data across telecommunication networks, information security is a concern.<sup id=\"rdp-ebb-cite_ref-smith_7-4\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Controversy\">Controversy<\/span><\/h2>\n<p>Published by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_England_Journal_of_Medicine\" class=\"mw-redirect\" title=\"New England Journal of Medicine\" rel=\"external_link\" target=\"_blank\">New England Journal of Medicine<\/a>, a randomized controlled trial involving congestive heart failure patients concluded that the use of telemonitoring failed to provide a benefit over usual care.<sup id=\"rdp-ebb-cite_ref-chan_14-0\" class=\"reference\"><a href=\"#cite_note-chan-14\" rel=\"external_link\">[14]<\/a><\/sup> The telemonitoring patient group was instructed to call a designated number daily, and answer a series of questions about their symptoms using a keypad.<sup id=\"rdp-ebb-cite_ref-chan_14-1\" class=\"reference\"><a href=\"#cite_note-chan-14\" rel=\"external_link\">[14]<\/a><\/sup> Clearly, the process described by Chaudhry et al. (2010) differs from the RPM methodology illustrated in the overview, which involves actual collection and transmission of physiological data through point-of-care devices. With articles<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forbes\" title=\"Forbes\" rel=\"external_link\" target=\"_blank\">Forbes<\/a> associating RPM with the negative findings by Chaudhry et al. (2010), it may be difficult to clear the misconception that telemonitoring is synonymous with remote patient monitoring. The lack of standardization of RPM nomenclature and definition makes it difficult to differentiate between different forms of patient monitoring involving technology.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biotelemetry\" title=\"Biotelemetry\" rel=\"external_link\" target=\"_blank\">Biotelemetry<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Telehealth\" title=\"Telehealth\" rel=\"external_link\" target=\"_blank\">Telehealth<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/EHealth\" title=\"EHealth\" rel=\"external_link\" target=\"_blank\">eHealth<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/MHealth\" title=\"MHealth\" rel=\"external_link\" target=\"_blank\">mHealth<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-bayliss-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-bayliss_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bayliss, E.; Steiner, J.F.; Fernald, D.H.; Crane, L.A.; Main, D.S. (2003). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1466563\" target=\"_blank\">\"Descriptions of barriers to self-care by persons with comorbid chronic diseases\"<\/a>. <i>Ann Fam Med<\/i>. <b>1<\/b> (1): 15\u201321. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1370%2Fafm.4\" target=\"_blank\">10.1370\/afm.4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1466563\" target=\"_blank\">1466563<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+Fam+Med&rft.atitle=Descriptions+of+barriers+to+self-care+by+persons+with+comorbid+chronic+diseases&rft.volume=1&rft.issue=1&rft.pages=15-21&rft.date=2003&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1466563&rft_id=info%3Adoi%2F10.1370%2Fafm.4&rft.aulast=Bayliss&rft.aufirst=E.&rft.au=Steiner%2C+J.F.&rft.au=Fernald%2C+D.H.&rft.au=Crane%2C+L.A.&rft.au=Main%2C+D.S.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1466563&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+patient+monitoring\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Cafazzo, J.A., Leonard, K., Easty, A.C., Rossos, P.G., & Chan, C.T. 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(2011). \"Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation\/Intracytoplasmic Sperm Injection\". <i>European Obstetrics & Gynaecology<\/i>. <b>6<\/b> (2): 92\u20134.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Obstetrics+%26+Gynaecology&rft.atitle=Pregnancy+Prognosis+in+Infertile+Couples+on+the+DuoFertility+Programme+Compared+with+In+Vitro+Fertilisation%2FIntracytoplasmic+Sperm+Injection&rft.volume=6&rft.issue=2&rft.pages=92-4&rft.date=2011&rft.aulast=Chausiaux&rft.aufirst=O.&rft.au=Hayes%2C+J.&rft.au=Long%2C+C.&rft.au=Morris%2C+S.&rft.au=Williams%2C+G.&rft.au=Husheer%2C+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+patient+monitoring\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Darkins, A.; Ryan, P.; Kobb, R.; Foster, L; Edmonson, E.; Wakefield, B.; Lancaster, A.E. (2008). \"Care coordination\/home Telehealth: the systematic implementation of health informatics, home Telehealth, and disease management to support the care of Veteran patients with chronic conditions\". <i>Telemed J E-Health<\/i>. <b>14<\/b> (10): 1118\u20131126. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Ftmj.2008.0021\" target=\"_blank\">10.1089\/tmj.2008.0021<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Telemed+J+E-Health&rft.atitle=Care+coordination%2Fhome+Telehealth%3A+the+systematic+implementation+of+health+informatics%2C+home+Telehealth%2C+and+disease+management+to+support+the+care+of+Veteran+patients+with+chronic+conditions&rft.volume=14&rft.issue=10&rft.pages=1118-1126&rft.date=2008&rft_id=info%3Adoi%2F10.1089%2Ftmj.2008.0021&rft.aulast=Darkins&rft.aufirst=A.&rft.au=Ryan%2C+P.&rft.au=Kobb%2C+R.&rft.au=Foster%2C+L&rft.au=Edmonson%2C+E.&rft.au=Wakefield%2C+B.&rft.au=Lancaster%2C+A.E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+patient+monitoring\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dh.gov.uk\/prod_consum_dh\/groups\/dh_digitalassets\/documents\/digitalasset\/dh_100947.pdf\" target=\"_blank\">Whole Systems Demonstrators: An Overview of Telecare and Telehealth<\/a><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dh.gov.uk\/health\/2012\/01\/roll-out-of-telehealth-and-telecare-to-benefit-three-million-lives\/\" target=\"_blank\">3 Million Lives Announcement<\/a><\/span>\n<\/li>\n<li id=\"cite_note-chan-14\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-chan_14-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-chan_14-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chaudhry, S.I.; Mattera, J.A.; Curtis, J.P.; Spertus, J.A.; Herrin, J.; Lin, Z.; Phillips, C.O.; Hodshon, B.V.; Coopers, L.S.; Krumholz, H.M. (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3237394\" target=\"_blank\">\"Telemonitoring in patients with heart failure\"<\/a>. <i>N Engl J Med<\/i>. <b>363<\/b>: 2301\u20132309. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2Fnejmoa1010029\" target=\"_blank\">10.1056\/nejmoa1010029<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3237394\" target=\"_blank\">3237394<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=N+Engl+J+Med&rft.atitle=Telemonitoring+in+patients+with+heart+failure&rft.volume=363&rft.pages=2301-2309&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3237394&rft_id=info%3Adoi%2F10.1056%2Fnejmoa1010029&rft.aulast=Chaudhry&rft.aufirst=S.I.&rft.au=Mattera%2C+J.A.&rft.au=Curtis%2C+J.P.&rft.au=Spertus%2C+J.A.&rft.au=Herrin%2C+J.&rft.au=Lin%2C+Z.&rft.au=Phillips%2C+C.O.&rft.au=Hodshon%2C+B.V.&rft.au=Coopers%2C+L.S.&rft.au=Krumholz%2C+H.M.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3237394&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+patient+monitoring\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Langreth, R. (2010, November 18). \"Why remote patient monitoring is overhyped\". Forbes. Retrieved from <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.forbes.com\/sites\/robertlangreth\/2010\/11\/18\/why-telemedicine-is-overhyped\/2\/\" target=\"_blank\">https:\/\/www.forbes.com\/sites\/robertlangreth\/2010\/11\/18\/why-telemedicine-is-overhyped\/2\/<\/a><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Krumholz, H. (2010, November 19). \"A double whammy for remote patient monitoring\". Forbes. Retrieved from <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.forbes.com\/sites\/sciencebiz\/2010\/11\/19\/a-double-whammy-for-remote-patient-monitoring\/\" target=\"_blank\">https:\/\/www.forbes.com\/sites\/sciencebiz\/2010\/11\/19\/a-double-whammy-for-remote-patient-monitoring\/<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181209114542\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.216 seconds\nReal time usage: 0.253 seconds\nPreprocessor visited node count: 805\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17595\/2097152 bytes\nTemplate argument size: 315\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 30359\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.119\/10.000 seconds\nLua memory usage: 3.14 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 197.322 1 Template:Reflist\n100.00% 197.322 1 -total\n<\/p>\n<pre>81.18% 160.187 8 Template:Cite_journal\n 5.31% 10.481 1 Template:Doi\n 2.80% 5.533 2 Template:Hide_in_print\n 1.37% 2.708 1 Template:Main_other\n 1.26% 2.480 1 Template:Only_in_print\n 1.25% 2.464 1 Template:Str_left\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:33537087-1!canonical and timestamp 20181209114541 and revision id 845122510\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_patient_monitoring\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214652\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.027 seconds\nReal time usage: 0.168 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 161.217 1 - wikipedia:Remote_patient_monitoring\n100.00% 161.217 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8551-0!*!*!*!*!*!* and timestamp 20181217214652 and revision id 27020\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring\">https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","459438aa577ac442814a6c6946908980_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Telehealth_-_Response_Watch.jpg\/440px-Telehealth_-_Response_Watch.jpg"],"459438aa577ac442814a6c6946908980_timestamp":1545083212,"523b73ff51fa83663dc0b1d59e6d0f05_type":"article","523b73ff51fa83663dc0b1d59e6d0f05_title":"Picture archiving and communication system","523b73ff51fa83663dc0b1d59e6d0f05_url":"https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system","523b73ff51fa83663dc0b1d59e6d0f05_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPicture archiving and communication system\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t This image demonstrates a basic set of interconnections among a PACS, a radiology information system (RIS), the imaging modalities, and other components of the PACS, standardized by DICOM.\nA picture archiving and communication system (PACS) is a digital imaging system composed of a set of components that allow for the digital acquisition, archiving, communication, retrieval, processing, distribution, and display of medical images.[1] The PACS may consist of only a few components or be sufficiently complex to handle a hospital or healthcare enterprise environment. Regardless, it must be durable enough for daily use in a clinical environment, integrate to and from several medical imaging modalities, and have sufficient workstations for technicians utilizing those modalities to perform their work inside and outside the radiology department.[1] PACS benefit healthcare providers by digitally managing medical images, eliminating the need to manually file, retrieve, or transport film jackets. This often saves processing time in both the diagnostics and reporting related to the imagery, especially when integrated with speech recognition technology.[2]\n\nContents\n\n1 History \n2 Technology \n3 See also \n4 References \n\n\n\nHistory \nWhile the theoretical concepts surrounding a digital image management system were around as early as the late 1970s, the idea didn't solidify until the January 1982 First International Conference and Workshop on Picture Archiving and Communications Systems in Newport Beach, California.[1] There researcher Carla Marceau defined the PACS as \"a digital system for acquiring, storing, moving and displaying picture or image information.\"[3] This was followed soon after (July 1982) by the The First International Symposium on PACS and PHD (Personal Health Data) in Japan and the EuroPACS annual conference in 1983. Another meeting dedicated to PACS occurred in Evian, France in October 1990, dubbed \"central to the formation of a critical PACS project: the Medical Diagnostic Imaging Support System.\"[1] By late 1997, the disparate PACS groups spread across the United States, Japan, and Europe began working together to form some truly international PACS implementations. This international effort was buoyed by the internationalization of the DICOM standard in 1993, globalization of imaging manufacturers, and sharing of PACS information and experiences among the groups.\n\nTechnology \nA quality PACS design depends on system connectivity and workflow efficiency. It features a standardized, open architecture and is expandable for future growth. Hardware includes imaging device interfaces, storage devices, communication networks, patient data servers, display tools, and imaging modalities \"integrated by a standardized, flexible software system for communication, database management, storage management, job scheduling, interprocessor communication, error handling, and network monitoring.\"[1] Other components that necessarily integrate to the PACS include a radiology information system (RIS) and a hospital information system (HIS), extending its effectiveness even further. All of these components \"talk\" to each other in no small part because of the DICOM (Digital Imaging and Communications in Medicine) standard which ensures a uniform handling, storing, printing, and transmitting of medical imaging data.[1][4] \nThis interfacing between multiple systems provides more consistent and reliable data by reducing the risk of entering incorrect patient information (through QA and error checking) and by strengthening merged datasets across multiple systems by using a unique, transferable ID like an NHS or Social Security number. Analysis and reporting also becomes more integrated and rapid across the entire provider-patient pipeline.[4]\n\nSee also \n Imaging informatics\n DICOM\n Radiology information system\n Medical imaging software (open source)\nReferences \n\n\u2191 1.0 1.1 1.2 1.3 1.4 1.5 Huang, H. K. (2010). \"Chapter 1: Introduction\". PACS and Imaging Informatics: Basic Principles and Applications. John Wiley & Sons. pp. 1\u201330. ISBN 9780470560518. http:\/\/books.google.com\/books?id=Pjjkyae_55oC&pg=PA1 . Retrieved 09 June 2014 .   \n\n\u2191 Fox, Matthew A.; Aschkenasi, Carl J.; Kalyanpur, Arjun (2013). \"Voice recognition is here comma like it or not period\". Indian Journal of Radiology and Imaging 23 (3): 191\u2013194. doi:10.4103\/0971-3026.120252. PMID 24347844. http:\/\/www.ijri.org\/article.asp?issn=0971-3026;year=2013;volume=23;issue=3;spage=191;epage=194;aulast=Fox . Retrieved 09 June 2014 .   \n\n\u2191 Marceau, Carla (14 January 1982). \"What Is A Picture Archiving And Communication System (PACS)?\". Proceedings of SPIE (1st Intl Conf and Workshop on Picture Archiving and Communication Systems) 0318: 24. doi:10.1117\/12.967618. http:\/\/spie.org\/Publications\/Proceedings\/Volume\/0318 . Retrieved 09 June 2014 .   \n\n\u2191 4.0 4.1 Ralston, Matthew D.; Coleman, Robert M. (2009). \"Chapter 3: Introduction to PACS\". Practical Imaging Informatics: Foundations and Applications for PACS Professionals. Springer. pp. 33\u201348. ISBN 9781441904850. http:\/\/books.google.com\/books?id=Q6Hc0oMyiYYC&pg=PA33 . Retrieved 09 June 2014 .   \n\n\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system\">https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system<\/a>\n\t\t\t\t\tCategories: Imaging informaticsMedical imagingSoftware systems\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 6 August 2014, at 18:58.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,468 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","523b73ff51fa83663dc0b1d59e6d0f05_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Picture_archiving_and_communication_system skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Picture archiving and communication system<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:442px;\"><a href=\"https:\/\/www.limswiki.org\/index.php\/File:PACS-RIS_Services.png\" class=\"image wiki-link\" target=\"_blank\" data-key=\"e3dc51ca9715a2a000819af0deb2a728\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/3\/3c\/PACS-RIS_Services.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/www.limswiki.org\/index.php\/File:PACS-RIS_Services.png\" class=\"internal wiki-link\" title=\"Enlarge\" target=\"_blank\" data-key=\"e3dc51ca9715a2a000819af0deb2a728\"><\/a><\/div>This image demonstrates a basic set of interconnections among a PACS, a <a href=\"https:\/\/www.limswiki.org\/index.php\/Radiology_information_system\" title=\"Radiology information system\" target=\"_blank\" class=\"wiki-link\" data-key=\"62d0a667f8b27309ea38a46507cfb500\">radiology information system<\/a> (RIS), the imaging modalities, and other components of the PACS, standardized by <a href=\"https:\/\/www.limswiki.org\/index.php\/DICOM\" title=\"DICOM\" target=\"_blank\" class=\"wiki-link\" data-key=\"f0c7c747895286ff8785b6ed4dbc7ec0\">DICOM<\/a>.<\/div><\/div><\/div>\n<p>A <b>picture archiving and communication system<\/b> (PACS) is a digital imaging system composed of a set of components that allow for the digital acquisition, archiving, communication, retrieval, processing, distribution, and display of medical images.<sup id=\"rdp-ebb-cite_ref-HuangPACS_1-0\" class=\"reference\"><a href=\"#cite_note-HuangPACS-1\" rel=\"external_link\">[1]<\/a><\/sup> The PACS may consist of only a few components or be sufficiently complex to handle a hospital or healthcare enterprise environment. Regardless, it must be durable enough for daily use in a clinical environment, integrate to and from several <a href=\"https:\/\/www.limswiki.org\/index.php\/Imaging_informatics#Diagnostic_imaging_modalities\" title=\"Imaging informatics\" target=\"_blank\" class=\"wiki-link\" data-key=\"140c26a981695d9b396d075e2f376299\">medical imaging modalities<\/a>, and have sufficient workstations for technicians utilizing those modalities to perform their work inside and outside the radiology department.<sup id=\"rdp-ebb-cite_ref-HuangPACS_1-1\" class=\"reference\"><a href=\"#cite_note-HuangPACS-1\" rel=\"external_link\">[1]<\/a><\/sup> PACS benefit healthcare providers by digitally managing medical images, eliminating the need to manually file, retrieve, or transport film jackets. This often saves processing time in both the diagnostics and reporting related to the imagery, especially when integrated with speech recognition technology.<sup id=\"rdp-ebb-cite_ref-FoxVoice_2-0\" class=\"reference\"><a href=\"#cite_note-FoxVoice-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>While the theoretical concepts surrounding a digital image management system were around as early as the late 1970s, the idea didn't solidify until the January 1982 First International Conference and Workshop on Picture Archiving and Communications Systems in Newport Beach, California.<sup id=\"rdp-ebb-cite_ref-HuangPACS_1-2\" class=\"reference\"><a href=\"#cite_note-HuangPACS-1\" rel=\"external_link\">[1]<\/a><\/sup> There researcher Carla Marceau defined the PACS as \"a digital system for acquiring, storing, moving and displaying picture or image information.\"<sup id=\"rdp-ebb-cite_ref-1stIntProc_3-0\" class=\"reference\"><a href=\"#cite_note-1stIntProc-3\" rel=\"external_link\">[3]<\/a><\/sup> This was followed soon after (July 1982) by the The First International Symposium on PACS and PHD (Personal Health Data) in Japan and the EuroPACS annual conference in 1983. Another meeting dedicated to PACS occurred in Evian, France in October 1990, dubbed \"central to the formation of a critical PACS project: the Medical Diagnostic Imaging Support System.\"<sup id=\"rdp-ebb-cite_ref-HuangPACS_1-3\" class=\"reference\"><a href=\"#cite_note-HuangPACS-1\" rel=\"external_link\">[1]<\/a><\/sup> By late 1997, the disparate PACS groups spread across the United States, Japan, and Europe began working together to form some truly international PACS implementations. This international effort was buoyed by the internationalization of the DICOM standard in 1993, globalization of imaging manufacturers, and sharing of PACS information and experiences among the groups.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technology\">Technology<\/span><\/h2>\n<p>A quality PACS design depends on system connectivity and workflow efficiency. It features a standardized, open architecture and is expandable for future growth. Hardware includes imaging device interfaces, storage devices, communication networks, patient data servers, display tools, and imaging modalities \"integrated by a standardized, flexible software system for communication, database management, storage management, job scheduling, interprocessor communication, error handling, and network monitoring.\"<sup id=\"rdp-ebb-cite_ref-HuangPACS_1-4\" class=\"reference\"><a href=\"#cite_note-HuangPACS-1\" rel=\"external_link\">[1]<\/a><\/sup> Other components that necessarily integrate to the PACS include a <a href=\"https:\/\/www.limswiki.org\/index.php\/Radiology_information_system\" title=\"Radiology information system\" target=\"_blank\" class=\"wiki-link\" data-key=\"62d0a667f8b27309ea38a46507cfb500\">radiology information system<\/a> (RIS) and a <a href=\"https:\/\/www.limswiki.org\/index.php\/Hospital_information_system\" title=\"Hospital information system\" target=\"_blank\" class=\"wiki-link\" data-key=\"d8385de7b1f39a39d793f8ce349b448d\">hospital information system<\/a> (HIS), extending its effectiveness even further. All of these components \"talk\" to each other in no small part because of the <a href=\"https:\/\/www.limswiki.org\/index.php\/DICOM\" title=\"DICOM\" target=\"_blank\" class=\"wiki-link\" data-key=\"f0c7c747895286ff8785b6ed4dbc7ec0\">DICOM<\/a> (Digital Imaging and Communications in Medicine) standard which ensures a uniform handling, storing, printing, and transmitting of medical imaging data.<sup id=\"rdp-ebb-cite_ref-HuangPACS_1-5\" class=\"reference\"><a href=\"#cite_note-HuangPACS-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BranstetterPractical_4-0\" class=\"reference\"><a href=\"#cite_note-BranstetterPractical-4\" rel=\"external_link\">[4]<\/a><\/sup> \n<\/p><p>This interfacing between multiple systems provides more consistent and reliable data by reducing the risk of entering incorrect patient information (through QA and error checking) and by strengthening merged datasets across multiple systems by using a unique, transferable ID like an NHS or Social Security number. Analysis and reporting also becomes more integrated and rapid across the entire provider-patient pipeline.<sup id=\"rdp-ebb-cite_ref-BranstetterPractical_4-1\" class=\"reference\"><a href=\"#cite_note-BranstetterPractical-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li> <a href=\"https:\/\/www.limswiki.org\/index.php\/Imaging_informatics\" title=\"Imaging informatics\" target=\"_blank\" class=\"wiki-link\" data-key=\"fc0ae6a154d8896767defefdb6d14d0e\">Imaging informatics<\/a><\/li>\n<li> <a href=\"https:\/\/www.limswiki.org\/index.php\/DICOM\" title=\"DICOM\" target=\"_blank\" class=\"wiki-link\" data-key=\"f0c7c747895286ff8785b6ed4dbc7ec0\">DICOM<\/a><\/li>\n<li> <a href=\"https:\/\/www.limswiki.org\/index.php\/Radiology_information_system\" title=\"Radiology information system\" target=\"_blank\" class=\"wiki-link\" data-key=\"62d0a667f8b27309ea38a46507cfb500\">Radiology information system<\/a><\/li>\n<li> <a href=\"https:\/\/www.limswiki.org\/index.php\/Category:Medical_imaging_software_(open_source)\" title=\"Category:Medical imaging software (open source)\" target=\"_blank\" class=\"wiki-link\" data-key=\"6bcfe3489a4f64086ebf71603b4d82ba\">Medical imaging software (open source)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ol class=\"references\">\n<li id=\"cite_note-HuangPACS-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-HuangPACS_1-0\" rel=\"external_link\">1.0<\/a><\/sup> <sup><a href=\"#cite_ref-HuangPACS_1-1\" rel=\"external_link\">1.1<\/a><\/sup> <sup><a href=\"#cite_ref-HuangPACS_1-2\" rel=\"external_link\">1.2<\/a><\/sup> <sup><a href=\"#cite_ref-HuangPACS_1-3\" rel=\"external_link\">1.3<\/a><\/sup> <sup><a href=\"#cite_ref-HuangPACS_1-4\" rel=\"external_link\">1.4<\/a><\/sup> <sup><a href=\"#cite_ref-HuangPACS_1-5\" rel=\"external_link\">1.5<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation book\">Huang, H. K. (2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/books.google.com\/books?id=Pjjkyae_55oC&pg=PA1\" target=\"_blank\">\"Chapter 1: Introduction\"<\/a>. <i>PACS and Imaging Informatics: Basic Principles and Applications<\/i>. John Wiley & Sons. pp. 1\u201330. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" target=\"_blank\">ISBN<\/a> 9780470560518<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/books.google.com\/books?id=Pjjkyae_55oC&pg=PA1\" target=\"_blank\">http:\/\/books.google.com\/books?id=Pjjkyae_55oC&pg=PA1<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 09 June 2014<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Chapter+1%3A+Introduction&rft.atitle=PACS+and+Imaging+Informatics%3A+Basic+Principles+and+Applications&rft.aulast=Huang%2C+H.+K.&rft.au=Huang%2C+H.+K.&rft.date=2010&rft.pages=pp.%26nbsp%3B1%E2%80%9330&rft.pub=John+Wiley+%26+Sons&rft.isbn=9780470560518&rft_id=http%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPjjkyae_55oC%26pg%3DPA1&rfr_id=info:sid\/en.wikipedia.org:Picture_archiving_and_communication_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FoxVoice-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-FoxVoice_2-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Fox, Matthew A.; Aschkenasi, Carl J.; Kalyanpur, Arjun (2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ijri.org\/article.asp?issn=0971-3026;year=2013;volume=23;issue=3;spage=191;epage=194;aulast=Fox\" target=\"_blank\">\"Voice recognition is here comma like it or not period\"<\/a>. <i>Indian Journal of Radiology and Imaging<\/i> <b>23<\/b> (3): 191\u2013194. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dx.doi.org\/10.4103%2F0971-3026.120252\" target=\"_blank\">10.4103\/0971-3026.120252<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24347844\" target=\"_blank\">24347844<\/a><span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ijri.org\/article.asp?issn=0971-3026;year=2013;volume=23;issue=3;spage=191;epage=194;aulast=Fox\" target=\"_blank\">http:\/\/www.ijri.org\/article.asp?issn=0971-3026;year=2013;volume=23;issue=3;spage=191;epage=194;aulast=Fox<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 09 June 2014<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Voice+recognition+is+here+comma+like+it+or+not+period&rft.jtitle=Indian+Journal+of+Radiology+and+Imaging&rft.aulast=Fox%2C+Matthew+A.%3B+Aschkenasi%2C+Carl+J.%3B+Kalyanpur%2C+Arjun&rft.au=Fox%2C+Matthew+A.%3B+Aschkenasi%2C+Carl+J.%3B+Kalyanpur%2C+Arjun&rft.date=2013&rft.volume=23&rft.issue=3&rft.pages=191%E2%80%93194&rft_id=info:doi\/10.4103%2F0971-3026.120252&rft_id=info:pmid\/24347844&rft_id=http%3A%2F%2Fwww.ijri.org%2Farticle.asp%3Fissn%3D0971-3026%3Byear%3D2013%3Bvolume%3D23%3Bissue%3D3%3Bspage%3D191%3Bepage%3D194%3Baulast%3DFox&rfr_id=info:sid\/en.wikipedia.org:Picture_archiving_and_communication_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-1stIntProc-3\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-1stIntProc_3-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Marceau, Carla (14 January 1982). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spie.org\/Publications\/Proceedings\/Volume\/0318\" target=\"_blank\">\"What Is A Picture Archiving And Communication System (PACS)?\"<\/a>. <i>Proceedings of SPIE<\/i> (1st Intl Conf and Workshop on Picture Archiving and Communication Systems) <b>0318<\/b>: 24. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dx.doi.org\/10.1117%2F12.967618\" target=\"_blank\">10.1117\/12.967618<\/a><span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/spie.org\/Publications\/Proceedings\/Volume\/0318\" target=\"_blank\">http:\/\/spie.org\/Publications\/Proceedings\/Volume\/0318<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 09 June 2014<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=What+Is+A+Picture+Archiving+And+Communication+System+%28PACS%29%3F&rft.jtitle=Proceedings+of+SPIE&rft.aulast=Marceau%2C+Carla&rft.au=Marceau%2C+Carla&rft.date=14+January+1982&rft.volume=0318&rft.pages=24&rft.place=1st+Intl+Conf+and+Workshop+on+Picture+Archiving+and+Communication+Systems&rft_id=info:doi\/10.1117%2F12.967618&rft_id=http%3A%2F%2Fspie.org%2FPublications%2FProceedings%2FVolume%2F0318&rfr_id=info:sid\/en.wikipedia.org:Picture_archiving_and_communication_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-BranstetterPractical-4\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-BranstetterPractical_4-0\" rel=\"external_link\">4.0<\/a><\/sup> <sup><a href=\"#cite_ref-BranstetterPractical_4-1\" rel=\"external_link\">4.1<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation book\">Ralston, Matthew D.; Coleman, Robert M. (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/books.google.com\/books?id=Q6Hc0oMyiYYC&pg=PA33\" target=\"_blank\">\"Chapter 3: Introduction to PACS\"<\/a>. <i>Practical Imaging Informatics: Foundations and Applications for PACS Professionals<\/i>. Springer. pp. 33\u201348. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" target=\"_blank\">ISBN<\/a> 9781441904850<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/books.google.com\/books?id=Q6Hc0oMyiYYC&pg=PA33\" target=\"_blank\">http:\/\/books.google.com\/books?id=Q6Hc0oMyiYYC&pg=PA33<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 09 June 2014<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Chapter+3%3A+Introduction+to+PACS&rft.atitle=Practical+Imaging+Informatics%3A+Foundations+and+Applications+for+PACS+Professionals&rft.aulast=Ralston%2C+Matthew+D.%3B+Coleman%2C+Robert+M.&rft.au=Ralston%2C+Matthew+D.%3B+Coleman%2C+Robert+M.&rft.date=2009&rft.pages=pp.%26nbsp%3B33%E2%80%9348&rft.pub=Springer&rft.isbn=9781441904850&rft_id=http%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DQ6Hc0oMyiYYC%26pg%3DPA33&rfr_id=info:sid\/en.wikipedia.org:Picture_archiving_and_communication_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<\/ol>\n\n<!-- \nNewPP limit report\nCached time: 20181217214652\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.191 seconds\nReal time usage: 1.028 seconds\nPreprocessor visited node count: 3084\/1000000\nPreprocessor generated node count: 17160\/1000000\nPost\u2010expand include size: 25444\/2097152 bytes\nTemplate argument size: 9155\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 119.993 1 - -total\n 89.48% 107.371 4 - Template:Citation\/core\n 55.21% 66.246 2 - Template:Cite_book\n 44.40% 53.275 2 - Template:Cite_journal\n 11.27% 13.519 5 - Template:Citation\/identifier\n 6.15% 7.383 6 - Template:Citation\/make_link\n 3.25% 3.899 10 - Template:Hide_in_print\n 2.66% 3.187 5 - Template:Only_in_print\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:5122-0!*!0!!en!5!* and timestamp 20181217214651 and revision id 15256\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system\">https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","523b73ff51fa83663dc0b1d59e6d0f05_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/3\/3c\/PACS-RIS_Services.png"],"523b73ff51fa83663dc0b1d59e6d0f05_timestamp":1545083211,"0da2c5b09d5a8a1c2d267d4bd9a7a5a5_type":"article","0da2c5b09d5a8a1c2d267d4bd9a7a5a5_title":"Patient management software","0da2c5b09d5a8a1c2d267d4bd9a7a5a5_url":"https:\/\/www.limswiki.org\/index.php\/Patient_management_software","0da2c5b09d5a8a1c2d267d4bd9a7a5a5_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPatient management software\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tPatient management software (PMS) is referred to as software that is regulated as a medical device.[1] It is software that is used to acquire medical information from a medical device to be used in the treatment or diagnosis of a patient. It can also be software that is an adjunct to a medical device and directly contributes to the treatment of the patient by performing analysis, or providing treatment or diagnosis functionality that replaces the decision and judgment of a physician.\n\nContents \n\n1 Clinical applications \n2 Controversies \n3 Canada \n\n3.1 History \n\n\n4 Notes \n\n\nClinical applications \nMedical devices are classified and these classifications became somewhat less restrictive in December, 2010. Regulations provide rules for classifying medical devices into four increasing risk levels \u2013 Class I, Class II, Class III, and Class IV. Patient management software is classified as either Class I or Class II. Software that is intended to be used to view images, or other real time data, as an adjunct to the monitoring device itself, for the purpose of aiding in treatment or diagnosis of a patient, would be Class I medical devices. Medical device software that is an adjunct to another medical device and is involved in data manipulation, data analysis, data editing, image generation, determination of measurements, identification of a region of interest in an image, or identification (by an alarm or alert) of results from a monitor that are outside of an established range, is a Class II medical device if it: (1) provides the only means and opportunity to capture or acquire data from a medical device for aiding directly in diagnosis or treatment of a patient; or (2) replaces a diagnostic or treatment decision made by a physician.[2]\nExamples of patient management software are PACS, remote patient monitoring. Others include any medical device that is used to transmit data from a medical device or analyze data from a medical device such as blood pressure monitors and glucose monitors.\n\nControversies \nMany in the health care industry have raised concerns over the quality and software development process of PMS. The development of PMS is often criticized as too focused on simply the software development process and not the product. Much of these concerns are rooted in safety issues[3] \nComputerized physician order entry, an example of PMS, highlights some of these safety concerns.\nOther criticisms are aimed at the regulations in place. Some critics argue that regulations stifle innovation and that vendors will no longer have any incentive to create new products. Also, existing and future products will have to adhere to strict licensing procedures and this may affect the sustainability of these products. \nAnother concern is that the rules are disproportionately strict in comparison to the actual risk associated with a wide variety of eHealth systems[4] and this may prevent companies from initiating the development of new products.\n\nCanada \nRegulation of patient management software applies to anyone importing, distributing or selling the software. Health Canada is responsible for regulating the sale, advertising and distribution of patient management software in Canada. Regulated software is classified based on risk increasing from Class I to Class II.[5]\nThe type of license required depends on the classification of the software. An establishment license is required from a vendor or manufacturer of Class I PMS and a medical device license is required from a vendor or manufacturer of Class II PMS. ISO 13485 certification is required of manufacturers of Class II medical devices.\n\nHistory \nIn August, 2009, Health Canada which is responsible for regulating the advertising, manufacturing and sale of medical devices in Canada issued a notice confirming that patient management software is a medical device and is subject to the Medical Devices Regulations and the Food and Drugs Act. The development of the regulation of patient management software as a medical device began three years earlier when a company called MedManager created a patient portal technology that was deemed a Class II medical device and subject to regulation by Health Canada. Developments had taken place thereafter, to indicate that medical device classification include patient management software. A notice was officially released by Health Canada in August, 2009 indicating that patient management software was indeed a medical device. \nTherefore, organizations that import, sell or otherwise distribute Class I patient management software must have an establishment license and Class II patient management software must have a medical device licence. In order to obtain a medical device licence, manufacturers must hold a quality management system (QMS) certificate issued by an accredited registrar showing that the QMS is compliant with ISO 13485: 2003 Medical devices \u2013 Quality management systems \u2013 requirements for regulatory purposes. Organizations are also required to perform certain post-market responsibilities such as maintaining distribution and complaint handling records, mandatory problem reporting and recalls.[6] \nIn December, 2010, a notice was released by Health Canada further clarifying the definition, classification and licensing requirements of software regulated as a medical device. For example, software used to transmit data from a medical device, or software that analyzes data from a medical device and makes diagnostic or treatment decisions normally made by a physician, would be considered software regulated as a medical device. A product that only stores and displays patient information is not a medical device. Examples of software that are not medical devices are middleware, EHR's including those that are custom built for use only within the organization, applications that perform administrative calculations and manipulations (such as determining time between appointments, or workflow management), the Wii Fit video game, personal BMI calculators and pedometer software used for fitness.[7] The regulations apply to software that is distributed with or without compensation.\n\nNotes \n\n\n^ Weber-Jahnke, J., Williams, J. (2010). Regulation of Patient Management Software. Health Law Journal. \n\n^ [1] \n\n^ \nWeber-Jahnke, J. (2011). A Preliminary Study of Apparent Causes and Outcomes of Reported Failures with Patient Management Software. International Conference on Software Engineering. New York: ACM. \n\n^ \nWhitney, J. (2011). Let's Strengthen Healthcare Software Regulation. Canadian Healthcare Technology. \n\n^ Morrison, A. Implications of ISO Certification and Licensing of Patient Management Software - Environmental Scan Issue 5. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2009 \n\n^ http:\/\/itac.ca\/uploads\/pdf\/FAQ-Patient_Management_Software_Licensing_V1.pdf \n\n^ \"Software Regulated as a Class I or Class II Medical Device - Health Canada Notice 2010-12-03\". Hc-sc.gc.ca. Retrieved 2013-08-06 . \n\n\nPharmacy Management System\u2014Bdtask \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Patient_management_software\">https:\/\/www.limswiki.org\/index.php\/Patient_management_software<\/a>\n\t\t\t\t\tCategories: Health informaticsSoftware systemsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 24 February 2016, at 20:18.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 689 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0da2c5b09d5a8a1c2d267d4bd9a7a5a5_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Patient_management_software skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Patient management software<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Patient management software<\/b> (<b>PMS<\/b>) is referred to as software that is regulated as a medical device.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> It is software that is used to acquire medical information from a medical device to be used in the treatment or diagnosis of a patient. It can also be software that is an adjunct to a medical device and directly contributes to the treatment of the patient by performing analysis, or providing treatment or diagnosis functionality that replaces the decision and judgment of a physician.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Clinical_applications\">Clinical applications<\/span><\/h2>\n<p>Medical devices are classified and these classifications became somewhat less restrictive in December, 2010. Regulations provide rules for classifying medical devices into four increasing risk levels \u2013 Class I, Class II, Class III, and Class IV. Patient management software is classified as either Class I or Class II. Software that is intended to be used to view images, or other real time data, as an adjunct to the monitoring device itself, for the purpose of aiding in treatment or diagnosis of a patient, would be Class I medical devices. Medical device software that is an adjunct to another medical device and is involved in data manipulation, data analysis, data editing, image generation, determination of measurements, identification of a region of interest in an image, or identification (by an alarm or alert) of results from a monitor that are outside of an established range, is a Class II medical device if it: (1) provides the only means and opportunity to capture or acquire data from a medical device for aiding directly in diagnosis or treatment of a patient; or (2) replaces a diagnostic or treatment decision made by a physician.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Examples of patient management software are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Picture_archiving_and_communication_system\" title=\"Picture archiving and communication system\" rel=\"external_link\" target=\"_blank\">PACS<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_patient_monitoring\" title=\"Remote patient monitoring\" rel=\"external_link\" target=\"_blank\">remote patient monitoring<\/a>. Others include any medical device that is used to transmit data from a medical device or analyze data from a medical device such as blood pressure monitors and glucose monitors.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Controversies\">Controversies<\/span><\/h2>\n<p>Many in the health care industry have raised concerns over the quality and software development process of PMS. The development of PMS is often criticized as too focused on simply the software development process and not the product. Much of these concerns are rooted in safety issues<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> \n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computerized_physician_order_entry\" title=\"Computerized physician order entry\" rel=\"external_link\" target=\"_blank\">Computerized physician order entry<\/a>, an example of PMS, highlights some of these safety concerns.\n<\/p><p>Other criticisms are aimed at the regulations in place. Some critics argue that regulations stifle innovation and that vendors will no longer have any incentive to create new products. Also, existing and future products will have to adhere to strict licensing procedures and this may affect the sustainability of these products. \n<\/p><p>Another concern is that the rules are disproportionately strict in comparison to the actual risk associated with a wide variety of eHealth systems<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> and this may prevent companies from initiating the development of new products.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Canada\">Canada<\/span><\/h2>\n<p>Regulation of patient management software applies to anyone importing, distributing or selling the software. Health Canada is responsible for regulating the sale, advertising and distribution of patient management software in Canada. Regulated software is classified based on risk increasing from Class I to Class II.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\nThe type of license required depends on the classification of the software. An establishment license is required from a vendor or manufacturer of Class I PMS and a medical device license is required from a vendor or manufacturer of Class II PMS. ISO 13485 certification is required of manufacturers of Class II medical devices.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"History\">History<\/span><\/h3>\n<p>In August, 2009, Health Canada which is responsible for regulating the advertising, manufacturing and sale of medical devices in Canada issued a notice confirming that patient management software is a medical device and is subject to the Medical Devices Regulations and the Food and Drugs Act. The development of the regulation of patient management software as a medical device began three years earlier when a company called MedManager created a patient portal technology that was deemed a Class II medical device and subject to regulation by Health Canada. Developments had taken place thereafter, to indicate that medical device classification include patient management software. A notice was officially released by Health Canada in August, 2009 indicating that patient management software was indeed a medical device. \n<\/p><p>Therefore, organizations that import, sell or otherwise distribute Class I patient management software must have an establishment license and Class II patient management software must have a medical device licence. In order to obtain a medical device licence, manufacturers must hold a quality management system (QMS) certificate issued by an accredited registrar showing that the QMS is compliant with ISO 13485: 2003 Medical devices \u2013 Quality management systems \u2013 requirements for regulatory purposes. Organizations are also required to perform certain post-market responsibilities such as maintaining distribution and complaint handling records, mandatory problem reporting and recalls.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> \n<\/p><p>In December, 2010, a notice was released by Health Canada further clarifying the definition, classification and licensing requirements of software regulated as a medical device. For example, software used to transmit data from a medical device, or software that analyzes data from a medical device and makes diagnostic or treatment decisions normally made by a physician, would be considered software regulated as a medical device. A product that only stores and displays patient information is not a medical device. Examples of software that are not medical devices are middleware, EHR's including those that are custom built for use only within the organization, applications that perform administrative calculations and manipulations (such as determining time between appointments, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Workflow_management\" class=\"mw-redirect\" title=\"Workflow management\" rel=\"external_link\" target=\"_blank\">workflow management<\/a>), the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wii_Fit\" title=\"Wii Fit\" rel=\"external_link\" target=\"_blank\">Wii Fit<\/a> video game, personal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_mass_index\" title=\"Body mass index\" rel=\"external_link\" target=\"_blank\">BMI calculators<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pedometer\" title=\"Pedometer\" rel=\"external_link\" target=\"_blank\">pedometer<\/a> software used for fitness.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> The regulations apply to software that is distributed with or without compensation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Weber-Jahnke, J., Williams, J. (2010). Regulation of Patient Management Software. Health Law Journal.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.hc-sc.gc.ca\/dhp-mps\/md-im\/activit\/announce-annonce\/md_qa_software_im_qr_logicels-eng.php\" target=\"_blank\">[1]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nWeber-Jahnke, J. (2011). A Preliminary Study of Apparent Causes and Outcomes of Reported Failures with Patient Management Software. International Conference on Software Engineering. New York: ACM.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nWhitney, J. (2011). Let's Strengthen Healthcare Software Regulation. Canadian Healthcare Technology.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Morrison, A. Implications of ISO Certification and Licensing of Patient Management Software - Environmental Scan Issue 5. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2009<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/itac.ca\/uploads\/pdf\/FAQ-Patient_Management_Software_Licensing_V1.pdf\" target=\"_blank\">http:\/\/itac.ca\/uploads\/pdf\/FAQ-Patient_Management_Software_Licensing_V1.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hc-sc.gc.ca\/dhp-mps\/md-im\/activit\/announce-annonce\/md_notice_software_im_avis_logicels-eng.php\" target=\"_blank\">\"Software Regulated as a Class I or Class II Medical Device - Health Canada Notice 2010-12-03\"<\/a>. Hc-sc.gc.ca<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-08-06<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Software+Regulated+as+a+Class+I+or+Class+II+Medical+Device+-+Health+Canada+Notice+2010-12-03&rft.pub=Hc-sc.gc.ca&rft_id=http%3A%2F%2Fwww.hc-sc.gc.ca%2Fdhp-mps%2Fmd-im%2Factivit%2Fannounce-annonce%2Fmd_notice_software_im_avis_logicels-eng.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3APatient+management+software\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bdtask.com\/pharmacy-management-system.php\" target=\"_blank\"><i>Pharmacy Management System<\/i>\u2014Bdtask <\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1246\nCached time: 20181217214650\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.128 seconds\nReal time usage: 0.149 seconds\nPreprocessor visited node count: 179\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2015\/2097152 bytes\nTemplate argument size: 91\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 5003\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.070\/10.000 seconds\nLua memory usage: 1.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 123.514 1 Template:Reflist\n100.00% 123.514 1 -total\n<\/p>\n<pre>84.45% 104.307 1 Template:Cite_web\n 2.73% 3.377 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:33805846-1!canonical and timestamp 20181217214650 and revision id 855790913\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_management_software\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214650\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.333 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 327.218 1 - wikipedia:Patient_management_software\n100.00% 327.218 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8117-0!*!*!*!*!*!* and timestamp 20181217214650 and revision id 24242\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Patient_management_software\">https:\/\/www.limswiki.org\/index.php\/Patient_management_software<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0da2c5b09d5a8a1c2d267d4bd9a7a5a5_images":[],"0da2c5b09d5a8a1c2d267d4bd9a7a5a5_timestamp":1545083210,"d6f52795cd579f0ad464f1d3845c675a_type":"article","d6f52795cd579f0ad464f1d3845c675a_title":"Medical calculator","d6f52795cd579f0ad464f1d3845c675a_url":"https:\/\/www.limswiki.org\/index.php\/Medical_calculator","d6f52795cd579f0ad464f1d3845c675a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical calculator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA medical calculator is a type of medical computer software, whose purpose is to allow easy calculation of various scores and indices, presenting the user with a friendly interface that hides the complexity of the formulas. Most offer further helpful information such as result interpretation guides and medical literature references.[1] Generally, such calculators are intended for use by health care professionals, and use by the general public is discouraged.\nMedical calculators arose because modern medicine makes frequent use of scores and indices that put physicians' memory and calculation skills to the test.[2] The advent of personal computers, the Internet and Web, and more recently personal digital assistants (PDAs) have formed an environment conducive to their development, spread and use.\n\nContents \n\n1 Types of calculators \n\n1.1 Hardware devices \n1.2 PDA \n1.3 Online Calculators \n\n\n2 References \n\n\nTypes of calculators \nHardware devices \nPurpose-built devices for specific medical calculations are available from various commercial sources. Pharma-Insight Inc. in Canada is one of the only companies in the world that is able to make custom specific medical calculators built to perform a specific medical calculation to make dosing or other calculation easy. Some of the standard units they make include eGFR, CrCl, BMI, BSA, DAS and many other custom units designed for a specific purpose. There are two ways to make a calculator using an array that looks up an answer based on a large array of data or where the calculator computes the answer using a mathematical equation.\n\nPDA \nSoftware-based medical calculators are available for various PDA-platforms, including the iPhone, Palm and Pocket PC. Handheld battery powered portable units are available and can be manufactured in smaller quantities than before thanks to OTP (one Time Programmable) chips.\n\nOnline Calculators \nVarious websites are available that provide calculations from a browser based input form.\n\nReferences \n\n\n^ Cornell Medical Calculators \n\n^ \nLee P. (2009). \"Design of infusion rate calculator tools for intravenous therapy\". Nurs Stand. (23): 43\u201348. \n\n\n\r\n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\nThis article related to a type of software is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_calculator\">https:\/\/www.limswiki.org\/index.php\/Medical_calculator<\/a>\n\t\t\t\t\tCategory: Medical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 18:17.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 578 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d6f52795cd579f0ad464f1d3845c675a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_calculator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical calculator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>medical calculator<\/b> is a type of medical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_software\" class=\"mw-redirect\" title=\"Computer software\" rel=\"external_link\" target=\"_blank\">computer software<\/a>, whose purpose is to allow easy calculation of various scores and indices, presenting the user with a friendly interface that hides the complexity of the formulas. Most offer further helpful information such as result interpretation guides and medical literature references.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Generally, such calculators are intended for use by health care professionals, and use by the general public is discouraged.\n<\/p><p>Medical calculators arose because modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a> makes frequent use of scores and indices that put <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physicians<\/a>' memory and calculation skills to the test.<sup id=\"rdp-ebb-cite_ref-Lee-2009_2-0\" class=\"reference\"><a href=\"#cite_note-Lee-2009-2\" rel=\"external_link\">[2]<\/a><\/sup> The advent of personal computers, the Internet and Web, and more recently <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personal_digital_assistant\" title=\"Personal digital assistant\" rel=\"external_link\" target=\"_blank\">personal digital assistants<\/a> (PDAs) have formed an environment conducive to their development, spread and use.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_calculators\">Types of calculators<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Hardware_devices\">Hardware devices<\/span><\/h3>\n<p>Purpose-built devices for specific medical calculations are available from various commercial sources. Pharma-Insight Inc. in Canada is one of the only companies in the world that is able to make custom specific medical calculators built to perform a specific medical calculation to make dosing or other calculation easy. Some of the standard units they make include eGFR, CrCl, BMI, BSA, DAS and many other custom units designed for a specific purpose. There are two ways to make a calculator using an array that looks up an answer based on a large array of data or where the calculator computes the answer using a mathematical equation.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"PDA\">PDA<\/span><\/h3>\n<p>Software-based medical calculators are available for various PDA-platforms, including the <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPhone\" title=\"IPhone\" rel=\"external_link\" target=\"_blank\">iPhone<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palm_OS\" title=\"Palm OS\" rel=\"external_link\" target=\"_blank\">Palm<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pocket_PC\" title=\"Pocket PC\" rel=\"external_link\" target=\"_blank\">Pocket PC<\/a>. Handheld battery powered portable units are available and can be manufactured in smaller quantities than before thanks to OTP (one Time Programmable) chips.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Online_Calculators\">Online Calculators<\/span><\/h3>\n<p>Various websites are available that provide calculations from a browser based input form.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www-users.med.cornell.edu\/~spon\/picu\/calc\/medcalc.htm?name1=Medical+Calculators&type1=2Active\" target=\"_blank\">Cornell Medical Calculators<\/a><\/span>\n<\/li>\n<li id=\"cite_note-Lee-2009-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Lee-2009_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<cite class=\"citation journal\">Lee P. (2009). \"Design of infusion rate calculator tools for intravenous therapy\". <i>Nurs Stand.<\/i> (23): 43\u201348.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nurs+Stand.&rft.atitle=Design+of+infusion+rate+calculator+tools+for+intravenous+therapy&rft.issue=23&rft.pages=43-48&rft.date=2009&rft.au=Lee+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+calculator\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><br \/>\n<\/p>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1263\nCached time: 20181127165908\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.104 seconds\nReal time usage: 0.145 seconds\nPreprocessor visited node count: 179\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 6803\/2097152 bytes\nTemplate argument size: 82\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 2850\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.056\/10.000 seconds\nLua memory usage: 1.68 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 120.037 1 -total\n<\/p>\n<pre>76.81% 92.203 1 Template:Reflist\n64.84% 77.835 1 Template:Cite_journal\n18.66% 22.395 2 Template:Asbox\n18.41% 22.100 1 Template:Medical-equipment-stub\n 4.64% 5.573 1 Template:Software-type-stub\n 2.72% 3.269 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:10806161-1!canonical and timestamp 20181127165908 and revision id 793705199\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_calculator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214650\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.152 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 146.633 1 - wikipedia:Medical_calculator\n100.00% 146.633 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8038-0!*!*!*!*!*!* and timestamp 20181217214650 and revision id 24196\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_calculator\">https:\/\/www.limswiki.org\/index.php\/Medical_calculator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d6f52795cd579f0ad464f1d3845c675a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/40\/Crystal_kpackage.png"],"d6f52795cd579f0ad464f1d3845c675a_timestamp":1545083210,"10641019dc4b5a2009d920f68a68bbe4_type":"article","10641019dc4b5a2009d920f68a68bbe4_title":"Immunization information system","10641019dc4b5a2009d920f68a68bbe4_url":"https:\/\/www.limswiki.org\/index.php\/Immunization_information_system","10641019dc4b5a2009d920f68a68bbe4_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tImmunization information system\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe examples and perspective in this article may not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (March 2015) (Learn how and when to remove this template message)\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2016) (Learn how and when to remove this template message)\nAn Immunization registry or Immunization Information System is a confidential, population-based, computerized information system that attempts to collect vaccination data about all persons within a geographic area. It consolidates the immunization records from multiple sources for each person living in its jurisdiction.\n\nIntroduction \nImmunization Information Systems (IIS) are an important tool to increase and sustain high vaccination coverage by consolidating vaccination records of children and adults from multiple providers, forecasting next doses past due, due, and next due to support generating reminder and recall vaccination notices for each individual, and providing official vaccination forms and vaccination coverage assessments. One of the national health objectives is to increase to 95% the proportion of children aged <6 years who participate in fully operational population-based IIS.\nA \"fully operational\" IIS includes 95% enrollment or higher of all catchment area children less than 6 years of age with 2 or more immunization encounters administered according to ACIP recommendations.\nIn a population-based IIS, children are entered into the IIS at birth, often through a linkage with electronic birth records. An IIS record also can be initiated by a health care provider at the time of a child's first immunization. If an IIS includes all children in a given geographical area and all providers are reporting immunization information, it can provide a single data source for all community immunization partners. Such a population-based IIS can make it easier to carry out the demonstrably effective immunization strategies (e.g., reminder\/recall, AFIX, and WIC linkages) and thereby decrease the resources needed to achieve and maintain high levels of coverage. IIS also can be used to enhance adult immunization services and coverage.\nThe concept of IIS is not new. Many individual practices and health plans administer immunizations to their patients. Records of these immunizations often are based on computerized information systems designed for other purposes such as billing. There also is a growing movement toward the development of totally computerized patient medical records. Although an IIS includes all immunizations administered by health care providers participating in it, only population-based IIS are capable of providing information on all children and all doses of vaccines administered by all providers.\n\nExternal links \nCDC entry\nCDC Immunization Information System\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Immunization_information_system\">https:\/\/www.limswiki.org\/index.php\/Immunization_information_system<\/a>\n\t\t\t\t\tCategories: Health informaticsSoftware systemsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 24 February 2016, at 20:19.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 574 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","10641019dc4b5a2009d920f68a68bbe4_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Immunization_information_system skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Immunization information system<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p>An <b>Immunization registry<\/b> or <b>Immunization Information System<\/b> is a confidential, population-based, computerized information system that attempts to collect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vaccination\" title=\"Vaccination\" rel=\"external_link\" target=\"_blank\">vaccination<\/a> data about all persons within a geographic area. It consolidates the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immunization\" title=\"Immunization\" rel=\"external_link\" target=\"_blank\">immunization<\/a> records from multiple sources for each person living in its jurisdiction.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Introduction\">Introduction<\/span><\/h2>\n<p>Immunization Information Systems (IIS) are an important tool to increase and sustain high by consolidating vaccination records of children and adults from multiple providers, forecasting next doses past due, due, and next due to support generating reminder and recall vaccination notices for each individual, and providing official vaccination forms and vaccination coverage assessments. One of the national health <a href=\"https:\/\/en.wikipedia.org\/wiki\/Objective_(goal)\" class=\"mw-redirect\" title=\"Objective (goal)\" rel=\"external_link\" target=\"_blank\">objectives<\/a> is to increase to 95% the proportion of children aged <6 years who participate in fully operational population-based IIS.\n<\/p><p>A \"fully operational\" IIS includes 95% enrollment or higher of all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catchment_area_(human_geography)\" class=\"mw-redirect\" title=\"Catchment area (human geography)\" rel=\"external_link\" target=\"_blank\">catchment area<\/a> children less than 6 years of age with 2 or more immunization encounters administered according to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Advisory_Committee_on_Immunization_Practices\" title=\"Advisory Committee on Immunization Practices\" rel=\"external_link\" target=\"_blank\">ACIP<\/a> recommendations.\n<\/p><p>In a population-based IIS, children are entered into the IIS at birth, often through a linkage with electronic . An IIS record also can be initiated by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care_provider\" class=\"mw-redirect\" title=\"Health care provider\" rel=\"external_link\" target=\"_blank\">health care provider<\/a> at the time of a child's first immunization. If an IIS includes all children in a given <a href=\"https:\/\/en.wikipedia.org\/wiki\/Geographical_area\" class=\"mw-redirect\" title=\"Geographical area\" rel=\"external_link\" target=\"_blank\">geographical area<\/a> and all providers are reporting immunization information, it can provide a single data source for all community immunization partners. Such a population-based IIS can make it easier to carry out the demonstrably effective immunization strategies (e.g., reminder\/recall, , and <a href=\"https:\/\/en.wikipedia.org\/wiki\/WIC\" title=\"WIC\" rel=\"external_link\" target=\"_blank\">WIC<\/a> linkages) and thereby decrease the resources needed to achieve and maintain high levels of coverage. IIS also can be used to enhance services and coverage.\n<\/p><p>The concept of IIS is not new. Many individual practices and health plans administer immunizations to their patients. Records of these immunizations often are based on computerized information systems designed for other purposes such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Invoice\" title=\"Invoice\" rel=\"external_link\" target=\"_blank\">billing<\/a>. There also is a growing movement toward the development of totally computerized patient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_records\" class=\"mw-redirect\" title=\"Medical records\" rel=\"external_link\" target=\"_blank\">medical records<\/a>. Although an IIS includes all immunizations administered by health care providers participating in it, only population-based IIS are capable of providing information on all children and all doses of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vaccine\" title=\"Vaccine\" rel=\"external_link\" target=\"_blank\">vaccines<\/a> administered by all providers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/vaccines\/programs\/iis\/default.htm\" target=\"_blank\">CDC entry<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/vaccines\/programs\/iis\/default.htm\" target=\"_blank\">CDC Immunization Information System<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1319\nCached time: 20181129162813\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.060 seconds\nReal time usage: 0.091 seconds\nPreprocessor visited node count: 158\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7980\/2097152 bytes\nTemplate argument size: 23\/2097152 bytes\nHighest expansion depth: 6\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.022\/10.000 seconds\nLua memory usage: 944 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 68.305 1 -total\n<\/p>\n<pre>86.77% 59.268 1 Template:Globalize\n62.47% 42.667 2 Template:Ambox\n13.13% 8.969 1 Template:Refimprove\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:13008203-1!canonical and timestamp 20181129162813 and revision id 799731890\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Immunization_registry\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214650\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.160 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 154.425 1 - wikipedia:Immunization_registry\n100.00% 154.425 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8105-0!*!*!*!*!*!* and timestamp 20181217214649 and revision id 24243\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Immunization_information_system\">https:\/\/www.limswiki.org\/index.php\/Immunization_information_system<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","10641019dc4b5a2009d920f68a68bbe4_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"10641019dc4b5a2009d920f68a68bbe4_timestamp":1545083209,"6f718776048815f19191246d38dd8790_type":"article","6f718776048815f19191246d38dd8790_title":"Laboratory Unit for Computer Assisted Surgery","6f718776048815f19191246d38dd8790_url":"https:\/\/www.limswiki.org\/index.php\/Laboratory_Unit_for_Computer_Assisted_Surgery","6f718776048815f19191246d38dd8790_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tLaboratory Unit for Computer Assisted Surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tLaboratory Unit for Computer Assisted SurgeryData gathering, based on CT \"slices\"SynonymsLUCAS[edit on Wikidata]\nLaboratory Unit for Computer Assisted Surgery is a system used for virtual surgical planning. Starting with 1998, LUCAS was developed at the University of Regensburg, Germany, with the support of the Carl Zeiss Company. The resulting surgical planning is then reproduced onto the patient by using a navigation system. In fact, LUCAS is integrated into the same platform together with the Surgical Segment Navigator (SSN), the Surgical Tool Navigator (STN), the Surgical Microscope Navigator (SMN) and the 6DOF Manipulator (or, in German, \"Mehrkoordinatenmanipulator\" - MKM), also from the Carl Zeiss Company.\n\nWorkflow \n obtained from the CT \"slices\"\nData from separate bidimensional slices generated by a CT or MRI scan are uploaded into the LUCAS system. The resulting dataset is then processed, in order to eliminate image noise, and to enhance the anatomical contours and also the general contrast of the images. The next step is to create a virtual 3D model from the gathered collection of 2D images. The bone segment that is to be repositioned is marked, on the 3D grid reconstructed model; then, the actual repositioning of that bone segment is done on the virtual model, until the optimal anatomical position is obtained. The criteria for the optimal position of the bone segment are: symmetry with the opposite side, the continuity of the normal bone contours, or the normal volume of an anatomical region (such as the Orbit. Afterwards, a textured final image is rendered. The calculated vectors for the bone segment repositioning, together with the whole virtual model are finally transferred to the Surgical Segment Navigator.\n\nReferences \nMarmulla R, Niederdellmann H: Surgical Planning of Computer Assisted Repositioning Osteotomies, Plast Reconstr Surg 104 (4): 938-944, 1999\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Laboratory_Unit_for_Computer_Assisted_Surgery\">https:\/\/www.limswiki.org\/index.php\/Laboratory_Unit_for_Computer_Assisted_Surgery<\/a>\n\t\t\t\t\tCategory: Medical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 18:20.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 387 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6f718776048815f19191246d38dd8790_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Laboratory_Unit_for_Computer_Assisted_Surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Laboratory Unit for Computer Assisted Surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Laboratory Unit for Computer Assisted Surgery<\/b> is a system used for virtual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_planning\" title=\"Surgical planning\" rel=\"external_link\" target=\"_blank\">surgical planning<\/a>. Starting with 1998, LUCAS was developed at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Regensburg\" title=\"University of Regensburg\" rel=\"external_link\" target=\"_blank\">University of Regensburg, Germany<\/a>, with the support of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Zeiss_AG\" title=\"Carl Zeiss AG\" rel=\"external_link\" target=\"_blank\">Carl Zeiss Company<\/a>. The resulting surgical planning is then <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">reproduced<\/a> onto the patient by using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_Segment_Navigator\" class=\"mw-redirect\" title=\"Surgical Segment Navigator\" rel=\"external_link\" target=\"_blank\">navigation system<\/a>. In fact, LUCAS is integrated into the same <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platform_(computing)\" class=\"mw-redirect\" title=\"Platform (computing)\" rel=\"external_link\" target=\"_blank\">platform<\/a> together with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_Segment_Navigator\" class=\"mw-redirect\" title=\"Surgical Segment Navigator\" rel=\"external_link\" target=\"_blank\">Surgical Segment Navigator (SSN)<\/a>, the Surgical Tool Navigator (STN), the Surgical Microscope Navigator (SMN) and the 6<a href=\"https:\/\/en.wikipedia.org\/wiki\/Degrees_of_freedom_(engineering)\" class=\"mw-redirect\" title=\"Degrees of freedom (engineering)\" rel=\"external_link\" target=\"_blank\">DOF<\/a> Manipulator (or, in German, \"Mehrkoordinatenmanipulator\" - MKM), also from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Zeiss_AG\" title=\"Carl Zeiss AG\" rel=\"external_link\" target=\"_blank\">Carl Zeiss Company<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Workflow\">Workflow<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:LUCASSegmentation2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/LUCASSegmentation2.jpg\/220px-LUCASSegmentation2.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:LUCASSegmentation2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>obtained from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> \"slices\"<\/div><\/div><\/div>\n<p>Data from separate <a href=\"https:\/\/en.wikipedia.org\/wiki\/2D_geometric_model\" title=\"2D geometric model\" rel=\"external_link\" target=\"_blank\">bidimensional<\/a> slices generated by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> scan are uploaded into the LUCAS system. The resulting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dataset\" class=\"mw-redirect\" title=\"Dataset\" rel=\"external_link\" target=\"_blank\">dataset<\/a> is then processed, in order to eliminate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image_noise\" title=\"Image noise\" rel=\"external_link\" target=\"_blank\">image noise<\/a>, and to enhance the anatomical contours and also the general contrast of the images. The next step is to create a virtual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Three-dimensional_space\" title=\"Three-dimensional space\" rel=\"external_link\" target=\"_blank\">3D<\/a> model from the gathered collection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/2D_geometric_model\" title=\"2D geometric model\" rel=\"external_link\" target=\"_blank\">2D<\/a> images. The bone segment that is to be repositioned is marked, on the 3D grid reconstructed model; then, the actual repositioning of that bone segment is done on the virtual model, until the optimal anatomical position is obtained. The criteria for the optimal position of the bone segment are: symmetry with the opposite side, the continuity of the normal bone contours, or the normal volume of an anatomical region (such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbit_(anatomy)\" title=\"Orbit (anatomy)\" rel=\"external_link\" target=\"_blank\">Orbit<\/a>. Afterwards, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Texture_(computer_graphics)\" class=\"mw-redirect\" title=\"Texture (computer graphics)\" rel=\"external_link\" target=\"_blank\">textured<\/a> final image is rendered. The calculated vectors for the bone segment repositioning, together with the whole virtual model are finally transferred to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_Segment_Navigator\" class=\"mw-redirect\" title=\"Surgical Segment Navigator\" rel=\"external_link\" target=\"_blank\">Surgical Segment Navigator<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.plasreconsurg.com\/pt\/re\/prs\/abstract.00006534-199909040-00007.htm;jsessionid=H8FQBGq1ly19ldpw1vTY1LyWGCnvsDrpFpHgTjZ4R9zbvQ5RQVbB!-383192544!181195628!8091!-1\" target=\"_blank\">Marmulla R, Niederdellmann H: <i>Surgical Planning of Computer Assisted Repositioning Osteotomies<\/i>, Plast Reconstr Surg 104 (4): 938-944, 1999<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181211212549\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.068 seconds\nReal time usage: 0.105 seconds\nPreprocessor visited node count: 213\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2000\/2097152 bytes\nTemplate argument size: 93\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.028\/10.000 seconds\nLua memory usage: 993 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 87.654 1 Template:Infobox_medical_intervention\n100.00% 87.654 1 -total\n<\/p>\n<pre>93.75% 82.173 1 Template:Infobox\n 8.87% 7.776 1 Template:PAGENAMEBASE\n 4.04% 3.537 1 Template:Template_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:16257394-1!canonical and timestamp 20181211212549 and revision id 873150100\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Laboratory_Unit_for_Computer_Assisted_Surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214649\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.150 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.013 1 - wikipedia:Laboratory_Unit_for_Computer_Assisted_Surgery\n100.00% 145.013 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8036-0!*!*!*!*!*!* and timestamp 20181217214649 and revision id 24197\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Laboratory_Unit_for_Computer_Assisted_Surgery\">https:\/\/www.limswiki.org\/index.php\/Laboratory_Unit_for_Computer_Assisted_Surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6f718776048815f19191246d38dd8790_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/4a\/LUCASSegmentation1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/21\/LUCASSegmentation2.jpg"],"6f718776048815f19191246d38dd8790_timestamp":1545083209,"095141425468d057aa977016869ca37d_type":"article","095141425468d057aa977016869ca37d_title":"Clinical decision support system","095141425468d057aa977016869ca37d_url":"https:\/\/www.limswiki.org\/index.php\/Clinical_decision_support_system","095141425468d057aa977016869ca37d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tClinical decision support system\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t This diagram demonstrates the interconnections among how knowledge is generated and validated, how knowledge is managed and disseminated, and how it finds its way into clinical decision support system (CDSS).\nA clinical decision support system (CDSS) is a \"computer [system] designed to impact clinician decision making about individual patients at the point in time these decisions are made.\"[1] As such, it can be viewed as a knowledge management tool used to further clinical advice for patient care based on multiple items of patient data.\n\nContents\n\n1 Characteristics \n\n1.1 Purpose \n\n\n2 Types of CDSS \n\n2.1 Knowledge-based CDSS \n2.2 Non-knowledge-based CDSS \n\n\n3 Regulations \n\n3.1 United States \n\n\n4 Effectiveness \n5 Challenges to adoption and implementation \n\n5.1 Clinical challenges \n5.2 Technical challenges \n5.3 Evaluation \n5.4 Maintenance \n\n\n6 Integration of CDSS with other systems \n\n6.1 Barriers to integration \n\n\n7 See also \n8 Notes \n9 Further reading \n10 References \n\n\n\nCharacteristics \nPurpose \nIn the early days, CDSSs were conceived of as being used to literally make decisions for the clinician. The clinician would input the information and wait for the CDSS to output the \"right\" choice, and the clinician would simply act on that output. In April 1963, a forward-looking doctor Roger Truesdail imagined a future 1985 where such a process would be a reality:\n\nThe year is 1985 when a middle-aged man enters a physician's office, suffering from a critical ailment. The doctor feeds into a small electronic computer the patient's symptoms, medical history, and other pertinent data. The computer transmits the information to a giant central electronic computer in a remote city. Seconds later the computer will transmit back to the doctor the combined medical diagnosis of the world's best medical minds. The man is given the proper treatment and his life is saved. The very latest medical information, often inaccessible to doctors, will be stored in the giant computer. This computer, linked with small computers in doctors' offices and hospitals all over the world, will place vital medical information at doctor's fingertips.[2]\nHowever, the modern methodology involves the clinician interacting with the CDSS at the point of care, utilizing both their own knowledge and the CDSS to produce the best diagnosis from the test data. Typically, a CDSS suggests avenues for the physician to explore, and the physician is expected to use their own knowledge and judgement to narrow down possibilities.\n\nTypes of CDSS \nCDSSs can be roughly divided into two types: those with knowledge bases and those without. The knowledge-based approach typically covers the diagnosis of many different diseases, while the non-knowledge-based approach often focuses on a narrow list of symptoms, such as symptoms for a single disease.\n\nKnowledge-based CDSS \nMost CDSSs contain a knowledge base as well as an inference engine and a mechanism to communicate. The knowledge base contains the rules and associations of compiled data, which most often take the form of IF-THEN rules. If this were a system for determining drug interactions, for example, then a rule might be that IF drug X is taken AND drug Y is taken, THEN alert the user. Using another interface, an advanced user can update the knowledge base with new drug information. The inference engine combines the rules from the knowledge base with the patient's data, while the communication mechanism allows the system to show the results and allow user input into the system.[1]\n\nNon-knowledge-based CDSS \nCDSSs that do not use a knowledge base use a form of artificial intelligence called machine learning, which allow computers to learn from past experiences and\/or find patterns in clinical data. This eliminates the need for writing rules and for expert input.[3] However, since systems based on machine learning cannot explain the reasons for their conclusions (neural networks and other machine learning systems are often referred to as \"black boxes\" because no meaningful information about how they work can be discerned by human inspection[4]), most clinicians do not use them directly for diagnoses due to reliability and accountability reasons.[1] Nevertheless, they can be useful as post-diagnostic systems that suggest data patterns for further investigation.\nTwo of the major types of non-knowledge-based systems are artificial neural networks and genetic algorithms. Artificial neural networks use nodes and weighted connections between them to analyze the patterns found in patient data to derive associations between symptoms and a diagnosis. Genetic algorithms are based on simplified evolutionary processes using directed selection to achieve optimal CDSS results. The selection algorithms evaluate components of random sets of solutions to a problem. The solutions that come out on top are then recombined and mutated and run through the process again. This happens over and over until the proper solution is discovered. They are functionally similar to neural networks in that they are also \"black boxes\" that attempt to derive knowledge from patient data.[5][1]\n\nRegulations \nUnited States \nWith the enactment of the American Recovery and Reinvestment Act of 2009 (ARRA), the U.S. government and medical professionals alike have been pushing for greater widespread adoption of health information technology. As such, more hospitals and clinics are integrating electronic health records (EHRs) and computerized physician order entry (CPOE) systems within their infrastructure. In fact, the National Academy of Sciences' Institute of Medicine had been actively promoting the use of health information technology \u2014 including the CDSS \u2014 to advance quality of patient care well before the ARRA was even enacted.[6]\nCurrently there are \"no national standards for the specific evidence-based guidelines or rules that should be built into CDS[6],\" though standards organizations like Health Level Seven and its Clinical Decision Support Work Group continue to make headway on this front.[7] Despite the absence of laws, several CDSS vendors have expressed both a desire to work together to provide a useful product to improve health outcomes and a need to express neutrality liability wise, stating\n\n...[t]he ultimate end user is responsible for how it influences patient care. This neutral stance on the part of the content vendors is also due to the legal situation. Some content vendor representatives spoke strongly about how the legal system in this country influences what they can provide. There are many legal, regulatory, antitrust, and fiduciary constraints that content vendors must navigate while still providing a useful and usable product for all their customers. Sometimes, depending on what is being sold, these constraints result in sub-optimal products for clinician end-users.[8]\nEffectiveness \nThe evidence of the effectiveness of CDSS is mixed. A 2005 systematic review by medical researchers concluded that CDSSs improved practitioner performance in 64 percent and improved patient outcomes in 13 percent of 97 selected studies.[9] Another 2005 systematic review found \"[d]ecision support systems significantly improved clinical practice in 68 percent of trials\" (70 selected studies). That research team found four features associated with successful CDSSs:[10]\n\n The CDSS is integrated into the clinical workflow rather than as a separate log-in or screen.\n The CDSS offers electronic output rather than only paper-based output.\n The CDSS provides decision support at the time and location of care rather than prior to or after the patient encounter.\n The CDSS provides actionable recommendations for care, not just assessments.\nHowever, other systematic reviews are less optimistic about the effects of a CDDS, with one from 2011 stating \"[t]here is a large gap between the postulated and empirically demonstrated benefits of [CDSS and other] eHealth technologies ... [and] their cost-effectiveness has yet to be demonstrated.\"[11] A 2014 systematic review by public health researchers did not find a benefit in terms of risk of death when the CDSS was combined with the electronic health record. However, there may be some benefits to morbidity outcomes.[12]\n\nChallenges to adoption and implementation \nClinical challenges \nMany medical institutions and software companies have tried to produce viable CDSSs to support all aspects of clinical tasks. However, with significant staff time demands and complex clinical workflows, care must be taken by the institution deploying the support system to ensure the system becomes a fluid and integral part of the clinical workflow. Yet despite the wide range of efforts by institutions to produce and use these systems, widespread adoption and acceptance has still not yet been achieved. One large roadblock to acceptance has historically been workflow integration. A tendency to focus only on the functional decision making core of the CDSS existed, causing a deficiency in planning for how the clinician will actually use the product in situ.[13]\nOften CDSSs were stand-alone applications, requiring the clinician to cease working on their current system, switch to the CDSS, input the necessary data (even if it had already been inputted into another system), and examine the results produced. The additional steps break the flow from the clinician's perspective and cost precious time. As such, CDS technologies have gradually integrated with other systems like EHRs and computerized physician order entry (CPOE) systems.[14]\n\nTechnical challenges \nClinical decision support systems face steep technical challenges in a number of areas. Biological systems are profoundly complicated, and a clinical decision may utilize an enormous range of potentially relevant data. For example, an electronic evidence-based medicine system may potentially consider a patient's symptoms, medical history, family history, and genetics, as well as historical and geographical trends of disease occurrence and published clinical data on medicinal effectiveness when recommending a patient's course of treatment.[13]\nAnother source of contention with many medical support systems is that they produce a massive number of alerts. When systems produce high volume of warnings (especially those that do not require escalation), aside from the annoyance, clinicians may pay less attention to warnings, causing potentially critical alerts to be missed.[8]\n\nEvaluation \nIn order for a CDSS to offer value, it must demonstrably improve clinical workflow or outcome. Its value must be quantified to better improve the system's quality and measure its effectiveness. Evaluating a CDSS isn't straightforward, however. Because different CDSSs serve different purposes, there is no generic metric which applies to all such systems. Attributes like \"consistency\" (with itself and with experts), applied across a wide spectrum of systems, tend to be a useful starting point.[15]\nThe evaluation benchmark for a CDSS depends on the system's goal. For example, a diagnostic decision support system may be rated based upon the consistency and accuracy of its classification of disease (as compared to physicians or other decision support systems). An evidence-based medicine system might be rated based upon a high incidence of patient improvement or higher financial reimbursement for care providers. More generally speaking, studies evaluating a CDSS's effectiveness give some clues: look for connections between the CDDS and whether short-term outcomes are improved, errors are reduced, costs are decreased, and readmission rates are reduced.[16]\n\nMaintenance \nOne of the core challenges facing CDSS is difficulty in incorporating the extensive quantity of clinical research being published on an ongoing basis. In a given year, tens of thousands of clinical trials are published.[17] Currently, each one of these studies must be manually read, evaluated for scientific legitimacy, and incorporated into the CDSS in an accurate way. In 2004, the process of gathering clinical data and medical knowledge and putting it all into a form that computers can manipulate to assist in clinical decision-support was \"still in its infancy.\"[18] In addition to being laborious, integration of new data can sometimes be difficult to quantify or incorporate into the existing decision support schema, particularly in instances where different clinical papers may appear conflicting. Ten years later, however, that process had improved somewhat. Developers and maintainers of knowledge bases now have access to special tools like knowledge acquisitions systems \"that allow trained individuals to enter new knowledge, and maintain or 'curate' what is already there\" as well as systems that allow direct knowledge acquisition with experts.[16]\n\nIntegration of CDSS with other systems \nIn 2012, researchers Sen et al. examined all the various CDSS architectures and proposed several benefits to an integrated architecture. They noted the following concerning independent and integrated models:\n\nIn the standalone category, the CDS system is separate from any other system, that is, there is no coupling. Such systems do not need standardization, require relatively low clinical knowledge, and do not need real patient data. However, these systems are quite slow and are not very practical. The integrated category, on the other hand, requires that CDS needs to be strongly coupled with other clinical information systems such as EHR and CPOE. In such systems, no new patient data need to be re-entered and alerts can be initiated. The major downside of the integrated architecture is that there is no easy way to share the systems or reuse their content.[14]\nEven though the benefits of an integrated system can be seen, implementing a CDSS that is integrated with an EHR has historically required significant planning by healthcare organizations in order for the implementation of the CDSS to be successful and effective. As mentioned previously, this effectiveness can be measured, for example, by improved short-term outcomes, reduced errors, decreased costs, and reduced readmission rates.[16] As EHR adoption continues to be pushed, it also becomes more obvious that EHR functionality like e-prescribing, computerized physician order entry (CPOE), and reporting fit well with CDDS' rule base, alert, and trigger functionality.[14]\n\nBarriers to integration \nImplementing the EHR in healthcare settings incurs challenges, none more important than maintaining efficiency and safety during roll out[19], but in order for the implementation process to be effective, an understanding of the EHR user's perspectives is key to the success of EHR implementation projects.[20] \nFurthermore, adoption needs to be actively fostered through a bottom-up, clinical-needs-first approach.[21] The same can be said for CDSS.\nThe main areas of concern with moving into a fully integrated EHR-CDSS are[1]:\n\n Privacy\n Confidentiality\n User-friendliness\n Document accuracy and completeness\n Integration\n Uniformity\n Acceptance\n Alert desensitization\nAdditionally, key aspects of data entry need to be addressed when implementing a CDSS to avoid potential adverse events from occurring. These aspects include whether[6][16]:\n\n correct data is being used\n all the data has been entered into the system \n current best practice is being followed\n the data is evidence-based\nA service oriented architecture has been proposed as a technical means to address some of these barriers.[22]\n\nSee also \n Clinical informatics\nNotes \nThis article reuses several elements from the Wikipedia article.\n\nFurther reading \n Berner, Ets S. (June 2009). \"Clinical Decision Support Systems: State of the Art\" (PDF). Agency for Healthcare Research and Quality. pp. 26. http:\/\/healthit.ahrq.gov\/sites\/default\/files\/docs\/page\/09-0069-EF_1.pdf .   \n Greenes, Robert A. (ed.) (2014). Clinical Decision Support: The Road to Broad Adoption (2nd ed.). Academic Press. pp. 930. ISBN 9780128005422. https:\/\/books.google.com\/books?id=rwrUAgAAQBAJ&printsec=frontcover .   \nReferences \n\n\n\u2191 1.0 1.1 1.2 1.3 1.4 Berner, Eta S. (ed.) (2007). Clinical Decision Support Systems: Theory and Practice (2nd ed.). Springer Science & Business Media. pp. 270. ISBN 9780387383194. https:\/\/books.google.com\/books?id=t4laP7U4a-AC&pg=PA3 . Retrieved 19 June 2015 .   \n\n\u2191 Truesdail, Roger (April 1963). \"Peeps at Things to Come\". The Rotarian 102 (4). https:\/\/books.google.com\/books?id=EjcEAAAAMBAJ&pg=PA54 . Retrieved 19 June 2015 .   \n\n\u2191 Syeda-Mahmood, Tanveer (March 2015). \"Tanveer Syeda-Mahmood plenary talk: The Role of Machine Learning in Clinical Decision Support\". SPIE Newsroom. doi:10.1117\/2.3201503.29. http:\/\/spie.org\/x112958.xml . Retrieved 20 June 2015 .   \n\n\u2191 Twain, Jack (14 April 2014). \"Meaning of a neural network as a black-box?\". Cross Validated. Stack Exchange, Inc. http:\/\/stats.stackexchange.com\/questions\/93705\/meaning-of-a-neural-network-as-a-black-box . Retrieved 20 June 2015 .   \n\n\u2191 Wagholikar, Kavishwar; Sundararajan, V.; Deshpande, Ashok (October 2012). \"Modeling Paradigms for Medical Diagnostic Decision Support: A Survey and Future Directions\". Journal of Medical Systems 35 (5): 3029\u201349. doi:10.1007\/s10916-011-9780-4. PMID 21964969. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21964969 . Retrieved 20 June 2015 .   \n\n\u2191 6.0 6.1 6.2 Berner, Ets S. (June 2009). \"Clinical Decision Support Systems: State of the Art\" (PDF). Agency for Healthcare Research and Quality. pp. 26. http:\/\/healthit.ahrq.gov\/sites\/default\/files\/docs\/page\/09-0069-EF_1.pdf . Retrieved 20 June 2015 .   \n\n\u2191 \"Clinical Decision Support\". Health Level Seven International. 2015. http:\/\/www.hl7.org\/Special\/committees\/dss\/index.cfm . Retrieved 20 June 2015 .   \n\n\u2191 8.0 8.1 Ash, Joan S. et al. (2011). \"Studying the Vendor Perspective on Clinical Decision Support\". AMIA Annual Symposium Proceedings Archive 2011: 80\u201387. http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3243293\/ . Retrieved 20 June 2015 .   \n\n\u2191 Garg, Amit et al. (2005). \"Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review\". JAMA 293 (10): 1223\u201338. doi:10.1001\/jama.293.10.1223. PMID 15755945. http:\/\/jama.jamanetwork.com\/article.aspx?articleid=200503 . Retrieved 22 June 2015 .   \n\n\u2191 Kawamoto, Kensaku; Houlihan, Caitlin A.; Balas, E. Andrew; Lobach, David F. (2005). \"Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success\". BMJ 330 (7494): 765\u2013773. doi:10.1136\/bmj.38398.500764.8F. PMC 555881. PMID 15767266. http:\/\/www.bmj.com\/content\/330\/7494\/765.full.pdf+html . Retrieved 22 June 2015 .   \n\n\u2191 Black, A.D. et al. (2011). \"The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview\". PLoS Medicine 8 (1). doi:10.1371\/journal.pmed.1000387. http:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1000387 . Retrieved 22 June 2015 .   \n\n\u2191 Moja, Lorenzo et al. (December 2014). \"Effectiveness of Computerized Decision Support Systems Linked to Electronic Health Records: A Systematic Review and Meta-Analysis\". American Journal of Public Health 104 (12): e12-22. doi:10.2105\/ajph.2014.302164. PMID 25322302. http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4232126\/ . Retrieved 22 June 2015 .   \n\n\u2191 13.0 13.1 Jao, Chiang S.; Hier, Daniel B. (2010). \"Chapter 8: Clinical Decision Support Systems: An Effective Pathway to Reduce Medical Errors and Improve Patient Safety\". Decision Support Systems. InTech. doi:10.5772\/3453. http:\/\/www.intechopen.com\/books\/decision-support-systems\/clinical-decision-support-systems-an-effective-pathway-to-reduce-medical-errors-and-improve-patient-# . Retrieved 22 June 2015 .   \n\n\u2191 14.0 14.1 14.2 Sen, Arun; Banerjee, Amaranth; Sinha, Atish P.; Bansal, Manish (2012). \"Clinical decision support: Converging toward an integrated architecture\". Journal of Biomedical Informatics 45 (5): 1009\u20131017. doi:10.1016\/j.jbi.2012.07.001. http:\/\/www.j-biomed-inform.com\/article\/S1532-0464%2812%2900098-6\/fulltext . Retrieved 22 June 2015 .   \n\n\u2191 Wagholikar, Kavishwar B. et al. (July 2013). \"Formative evaluation of the accuracy of a clinical decision support system for cervical cancer screening\". Journal of American Medical Informatics Association 20 (4): 749\u2013757. doi:10.1136\/amiajnl-2013-001613. http:\/\/jamia.oxfordjournals.org\/content\/20\/4\/749 . Retrieved 22 June 2015 .   \n\n\u2191 16.0 16.1 16.2 16.3 Greenes, Robert A. (ed.) (2014). Clinical Decision Support: The Road to Broad Adoption (2nd ed.). Academic Press. pp. 930. ISBN 9780128005422. https:\/\/books.google.com\/books?id=rwrUAgAAQBAJ&printsec=frontcover . Retrieved 22 June 2015 .   \n\n\u2191 Gluud, Christian; Nikolova, Dimitrinka (2007). \"Likely country of origin in publications on randomised controlled trials and controlled clinical trials during the last 60 years\". Trials 8: 7. doi:10.1186\/1745-6215-8-7. PMC 1808475. PMID 17326823. http:\/\/www.trialsjournal.com\/content\/8\/1\/7 . Retrieved 22 June 2015 .   \n\n\u2191 Gardner, Reed M. (April 2004). \"Computerized Clinical Decision-Support in Respiratory Care\". Respiratory Care 49 (4): 378\u2013388. PMID 15030611. http:\/\/rc.rcjournal.com\/content\/49\/4\/378.short . Retrieved 22 June 2015 .   \n\n\u2191 Spellman, Stephanie K.; Timm, Nathan; Farrell, Michael K.; Spooner, S. Andrew (May\u2013June 2012). \"Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department\". Journal of the American Medical Informatics Association 19 (3): 443\u2013447. doi:10.1136\/amiajnl-2011-000462. http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3341791\/ . Retrieved 22 June 2015 .   \n\n\u2191 McGinn, Carrie A. et al. (September 2012). \"Users' perspectives of key factors to implementing electronic health records in Canada: a Delphi study\". BMC Medical Informatics & Decision Making 12 (105). doi:10.1186\/1472-6947-12-105. http:\/\/www.biomedcentral.com\/1472-6947\/12\/105 . Retrieved 22 June 2015 .   \n\n\u2191 Rozenblum, Ronen et al. (March 2011). \"A qualitative study of Canada's experience with the implementation of electronic health information technology\". Canadian Medical Association Journal 183 (5): E281\u2013E288. doi:10.1503\/cmaj.100856. http:\/\/www.cmaj.ca\/content\/183\/5\/E281.abstract . Retrieved 22 June 2015 .   \n\n\u2191 Loya, Salvador R.; Kawamoto, Kensaku; Chatwin, Chris; Huser, Vojtech (December 2014). \"Service Oriented Architecture for Clinical Decision Support: A Systematic Review and Future Directions\". Journal of Medical Systems 38 (12). doi:10.1007\/s10916-014-0140-z. PMID 25325996. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25325996 . Retrieved 22 June 2015 .   \n\n\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Clinical_decision_support_system\">https:\/\/www.limswiki.org\/index.php\/Clinical_decision_support_system<\/a>\n\t\t\t\t\tCategories: EHealthHealth informaticsSoftware systems\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 13 August 2016, at 18:16.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 3,907 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","095141425468d057aa977016869ca37d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Clinical_decision_support_system skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Clinical decision support system<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:462px;\"><a href=\"https:\/\/www.limswiki.org\/index.php\/File:DSS-Figure-1.PNG\" class=\"image wiki-link\" target=\"_blank\" data-key=\"673554232e39ce8352fbd674c7b50983\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/20\/DSS-Figure-1.PNG\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/www.limswiki.org\/index.php\/File:DSS-Figure-1.PNG\" class=\"internal wiki-link\" title=\"Enlarge\" target=\"_blank\" data-key=\"673554232e39ce8352fbd674c7b50983\"><\/a><\/div>This diagram demonstrates the interconnections among how knowledge is generated and validated, how knowledge is managed and disseminated, and how it finds its way into clinical decision support system (CDSS).<\/div><\/div><\/div>\n<p>A <b>clinical decision support system<\/b> (<b>CDSS<\/b>) is a \"computer [system] designed to impact clinician decision making about individual patients at the point in time these decisions are made.\"<sup id=\"rdp-ebb-cite_ref-BernerCDSS_1-0\" class=\"reference\"><a href=\"#cite_note-BernerCDSS-1\" rel=\"external_link\">[1]<\/a><\/sup> As such, it can be viewed as a knowledge management tool used to further clinical advice for patient care based on multiple items of patient data.\n<\/p>\n\n\n<h2><span class=\"mw-headline\" id=\"Characteristics\">Characteristics<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Purpose\">Purpose<\/span><\/h3>\n<p>In the early days, CDSSs were conceived of as being used to literally make decisions for the clinician. The clinician would input the information and wait for the CDSS to output the \"right\" choice, and the clinician would simply act on that output. In April 1963, a forward-looking doctor Roger Truesdail imagined a future 1985 where such a process would be a reality:\n<\/p>\n<blockquote>The year is 1985 when a middle-aged man enters a physician's office, suffering from a critical ailment. The doctor feeds into a small electronic computer the patient's symptoms, medical history, and other pertinent data. The computer transmits the information to a giant central electronic computer in a remote city. Seconds later the computer will transmit back to the doctor the combined medical diagnosis of the world's best medical minds. The man is given the proper treatment and his life is saved. The very latest medical information, often inaccessible to doctors, will be stored in the giant computer. This computer, linked with small computers in doctors' offices and hospitals all over the world, will place vital medical information at doctor's fingertips.<sup id=\"rdp-ebb-cite_ref-TruesdailRotarian_2-0\" class=\"reference\"><a href=\"#cite_note-TruesdailRotarian-2\" rel=\"external_link\">[2]<\/a><\/sup><\/blockquote>\n<p>However, the modern methodology involves the clinician interacting with the CDSS at the point of care, utilizing both their own knowledge and the CDSS to produce the best diagnosis from the test data. Typically, a CDSS suggests avenues for the physician to explore, and the physician is expected to use their own knowledge and judgement to narrow down possibilities.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_CDSS\">Types of CDSS<\/span><\/h2>\n<p>CDSSs can be roughly divided into two types: those with knowledge bases and those without. The knowledge-based approach typically covers the diagnosis of many different diseases, while the non-knowledge-based approach often focuses on a narrow list of symptoms, such as symptoms for a single disease.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Knowledge-based_CDSS\">Knowledge-based CDSS<\/span><\/h3>\n<p>Most CDSSs contain a knowledge base as well as an inference engine and a mechanism to communicate. The knowledge base contains the rules and associations of compiled data, which most often take the form of IF-THEN rules. If this were a system for determining drug interactions, for example, then a rule might be that IF drug X is taken AND drug Y is taken, THEN alert the user. Using another interface, an advanced user can update the knowledge base with new drug information. The inference engine combines the rules from the knowledge base with the patient's data, while the communication mechanism allows the system to show the results and allow user input into the system.<sup id=\"rdp-ebb-cite_ref-BernerCDSS_1-1\" class=\"reference\"><a href=\"#cite_note-BernerCDSS-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Non-knowledge-based_CDSS\">Non-knowledge-based CDSS<\/span><\/h3>\n<p>CDSSs that do not use a knowledge base use a form of artificial intelligence called machine learning, which allow computers to learn from past experiences and\/or find patterns in clinical data. This eliminates the need for writing rules and for expert input.<sup id=\"rdp-ebb-cite_ref-SyedaMachine_3-0\" class=\"reference\"><a href=\"#cite_note-SyedaMachine-3\" rel=\"external_link\">[3]<\/a><\/sup> However, since systems based on machine learning cannot explain the reasons for their conclusions (neural networks and other machine learning systems are often referred to as \"black boxes\" because no meaningful information about how they work can be discerned by human inspection<sup id=\"rdp-ebb-cite_ref-StackBB_4-0\" class=\"reference\"><a href=\"#cite_note-StackBB-4\" rel=\"external_link\">[4]<\/a><\/sup>), most clinicians do not use them directly for diagnoses due to reliability and accountability reasons.<sup id=\"rdp-ebb-cite_ref-BernerCDSS_1-2\" class=\"reference\"><a href=\"#cite_note-BernerCDSS-1\" rel=\"external_link\">[1]<\/a><\/sup> Nevertheless, they can be useful as post-diagnostic systems that suggest data patterns for further investigation.\n<\/p><p>Two of the major types of non-knowledge-based systems are artificial neural networks and genetic algorithms. Artificial neural networks use nodes and weighted connections between them to analyze the patterns found in patient data to derive associations between symptoms and a diagnosis. Genetic algorithms are based on simplified evolutionary processes using directed selection to achieve optimal CDSS results. The selection algorithms evaluate components of random sets of solutions to a problem. The solutions that come out on top are then recombined and mutated and run through the process again. This happens over and over until the proper solution is discovered. They are functionally similar to neural networks in that they are also \"black boxes\" that attempt to derive knowledge from patient data.<sup id=\"rdp-ebb-cite_ref-WagModel_5-0\" class=\"reference\"><a href=\"#cite_note-WagModel-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BernerCDSS_1-3\" class=\"reference\"><a href=\"#cite_note-BernerCDSS-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Regulations\">Regulations<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"United_States\">United States<\/span><\/h3>\n<p>With the enactment of the American Recovery and Reinvestment Act of 2009 (ARRA), the U.S. government and medical professionals alike have been pushing for greater widespread adoption of <a href=\"https:\/\/www.limswiki.org\/index.php\/Health_information_technology\" title=\"Health information technology\" target=\"_blank\" class=\"wiki-link\" data-key=\"9c8ef822470559f757db89f3fa234cc0\">health information technology<\/a>. As such, more hospitals and clinics are integrating <a href=\"https:\/\/www.limswiki.org\/index.php\/Electronic_health_record\" title=\"Electronic health record\" target=\"_blank\" class=\"wiki-link\" data-key=\"f2e31a73217185bb01389404c1fd5255\">electronic health records<\/a> (EHRs) and <a href=\"https:\/\/www.limswiki.org\/index.php\/Computerized_physician_order_entry\" title=\"Computerized physician order entry\" target=\"_blank\" class=\"wiki-link\" data-key=\"f9e67e685f2b29f79e9b0991330f2b10\">computerized physician order entry<\/a> (CPOE) systems within their infrastructure. In fact, the National Academy of Sciences' Institute of Medicine had been actively promoting the use of health information technology \u2014 including the CDSS \u2014 to advance quality of patient care well before the ARRA was even enacted.<sup id=\"rdp-ebb-cite_ref-AHRQCDSS_6-0\" class=\"reference\"><a href=\"#cite_note-AHRQCDSS-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Currently there are \"no national standards for the specific evidence-based guidelines or rules that should be built into CDS<sup id=\"rdp-ebb-cite_ref-AHRQCDSS_6-1\" class=\"reference\"><a href=\"#cite_note-AHRQCDSS-6\" rel=\"external_link\">[6]<\/a><\/sup>,\" though standards organizations like <a href=\"https:\/\/www.limswiki.org\/index.php\/Health_Level_Seven\" title=\"Health Level Seven\" class=\"mw-redirect wiki-link\" target=\"_blank\" data-key=\"c5b65d5af4e94435ec8a563c37fee00b\">Health Level Seven<\/a> and its Clinical Decision Support Work Group continue to make headway on this front.<sup id=\"rdp-ebb-cite_ref-HL7CDSS_7-0\" class=\"reference\"><a href=\"#cite_note-HL7CDSS-7\" rel=\"external_link\">[7]<\/a><\/sup> Despite the absence of laws, several CDSS vendors have expressed both a desire to work together to provide a useful product to improve health outcomes and a need to express neutrality liability wise, stating\n<\/p>\n<blockquote>...[t]he ultimate end user is responsible for how it influences patient care. This neutral stance on the part of the content vendors is also due to the legal situation. Some content vendor representatives spoke strongly about how the legal system in this country influences what they can provide. There are many legal, regulatory, antitrust, and fiduciary constraints that content vendors must navigate while still providing a useful and usable product for all their customers. Sometimes, depending on what is being sold, these constraints result in sub-optimal products for clinician end-users.<sup id=\"rdp-ebb-cite_ref-AshVendor_8-0\" class=\"reference\"><a href=\"#cite_note-AshVendor-8\" rel=\"external_link\">[8]<\/a><\/sup><\/blockquote>\n<h2><span class=\"mw-headline\" id=\"Effectiveness\">Effectiveness<\/span><\/h2>\n<p>The evidence of the effectiveness of CDSS is mixed. A 2005 systematic review by medical researchers concluded that CDSSs improved practitioner performance in 64 percent and improved patient outcomes in 13 percent of 97 selected studies.<sup id=\"rdp-ebb-cite_ref-pmid15755945_9-0\" class=\"reference\"><a href=\"#cite_note-pmid15755945-9\" rel=\"external_link\">[9]<\/a><\/sup> Another 2005 systematic review found \"[d]ecision support systems significantly improved clinical practice in 68 percent of trials\" (70 selected studies). That research team found four features associated with successful CDSSs:<sup id=\"rdp-ebb-cite_ref-PMID_15767266_10-0\" class=\"reference\"><a href=\"#cite_note-PMID_15767266-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<ul><li> The CDSS is integrated into the clinical workflow rather than as a separate log-in or screen.<\/li>\n<li> The CDSS offers electronic output rather than only paper-based output.<\/li>\n<li> The CDSS provides decision support at the time and location of care rather than prior to or after the patient encounter.<\/li>\n<li> The CDSS provides actionable recommendations for care, not just assessments.<\/li><\/ul>\n<p>However, other systematic reviews are less optimistic about the effects of a CDDS, with one from 2011 stating \"[t]here is a large gap between the postulated and empirically demonstrated benefits of [CDSS and other] eHealth technologies ... [and] their cost-effectiveness has yet to be demonstrated.\"<sup id=\"rdp-ebb-cite_ref-pmid1000387_11-0\" class=\"reference\"><a href=\"#cite_note-pmid1000387-11\" rel=\"external_link\">[11]<\/a><\/sup> A 2014 systematic review by public health researchers did not find a benefit in terms of risk of death when the CDSS was combined with the electronic health record. However, there may be some benefits to morbidity outcomes.<sup id=\"rdp-ebb-cite_ref-Moja2014_12-0\" class=\"reference\"><a href=\"#cite_note-Moja2014-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Challenges_to_adoption_and_implementation\">Challenges to adoption and implementation<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Clinical_challenges\">Clinical challenges<\/span><\/h3>\n<p>Many medical institutions and software companies have tried to produce viable CDSSs to support all aspects of clinical tasks. However, with significant staff time demands and complex clinical workflows, care must be taken by the institution deploying the support system to ensure the system becomes a fluid and integral part of the clinical workflow. Yet despite the wide range of efforts by institutions to produce and use these systems, widespread adoption and acceptance has still not yet been achieved. One large roadblock to acceptance has historically been workflow integration. A tendency to focus only on the functional decision making core of the CDSS existed, causing a deficiency in planning for how the clinician will actually use the product in situ.<sup id=\"rdp-ebb-cite_ref-JaoCDS_13-0\" class=\"reference\"><a href=\"#cite_note-JaoCDS-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>Often CDSSs were stand-alone applications, requiring the clinician to cease working on their current system, switch to the CDSS, input the necessary data (even if it had already been inputted into another system), and examine the results produced. The additional steps break the flow from the clinician's perspective and cost precious time. As such, CDS technologies have gradually integrated with other systems like EHRs and computerized physician order entry (CPOE) systems.<sup id=\"rdp-ebb-cite_ref-SenCDS_14-0\" class=\"reference\"><a href=\"#cite_note-SenCDS-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Technical_challenges\">Technical challenges<\/span><\/h3>\n<p>Clinical decision support systems face steep technical challenges in a number of areas. Biological systems are profoundly complicated, and a clinical decision may utilize an enormous range of potentially relevant data. For example, an electronic evidence-based medicine system may potentially consider a patient's symptoms, medical history, family history, and genetics, as well as historical and geographical trends of disease occurrence and published clinical data on medicinal effectiveness when recommending a patient's course of treatment.<sup id=\"rdp-ebb-cite_ref-JaoCDS_13-1\" class=\"reference\"><a href=\"#cite_note-JaoCDS-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>Another source of contention with many medical support systems is that they produce a massive number of alerts. When systems produce high volume of warnings (especially those that do not require escalation), aside from the annoyance, clinicians may pay less attention to warnings, causing potentially critical alerts to be missed.<sup id=\"rdp-ebb-cite_ref-AshVendor_8-1\" class=\"reference\"><a href=\"#cite_note-AshVendor-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Evaluation\">Evaluation<\/span><\/h3>\n<p>In order for a CDSS to offer value, it must demonstrably improve clinical workflow or outcome. Its value must be quantified to better improve the system's quality and measure its effectiveness. Evaluating a CDSS isn't straightforward, however. Because different CDSSs serve different purposes, there is no generic metric which applies to all such systems. Attributes like \"consistency\" (with itself and with experts), applied across a wide spectrum of systems, tend to be a useful starting point.<sup id=\"rdp-ebb-cite_ref-WagholikarCerv_15-0\" class=\"reference\"><a href=\"#cite_note-WagholikarCerv-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>The evaluation benchmark for a CDSS depends on the system's goal. For example, a diagnostic decision support system may be rated based upon the consistency and accuracy of its classification of disease (as compared to physicians or other decision support systems). An evidence-based medicine system might be rated based upon a high incidence of patient improvement or higher financial reimbursement for care providers. More generally speaking, studies evaluating a CDSS's effectiveness give some clues: look for connections between the CDDS and whether short-term outcomes are improved, errors are reduced, costs are decreased, and readmission rates are reduced.<sup id=\"rdp-ebb-cite_ref-GreenesCDS_16-0\" class=\"reference\"><a href=\"#cite_note-GreenesCDS-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Maintenance\">Maintenance<\/span><\/h3>\n<p>One of the core challenges facing CDSS is difficulty in incorporating the extensive quantity of clinical research being published on an ongoing basis. In a given year, tens of thousands of clinical trials are published.<sup id=\"rdp-ebb-cite_ref-pmid17326823_17-0\" class=\"reference\"><a href=\"#cite_note-pmid17326823-17\" rel=\"external_link\">[17]<\/a><\/sup> Currently, each one of these studies must be manually read, evaluated for scientific legitimacy, and incorporated into the CDSS in an accurate way. In 2004, the process of gathering clinical data and medical knowledge and putting it all into a form that computers can manipulate to assist in clinical decision-support was \"still in its infancy.\"<sup id=\"rdp-ebb-cite_ref-GardnerCDS_18-0\" class=\"reference\"><a href=\"#cite_note-GardnerCDS-18\" rel=\"external_link\">[18]<\/a><\/sup> In addition to being laborious, integration of new data can sometimes be difficult to quantify or incorporate into the existing decision support schema, particularly in instances where different clinical papers may appear conflicting. Ten years later, however, that process had improved somewhat. Developers and maintainers of knowledge bases now have access to special tools like knowledge acquisitions systems \"that allow trained individuals to enter new knowledge, and maintain or 'curate' what is already there\" as well as systems that allow direct knowledge acquisition with experts.<sup id=\"rdp-ebb-cite_ref-GreenesCDS_16-1\" class=\"reference\"><a href=\"#cite_note-GreenesCDS-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Integration_of_CDSS_with_other_systems\">Integration of CDSS with other systems<\/span><\/h2>\n<p>In 2012, researchers Sen et al. examined all the various CDSS architectures and proposed several benefits to an integrated architecture. They noted the following concerning independent and integrated models:\n<\/p>\n<blockquote>In the standalone category, the CDS system is separate from any other system, that is, there is no coupling. Such systems do not need standardization, require relatively low clinical knowledge, and do not need real patient data. However, these systems are quite slow and are not very practical. The integrated category, on the other hand, requires that CDS needs to be strongly coupled with other clinical information systems such as EHR and CPOE. In such systems, no new patient data need to be re-entered and alerts can be initiated. The major downside of the integrated architecture is that there is no easy way to share the systems or reuse their content.<sup id=\"rdp-ebb-cite_ref-SenCDS_14-1\" class=\"reference\"><a href=\"#cite_note-SenCDS-14\" rel=\"external_link\">[14]<\/a><\/sup><\/blockquote>\n<p>Even though the benefits of an integrated system can be seen, implementing a CDSS that is integrated with an EHR has historically required significant planning by healthcare organizations in order for the implementation of the CDSS to be successful and effective. As mentioned previously, this effectiveness can be measured, for example, by improved short-term outcomes, reduced errors, decreased costs, and reduced readmission rates.<sup id=\"rdp-ebb-cite_ref-GreenesCDS_16-2\" class=\"reference\"><a href=\"#cite_note-GreenesCDS-16\" rel=\"external_link\">[16]<\/a><\/sup> As EHR adoption continues to be pushed, it also becomes more obvious that EHR functionality like e-prescribing, computerized physician order entry (CPOE), and reporting fit well with CDDS' rule base, alert, and trigger functionality.<sup id=\"rdp-ebb-cite_ref-SenCDS_14-2\" class=\"reference\"><a href=\"#cite_note-SenCDS-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Barriers_to_integration\">Barriers to integration<\/span><\/h3>\n<p>Implementing the EHR in healthcare settings incurs challenges, none more important than maintaining efficiency and safety during roll out<sup id=\"rdp-ebb-cite_ref-SpellmanEHR_19-0\" class=\"reference\"><a href=\"#cite_note-SpellmanEHR-19\" rel=\"external_link\">[19]<\/a><\/sup>, but in order for the implementation process to be effective, an understanding of the EHR user's perspectives is key to the success of EHR implementation projects.<sup id=\"rdp-ebb-cite_ref-McGinnEHR_20-0\" class=\"reference\"><a href=\"#cite_note-McGinnEHR-20\" rel=\"external_link\">[20]<\/a><\/sup> \n<\/p><p>Furthermore, adoption needs to be actively fostered through a bottom-up, clinical-needs-first approach.<sup id=\"rdp-ebb-cite_ref-RozenblumEHR_21-0\" class=\"reference\"><a href=\"#cite_note-RozenblumEHR-21\" rel=\"external_link\">[21]<\/a><\/sup> The same can be said for CDSS.\n<\/p><p>The main areas of concern with moving into a fully integrated EHR-CDSS are<sup id=\"rdp-ebb-cite_ref-BernerCDSS_1-4\" class=\"reference\"><a href=\"#cite_note-BernerCDSS-1\" rel=\"external_link\">[1]<\/a><\/sup>:\n<\/p>\n<ol><li> Privacy<\/li>\n<li> Confidentiality<\/li>\n<li> User-friendliness<\/li>\n<li> Document accuracy and completeness<\/li>\n<li> Integration<\/li>\n<li> Uniformity<\/li>\n<li> Acceptance<\/li>\n<li> Alert desensitization<\/li><\/ol>\n<p>Additionally, key aspects of data entry need to be addressed when implementing a CDSS to avoid potential adverse events from occurring. These aspects include whether<sup id=\"rdp-ebb-cite_ref-AHRQCDSS_6-2\" class=\"reference\"><a href=\"#cite_note-AHRQCDSS-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-GreenesCDS_16-3\" class=\"reference\"><a href=\"#cite_note-GreenesCDS-16\" rel=\"external_link\">[16]<\/a><\/sup>:\n<\/p>\n<ul><li> correct data is being used<\/li>\n<li> all the data has been entered into the system <\/li>\n<li> current best practice is being followed<\/li>\n<li> the data is evidence-based<\/li><\/ul>\n<p>A service oriented architecture has been proposed as a technical means to address some of these barriers.<sup id=\"rdp-ebb-cite_ref-LoyaService_22-0\" class=\"reference\"><a href=\"#cite_note-LoyaService-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li> <a href=\"https:\/\/www.limswiki.org\/index.php\/Clinical_informatics\" title=\"Clinical informatics\" class=\"mw-redirect wiki-link\" target=\"_blank\" data-key=\"bda8123083aecb94afe79afec9ae4686\">Clinical informatics<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article reuses several elements from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/Clinical_decision_support_system\" target=\"_blank\">the Wikipedia article<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li> <span class=\"citation web\">Berner, Ets S. (June 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/healthit.ahrq.gov\/sites\/default\/files\/docs\/page\/09-0069-EF_1.pdf\" target=\"_blank\">\"Clinical Decision Support Systems: State of the Art\"<\/a> (PDF). Agency for Healthcare Research and Quality. pp. 26<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/healthit.ahrq.gov\/sites\/default\/files\/docs\/page\/09-0069-EF_1.pdf\" target=\"_blank\">http:\/\/healthit.ahrq.gov\/sites\/default\/files\/docs\/page\/09-0069-EF_1.pdf<\/a><\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Clinical+Decision+Support+Systems%3A+State+of+the+Art&rft.atitle=&rft.aulast=Berner%2C+Ets+S.&rft.au=Berner%2C+Ets+S.&rft.date=June+2009&rft.pages=pp.+26&rft.pub=Agency+for+Healthcare+Research+and+Quality&rft_id=http%3A%2F%2Fhealthit.ahrq.gov%2Fsites%2Fdefault%2Ffiles%2Fdocs%2Fpage%2F09-0069-EF_1.pdf&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/li><\/ul>\n<ul><li> <span class=\"citation book\">Greenes, Robert A. (ed.) (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=rwrUAgAAQBAJ&printsec=frontcover\" target=\"_blank\"><i>Clinical Decision Support: The Road to Broad Adoption<\/i><\/a> (2nd ed.). Academic Press. pp. 930. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" target=\"_blank\">ISBN<\/a> 9780128005422<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/books.google.com\/books?id=rwrUAgAAQBAJ&printsec=frontcover\" target=\"_blank\">https:\/\/books.google.com\/books?id=rwrUAgAAQBAJ&printsec=frontcover<\/a><\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Clinical+Decision+Support%3A+The+Road+to+Broad+Adoption&rft.aulast=Greenes%2C+Robert+A.+%28ed.%29&rft.au=Greenes%2C+Robert+A.+%28ed.%29&rft.date=2014&rft.pages=pp.%26nbsp%3B930&rft.edition=2nd&rft.pub=Academic+Press&rft.isbn=9780128005422&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DrwrUAgAAQBAJ%26printsec%3Dfrontcover&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-BernerCDSS-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-BernerCDSS_1-0\" rel=\"external_link\">1.0<\/a><\/sup> <sup><a href=\"#cite_ref-BernerCDSS_1-1\" rel=\"external_link\">1.1<\/a><\/sup> <sup><a href=\"#cite_ref-BernerCDSS_1-2\" rel=\"external_link\">1.2<\/a><\/sup> <sup><a href=\"#cite_ref-BernerCDSS_1-3\" rel=\"external_link\">1.3<\/a><\/sup> <sup><a href=\"#cite_ref-BernerCDSS_1-4\" rel=\"external_link\">1.4<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation book\">Berner, Eta S. (ed.) (2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=t4laP7U4a-AC&pg=PA3\" target=\"_blank\"><i>Clinical Decision Support Systems: Theory and Practice<\/i><\/a> (2nd ed.). Springer Science & Business Media. pp. 270. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" target=\"_blank\">ISBN<\/a> 9780387383194<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/books.google.com\/books?id=t4laP7U4a-AC&pg=PA3\" target=\"_blank\">https:\/\/books.google.com\/books?id=t4laP7U4a-AC&pg=PA3<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 19 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Clinical+Decision+Support+Systems%3A+Theory+and+Practice&rft.aulast=Berner%2C+Eta+S.+%28ed.%29&rft.au=Berner%2C+Eta+S.+%28ed.%29&rft.date=2007&rft.pages=pp.%26nbsp%3B270&rft.edition=2nd&rft.pub=Springer+Science+%26+Business+Media&rft.isbn=9780387383194&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dt4laP7U4a-AC%26pg%3DPA3&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-TruesdailRotarian-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-TruesdailRotarian_2-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Truesdail, Roger (April 1963). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=EjcEAAAAMBAJ&pg=PA54\" target=\"_blank\">\"Peeps at Things to Come\"<\/a>. <i>The Rotarian<\/i> <b>102<\/b> (4)<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/books.google.com\/books?id=EjcEAAAAMBAJ&pg=PA54\" target=\"_blank\">https:\/\/books.google.com\/books?id=EjcEAAAAMBAJ&pg=PA54<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 19 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Peeps+at+Things+to+Come&rft.jtitle=The+Rotarian&rft.aulast=Truesdail%2C+Roger&rft.au=Truesdail%2C+Roger&rft.date=April+1963&rft.volume=102&rft.issue=4&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DEjcEAAAAMBAJ%26pg%3DPA54&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-SyedaMachine-3\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-SyedaMachine_3-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Syeda-Mahmood, Tanveer (March 2015). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spie.org\/x112958.xml\" target=\"_blank\">\"Tanveer Syeda-Mahmood plenary talk: The Role of Machine Learning in Clinical Decision Support\"<\/a>. <i>SPIE Newsroom<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dx.doi.org\/10.1117%2F2.3201503.29\" target=\"_blank\">10.1117\/2.3201503.29<\/a><span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/spie.org\/x112958.xml\" target=\"_blank\">http:\/\/spie.org\/x112958.xml<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 20 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Tanveer+Syeda-Mahmood+plenary+talk%3A+The+Role+of+Machine+Learning+in+Clinical+Decision+Support&rft.jtitle=SPIE+Newsroom&rft.aulast=Syeda-Mahmood%2C+Tanveer&rft.au=Syeda-Mahmood%2C+Tanveer&rft.date=March+2015&rft_id=info:doi\/10.1117%2F2.3201503.29&rft_id=http%3A%2F%2Fspie.org%2Fx112958.xml&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-StackBB-4\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-StackBB_4-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation web\">Twain, Jack (14 April 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/stats.stackexchange.com\/questions\/93705\/meaning-of-a-neural-network-as-a-black-box\" target=\"_blank\">\"Meaning of a neural network as a black-box?\"<\/a>. <i>Cross Validated<\/i>. Stack Exchange, Inc<span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/stats.stackexchange.com\/questions\/93705\/meaning-of-a-neural-network-as-a-black-box\" target=\"_blank\">http:\/\/stats.stackexchange.com\/questions\/93705\/meaning-of-a-neural-network-as-a-black-box<\/a><\/span><span class=\"reference-accessdate\">. 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Retrieved 22 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Chapter+8%3A+Clinical+Decision+Support+Systems%3A+An+Effective+Pathway+to+Reduce+Medical+Errors+and+Improve+Patient+Safety&rft.atitle=Decision+Support+Systems&rft.aulast=Jao%2C+Chiang+S.%3B+Hier%2C+Daniel+B.&rft.au=Jao%2C+Chiang+S.%3B+Hier%2C+Daniel+B.&rft.date=2010&rft.pub=InTech&rft_id=info:doi\/10.5772%2F3453&rft_id=http%3A%2F%2Fwww.intechopen.com%2Fbooks%2Fdecision-support-systems%2Fclinical-decision-support-systems-an-effective-pathway-to-reduce-medical-errors-and-improve-patient-%23&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-SenCDS-14\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-SenCDS_14-0\" rel=\"external_link\">14.0<\/a><\/sup> <sup><a href=\"#cite_ref-SenCDS_14-1\" rel=\"external_link\">14.1<\/a><\/sup> <sup><a href=\"#cite_ref-SenCDS_14-2\" rel=\"external_link\">14.2<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Sen, Arun; Banerjee, Amaranth; Sinha, Atish P.; Bansal, Manish (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.j-biomed-inform.com\/article\/S1532-0464%2812%2900098-6\/fulltext\" target=\"_blank\">\"Clinical decision support: Converging toward an integrated architecture\"<\/a>. <i>Journal of Biomedical Informatics<\/i> <b>45<\/b> (5): 1009\u20131017. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dx.doi.org\/10.1016%2Fj.jbi.2012.07.001\" target=\"_blank\">10.1016\/j.jbi.2012.07.001<\/a><span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.j-biomed-inform.com\/article\/S1532-0464%2812%2900098-6\/fulltext\" target=\"_blank\">http:\/\/www.j-biomed-inform.com\/article\/S1532-0464%2812%2900098-6\/fulltext<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 22 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Clinical+decision+support%3A+Converging+toward+an+integrated+architecture&rft.jtitle=Journal+of+Biomedical+Informatics&rft.aulast=Sen%2C+Arun%3B+Banerjee%2C+Amaranth%3B+Sinha%2C+Atish+P.%3B+Bansal%2C+Manish&rft.au=Sen%2C+Arun%3B+Banerjee%2C+Amaranth%3B+Sinha%2C+Atish+P.%3B+Bansal%2C+Manish&rft.date=2012&rft.volume=45&rft.issue=5&rft.pages=1009%E2%80%931017&rft_id=info:doi\/10.1016%2Fj.jbi.2012.07.001&rft_id=http%3A%2F%2Fwww.j-biomed-inform.com%2Farticle%2FS1532-0464%252812%252900098-6%2Ffulltext&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-WagholikarCerv-15\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-WagholikarCerv_15-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Wagholikar, Kavishwar B. et al. 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Retrieved 22 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Formative+evaluation+of+the+accuracy+of+a+clinical+decision+support+system+for+cervical+cancer+screening&rft.jtitle=Journal+of+American+Medical+Informatics+Association&rft.aulast=Wagholikar%2C+Kavishwar+B.+et+al.&rft.au=Wagholikar%2C+Kavishwar+B.+et+al.&rft.date=July+2013&rft.volume=20&rft.issue=4&rft.pages=749%E2%80%93757&rft_id=info:doi\/10.1136%2Famiajnl-2013-001613&rft_id=http%3A%2F%2Fjamia.oxfordjournals.org%2Fcontent%2F20%2F4%2F749&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-GreenesCDS-16\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-GreenesCDS_16-0\" rel=\"external_link\">16.0<\/a><\/sup> <sup><a href=\"#cite_ref-GreenesCDS_16-1\" rel=\"external_link\">16.1<\/a><\/sup> <sup><a href=\"#cite_ref-GreenesCDS_16-2\" rel=\"external_link\">16.2<\/a><\/sup> <sup><a href=\"#cite_ref-GreenesCDS_16-3\" rel=\"external_link\">16.3<\/a><\/sup><\/span> <span class=\"reference-text\"><span class=\"citation book\">Greenes, Robert A. 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(March 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cmaj.ca\/content\/183\/5\/E281.abstract\" target=\"_blank\">\"A qualitative study of Canada's experience with the implementation of electronic health information technology\"<\/a>. <i>Canadian Medical Association Journal<\/i> <b>183<\/b> (5): E281\u2013E288. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dx.doi.org\/10.1503%2Fcmaj.100856\" target=\"_blank\">10.1503\/cmaj.100856<\/a><span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.cmaj.ca\/content\/183\/5\/E281.abstract\" target=\"_blank\">http:\/\/www.cmaj.ca\/content\/183\/5\/E281.abstract<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 22 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=A+qualitative+study+of+Canada%27s+experience+with+the+implementation+of+electronic+health+information+technology&rft.jtitle=Canadian+Medical+Association+Journal&rft.aulast=Rozenblum%2C+Ronen+et+al.&rft.au=Rozenblum%2C+Ronen+et+al.&rft.date=March+2011&rft.volume=183&rft.issue=5&rft.pages=E281%E2%80%93E288&rft_id=info:doi\/10.1503%2Fcmaj.100856&rft_id=http%3A%2F%2Fwww.cmaj.ca%2Fcontent%2F183%2F5%2FE281.abstract&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-LoyaService-22\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-LoyaService_22-0\" rel=\"external_link\">\u2191<\/a><\/span> <span class=\"reference-text\"><span class=\"citation Journal\">Loya, Salvador R.; Kawamoto, Kensaku; Chatwin, Chris; Huser, Vojtech (December 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25325996\" target=\"_blank\">\"Service Oriented Architecture for Clinical Decision Support: A Systematic Review and Future Directions\"<\/a>. <i>Journal of Medical Systems<\/i> <b>38<\/b> (12). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dx.doi.org\/10.1007%2Fs10916-014-0140-z\" target=\"_blank\">10.1007\/s10916-014-0140-z<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25325996\" target=\"_blank\">25325996<\/a><span class=\"printonly\">. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25325996\" target=\"_blank\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25325996<\/a><\/span><span class=\"reference-accessdate\">. Retrieved 22 June 2015<\/span>.<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Service+Oriented+Architecture+for+Clinical+Decision+Support%3A+A+Systematic+Review+and+Future+Directions&rft.jtitle=Journal+of+Medical+Systems&rft.aulast=Loya%2C+Salvador+R.%3B+Kawamoto%2C+Kensaku%3B+Chatwin%2C+Chris%3B+Huser%2C+Vojtech&rft.au=Loya%2C+Salvador+R.%3B+Kawamoto%2C+Kensaku%3B+Chatwin%2C+Chris%3B+Huser%2C+Vojtech&rft.date=December+2014&rft.volume=38&rft.issue=12&rft_id=info:doi\/10.1007%2Fs10916-014-0140-z&rft_id=info:pmid\/25325996&rft_id=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F25325996&rfr_id=info:sid\/en.wikipedia.org:Clinical_decision_support_system\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n\n<!-- \nNewPP limit report\nCached time: 20181217214649\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.606 seconds\nReal time usage: 1.320 seconds\nPreprocessor visited node count: 17388\/1000000\nPreprocessor generated node count: 24108\/1000000\nPost\u2010expand include size: 141386\/2097152 bytes\nTemplate argument size: 50478\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 519.303 1 - -total\n 86.15% 447.393 1 - Template:Reflist\n 84.64% 439.555 24 - Template:Citation\/core\n 57.76% 299.969 16 - Template:Cite_journal\n 18.86% 97.961 4 - Template:Cite_book\n 14.83% 77.020 4 - Template:Cite_web\n 7.99% 41.512 26 - Template:Citation\/identifier\n 4.11% 21.356 26 - Template:Citation\/make_link\n 2.73% 14.154 52 - Template:Hide_in_print\n 1.72% 8.935 26 - Template:Only_in_print\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7585-0!*!0!!en!5!* and timestamp 20181217214648 and revision id 26958\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Clinical_decision_support_system\">https:\/\/www.limswiki.org\/index.php\/Clinical_decision_support_system<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","095141425468d057aa977016869ca37d_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/20\/DSS-Figure-1.PNG"],"095141425468d057aa977016869ca37d_timestamp":1545083207,"cd2a8a0efe4ab3b4dc490ddf74410b75_type":"article","cd2a8a0efe4ab3b4dc490ddf74410b75_title":"Critical test result management","cd2a8a0efe4ab3b4dc490ddf74410b75_url":"https:\/\/www.limswiki.org\/index.php\/Critical_test_result_management","cd2a8a0efe4ab3b4dc490ddf74410b75_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCritical test result management\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCritical Test Results Management (CTRM) also known as Critical Test Results Reporting, and Closed-Loop Reporting, is the software that handles a medical test result that has come back as critical to a patient\u2019s health. CTRM software prevents the critical result from being lost in communication failures, improves patient safety, and documents the delivery of the results.\n\nContents \n\n1 History \n2 How It Works \n3 Providers \n4 See also \n5 References \n\n\nHistory \nThe Patient Safety and Quality Improvement Act of 2005 was passed into law in response to growing concerns about patient safety in the United States. The goal of the act was to improve patient safety by encouraging hospitals and their staff to voluntarily report events that adversely affected patients.[1]\nThe Joint Commission on Accreditation of Healthcare Organizations is a non-profit organization that gives accreditation to hospitals that meet the standards in The Joint Commission\u2019s National Patient Safety Goals.[2] The Joint Commission Goal 2 states that \"ineffective communication is the most frequently cited root cause for sentinel events,[3]\" and requires that hospitals \"implement a standardized approach to hand-off communications, including an opportunity to ask and respond to questions\".[4] Software has been developed to help hospitals achieve accreditation through The Joint Commission, while saving hospitals and other medical organizations from communication errors that could result in patient injury or death, and lawsuits against the caregiver.\n\nHow It Works \nWhen a radiologist, pathologist, interpreting clinician, diagnostician, or emergency department or laboratory personnel flag a study as a critical finding, this critical information is sent immediately to a healthcare professional (such as surgeons, physicians, nurses, etc.) via secure SMS text, secure email, pager, or voice. This information can include images, reports, annotations, voice clips, handwritten notes, and other critical information. When the recipient opens the message a receipt confirmation is automatically sent to the sender and recorded in the software, thereby eliminating the need to check if the message was received. Automated monitoring and escalation of undelivered findings ensure a timely receipt of the message. Audit trails and automatic report generation ensure that hospital administration has a way to document and check that results have gotten to an appropriate caregiver in the amount of time specified by an individual hospital.\n\nProviders \nA small number of companies have developed products in critical test results management; some of these include HIT Application Solutions,[5] IMCO Technologies,[6] Insure Communication,[7] Nuance Communications,[8] peerVue Solutions,[9] Radar Medical Systems,[10] and Zen Medical Technologies.[11] Currently only IMCO-STAT, an IMCO Technologies product, has been FDA cleared for Device Regulatory Class II (Special Controls).[12]\n\nSee also \nPatient safety\nHospital Accreditation\nJoint Commission\nHealth Informatics\nManagement systems\nReferences \n\n^ http:\/\/www.ahrq.gov\/qual\/psoact.htm AHRQ Retrieved on 2009-05-07. \n\n^ http:\/\/www.jointcommission.org\/PatientSafety\/NationalPatientSafetyGoals\/npsg_intro.htm The Joint Commission Retrieved on 2009-05-07. \n\n^ http:\/\/www.jointcommission.org\/sentinel_event.aspx \n\n^ http:\/\/www.jointcommission.org\/NR\/rdonlyres\/31666E86-E7F4-423E-9BE8-F05BD1CB0AA8\/0\/HAP_NPSG.pdf The Joint Commission Retrieved on 2009-05-05. \n\n^ http:\/\/www.healthitservices.com\/hitas_notifi.html \n\n^ http:\/\/www.imco-tech.com\/stat.html \n\n^ http:\/\/www.insurecommunication.com Archived 2010-10-27 at the Wayback Machine. \n\n^ http:\/\/www.nuance.com\/products\/veriphy\/index.htm \n\n^ http:\/\/www.peervue.com \n\n^ http:\/\/www.radarmed.com \n\n^ http:\/\/www.justzenit.com Archived 2012-01-23 at the Wayback Machine. \n\n^ http:\/\/www.fda.gov\/cdrh\/pdf6\/K063392.pdf U.S. Food and Drug Administration Retrieved on 2009-05-02. \n\n\nhttp:\/\/www.linkedin.com\/groups\/CTRM-Critical-Test-Results-Management-3217442?\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Critical_test_result_management\">https:\/\/www.limswiki.org\/index.php\/Critical_test_result_management<\/a>\n\t\t\t\t\tCategories: Health informaticsMedical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 21:06.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 383 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","cd2a8a0efe4ab3b4dc490ddf74410b75_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Critical_test_result_management skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Critical test result management<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Critical Test Results Management (CTRM)<\/b> also known as <b>Critical Test Results Reporting<\/b>, and <b>Closed-Loop Reporting<\/b>, is the software that handles a medical test result that has come back as critical to a patient\u2019s health. CTRM software prevents the critical result from being lost in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Communication\" title=\"Communication\" rel=\"external_link\" target=\"_blank\">communication<\/a> failures, improves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_safety\" title=\"Patient safety\" rel=\"external_link\" target=\"_blank\">patient safety<\/a>, and documents the delivery of the results.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The Patient Safety and Quality Improvement Act of 2005 was passed into law in response to growing concerns about <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_safety\" title=\"Patient safety\" rel=\"external_link\" target=\"_blank\">patient safety<\/a> in the United States. The goal of the act was to improve patient safety by encouraging hospitals and their staff to voluntarily report events that adversely affected patients.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a> on Accreditation of Healthcare Organizations is a non-profit organization that gives accreditation to hospitals that meet the standards in The Joint Commission\u2019s National Patient Safety Goals.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> The Joint Commission Goal 2 states that \"ineffective communication is the most frequently cited root cause for sentinel events,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\" and requires that hospitals \"implement a standardized approach to hand-off communications, including an opportunity to ask and respond to questions\".<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Software has been developed to help hospitals achieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_Accreditation\" class=\"mw-redirect\" title=\"Hospital Accreditation\" rel=\"external_link\" target=\"_blank\">accreditation<\/a> through The Joint Commission, while saving hospitals and other medical organizations from communication errors that could result in patient injury or death, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lawsuit\" title=\"Lawsuit\" rel=\"external_link\" target=\"_blank\">lawsuits<\/a> against the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caregiver\" title=\"Caregiver\" rel=\"external_link\" target=\"_blank\">caregiver<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"How_It_Works\">How It Works<\/span><\/h2>\n<p>When a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiologist\" class=\"mw-redirect\" title=\"Radiologist\" rel=\"external_link\" target=\"_blank\">radiologist<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathologist\" class=\"mw-redirect\" title=\"Pathologist\" rel=\"external_link\" target=\"_blank\">pathologist<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinician\" title=\"Clinician\" rel=\"external_link\" target=\"_blank\">interpreting clinician<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnostician\" class=\"mw-redirect\" title=\"Diagnostician\" rel=\"external_link\" target=\"_blank\">diagnostician<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_department\" title=\"Emergency department\" rel=\"external_link\" target=\"_blank\">emergency department<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laboratory\" title=\"Laboratory\" rel=\"external_link\" target=\"_blank\">laboratory<\/a> personnel flag a study as a critical finding, this critical information is sent immediately to a healthcare professional (such as surgeons, physicians, nurses, etc.) via secure <a href=\"https:\/\/en.wikipedia.org\/wiki\/SMS\" title=\"SMS\" rel=\"external_link\" target=\"_blank\">SMS text<\/a>, secure email, pager, or voice. This information can include images, reports, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Annotations\" class=\"mw-redirect\" title=\"Annotations\" rel=\"external_link\" target=\"_blank\">annotations<\/a>, voice clips, handwritten notes, and other critical information. When the recipient opens the message a receipt confirmation is automatically sent to the sender and recorded in the software, thereby eliminating the need to check if the message was received. Automated monitoring and escalation of undelivered findings ensure a timely receipt of the message. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Audit_Trail\" class=\"mw-redirect\" title=\"Audit Trail\" rel=\"external_link\" target=\"_blank\">Audit trails<\/a> and automatic report generation ensure that hospital administration has a way to document and check that results have gotten to an appropriate caregiver in the amount of time specified by an individual hospital.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Providers\">Providers<\/span><\/h2>\n<p>A small number of companies have developed products in critical test results management; some of these include HIT Application Solutions,<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> IMCO Technologies,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Insure Communication,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Nuance Communications,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> peerVue Solutions,<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Radar Medical Systems,<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> and Zen Medical Technologies.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> Currently only IMCO-STAT, an IMCO Technologies product, has been FDA cleared for Device Regulatory Class II (Special Controls).<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_safety\" title=\"Patient safety\" rel=\"external_link\" target=\"_blank\">Patient safety<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_Accreditation\" class=\"mw-redirect\" title=\"Hospital Accreditation\" rel=\"external_link\" target=\"_blank\">Hospital Accreditation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Informatics\" class=\"mw-redirect\" title=\"Health Informatics\" rel=\"external_link\" target=\"_blank\">Health Informatics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Management_systems\" class=\"mw-redirect\" title=\"Management systems\" rel=\"external_link\" target=\"_blank\">Management systems<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ahrq.gov\/qual\/psoact.htm\" target=\"_blank\">http:\/\/www.ahrq.gov\/qual\/psoact.htm<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/AHRQ\" class=\"mw-redirect\" title=\"AHRQ\" rel=\"external_link\" target=\"_blank\">AHRQ<\/a> Retrieved on 2009-05-07.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.jointcommission.org\/PatientSafety\/NationalPatientSafetyGoals\/npsg_intro.htm\" target=\"_blank\">http:\/\/www.jointcommission.org\/PatientSafety\/NationalPatientSafetyGoals\/npsg_intro.htm<\/a> The Joint Commission Retrieved on 2009-05-07.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.jointcommission.org\/sentinel_event.aspx\" target=\"_blank\">http:\/\/www.jointcommission.org\/sentinel_event.aspx<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.jointcommission.org\/NR\/rdonlyres\/31666E86-E7F4-423E-9BE8-F05BD1CB0AA8\/0\/HAP_NPSG.pdf\" target=\"_blank\">http:\/\/www.jointcommission.org\/NR\/rdonlyres\/31666E86-E7F4-423E-9BE8-F05BD1CB0AA8\/0\/HAP_NPSG.pdf<\/a> The Joint Commission Retrieved on 2009-05-05.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.healthitservices.com\/hitas_notifi.html\" target=\"_blank\">http:\/\/www.healthitservices.com\/hitas_notifi.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.imco-tech.com\/stat.html\" target=\"_blank\">http:\/\/www.imco-tech.com\/stat.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.insurecommunication.com\" target=\"_blank\">http:\/\/www.insurecommunication.com<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101027070717\/http:\/\/www.insurecommunication.com\/\" target=\"_blank\">Archived<\/a> 2010-10-27 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.nuance.com\/products\/veriphy\/index.htm\" target=\"_blank\">http:\/\/www.nuance.com\/products\/veriphy\/index.htm<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.peervue.com\" target=\"_blank\">http:\/\/www.peervue.com<\/a><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.radarmed.com\" target=\"_blank\">http:\/\/www.radarmed.com<\/a><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.justzenit.com\" target=\"_blank\">http:\/\/www.justzenit.com<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120123045840\/http:\/\/www.justzenit.com\/\" target=\"_blank\">Archived<\/a> 2012-01-23 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.fda.gov\/cdrh\/pdf6\/K063392.pdf\" target=\"_blank\">http:\/\/www.fda.gov\/cdrh\/pdf6\/K063392.pdf<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration_(United_States)\" class=\"mw-redirect\" title=\"Food and Drug Administration (United States)\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a> Retrieved on 2009-05-02.<\/span>\n<\/li>\n<\/ol><\/div>\n<p><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.linkedin.com\/groups\/CTRM-Critical-Test-Results-Management-3217442\" target=\"_blank\">http:\/\/www.linkedin.com\/groups\/CTRM-Critical-Test-Results-Management-3217442<\/a>?\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181129102334\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.044 seconds\nReal time usage: 0.064 seconds\nPreprocessor visited node count: 176\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 676\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 3\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 4968\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.009\/10.000 seconds\nLua memory usage: 789 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 30.175 1 -total\n<\/p>\n<pre>99.71% 30.088 2 Template:Webarchive\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:22732540-1!canonical and timestamp 20181129102334 and revision id 855775701\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Critical_Test_Results_Management\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214647\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.148 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 143.198 1 - wikipedia:Critical_Test_Results_Management\n100.00% 143.198 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8101-0!*!*!*!*!*!* and timestamp 20181217214647 and revision id 24220\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Critical_test_result_management\">https:\/\/www.limswiki.org\/index.php\/Critical_test_result_management<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","cd2a8a0efe4ab3b4dc490ddf74410b75_images":[],"cd2a8a0efe4ab3b4dc490ddf74410b75_timestamp":1545083207,"093a43ff657e8d7626758215c3314f13_type":"article","093a43ff657e8d7626758215c3314f13_title":"Amira (software)","093a43ff657e8d7626758215c3314f13_url":"https:\/\/www.limswiki.org\/index.php\/Amira_(software)","093a43ff657e8d7626758215c3314f13_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAmira (software)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAmiraDeveloper(s)Zuse Institute Berlin\r\nThermo Fisher ScientificInitial releaseOctober 1999; 19 years ago  (1999-10 ) Stable release6.5\n \/ March 12, 2018; 9 months ago  (2018-03-12 ) \nOperating systemWindows XP SP3, Windows Vista, Windows 7\r\nOS X 10.5, OS X 10.6, OS X 10.7\r\nRHEL 5.5PlatformIA-32, x64Available inEnglishType3D data visualization and processingLicenseTrialwareWebsitethermofisher.com\/amira-avizo \nAmira (pronounce: Ah-meer-ah) is a software platform for 3D and 4D data visualization, processing, and analysis. It is being actively developed by Thermo Fisher Scientific in collaboration with the Zuse Institute Berlin (ZIB), and commercially distributed by Thermo Fisher Scientific.\n\nContents \n\n1 Overview \n2 History \n\n2.1 1994\u20131998: Research software \n2.2 1998\u2013today: Commercially supported product \n\n\n3 Amira options \n\n3.1 Microscopy option \n3.2 DICOM reader \n3.3 Mesh option \n3.4 Skeletonization option \n3.5 Molecular option \n3.6 Developer option \n3.7 Neuro option \n3.8 VR option \n3.9 Very large data option \n\n\n4 Application areas \n5 References \n6 External links \n\n\nOverview \nAmira[1] is an extendable software system for scientific visualization, data analysis, and presentation of 3D and 4D data. It is being used by several thousand researchers and engineers in academia and industry around the world.\nIts flexible user interface and modular architecture make it a universal tool for processing and analysis of data from various modalities; e.g. micro-CT,[2] PET,[3] Ultrasound.[4] Its ever-expanding functionality has made it a versatile data analysis and visualization solution, applicable to and being used in many fields, such as microscopy in biology[5] and materials science,[6] molecular biology,[7] quantum physics,[8] astrophysics,[9] computational fluid dynamics (CFD),[10] finite element modeling (FEM),[11] non-destructive testing (NDT),[12] and many more. \nOne of the key features, besides data visualization, is Amira\u2019s set of tools for image segmentation[13] and geometry reconstruction.[14] This allows the user to mark (or segment) structures and regions of interest in 3D image volumes using automatic, semi-automatic, and manual tools. The segmentation can then be used for a variety of subsequent tasks, such as volumetric analysis,[4] density analysis,[15] shape analysis,[16] or the generation of 3D computer models for visualization,[17] numerical simulations,[18] or rapid prototyping[19] or 3D printing, to name a few. \nOther key Amira features are multi-planar and volume visualization, image registration,[20] filament tracing,[21] cell separation and analysis,[16] tetrahedral mesh generation,[22] fiber-tracking from diffusion tensor imaging (DTI) data,[23] skeletonization,[24] spatial graph analysis, and stereoscopic rendering[25] of 3D data over multiple displays including CAVEs (Cave automatic virtual environments).[26]\nAs a commercial product Amira requires the purchase of a license or an academic subscription. A time-limited, but full-featured evaluation version is available for download free of charge.\n\nHistory \n 1994\u20131998: Research software \nAmira\u2019s roots go back to 1994 and the Department for Scientific Visualization, headed by Hans-Christian Hege at the Zuse Institute Berlin (ZIB). The ZIB is a research institute for mathematics and informatics. The Scientific Visualization department\u2019s mission is to help solve computationally and scientifically challenging tasks in medicine, biology, and engineering. For this purpose, it develops algorithms and software for 2D, 3D, and 4D data visualization and visually supported exploration and analysis. At that time, the young visualization group at the ZIB had experience with the extendable, data flow-oriented visualization environments apE,[27] IRIS Explorer,[28] and Advanced Visualization Studio (AVS), but was not satisfied with these products\u2019 interactivity, flexibility, and ease-of-use for non-computer scientists.\nTherefore, in a subproject[29] within a medically oriented, multi-disciplinary collaborative research center[30] the development of a new software system was started in early 1994. The initial development was performed by Detlev Stalling, who later became the chief software architect. The software system was called \u201cHyperPlan\u201d, highlighting its initial target application  \u2013 a planning system for hyperthermia cancer treatment. The system was being developed on Silicon Graphics (SGI) computers, which at the time were the standard workstations used for high-end graphics computing. Software development was based on libraries such as OpenGL, SGI Open Inventor, and the graphical user interface libraries X11, Motif (software), and ViewKit. In 1998, X11\/Motif\/Viewkit were replaced by the Qt toolkit.\nThe HyperPlan framework served as the base for more and more projects at the ZIB and was used by a growing number of researchers in collaborating institutions. The projects included applications in neurobiology, confocal microscopy, flow visualization, molecule visualization and analysis and computational astrophysics.\n\n 1998\u2013today: Commercially supported product \nThe growing number of users of the system started to exceed the capacities that ZIB could spare for software distribution and support, as ZIB\u2019s primary mission was algorithmic research. Therefore, the spin-off company Indeed, \u2013 Visual Concepts GmbH was founded by Hans-Christian Hege, Detlev Stalling, and Malte Westerhoff with the vision of making the extensive capabilities of the software available to researchers in industry and academia worldwide and to provide the product support and robustness needed in today\u2019s fast-paced and competitive world.\nIn Feb 1998 the HyperPlan software was given the new, less application-specific name \u201cAmira\u201d. This name is not an acronym but was chosen for being pronounceable in different languages, starting with an \u2018A\u2019, and having an appropriate connotation: the Latin verb \u201cadmirare\u201d (to admire), meaning \u201cto look at\u201d and \u201cto wonder at\u201d, describes a typical situation in data visualization.\nA major re-design of the software was undertaken by Detlev Stalling and Malte Westerhoff in order to make it a commercially supportable product and to make it available on non-SGI computers as well. In March 1999, the first version of the commercial Amira was shown at the CeBIT tradeshow in Hannover, Germany on SGI IRIX and Hewlett-Packard UniX (HP-UX). Versions for Linux and Microsoft Windows followed within the following twelve months. Later Mac OS X support was added. \nIndeed, \u2013 Visual Concepts selected the Bordeaux, France and San Diego, United States based company TGS, Inc. as the worldwide distributor for Amira and completed five major releases (up to version 3.1) in the subsequent four years.\n\n<\/p>In 2003 both Indeed, as well as TGS were acquired by Massachusetts-based Mercury Computer Systems, Inc. (NASDAQ:MRCY) and became part of Mercury\u2019s newly formed life sciences business unit, later branded Visage Imaging. In 2009, Mercury Computer Systems, Inc. spun off Visage Imaging again and sold it to Melbourne, Australia based Promedicus Ltd (ASX:PME), a leading provider of radiology information systems and medical IT solutions. During this time, Amira continued to be developed in Berlin, Germany and in close collaboration with the ZIB, still headed by the original creators of Amira. TGS, located in Bordeaux, France was sold by Mercury Computer systems to a French investor and renamed to Visualization Sciences Group (VSG). VSG continued the work on a complementary product named Avizo, based on the same source code but customized for material sciences.\nIn August 2012, FEI, to that date the largest OEM reseller of Amira, purchased VSG and the Amira business from Promedicus. In August 2013, Visualization Sciences Group (VSG) became a business unit of FEI. In 2016 FEI has been bought by Thermo Fisher Scientific and became part of its Materials & Structural Analysis division in early 2017.\nAmira and Avizo are still being marketed as two different products; Amira for life sciences and Avizo for materials science, but the development efforts are now joined once again. As in the beginning, the Amira roadmap continues to be driven by the interesting and challenging scientific questions that Amira users around the world are trying to answer, often at the leading edge in their fields.\n\nAmira options \nMicroscopy option \nSpecific readers for microscopy data\nImage deconvolution\nExploration of 3D imagery obtained from virtually any microscope\nExtraction and editing of filament networks from microscopy images\nDICOM reader \nImport of clinical and preclinical data in DICOM format\nMesh option \nGeneration of 3D finite element (FE) meshes from segmented image data\nSupport for many state-of-the-art FE solver formats\nHigh-quality visualization of simulation mesh-based results, using scalar, vector, and tensor field display modules\nSkeletonization option \nReconstruction and analysis of neural and vascular networks\nVisualization of skeletonized networks\nLength and diameter quantification of network segments\nOrdering of segments in a tree graph\nSkeletonization of very large image stacks\nMolecular option \nAdvanced tools for the visualization of molecule models\nHardware-accelerated volume rendering\nPowerful molecule editor\nSpecific tools for complex molecular visualization\nDeveloper option \nCreation of new custom components for visualizing or data processing\nImplementation of new file readers or writers\nC++ programming language\nDevelopment wizard for getting started quickly\nNeuro option \nMedical image analysis for DTI and brain perfusion\nFiber tracking supporting several stream-line based algorithms\nFiber separation into fiber bundles based on user defined source and destination regions\nComputation of tensor fields, diffusion weighted maps\nEigenvalue decomposition of tensor fields\nComputation of mean transit time, cerebral blood flow, and cerebral blood volume\nVR option \nVisualization of data on large tiled displays or in immersive Virtual Reality (VR) environments\nSupport of 3D navigation devices\nFast multi-threaded and distributed rendering\nVery large data option \nSupport for visualization of image data exceeding the available main memory, using efficient out-of-core data management\nExtensions of many standard modules, such as orthogonal and oblique slicing, volume rendering, and isosurface rendering, to work on out-of-core data\nApplication areas \nAnatomy[31][32]\nBiochemistry[33]\nBiophysics[33]\nCellular microbiology[34][35]\nComputational fluid dynamics[36]\nCryo-electron tomography[34]\nDiffusion MRI\/Fiber Tracking\nEmbryology[31]\nEndocrinology[37]\nFinite Element Modelling[38]\nHistology[31][33][39]\nMedical imaging research\nMicroscopy in life and material sciences\nMolecular biology[40]\nNeuroscience[39][41]\nOrthopedics[38][42][43]\nOtolaryngology[44]\nPreclinical imaging[40]\nUrology[45]\nReferences \n\n\n^ Stalling, D.; Westerhoff, M.; Hege, H.-C. (2005). C.D. Hansen and C.R. Johnson, ed. \"Amira: A Highly Interactive System for Visual Data Analysis\". The Visualization Handbook: 749\u2013767. CiteSeerX 10.1.1.129.6785 . \n\n^ Adam, R.; Smith, A.R.; Sieren, J.C.; Eggleston, T.; McLennan, G. (2010). \"Characterization Of The Airways And Lungs For The FABP\/CFTR-Knockout Mouse Using Micro-Computed Tomography And Large Image Microscope Array\" (PDF) . American Journal of Respiratory and Critical Care Medicine. 181: A6264. doi:10.1164\/ajrccm-conference.2010.181.1_meetingabstracts.a6264. \n\n^ Awasthi, V.; Holter, J.; Thorp, K.; Anderson, S.; Epstein, R. (2010). \"F-18-fluorothymidine-PET evaluation of bone marrow transplant in a rat model\". Nuclear Medicine Communications. 31 (2): 152\u2013158. doi:10.1097\/mnm.0b013e3283339f92. PMID 19966596. \n\n^ a b Ayers, G.D.; McKinley, E.T.; Zhao, P.; Fritz, J.M.; Metry, R.E.; Deal, B.C.; Adlerz, K.M.; Coffey, R.J.; Manning, H.C. (2010). \"Volume of Preclinical Xenograft Tumors Is More Accurately Assessed by Ultrasound Imaging Than Manual Caliper Measurements\". Journal of Ultrasound in Medicine. 29 (6): 891. \n\n^ Dlaskov\u00e1, A.; Spacek, T.; Santorov\u00e1, J.; Plecit\u00e1-Hlavat\u00e1, L.; Berkov\u00e1, Z.; Saudek, F.; Lessard, M.; Bewersdorf, J.; Jezek, P. (2010). \"4Pi microscopy reveals an impaired three-dimensional mitochondrial network of pancreatic islet beta-cells, an experimental model of type-2 diabetes\". Biochimica et Biophysica Acta (BBA) - Bioenergetics. 1797 (6\u20137): 1327\u20131341. doi:10.1016\/j.bbabio.2010.02.003. PMID 20144584. \n\n^ Clark, N.D.L.; Daly., C. (2010). \"Using confocal laser scanning microscopy to image trichome inclusions in amber\" (PDF) . Journal of Paleontological Techniques. 8. \n\n^ Amstalden van Hove, E.R.; Blackwell, T.R.; Klinkert, I.; Eijkel, G.B.; Heeren, R.; Glunde, K. (2010). \"Multimodal Mass Spectrometric Imaging of Small Molecules Reveals Distinct Spatio-Molecular Signatures in Differentially Metastatic Breast Tumor Models\". Cancer Research. 70 (22): 9012\u20139021. doi:10.1158\/0008-5472.can-10-0360. PMC 5555163 . PMID 21045154. \n\n^ Sherman, D.M. (2010). Metal complexation and ion association in hydrothermal fluids: insights from quantum chemistry and molecular dynamics. Geofluids. 10. pp. 41\u201357. doi:10.1002\/9781444394900.ch4. ISBN 9781444394900. \n\n^ O'Neill, S.M.; Jones, T.W. (2010). \"Three-Dimensional Simulations of Bi-Directed Magnetohydrodynamic Jets Interacting with Cluster Environments\". The Astrophysical Journal. 710 (1): 180\u2013196. arXiv:1001.1747 . Bibcode:2010ApJ...710..180O. doi:10.1088\/0004-637x\/710\/1\/180. \n\n^ Baharoglu, M.I.; Schirmer, C.M.; Hoit, D.A.; Gao, B.L.; Malek, A.M. (2010). \"Aneurysm Inflow-Angle as a Discriminant for Rupture in Sidewall Cerebral Aneurysms\". Morphometric and Computational Fluid Dynamic Analysis. \n\n^ Bardyn,, T.; G\u00e9det, P.; Hallermann, W.; B\u00fcchler., P. (2010). \"Prediction of dental implant torque with a fast and automatic finite element analysis: a pilot study\". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 109 (4): 594\u2013603. doi:10.1016\/j.tripleo.2009.11.010. PMID 20163974. \n\n^ Shearing, P.R.; Gelb, J.; Yi, J.; Lee, W.K.; Drakopolous, M.; Brandon, N.P. (2010). \"Analysis of Triple Phase Contact in Ni-YSZ Microstructures Using Non-destructive X-ray Tomography with Synchrotron Radiation\". Electrochemistry Communications. 12 (8): 1021\u20131024. doi:10.1016\/j.elecom.2010.05.014. \n\n^ J\u00e4hrling, N.; Becker, K.; Sch\u00f6nbauer, C.; Schnorrer, F.; Dodt, H.U. (2010). \"Three-dimensional reconstruction and segmentation of intact Drosophila by ultramicroscopy\". Frontiers in Systems Neuroscience. 4: 1. doi:10.3389\/neuro.06.001.2010. PMC 2831709 . PMID 20204156. \n\n^ Zheng, G. (2010). \"Statistical shape model-based reconstruction of a scaled, patient-specific surface model of the pelvis from a single standard AP x-ray radiograph\". Medical Physics. 37 (4): 1424\u20131439. Bibcode:2010MedPh..37.1424Z. doi:10.1118\/1.3327453. PMID 20443464. \n\n^ Rodriguez-Soto, A.E.; Fritscher, K.D.; Schuler, B.; Issever, A.S.; Roth, T.; Kamelger, F.; Kammerlander, C.; Blauth, M.; Schubert, R.; Link, T.M. (2010). \"Texture Analysis, Bone Mineral Density, and Cortical Thickness of the Proximal Femur: Fracture Risk Prediction\". Journal of Computer Assisted Tomography. 34 (6): 949\u2013957. doi:10.1097\/rct.0b013e3181ec05e4. PMID 21084915. \n\n^ a b Leischner, U.; Schierloh, A.; Zieglg\u00e4nsberger, W.; Dodt, H.U. (2010). \"Formalin-Induced Fluorescence Reveals Cell Shape and Morphology in Biological Tissue Samples\". Public Library of Science. 5 (4): e10391. Bibcode:2010PLoSO...510391L. doi:10.1371\/journal.pone.0010391. PMC 2861007 . PMID 20436930. \n\n^ Felts, R.L.; Narayan, K.; Estes, J.D.; Shi, D.; Trubey, C.M.; Fu, J.; Hartnell, L.M.; Ruthel, G.T.; Schneider, D.K.; Nagashima, K. (2010). \"3D visualization of HIV transfer at the virological synapse between dendritic cells and T cells\". Proceedings of the National Academy of Sciences of the United States of America. 107 (30): 13336\u201313341. Bibcode:2010PNAS..10713336F. doi:10.1073\/pnas.1003040107. PMC 2922156 . PMID 20624966. \n\n^ Taylor, D.J.; Doorly, D.J.; Schroter, R.C. (2010). \"Inflow boundary profile prescription for numerical simulation of nasal airflow\". Journal of the Royal Society Interface. 7 (44): 515\u2013527. doi:10.1098\/rsif.2009.0306. PMC 2842801 . PMID 19740920. \n\n^ Lucas, B.C.; Bogovic, J.A.; Carass, A.; Bazin, P.L.; Prince, J.L.; Pham, D.L.; Landman, B.A. (2010). \"The Java Image Science Toolkit (JIST) for Rapid Prototyping and Publishing of Neuroimaging Software\" (PDF) . 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(2011). \"Three-dimensional imaging of the unsectioned adult spinal cord to assess axon regeneration and glial responses after injury\". Nature Medicine. 18 (1): 166\u2013171. doi:10.1038\/nm.2600. PMID 22198277. \n\n^ Carlson, K.J.; Wrangham, R.W.; Muller, M.N.; Sumner, D.R.; Morbeck, M.E.; Nishida, T.; Yamanaka, A.; Boesch, C. (2011). Comparisons of Limb Structural Properties in Free-ranging Chimpanzees from Kibale, Gombe, Mahale, and Tai Communities. Primate Locomotion. pp. 155\u2013182. doi:10.1007\/978-1-4419-1420-0_9. ISBN 978-1-4419-1419-4. \n\n^ Hartwig, T.; Streitparth, F.; Gro, C.; M\u00fcller, M.; Perka, C.; Putzier, M.; Strube, P. (2011). \"Digital 3-Dimensional Analysis of the Paravertebral Lumbar Muscles After Circumferential Single-level Fusion\". Journal of Spinal Disorders & Techniques. \n\n^ Lee, J.; Eddington, D.K.; Nadol, J.B. (2011). \"The Histopathology of Revision Cochlear Implantation\". Audiology and Neurotology. 16 (5): 336\u2013346. doi:10.1159\/000322307. 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PMID 21067797. \n\n\nExternal links \nOfficial website \nvteImage processing softwareFree\n3D Slicer\nAFNI\nCellCognition\nCellProfiler\nDlib\nEndrov\nFiji\nFMRIB Software Library\nFreeSurfer\nGemIdent\nGNU Octave\nilastik\nImageJ\nITK\nIVT\nInVesalius\nITK-SNAP\nKNIME\nMango\nOpenCV\nOsiriX\nVIGRA\nVXL\nProprietary\nAmira\nAnalyze\nAphelion\nBitplane\nIDL\nMathematica\nMATLAB\nMimics\nMountainsMap\nVisage SDK\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Amira_(software)\">https:\/\/www.limswiki.org\/index.php\/Amira_(software)<\/a>\n\t\t\t\t\tCategory: Medical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 19:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 979 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","093a43ff657e8d7626758215c3314f13_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Amira_software skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Amira (software)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Amira<\/b> (pronounce: Ah-meer-ah) is a software platform for 3D and 4D data visualization, processing, and analysis. It is being actively developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermo_Fisher_Scientific\" title=\"Thermo Fisher Scientific\" rel=\"external_link\" target=\"_blank\">Thermo Fisher Scientific<\/a> in collaboration with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zuse_Institute_Berlin\" title=\"Zuse Institute Berlin\" rel=\"external_link\" target=\"_blank\">Zuse Institute Berlin (ZIB)<\/a>, and commercially distributed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermo_Fisher_Scientific\" title=\"Thermo Fisher Scientific\" rel=\"external_link\" target=\"_blank\">Thermo Fisher Scientific<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Overview\">Overview<\/span><\/h2>\n<p>Amira<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> is an extendable software system for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scientific_visualization\" title=\"Scientific visualization\" rel=\"external_link\" target=\"_blank\">scientific visualization<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_analysis\" title=\"Data analysis\" rel=\"external_link\" target=\"_blank\">data analysis<\/a>, and presentation of 3D and 4D data. It is being used by several thousand researchers and engineers in academia and industry around the world.\nIts flexible user interface and modular architecture make it a universal tool for processing and analysis of data from various modalities; e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micro-CT\" class=\"mw-redirect\" title=\"Micro-CT\" rel=\"external_link\" target=\"_blank\">micro-CT<\/a>,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positron_emission_tomography\" title=\"Positron emission tomography\" rel=\"external_link\" target=\"_blank\">PET<\/a>,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">Ultrasound<\/a>.<sup id=\"rdp-ebb-cite_ref-Ayers2010_4-0\" class=\"reference\"><a href=\"#cite_note-Ayers2010-4\" rel=\"external_link\">[4]<\/a><\/sup> Its ever-expanding functionality has made it a versatile data analysis and visualization solution, applicable to and being used in many fields, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microscopy\" title=\"Microscopy\" rel=\"external_link\" target=\"_blank\">microscopy<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biology\" title=\"Biology\" rel=\"external_link\" target=\"_blank\">biology<\/a><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Materials_science\" title=\"Materials science\" rel=\"external_link\" target=\"_blank\">materials science<\/a>,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_biology\" title=\"Molecular biology\" rel=\"external_link\" target=\"_blank\">molecular biology<\/a>,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quantum_physics\" class=\"mw-redirect\" title=\"Quantum physics\" rel=\"external_link\" target=\"_blank\">quantum physics<\/a>,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Astrophysics\" title=\"Astrophysics\" rel=\"external_link\" target=\"_blank\">astrophysics<\/a>,<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computational_fluid_dynamics\" title=\"Computational fluid dynamics\" rel=\"external_link\" target=\"_blank\">computational fluid dynamics (CFD)<\/a>,<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Finite_element_method\" title=\"Finite element method\" rel=\"external_link\" target=\"_blank\">finite element modeling (FEM)<\/a>,<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nondestructive_testing\" title=\"Nondestructive testing\" rel=\"external_link\" target=\"_blank\">non-destructive testing (NDT)<\/a>,<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> and many more. \nOne of the key features, besides data visualization, is Amira\u2019s set of tools for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Segmentation_(image_processing)\" class=\"mw-redirect\" title=\"Segmentation (image processing)\" rel=\"external_link\" target=\"_blank\">image segmentation<\/a><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_graphics_(computer_science)#Geometry\" title=\"Computer graphics (computer science)\" rel=\"external_link\" target=\"_blank\">geometry reconstruction<\/a>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> This allows the user to mark (or segment) structures and regions of interest in 3D image volumes using automatic, semi-automatic, and manual tools. The segmentation can then be used for a variety of subsequent tasks, such as volumetric analysis,<sup id=\"rdp-ebb-cite_ref-Ayers2010_4-1\" class=\"reference\"><a href=\"#cite_note-Ayers2010-4\" rel=\"external_link\">[4]<\/a><\/sup> density analysis,<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shape_analysis_(digital_geometry)\" title=\"Shape analysis (digital geometry)\" rel=\"external_link\" target=\"_blank\">shape analysis<\/a>,<sup id=\"rdp-ebb-cite_ref-ncbi.nlm.nih.gov_16-0\" class=\"reference\"><a href=\"#cite_note-ncbi.nlm.nih.gov-16\" rel=\"external_link\">[16]<\/a><\/sup> or the generation of 3D computer models for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visualization_(computer_graphics)\" class=\"mw-redirect\" title=\"Visualization (computer graphics)\" rel=\"external_link\" target=\"_blank\">visualization<\/a>,<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Numerical_simulation\" class=\"mw-redirect\" title=\"Numerical simulation\" rel=\"external_link\" target=\"_blank\">numerical simulations<\/a>,<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rapid_prototyping\" title=\"Rapid prototyping\" rel=\"external_link\" target=\"_blank\">rapid prototyping<\/a><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a>, to name a few. \nOther key Amira features are <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_computed_tomography#Multiplanar_reconstruction\" class=\"mw-redirect\" title=\"X-ray computed tomography\" rel=\"external_link\" target=\"_blank\">multi-planar<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scientific_visualization#Volume_visualization\" title=\"Scientific visualization\" rel=\"external_link\" target=\"_blank\">volume<\/a> visualization, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image_registration\" title=\"Image registration\" rel=\"external_link\" target=\"_blank\">image registration<\/a>,<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> filament tracing,<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> cell separation and analysis,<sup id=\"rdp-ebb-cite_ref-ncbi.nlm.nih.gov_16-1\" class=\"reference\"><a href=\"#cite_note-ncbi.nlm.nih.gov-16\" rel=\"external_link\">[16]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mesh_generation\" title=\"Mesh generation\" rel=\"external_link\" target=\"_blank\">tetrahedral mesh generation<\/a>,<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_morphometry#Fiber-tracking_techniques\" title=\"Brain morphometry\" rel=\"external_link\" target=\"_blank\">fiber-tracking<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_MRI#Diffusion_tensor_imaging\" title=\"Diffusion MRI\" rel=\"external_link\" target=\"_blank\">diffusion tensor imaging (DTI)<\/a> data,<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Topological_skeleton\" title=\"Topological skeleton\" rel=\"external_link\" target=\"_blank\">skeletonization<\/a>,<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> spatial graph analysis, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereoscopy\" title=\"Stereoscopy\" rel=\"external_link\" target=\"_blank\">stereoscopic<\/a> rendering<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> of 3D data over multiple displays including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cave_Automatic_Virtual_Environment\" class=\"mw-redirect\" title=\"Cave Automatic Virtual Environment\" rel=\"external_link\" target=\"_blank\">CAVEs (Cave automatic virtual environments)<\/a>.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\nAs a commercial product Amira requires the purchase of a license or an academic subscription. A time-limited, but full-featured evaluation version is available for download free of charge.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<h3><span id=\"rdp-ebb-1994.E2.80.931998:_Research_software\"><\/span><span class=\"mw-headline\" id=\"1994\u20131998:_Research_software\">1994\u20131998: Research software<\/span><\/h3>\n<p>Amira\u2019s roots go back to 1994 and the Department for Scientific Visualization, headed by <a href=\"https:\/\/de.wikipedia.org\/wiki\/Hans-Christian_Hege\" class=\"extiw\" title=\"de:Hans-Christian Hege\" rel=\"external_link\" target=\"_blank\">Hans-Christian Hege<\/a> at the Zuse Institute Berlin (ZIB). The ZIB is a research institute for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mathematics\" title=\"Mathematics\" rel=\"external_link\" target=\"_blank\">mathematics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informatics_(academic_field)\" class=\"mw-redirect\" title=\"Informatics (academic field)\" rel=\"external_link\" target=\"_blank\">informatics<\/a>. The Scientific Visualization department\u2019s mission is to help solve computationally and scientifically challenging tasks in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biology\" title=\"Biology\" rel=\"external_link\" target=\"_blank\">biology<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering\" title=\"Engineering\" rel=\"external_link\" target=\"_blank\">engineering<\/a>. For this purpose, it develops algorithms and software for 2D, 3D, and 4D data visualization and visually supported exploration and analysis. At that time, the young visualization group at the ZIB had experience with the extendable, data flow-oriented <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visualization_(computer_graphics)\" class=\"mw-redirect\" title=\"Visualization (computer graphics)\" rel=\"external_link\" target=\"_blank\">visualization<\/a> environments apE,<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> IRIS Explorer,<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Advanced_Visualization_Studio\" title=\"Advanced Visualization Studio\" rel=\"external_link\" target=\"_blank\">Advanced Visualization Studio (AVS)<\/a>, but was not satisfied with these products\u2019 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interactivity#Computing_science\" title=\"Interactivity\" rel=\"external_link\" target=\"_blank\">interactivity<\/a>, flexibility, and ease-of-use for non-computer scientists.\n<\/p><p>Therefore, in a subproject<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> within a medically oriented, multi-disciplinary collaborative research center<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> the development of a new software system was started in early 1994. The initial development was performed by Detlev Stalling, who later became the chief software architect. The software system was called \u201cHyperPlan\u201d, highlighting its initial target application  \u2013 a planning system for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperthermia_therapy\" title=\"Hyperthermia therapy\" rel=\"external_link\" target=\"_blank\">hyperthermia cancer treatment<\/a>. The system was being developed on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_Graphics\" title=\"Silicon Graphics\" rel=\"external_link\" target=\"_blank\"> Silicon Graphics (SGI)<\/a> computers, which at the time were the standard workstations used for high-end graphics computing. Software development was based on libraries such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/OpenGL\" title=\"OpenGL\" rel=\"external_link\" target=\"_blank\">OpenGL<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_Inventor\" title=\"Open Inventor\" rel=\"external_link\" target=\"_blank\">SGI Open Inventor<\/a>, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Graphical_user_interface\" title=\"Graphical user interface\" rel=\"external_link\" target=\"_blank\">graphical user interface<\/a> libraries <a href=\"https:\/\/en.wikipedia.org\/wiki\/X11\" class=\"mw-redirect\" title=\"X11\" rel=\"external_link\" target=\"_blank\">X11<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motif_(software)\" title=\"Motif (software)\" rel=\"external_link\" target=\"_blank\">Motif (software)<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_widget_toolkits#On_Unix,_under_the_X_Window_System\" title=\"List of widget toolkits\" rel=\"external_link\" target=\"_blank\">ViewKit<\/a>. In 1998, X11\/Motif\/Viewkit were replaced by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Qt_(framework)\" class=\"mw-redirect\" title=\"Qt (framework)\" rel=\"external_link\" target=\"_blank\">Qt toolkit<\/a>.\n<\/p><p>The HyperPlan framework served as the base for more and more projects at the ZIB and was used by a growing number of researchers in collaborating institutions. The projects included applications in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurobiology\" class=\"mw-redirect\" title=\"Neurobiology\" rel=\"external_link\" target=\"_blank\">neurobiology<\/a>, confocal microscopy, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flow_visualization\" title=\"Flow visualization\" rel=\"external_link\" target=\"_blank\">flow visualization<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecule_viewer\" class=\"mw-redirect\" title=\"Molecule viewer\" rel=\"external_link\" target=\"_blank\">molecule visualization<\/a> and analysis and computational astrophysics.\n<\/p>\n<h3><span id=\"rdp-ebb-1998.E2.80.93today:_Commercially_supported_product\"><\/span><span class=\"mw-headline\" id=\"1998\u2013today:_Commercially_supported_product\">1998\u2013today: Commercially supported product<\/span><\/h3>\n<p>The growing number of users of the system started to exceed the capacities that ZIB could spare for software distribution and support, as ZIB\u2019s primary mission was algorithmic research. Therefore, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corporate_spin-off\" title=\"Corporate spin-off\" rel=\"external_link\" target=\"_blank\">spin-off company<\/a> Indeed, \u2013 Visual Concepts GmbH was founded by Hans-Christian Hege, Detlev Stalling, and Malte Westerhoff with the vision of making the extensive capabilities of the software available to researchers in industry and academia worldwide and to provide the product support and robustness needed in today\u2019s fast-paced and competitive world.\n<\/p><p>In Feb 1998 the HyperPlan software was given the new, less application-specific name \u201c<a href=\"https:\/\/en.wikipedia.org\/wiki\/Amira_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Amira (disambiguation)\" rel=\"external_link\" target=\"_blank\">Amira<\/a>\u201d. This name is not an acronym but was chosen for being pronounceable in different languages, starting with an \u2018A\u2019, and having an appropriate connotation: the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Latin\" title=\"Latin\" rel=\"external_link\" target=\"_blank\">Latin<\/a> verb \u201cadmirare\u201d (to admire), meaning \u201cto look at\u201d and \u201cto wonder at\u201d, describes a typical situation in data visualization.\n<\/p><p>A major re-design of the software was undertaken by Detlev Stalling and Malte Westerhoff in order to make it a commercially supportable product and to make it available on non-SGI computers as well. In March 1999, the first version of the commercial Amira was shown at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/CeBIT\" class=\"mw-redirect\" title=\"CeBIT\" rel=\"external_link\" target=\"_blank\">CeBIT<\/a> tradeshow in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hannover\" class=\"mw-redirect\" title=\"Hannover\" rel=\"external_link\" target=\"_blank\">Hannover<\/a>, Germany on SGI <a href=\"https:\/\/en.wikipedia.org\/wiki\/IRIX\" title=\"IRIX\" rel=\"external_link\" target=\"_blank\">IRIX<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/HP-UX\" title=\"HP-UX\" rel=\"external_link\" target=\"_blank\">Hewlett-Packard UniX (HP-UX)<\/a>. Versions for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linux\" title=\"Linux\" rel=\"external_link\" target=\"_blank\">Linux<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microsoft_Windows\" title=\"Microsoft Windows\" rel=\"external_link\" target=\"_blank\">Microsoft Windows<\/a> followed within the following twelve months. Later Mac OS X support was added. \n<p>Indeed, \u2013 Visual Concepts selected the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bordeaux,_France\" class=\"mw-redirect\" title=\"Bordeaux, France\" rel=\"external_link\" target=\"_blank\">Bordeaux<\/a>, France and <a href=\"https:\/\/en.wikipedia.org\/wiki\/San_Diego\" title=\"San Diego\" rel=\"external_link\" target=\"_blank\">San Diego<\/a>, United States based company TGS, Inc. as the worldwide distributor for Amira and completed five <a href=\"https:\/\/en.wikipedia.org\/wiki\/Software_versioning\" title=\"Software versioning\" rel=\"external_link\" target=\"_blank\">major releases<\/a> (up to version 3.1) in the subsequent four years.\n<\/p>\n<\/p><p>In 2003 both Indeed, as well as TGS were acquired by Massachusetts-based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_Computer_Systems\" class=\"mw-redirect\" title=\"Mercury Computer Systems\" rel=\"external_link\" target=\"_blank\">Mercury Computer Systems, Inc. (NASDAQ:MRCY)<\/a> and became part of Mercury\u2019s newly formed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Life_sciences\" class=\"mw-redirect\" title=\"Life sciences\" rel=\"external_link\" target=\"_blank\">life sciences<\/a> business unit, later branded Visage Imaging. In 2009, Mercury Computer Systems, Inc. spun off Visage Imaging again and sold it to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melbourne\" title=\"Melbourne\" rel=\"external_link\" target=\"_blank\">Melbourne<\/a>, Australia based Promedicus Ltd (ASX:PME), a leading provider of radiology information systems and medical IT solutions. During this time, Amira continued to be developed in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Berlin\" title=\"Berlin\" rel=\"external_link\" target=\"_blank\">Berlin<\/a>, Germany and in close collaboration with the ZIB, still headed by the original creators of Amira. TGS, located in Bordeaux, France was sold by Mercury Computer systems to a French investor and renamed to Visualization Sciences Group (VSG). VSG continued the work on a complementary product named <a href=\"https:\/\/en.wikipedia.org\/wiki\/Avizo_(software)\" title=\"Avizo (software)\" rel=\"external_link\" target=\"_blank\">Avizo<\/a>, based on the same source code but customized for material sciences.\n<\/p><p>In August 2012, <a href=\"https:\/\/en.wikipedia.org\/wiki\/FEI_Company\" title=\"FEI Company\" rel=\"external_link\" target=\"_blank\">FEI<\/a>, to that date the largest OEM reseller of Amira, purchased VSG and the Amira business from Promedicus. In August 2013, Visualization Sciences Group (VSG) became a business unit of FEI. In 2016 FEI has been bought by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermo_Fisher_Scientific\" title=\"Thermo Fisher Scientific\" rel=\"external_link\" target=\"_blank\">Thermo Fisher Scientific<\/a> and became part of its Materials & Structural Analysis division in early 2017.\n<\/p><p>Amira and Avizo are still being marketed as two different products; Amira for life sciences and Avizo for materials science, but the development efforts are now joined once again. As in the beginning, the Amira roadmap continues to be driven by the interesting and challenging scientific questions that Amira users around the world are trying to answer, often at the leading edge in their fields.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Amira_options\">Amira options<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Microscopy_option\">Microscopy option<\/span><\/h3>\n<ul><li>Specific readers for microscopy data<\/li>\n<li>Image deconvolution<\/li>\n<li>Exploration of 3D imagery obtained from virtually any microscope<\/li>\n<li>Extraction and editing of filament networks from microscopy images<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"DICOM_reader\">DICOM reader<\/span><\/h3>\n<ul><li>Import of clinical and preclinical data in DICOM format<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Mesh_option\">Mesh option<\/span><\/h3>\n<ul><li>Generation of 3D finite element (FE) meshes from segmented image data<\/li>\n<li>Support for many state-of-the-art FE solver formats<\/li>\n<li>High-quality visualization of simulation mesh-based results, using scalar, vector, and tensor field display modules<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Skeletonization_option\">Skeletonization option<\/span><\/h3>\n<ul><li>Reconstruction and analysis of neural and vascular networks<\/li>\n<li>Visualization of skeletonized networks<\/li>\n<li>Length and diameter quantification of network segments<\/li>\n<li>Ordering of segments in a tree graph<\/li>\n<li>Skeletonization of very large image stacks<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Molecular_option\">Molecular option<\/span><\/h3>\n<ul><li>Advanced tools for the visualization of molecule models<\/li>\n<li>Hardware-accelerated volume rendering<\/li>\n<li>Powerful molecule editor<\/li>\n<li>Specific tools for complex molecular visualization<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Developer_option\">Developer option<\/span><\/h3>\n<ul><li>Creation of new custom components for visualizing or data processing<\/li>\n<li>Implementation of new file readers or writers<\/li>\n<li>C++ programming language<\/li>\n<li>Development wizard for getting started quickly<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Neuro_option\">Neuro option<\/span><\/h3>\n<ul><li>Medical image analysis for DTI and brain perfusion<\/li>\n<li>Fiber tracking supporting several stream-line based algorithms<\/li>\n<li>Fiber separation into fiber bundles based on user defined source and destination regions<\/li>\n<li>Computation of tensor fields, diffusion weighted maps<\/li>\n<li>Eigenvalue decomposition of tensor fields<\/li>\n<li>Computation of mean transit time, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_blood_flow\" class=\"mw-redirect\" title=\"Cerebral blood flow\" rel=\"external_link\" target=\"_blank\">cerebral blood flow<\/a>, and cerebral blood volume<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"VR_option\">VR option<\/span><\/h3>\n<ul><li>Visualization of data on large tiled displays or in immersive Virtual Reality (VR) environments<\/li>\n<li>Support of 3D navigation devices<\/li>\n<li>Fast multi-threaded and distributed rendering<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Very_large_data_option\">Very large data option<\/span><\/h3>\n<ul><li>Support for visualization of image data exceeding the available main memory, using efficient out-of-core data management<\/li>\n<li>Extensions of many standard modules, such as orthogonal and oblique slicing, volume rendering, and isosurface rendering, to work on out-of-core data<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Application_areas\">Application areas<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomy\" title=\"Anatomy\" rel=\"external_link\" target=\"_blank\">Anatomy<\/a><sup id=\"rdp-ebb-cite_ref-deboer2011_31-0\" class=\"reference\"><a href=\"#cite_note-deboer2011-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-specht2007_32-0\" class=\"reference\"><a href=\"#cite_note-specht2007-32\" rel=\"external_link\">[32]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biochemistry\" title=\"Biochemistry\" rel=\"external_link\" target=\"_blank\">Biochemistry<\/a><sup id=\"rdp-ebb-cite_ref-gaemers2011_33-0\" class=\"reference\"><a href=\"#cite_note-gaemers2011-33\" rel=\"external_link\">[33]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biophysics\" title=\"Biophysics\" rel=\"external_link\" target=\"_blank\">Biophysics<\/a><sup id=\"rdp-ebb-cite_ref-gaemers2011_33-1\" class=\"reference\"><a href=\"#cite_note-gaemers2011-33\" rel=\"external_link\">[33]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cellular_microbiology\" title=\"Cellular microbiology\" rel=\"external_link\" target=\"_blank\">Cellular microbiology<\/a><sup id=\"rdp-ebb-cite_ref-kudryashev2011_34-0\" class=\"reference\"><a href=\"#cite_note-kudryashev2011-34\" rel=\"external_link\">[34]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computational_fluid_dynamics\" title=\"Computational fluid dynamics\" rel=\"external_link\" target=\"_blank\">Computational fluid dynamics<\/a><sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryo-electron_tomography\" class=\"mw-redirect\" title=\"Cryo-electron tomography\" rel=\"external_link\" target=\"_blank\">Cryo-electron tomography<\/a><sup id=\"rdp-ebb-cite_ref-kudryashev2011_34-1\" class=\"reference\"><a href=\"#cite_note-kudryashev2011-34\" rel=\"external_link\">[34]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_MRI\" title=\"Diffusion MRI\" rel=\"external_link\" target=\"_blank\">Diffusion MRI<\/a>\/Fiber Tracking<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Embryology\" title=\"Embryology\" rel=\"external_link\" target=\"_blank\">Embryology<\/a><sup id=\"rdp-ebb-cite_ref-deboer2011_31-1\" class=\"reference\"><a href=\"#cite_note-deboer2011-31\" rel=\"external_link\">[31]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocrinology\" title=\"Endocrinology\" rel=\"external_link\" target=\"_blank\">Endocrinology<\/a><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Finite_element_method\" title=\"Finite element method\" rel=\"external_link\" target=\"_blank\">Finite Element Modelling<\/a><sup id=\"rdp-ebb-cite_ref-cai2011_38-0\" class=\"reference\"><a href=\"#cite_note-cai2011-38\" rel=\"external_link\">[38]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Histology\" title=\"Histology\" rel=\"external_link\" target=\"_blank\">Histology<\/a><sup id=\"rdp-ebb-cite_ref-deboer2011_31-2\" class=\"reference\"><a href=\"#cite_note-deboer2011-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-gaemers2011_33-2\" class=\"reference\"><a href=\"#cite_note-gaemers2011-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-irving2011_39-0\" class=\"reference\"><a href=\"#cite_note-irving2011-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">Medical imaging<\/a> research<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microscopy\" title=\"Microscopy\" rel=\"external_link\" target=\"_blank\">Microscopy<\/a> in life and material sciences<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_biology\" title=\"Molecular biology\" rel=\"external_link\" target=\"_blank\">Molecular biology<\/a><sup id=\"rdp-ebb-cite_ref-Obenaus2011_40-0\" class=\"reference\"><a href=\"#cite_note-Obenaus2011-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroscience\" title=\"Neuroscience\" rel=\"external_link\" target=\"_blank\">Neuroscience<\/a><sup id=\"rdp-ebb-cite_ref-irving2011_39-1\" class=\"reference\"><a href=\"#cite_note-irving2011-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-erturk2011_41-0\" class=\"reference\"><a href=\"#cite_note-erturk2011-41\" rel=\"external_link\">[41]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedics\" class=\"mw-redirect\" title=\"Orthopedics\" rel=\"external_link\" target=\"_blank\">Orthopedics<\/a><sup id=\"rdp-ebb-cite_ref-cai2011_38-1\" class=\"reference\"><a href=\"#cite_note-cai2011-38\" rel=\"external_link\">[38]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-hartwig2011_43-0\" class=\"reference\"><a href=\"#cite_note-hartwig2011-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Otolaryngology\" class=\"mw-redirect\" title=\"Otolaryngology\" rel=\"external_link\" target=\"_blank\">Otolaryngology<\/a><sup id=\"rdp-ebb-cite_ref-lee2011_44-0\" class=\"reference\"><a href=\"#cite_note-lee2011-44\" rel=\"external_link\">[44]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Preclinical_imaging\" title=\"Preclinical imaging\" rel=\"external_link\" target=\"_blank\">Preclinical imaging<\/a><sup id=\"rdp-ebb-cite_ref-Obenaus2011_40-1\" class=\"reference\"><a href=\"#cite_note-Obenaus2011-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Urology\" title=\"Urology\" rel=\"external_link\" target=\"_blank\">Urology<\/a><sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stalling, D.; Westerhoff, M.; Hege, H.-C. (2005). C.D. Hansen and C.R. Johnson, ed. \"Amira: A Highly Interactive System for Visual Data Analysis\". <i>The Visualization Handbook<\/i>: 749\u2013767. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CiteSeerX\" title=\"CiteSeerX\" rel=\"external_link\" target=\"_blank\">CiteSeerX<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/citeseerx.ist.psu.edu\/viewdoc\/summary?doi=10.1.1.129.6785\" target=\"_blank\">10.1.1.129.6785<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Visualization+Handbook&rft.atitle=Amira%3A+A+Highly+Interactive+System+for+Visual+Data+Analysis&rft.pages=749-767&rft.date=2005&rft_id=%2F%2Fciteseerx.ist.psu.edu%2Fviewdoc%2Fsummary%3Fdoi%3D10.1.1.129.6785&rft.aulast=Stalling&rft.aufirst=D.&rft.au=Westerhoff%2C+M.&rft.au=Hege%2C+H.-C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Adam, R.; Smith, A.R.; Sieren, J.C.; Eggleston, T.; McLennan, G. 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(2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/journals.lww.com\/nuclearmedicinecomm\/Abstract\/2010\/02000\/F_18_fluorothymidine_PET_evaluation_of_bone_marrow.11.aspx\" target=\"_blank\">\"F-18-fluorothymidine-PET evaluation of bone marrow transplant in a rat model\"<\/a>. <i>Nuclear Medicine Communications<\/i>. <b>31<\/b> (2): 152\u2013158. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Fmnm.0b013e3283339f92\" target=\"_blank\">10.1097\/mnm.0b013e3283339f92<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19966596\" target=\"_blank\">19966596<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nuclear+Medicine+Communications&rft.atitle=F-18-fluorothymidine-PET+evaluation+of+bone+marrow+transplant+in+a+rat+model&rft.volume=31&rft.issue=2&rft.pages=152-158&rft.date=2010&rft_id=info%3Adoi%2F10.1097%2Fmnm.0b013e3283339f92&rft_id=info%3Apmid%2F19966596&rft.aulast=Awasthi&rft.aufirst=V.&rft.au=Holter%2C+J.&rft.au=Thorp%2C+K.&rft.au=Anderson%2C+S.&rft.au=Epstein%2C+R.&rft_id=http%3A%2F%2Fjournals.lww.com%2Fnuclearmedicinecomm%2FAbstract%2F2010%2F02000%2FF_18_fluorothymidine_PET_evaluation_of_bone_marrow.11.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ayers2010-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ayers2010_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ayers2010_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ayers, G.D.; McKinley, E.T.; Zhao, P.; Fritz, J.M.; Metry, R.E.; Deal, B.C.; Adlerz, K.M.; Coffey, R.J.; Manning, H.C. (2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jultrasoundmed.org\/cgi\/content\/abstract\/29\/6\/891\" target=\"_blank\">\"Volume of Preclinical Xenograft Tumors Is More Accurately Assessed by Ultrasound Imaging Than Manual Caliper Measurements\"<\/a>. <i>Journal of Ultrasound in Medicine<\/i>. <b>29<\/b> (6): 891.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Ultrasound+in+Medicine&rft.atitle=Volume+of+Preclinical+Xenograft+Tumors+Is+More+Accurately+Assessed+by+Ultrasound+Imaging+Than+Manual+Caliper+Measurements&rft.volume=29&rft.issue=6&rft.pages=891&rft.date=2010&rft.aulast=Ayers&rft.aufirst=G.D.&rft.au=McKinley%2C+E.T.&rft.au=Zhao%2C+P.&rft.au=Fritz%2C+J.M.&rft.au=Metry%2C+R.E.&rft.au=Deal%2C+B.C.&rft.au=Adlerz%2C+K.M.&rft.au=Coffey%2C+R.J.&rft.au=Manning%2C+H.C.&rft_id=http%3A%2F%2Fwww.jultrasoundmed.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F6%2F891&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dlaskov\u00e1, A.; Spacek, T.; Santorov\u00e1, J.; Plecit\u00e1-Hlavat\u00e1, L.; Berkov\u00e1, Z.; Saudek, F.; Lessard, M.; Bewersdorf, J.; Jezek, P. (2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0005272810000496\" target=\"_blank\">\"4Pi microscopy reveals an impaired three-dimensional mitochondrial network of pancreatic islet beta-cells, an experimental model of type-2 diabetes\"<\/a>. <i>Biochimica et Biophysica Acta (BBA) - Bioenergetics<\/i>. <b>1797<\/b> (6\u20137): 1327\u20131341. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bbabio.2010.02.003\" target=\"_blank\">10.1016\/j.bbabio.2010.02.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20144584\" target=\"_blank\">20144584<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biochimica+et+Biophysica+Acta+%28BBA%29+-+Bioenergetics&rft.atitle=4Pi+microscopy+reveals+an+impaired+three-dimensional+mitochondrial+network+of+pancreatic+islet+beta-cells%2C+an+experimental+model+of+type-2+diabetes&rft.volume=1797&rft.issue=6%E2%80%937&rft.pages=1327-1341&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.bbabio.2010.02.003&rft_id=info%3Apmid%2F20144584&rft.aulast=Dlaskov%C3%A1&rft.aufirst=A.&rft.au=Spacek%2C+T.&rft.au=Santorov%C3%A1%2C+J.&rft.au=Plecit%C3%A1-Hlavat%C3%A1%2C+L.&rft.au=Berkov%C3%A1%2C+Z.&rft.au=Saudek%2C+F.&rft.au=Lessard%2C+M.&rft.au=Bewersdorf%2C+J.&rft.au=Jezek%2C+P.&rft_id=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0005272810000496&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Clark, N.D.L.; Daly., C. 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(2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jneurosci.org\/content\/31\/7\/2493.full\" target=\"_blank\">\"Olivocochlear Efferent Control in Sound Localization and Experience-Dependent Learning\"<\/a>. <i>Journal of Neuroscience<\/i>. <b>31<\/b> (7): 2493\u20132501. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2Fjneurosci.2679-10.2011\" target=\"_blank\">10.1523\/jneurosci.2679-10.2011<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3292219\" target=\"_blank\">3292219<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21325517\" target=\"_blank\">21325517<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neuroscience&rft.atitle=Olivocochlear+Efferent+Control+in+Sound+Localization+and+Experience-Dependent+Learning&rft.volume=31&rft.issue=7&rft.pages=2493-2501&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3292219&rft_id=info%3Apmid%2F21325517&rft_id=info%3Adoi%2F10.1523%2Fjneurosci.2679-10.2011&rft.aulast=Irving&rft.aufirst=S.&rft.au=Moore%2C+D.R.&rft.au=Liberman%2C+M.C.&rft.au=Sumner%2C+C.J.&rft_id=http%3A%2F%2Fwww.jneurosci.org%2Fcontent%2F31%2F7%2F2493.full&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Obenaus2011-40\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Obenaus2011_40-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Obenaus2011_40-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Obenaus, A.; Hayes, P. 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(2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/journals.lww.com\/jspinaldisorders\/Abstract\/publishahead\/Digital_3_Dimensional_Analysis_of_the.99831.aspx\" target=\"_blank\">\"Digital 3-Dimensional Analysis of the Paravertebral Lumbar Muscles After Circumferential Single-level Fusion\"<\/a>. <i>Journal of Spinal Disorders & Techniques<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Spinal+Disorders+%26+Techniques&rft.atitle=Digital+3-Dimensional+Analysis+of+the+Paravertebral+Lumbar+Muscles+After+Circumferential+Single-level+Fusion&rft.date=2011&rft.aulast=Hartwig&rft.aufirst=T.&rft.au=Streitparth%2C+F.&rft.au=Gro%2C+C.&rft.au=M%C3%BCller%2C+M.&rft.au=Perka%2C+C.&rft.au=Putzier%2C+M.&rft.au=Strube%2C+P.&rft_id=http%3A%2F%2Fjournals.lww.com%2Fjspinaldisorders%2FAbstract%2Fpublishahead%2FDigital_3_Dimensional_Analysis_of_the.99831.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-lee2011-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-lee2011_44-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lee, J.; Eddington, D.K.; Nadol, J.B. (2011). \"The Histopathology of Revision Cochlear Implantation\". <i>Audiology and Neurotology<\/i>. <b>16<\/b> (5): 336\u2013346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000322307\" target=\"_blank\">10.1159\/000322307<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21196725\" target=\"_blank\">21196725<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Audiology+and+Neurotology&rft.atitle=The+Histopathology+of+Revision+Cochlear+Implantation&rft.volume=16&rft.issue=5&rft.pages=336-346&rft.date=2011&rft_id=info%3Adoi%2F10.1159%2F000322307&rft_id=info%3Apmid%2F21196725&rft.aulast=Lee&rft.aufirst=J.&rft.au=Eddington%2C+D.K.&rft.au=Nadol%2C+J.B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Han, M.; Kim, C.; Mozer, P.; Schafer, F.; Badaan, S.; Vigaru, B.; Tseng, K.; Petrisor, D.; Trock, B.; Stoianovici, D. (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/urobotics.urology.jhu.edu\/pub\/2011-han-urology.pdf\" target=\"_blank\">\"Tandem-robot Assisted Laparoscopic Radical Prostatectomy to Improve the Neurovascular Bundle Visualization: A Feasibility Study\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Urology<\/i>. <b>77<\/b> (2): 502\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.urology.2010.06.064\" target=\"_blank\">10.1016\/j.urology.2010.06.064<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3051397\" target=\"_blank\">3051397<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21067797\" target=\"_blank\">21067797<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Urology&rft.atitle=Tandem-robot+Assisted+Laparoscopic+Radical+Prostatectomy+to+Improve+the+Neurovascular+Bundle+Visualization%3A+A+Feasibility+Study&rft.volume=77&rft.issue=2&rft.pages=502-6&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3051397&rft_id=info%3Apmid%2F21067797&rft_id=info%3Adoi%2F10.1016%2Fj.urology.2010.06.064&rft.aulast=Han&rft.aufirst=M.&rft.au=Kim%2C+C.&rft.au=Mozer%2C+P.&rft.au=Schafer%2C+F.&rft.au=Badaan%2C+S.&rft.au=Vigaru%2C+B.&rft.au=Tseng%2C+K.&rft.au=Petrisor%2C+D.&rft.au=Trock%2C+B.&rft.au=Stoianovici%2C+D.&rft_id=http%3A%2F%2Furobotics.urology.jhu.edu%2Fpub%2F2011-han-urology.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAmira+%28software%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><span class=\"official-website\"><span class=\"url\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/thermofisher.com.amira-avizo\" target=\"_blank\">Official website<\/a><\/span><\/span><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181217214647\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.736 seconds\nReal time usage: 0.837 seconds\nPreprocessor visited node count: 3916\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 129921\/2097152 bytes\nTemplate argument size: 2114\/2097152 bytes\nHighest expansion depth: 25\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 146259\/5000000 bytes\nNumber of Wikibase entities loaded: 6\/400\nLua time usage: 0.426\/10.000 seconds\nLua memory usage: 4.82 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 715.763 1 -total\n<\/p>\n<pre>71.96% 515.080 1 Template:Reflist\n56.62% 405.256 40 Template:Cite_journal\n24.78% 177.396 2 Template:Infobox\n20.72% 148.290 1 Template:Infobox_software\n 7.18% 51.407 2 Template:Start_date_and_age\n 6.79% 48.636 1 Template:Infobox_software\/simple\n 3.26% 23.363 3 Template:Cite_book\n 2.33% 16.656 1 Template:Time_ago\n 1.90% 13.631 1 Template:Image_Processing_Software\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:35691407-1!canonical and timestamp 20181217214646 and revision id 868162498\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Amira_%28software%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214647\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 1.027 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1018.277 1 - wikipedia:Amira_(software)\n100.00% 1018.277 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8094-0!*!*!*!*!*!* and timestamp 20181217214646 and revision id 24213\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Amira_(software)\">https:\/\/www.limswiki.org\/index.php\/Amira_(software)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","093a43ff657e8d7626758215c3314f13_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/05\/Amira_Screenshot_with_Honeybee_Brain_visualization.png\/600px-Amira_Screenshot_with_Honeybee_Brain_visualization.png"],"093a43ff657e8d7626758215c3314f13_timestamp":1545083206,"846897ccb14ad08184d684f4f3c14b7a_type":"article","846897ccb14ad08184d684f4f3c14b7a_title":"Sofie (surgical robot)","846897ccb14ad08184d684f4f3c14b7a_url":"https:\/\/www.limswiki.org\/index.php\/Sofie_(surgical_robot)","846897ccb14ad08184d684f4f3c14b7a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSofie (surgical robot)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe Surgeon\u2019s Operating Force-feedback Interface Eindhoven (Sofie) surgical robot is a surgical robot developed at the Eindhoven University of Technology. It was developed as part of a Ph.D thesis by dr. ir. Linda van den Bedem and is the first surgical robot to incorporate force feedback.[1][2]\n\nContents \n\n1 Background \n2 Design \n\n2.1 The master \n2.2 The slave \n\n\n3 Commercial advantages and exploitation \n4 External links \n5 References \n\n\nBackground \nThe Sofie surgical robot was developed as part of the Ph.D work of ir. Linda van den Bedem on the improvement of existing surgical systems.\nThe surgical systems commercially available as of September 2010 (such as the da Vinci Surgical System) all focus on translating movements made by a surgeon at a surgical console into movements by robot arms. However, a great limitation of this generation of robots is a complete lack of any tactile feedback: the surgeon cannot feel what he is doing, so he must rely completely on visual feedback to check his incisions, sutures and so on. A secondary drawback to this generation of robot is the average size and bulkiness, limiting the movements of surgical staff around the table and necessitating time-consuming recalibrations whenever the patient must be moved.\nThe Sofie robot improves upon the design of the previous generation of surgical robots by adding force feedback to the surgeon's controls, restoring the use of tactile senses that surgeons learn to use in their training.[1][2][3]\n\nDesign \nLike several of the previous generations of surgical robot, Sofie is a master-slave design. The two components (master and slave) are completely separated from each other, however, with all communication between the two taking place over data cables arranged in an overhead wiring boom.\n\nThe master \nThe master, or control console, is a workstation from which the surgeon controls the robotic arms and surgical tools. The workstation consists of a monitor on which an image of the work area is shown, plus a number of force-feedback joysticks. The console was designed to be a separate module from the slave, which allows it to be placed at some distance from the surgical table; this means that personnel working at the table will not be hampered in their movement by a large control console in the vicinity of the table. The master console was developed by ir. Ron Hendrix.[2]\n\nThe slave \nThe slave (the actual subject of dr.ir. Van den Bedem's thesis) is a robotic arm frame which can accommodate three independent manipulators (two for surgical tools, one for a camera). The frame for the manipulators is of the type used for pick-and-place robots, allowing the manipulators full freedom of motion in space. This means that the surgeon can also choose the optimal direction of approach for any organ, rather than having to move the patient to suit the machine.[1][2] Of course the manipulators also provide force feedback through the overhead cable boom.\nIn addition to having a large degree of freedom, the Sofie slave is also quite compact when compared to the generation of surgical robots in current use. Whereas the current generation requires a large robot arm installation next to the surgical table, the slave is small enough to be clamped onto the surgical bed itself. This means that the slave moves with the bed when the surgical table is moved or adjusted and doesn't have to be adjusted separately for the new position of the table in the operating room.[2]\n\nCommercial advantages and exploitation \nAnother advantage to the design of Sofie is that its construction is cheaper than that of the previous generation of robot. Although there is no notion yet of what a Sofie-like robot would cost in a commercial offering, it is already clear that the design allows for a robot that costs substantially less than the \u20ac1,000,000 average of the da Vinci Surgical System.[2]\nAs of October 2010, dr.ir. Van den Bedem is investigating the possibilities for commercial exploitation of the basic design. The expectation however, is that any robot could only be available in the market by 2016 at the earliest.[2]\n\nExternal links \nvan den Bedem, Linda Jacoba Martina (22 September 2010), Realization of a demonstrator slave for robotic minimally invasive surgery, Eindhoven: Technische Universiteit Eindhoven, ISBN 978-90-386-2300-9, retrieved 26 April 2010 \nReferences \n\n\n^ a b c \"Beter opereren met nieuwe Nederlandse operatierobot Sofie\" (in Dutch). TU\/e. 27 September 2010. Archived from the original on 24 July 2011. Retrieved 10 October 2010 . \n\n^ a b c d e f g Mischa, Brendel (10 October 2010). \"Operatierobot met gevoel\" [Feeling surgical robot]. Technisch Weekblad (in Dutch). The Hague, Netherlands: Beta Publishers. p. 4. ISSN 0923-1919. Retrieved 10 October 2010 . \n\n^ \"Better Surgery With New Surgical Robot With Force Feedback\". Science Daily. 29 September 2010. Retrieved 10 October 2010 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sofie_(surgical_robot)\">https:\/\/www.limswiki.org\/index.php\/Sofie_(surgical_robot)<\/a>\n\t\t\t\t\tCategories: Computer-assisted surgeryHealth informaticsMedical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:51.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 690 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","846897ccb14ad08184d684f4f3c14b7a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sofie_surgical_robot skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sofie (surgical robot)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>The <b>Surgeon\u2019s Operating Force-feedback Interface Eindhoven (Sofie)<\/b> surgical robot is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_robot\" class=\"mw-redirect\" title=\"Surgical robot\" rel=\"external_link\" target=\"_blank\">surgical robot<\/a> developed at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eindhoven_University_of_Technology\" title=\"Eindhoven University of Technology\" rel=\"external_link\" target=\"_blank\">Eindhoven University of Technology<\/a>. It was developed as part of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ph.D\" class=\"mw-redirect\" title=\"Ph.D\" rel=\"external_link\" target=\"_blank\">Ph.D<\/a> thesis by dr. ir. Linda van den Bedem and is the first surgical robot to incorporate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Haptic_technology\" title=\"Haptic technology\" rel=\"external_link\" target=\"_blank\">force feedback<\/a>.<sup id=\"rdp-ebb-cite_ref-TUE_1-0\" class=\"reference\"><a href=\"#cite_note-TUE-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-TW_2-0\" class=\"reference\"><a href=\"#cite_note-TW-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<p>The Sofie surgical robot was developed as part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ph.D\" class=\"mw-redirect\" title=\"Ph.D\" rel=\"external_link\" target=\"_blank\">Ph.D<\/a> work of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Doctor_(title)#The_Netherlands\" title=\"Doctor (title)\" rel=\"external_link\" target=\"_blank\">ir.<\/a> Linda van den Bedem on the improvement of existing surgical systems.\n<\/p><p>The surgical systems commercially available as of September 2010 (such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci Surgical System<\/a>) all focus on translating movements made by a surgeon at a surgical console into movements by robot arms. However, a great limitation of this generation of robots is a complete lack of any tactile feedback: the surgeon cannot feel what he is doing, so he must rely completely on visual feedback to check his incisions, sutures and so on. A secondary drawback to this generation of robot is the average size and bulkiness, limiting the movements of surgical staff around the table and necessitating time-consuming recalibrations whenever the patient must be moved.\n<\/p><p>The Sofie robot improves upon the design of the previous generation of surgical robots by adding force feedback to the surgeon's controls, restoring the use of tactile senses that surgeons learn to use in their training.<sup id=\"rdp-ebb-cite_ref-TUE_1-1\" class=\"reference\"><a href=\"#cite_note-TUE-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-TW_2-1\" class=\"reference\"><a href=\"#cite_note-TW-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ScienceDaily_3-0\" class=\"reference\"><a href=\"#cite_note-ScienceDaily-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<p>Like several of the previous generations of surgical robot, Sofie is a master-slave design. The two components (master and slave) are completely separated from each other, however, with all communication between the two taking place over data cables arranged in an overhead wiring boom.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"The_master\">The master<\/span><\/h3>\n<p>The master, or control console, is a workstation from which the surgeon controls the robotic arms and surgical tools. The workstation consists of a monitor on which an image of the work area is shown, plus a number of force-feedback joysticks. The console was designed to be a separate module from the slave, which allows it to be placed at some distance from the surgical table; this means that personnel working at the table will not be hampered in their movement by a large control console in the vicinity of the table. The master console was developed by ir. Ron Hendrix.<sup id=\"rdp-ebb-cite_ref-TW_2-2\" class=\"reference\"><a href=\"#cite_note-TW-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"The_slave\">The slave<\/span><\/h3>\n<p>The slave (the actual subject of dr.ir. Van den Bedem's thesis) is a robotic arm frame which can accommodate three independent manipulators (two for surgical tools, one for a camera). The frame for the manipulators is of the type used for pick-and-place robots, allowing the manipulators full freedom of motion in space. This means that the surgeon can also choose the optimal direction of approach for any organ, rather than having to move the patient to suit the machine.<sup id=\"rdp-ebb-cite_ref-TUE_1-2\" class=\"reference\"><a href=\"#cite_note-TUE-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-TW_2-3\" class=\"reference\"><a href=\"#cite_note-TW-2\" rel=\"external_link\">[2]<\/a><\/sup> Of course the manipulators also provide force feedback through the overhead cable boom.\n<\/p><p>In addition to having a large degree of freedom, the Sofie slave is also quite compact when compared to the generation of surgical robots in current use. Whereas the current generation requires a large robot arm installation next to the surgical table, the slave is small enough to be clamped onto the surgical bed itself. This means that the slave moves with the bed when the surgical table is moved or adjusted and doesn't have to be adjusted separately for the new position of the table in the operating room.<sup id=\"rdp-ebb-cite_ref-TW_2-4\" class=\"reference\"><a href=\"#cite_note-TW-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Commercial_advantages_and_exploitation\">Commercial advantages and exploitation<\/span><\/h2>\n<p>Another advantage to the design of Sofie is that its construction is cheaper than that of the previous generation of robot. Although there is no notion yet of what a Sofie-like robot would cost in a commercial offering, it is already clear that the design allows for a robot that costs substantially less than the \u20ac1,000,000 average of the da Vinci Surgical System.<sup id=\"rdp-ebb-cite_ref-TW_2-5\" class=\"reference\"><a href=\"#cite_note-TW-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>As of October 2010, dr.ir. Van den Bedem is investigating the possibilities for commercial exploitation of the basic design. The expectation however, is that any robot could only be available in the market by 2016 at the earliest.<sup id=\"rdp-ebb-cite_ref-TW_2-6\" class=\"reference\"><a href=\"#cite_note-TW-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><cite id=\"rdp-ebb-CITEREFvan_den_Bedem2010\" class=\"citation\">van den Bedem, Linda Jacoba Martina (22 September 2010), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/repository.tue.nl\/684835\" target=\"_blank\"><i>Realization of a demonstrator slave for robotic minimally invasive surgery<\/i><\/a>, Eindhoven: Technische Universiteit Eindhoven, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-90-386-2300-9<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">26 April<\/span> 2010<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Realization+of+a+demonstrator+slave+for+robotic+minimally+invasive+surgery&rft.place=Eindhoven&rft.pub=Technische+Universiteit+Eindhoven&rft.date=2010-09-22&rft.isbn=978-90-386-2300-9&rft.aulast=van+den+Bedem&rft.aufirst=Linda+Jacoba+Martina&rft_id=http%3A%2F%2Frepository.tue.nl%2F684835&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASofie+%28surgical+robot%29\" class=\"Z3988\"><\/span><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-TUE-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-TUE_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TUE_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TUE_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110724171318\/http:\/\/w3.wtb.tue.nl\/nl\/nieuws\/artikel\/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff\" target=\"_blank\">\"Beter opereren met nieuwe Nederlandse operatierobot Sofie\"<\/a> (in Dutch). TU\/e. 27 September 2010. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/w3.wtb.tue.nl\/nl\/nieuws\/artikel\/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff\" target=\"_blank\">the original<\/a> on 24 July 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 October<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Beter+opereren+met+nieuwe+Nederlandse+operatierobot+Sofie&rft.pub=TU%2Fe&rft.date=2010-09-27&rft_id=http%3A%2F%2Fw3.wtb.tue.nl%2Fnl%2Fnieuws%2Fartikel%2F%3Ftx_ttnews%255Btt_news%255D%3D10041%26tx_ttnews%255BbackPid%255D%3D465%26cHash%3Debb243e7ff&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASofie+%28surgical+robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-TW-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-TW_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TW_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TW_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TW_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TW_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TW_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TW_2-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Mischa, Brendel (10 October 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.technischweekblad.nl\/operatierobot-met-gevoel.109685.lynkx\" target=\"_blank\">\"Operatierobot met gevoel\"<\/a> [Feeling surgical robot]. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Technisch_Weekblad\" title=\"Technisch Weekblad\" rel=\"external_link\" target=\"_blank\">Technisch Weekblad<\/a><\/i> (in Dutch). <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Hague\" title=\"The Hague\" rel=\"external_link\" target=\"_blank\">The Hague<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Netherlands\" title=\"Netherlands\" rel=\"external_link\" target=\"_blank\">Netherlands<\/a>: Beta Publishers. p. 4. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0923-1919\" target=\"_blank\">0923-1919<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 October<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Technisch+Weekblad&rft.atitle=Operatierobot+met+gevoel&rft.pages=4&rft.date=2010-10-10&rft.issn=0923-1919&rft.aulast=Mischa&rft.aufirst=Brendel&rft_id=http%3A%2F%2Fwww.technischweekblad.nl%2Foperatierobot-met-gevoel.109685.lynkx&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASofie+%28surgical+robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ScienceDaily-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ScienceDaily_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.sciencedaily.com\/releases\/2010\/09\/100928083848.htm\" target=\"_blank\">\"Better Surgery With New Surgical Robot With Force Feedback\"<\/a>. <i>Science Daily<\/i>. 29 September 2010<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 October<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Science+Daily&rft.atitle=Better+Surgery+With+New+Surgical+Robot+With+Force+Feedback&rft.date=2010-09-29&rft_id=https%3A%2F%2Fwww.sciencedaily.com%2Freleases%2F2010%2F09%2F100928083848.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASofie+%28surgical+robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181210002119\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.148 seconds\nReal time usage: 0.178 seconds\nPreprocessor visited node count: 305\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9002\/2097152 bytes\nTemplate argument size: 86\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11318\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.086\/10.000 seconds\nLua memory usage: 2.41 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 151.528 1 -total\n<\/p>\n<pre>56.81% 86.084 1 Template:Citation\n43.12% 65.343 1 Template:Reflist\n20.50% 31.060 1 Template:Cite_news\n10.34% 15.669 2 Template:Cite_web\n 1.42% 2.159 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:29140499-1!canonical and timestamp 20181210002119 and revision id 842511221\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sofie_%28surgical_robot%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214646\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.026 seconds\nReal time usage: 0.163 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 157.146 1 - wikipedia:Sofie_(surgical_robot)\n100.00% 157.146 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8550-0!*!*!*!*!*!* and timestamp 20181217214645 and revision id 27029\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sofie_(surgical_robot)\">https:\/\/www.limswiki.org\/index.php\/Sofie_(surgical_robot)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","846897ccb14ad08184d684f4f3c14b7a_images":[],"846897ccb14ad08184d684f4f3c14b7a_timestamp":1545083205,"3f2190c5a9f58ce59dc4156375104be1_type":"article","3f2190c5a9f58ce59dc4156375104be1_title":"Robotic sperm","3f2190c5a9f58ce59dc4156375104be1_url":"https:\/\/www.limswiki.org\/index.php\/Robotic_sperm","3f2190c5a9f58ce59dc4156375104be1_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRobotic sperm\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (November 2017)\nRobotic Sperm (also called spermbots) are biohybrid microrobots consisting of sperm cells and artificial microstructures.[1][2][3] Currently there are two types of spermbots. The first type, the tubular spermbot, consists of a single sperm cell that is captured inside a microtube. Single bull sperm cells enter these microtubes and become trapped inside. The tail of the sperm is the driving force for the microtube.[1] The second type, the helical spermbot, is a small helix structure which captures and transports single immotile sperm cells. In this case, a rotating magnetic field drives the helix in a screw-like motion. Both kinds of spermbots can be guided by weak magnetic fields.[2] These two spermbot designs are hybrid microdevices, they consist of a living cell combined with synthetic attachments. Other approaches exist to create purely synthetic microdevices inspired by the swimming of natural sperm cells, i.e. with a biomimetic design, for example so-called Magnetosperm which are made of a flexible polymeric structure coated with a magnetic layer and can be actuated by a magnetic field.[4]\n\nContents \n\n1 Design \n\n1.1 Tubular spermbots \n1.2 Helical spermbots \n\n\n2 Navigation \n3 Applications \n4 Perspectives \n5 References \n\n\nDesign \nTubular spermbots \nInitially, the microtubes for the tubular spermbots were made using roll-up nanotechnology on photoresist.[5] In this process, thin films of titanium and iron were deposited onto a sacrificial layer. When the sacrificial layer was removed, the thin films rolled into 50 \u00b5m long microtubes with a diameter of 5 - 8 \u00b5m. Later on, the microtubes were made from a temperature-responsive polymer to enable the controlled release of the sperm cells upon a small temperature change of a few degrees.[6]\nTubular spermbots are assembled by adding a large amount of the microtubes to a diluted sperm sample under the microscope. The sperm cells randomly enter the microtubes and become trapped in their slightly conical cavity. In order to increase the coupling efficiency between sperm cells and microtubes, the microtubes have been functionalized with proteins or sperm chemoattractant. This has been done using thiol chemistry once the tubes are rolled-up or by transferring the molecules with an elastomer stamp onto the material before rolling the tubes.[7]\n\nHelical spermbots \nHelical spermbots are assembled by driving a magnetic microhelix over an individual sperm cell, thereby confining its tail inside the helix lumen and pushing the head of the sperm forward. The sperm cell is loosely coupled to the helix and can be released by reversing the rotation of the helix, letting it withdraw from the head and free the confined tail in the process. Such microhelices were fabricated by direct laser lithography and coated with nickel or iron for magnetization.[2]\n\nNavigation \nRobotic sperm can be navigated by weak external magnetic fields of a few mT. These fields can be generated by permanent magnets or by a setup of electromagnets. The applied magnetic field can be a homogeneous, rotating, or gradient field.[8] Tubular and helical spermbots can also be navigated in a closed-loop control scheme with an electromagnetic coil setup.[9]\n\nApplications \nSpermbots hold promise for potential application in single cell manipulation and assisted reproduction, but also for targeted drug delivery. A recent study shows that modified tubular spermbots can be used for delivery of cancer drugs.[10] In this case, the sperm cell is loaded with doxorubicin. The artificial microstructure fabricated by two-photon nanolithography captures the drug-loaded sperm cell. The sperm cell is the actuation source for the magnetic microstructure and can propel it to cancer spheroids. At this location, the drug-loaded sperm is released by a spring mechanism and the sperm cell delivers the drug to the cancer cells.\n\nPerspectives \nRobotic sperms as microswimmers are interesting for diverse biomedical applications, specifically for new assisted fertilization techniques and for the targeted delivery of therapeutic cargo. These microswimmers are meant to operate in in vivo environments, a feature that may revolutionize assisted reproduction technologies and nanomedicine in the future.[11] New designs are emerging and plenty of applications can be derived from the here reported concept.[3][11]\n\nReferences \n\n\n^ a b Magdanz, Veronika; Sanchez, Samuel; Schmidt, Oliver G. (2013). \"Development of a Sperm-Flagella Driven Micro-Bio-Robot\". Advanced Materials. 25: 6581\u20136588. doi:10.1002\/adma.201302544. \n\n^ a b c Medina-S\u00e1nchez, Mariana; Schwarz, Lukas; Meyer, Anne K.; Hebenstreit, Franziska; Schmidt, Oliver G. (2016). \"Cellular Cargo Delivery: Toward Assisted Fertilization by Sperm-Carrying Micromotors\". Nano Letters. 16: 555\u2013561. Bibcode:2016NanoL..16..555M. doi:10.1021\/acs.nanolett.5b04221. \n\n^ a b Magdanz, Veronika; Medina-S\u00e1nchez, Mariana; Schwarz, Lukas; Xu, Haifeng; Elgeti, Jens; Schmidt, Oliver G. (2017). \"Spermatozoa as Functional Components of Robotic Microswimmers\". Advanced Materials. 29: 1606301. doi:10.1002\/adma.201606301. \n\n^ Khalil, Islam S. M.; Dijkslag, Herman C.; Abelmann, Leon; Misra, Sarthak (2014). \"MagnetoSperm: A microrobot that navigates using weak magnetic fields\". Applied Physics Letters. 104 (22): 223701. Bibcode:2014ApPhL.104v3701K. doi:10.1063\/1.4880035. \n\n^ Mei, Yongfeng; Huang, Gaoshan; Solovev, Alexander A.; Berm\u00fadez Ure\u00f1a, Esteban (2008). \"Versatile Approach for Integrative and Functionalized Tubes by Strain Engineering of Nanomembranes on Polymers\". Advanced Materials. 20: 4085\u20134090. doi:10.1002\/adma.200801589. \n\n^ Magdanz, Veronika; Guix, Maria; Hebenstreit, Franziska; Schmidt, Oliver G. (2016). \"Dynamic Polymeric Microtubes for the Remote-Controlled Capture, Guidance, and Release of Sperm Cells\". Advanced Materials. 28: 4084\u20134089. doi:10.1002\/adma.201505487. \n\n^ Magdanz, Veronika; Medina-S\u00e1nchez, Mariana; Chen, Yan; Guix, Maria; Schmidt, Oliver G. (2015). \"How to Improve Spermbot Performance\". Advanced Functional Materials. 25: 2763\u20132770. doi:10.1002\/adfm.201500015. \n\n^ Zhang, Li; Abbott, Jake J.; Dong, Lixing; Kratochvil, Bradley E.; Bell, Dominik; Nelson, Bradley J. (2009). \"Artificial bacterial flagella: Fabrication and magnetic control\". Applied Physics Letters. 94 (6): 064107. Bibcode:2009ApPhL..94f4107Z. doi:10.1063\/1.3079655. \n\n^ Khalil, Islam S. M.; Magdanz, Veronika; Sanchez, Samuel; Schmidt, Oliver G.; Misra, Sarthak (2013). \"Three-dimensional closed-loop control of self-propelled microjets\". Applied Physics Letters. 103 (17): 172404. Bibcode:2013ApPhL.103q2404K. doi:10.1063\/1.4826141. \n\n^ Xu, Haifeng; Medina-S\u00e1nchez, Mariana; Magdanz, Veronika; Schwarz, Lukas; Hebenstreit, Franziska; Schmidt, Oliver G. (2017). \"Sperm-hybrid micromotor for drug delivery in the female reproductive tract\". arXiv:1703.08510 [physics.med-ph]. \n\n^ a b Medina-S\u00e1nchez, Mariana; Schmidt, Oliver G. (2017). \"Medical microbots need better imaging and control\". Nature. 545 (7655): 406\u2013408. Bibcode:2017Natur.545..406M. doi:10.1038\/545406a. PMID 28541344. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Robotic_sperm\">https:\/\/www.limswiki.org\/index.php\/Robotic_sperm<\/a>\n\t\t\t\t\tCategories: Medical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 2 March 2016, at 20:27.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,002 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3f2190c5a9f58ce59dc4156375104be1_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Robotic_sperm skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Robotic sperm<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Robotic Sperm<\/b> (also called <b>spermbots<\/b>) are biohybrid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microbotics\" title=\"Microbotics\" rel=\"external_link\" target=\"_blank\">microrobots<\/a> consisting of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spermatozoon\" title=\"Spermatozoon\" rel=\"external_link\" target=\"_blank\">sperm cells<\/a> and artificial microstructures.<sup id=\"rdp-ebb-cite_ref-:0_1-0\" class=\"reference\"><a href=\"#cite_note-:0-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:1_2-0\" class=\"reference\"><a href=\"#cite_note-:1-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:2_3-0\" class=\"reference\"><a href=\"#cite_note-:2-3\" rel=\"external_link\">[3]<\/a><\/sup> Currently there are two types of spermbots. The first type, the tubular spermbot, consists of a single sperm cell that is captured inside a microtube. Single bull sperm cells enter these microtubes and become trapped inside. The tail of the sperm is the driving force for the microtube.<sup id=\"rdp-ebb-cite_ref-:0_1-1\" class=\"reference\"><a href=\"#cite_note-:0-1\" rel=\"external_link\">[1]<\/a><\/sup> The second type, the helical spermbot, is a small helix structure which captures and transports single immotile sperm cells. In this case, a rotating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic field<\/a> drives the helix in a screw-like motion. Both kinds of spermbots can be guided by weak magnetic fields.<sup id=\"rdp-ebb-cite_ref-:1_2-1\" class=\"reference\"><a href=\"#cite_note-:1-2\" rel=\"external_link\">[2]<\/a><\/sup> These two spermbot designs are hybrid microdevices, they consist of a living cell combined with synthetic attachments. Other approaches exist to create purely synthetic microdevices inspired by the swimming of natural sperm cells, i.e. with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomimetics\" title=\"Biomimetics\" rel=\"external_link\" target=\"_blank\">biomimetic<\/a> design, for example so-called Magnetosperm which are made of a flexible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymeric<\/a> structure coated with a magnetic layer and can be actuated by a magnetic field.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Tubular_spermbots\"><i>Tubular spermbots<\/i><\/span><\/h3>\n<p>Initially, the microtubes for the tubular spermbots were made using roll-up nanotechnology on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoresist\" title=\"Photoresist\" rel=\"external_link\" target=\"_blank\">photoresist<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> In this process, thin films of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a> were deposited onto a sacrificial layer. When the sacrificial layer was removed, the thin films rolled into 50 \u00b5m long microtubes with a diameter of 5 - 8 \u00b5m. Later on, the microtubes were made from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Temperature-responsive_polymer\" title=\"Temperature-responsive polymer\" rel=\"external_link\" target=\"_blank\">temperature-responsive polymer<\/a> to enable the controlled release of the sperm cells upon a small temperature change of a few degrees.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Tubular spermbots are assembled by adding a large amount of the microtubes to a diluted sperm sample under the microscope. The sperm cells randomly enter the microtubes and become trapped in their slightly conical cavity. In order to increase the coupling efficiency between sperm cells and microtubes, the microtubes have been functionalized with proteins or sperm <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemotaxis\" title=\"Chemotaxis\" rel=\"external_link\" target=\"_blank\">chemoattractant<\/a>. This has been done using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thiol\" title=\"Thiol\" rel=\"external_link\" target=\"_blank\">thiol<\/a> chemistry once the tubes are rolled-up or by transferring the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecule\" title=\"Molecule\" rel=\"external_link\" target=\"_blank\">molecules<\/a> with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomer<\/a> stamp onto the material before rolling the tubes.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Helical_spermbots\"><i>Helical spermbots<\/i><\/span><\/h3>\n<p>Helical spermbots are assembled by driving a magnetic microhelix over an individual sperm cell, thereby confining its tail inside the helix <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumen_(anatomy)\" title=\"Lumen (anatomy)\" rel=\"external_link\" target=\"_blank\">lumen<\/a> and pushing the head of the sperm forward. The sperm cell is loosely coupled to the helix and can be released by reversing the rotation of the helix, letting it withdraw from the head and free the confined tail in the process. Such microhelices were fabricated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Direct_laser_lithography\" class=\"mw-redirect\" title=\"Direct laser lithography\" rel=\"external_link\" target=\"_blank\">direct laser lithography<\/a> and coated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a> or iron for magnetization.<sup id=\"rdp-ebb-cite_ref-:1_2-2\" class=\"reference\"><a href=\"#cite_note-:1-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Navigation\">Navigation<\/span><\/h2>\n<p>Robotic sperm can be navigated by weak external magnetic fields of a few <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">mT<\/a>. These fields can be generated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnet\" title=\"Magnet\" rel=\"external_link\" target=\"_blank\">permanent magnets<\/a> or by a setup of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnet\" title=\"Electromagnet\" rel=\"external_link\" target=\"_blank\">electromagnets<\/a>. The applied magnetic field can be a homogeneous, rotating, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gradient\" title=\"Gradient\" rel=\"external_link\" target=\"_blank\">gradient<\/a> field.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Tubular and helical spermbots can also be navigated in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Closed-loop_control\" class=\"mw-redirect\" title=\"Closed-loop control\" rel=\"external_link\" target=\"_blank\">closed-loop control<\/a> scheme with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetic_coil\" title=\"Electromagnetic coil\" rel=\"external_link\" target=\"_blank\">electromagnetic coil<\/a> setup.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Spermbots hold promise for potential application in single cell manipulation and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assisted_reproductive_technology\" title=\"Assisted reproductive technology\" rel=\"external_link\" target=\"_blank\">assisted reproduction<\/a>, but also for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Targeted_drug_delivery\" title=\"Targeted drug delivery\" rel=\"external_link\" target=\"_blank\">targeted drug delivery<\/a>. A recent study shows that modified tubular spermbots can be used for delivery of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancer<\/a> drugs.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In this case, the sperm cell is loaded with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Doxorubicin\" title=\"Doxorubicin\" rel=\"external_link\" target=\"_blank\">doxorubicin<\/a>. The artificial microstructure fabricated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiphoton_lithography\" title=\"Multiphoton lithography\" rel=\"external_link\" target=\"_blank\">two-photon nanolithography<\/a> captures the drug-loaded sperm cell. The sperm cell is the actuation source for the magnetic microstructure and can propel it to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grading_(tumors)\" title=\"Grading (tumors)\" rel=\"external_link\" target=\"_blank\">cancer spheroids<\/a>. At this location, the drug-loaded sperm is released by a spring mechanism and the sperm cell delivers the drug to the cancer cells.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Perspectives\">Perspectives<\/span><\/h2>\n<p>Robotic sperms as microswimmers are interesting for diverse biomedical applications, specifically for new assisted fertilization techniques and for the targeted delivery of therapeutic cargo. These microswimmers are meant to operate in <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo\" title=\"In vivo\" rel=\"external_link\" target=\"_blank\">in vivo<\/a><\/i> environments, a feature that may revolutionize assisted reproduction technologies and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanomedicine\" title=\"Nanomedicine\" rel=\"external_link\" target=\"_blank\">nanomedicine<\/a> in the future.<sup id=\"rdp-ebb-cite_ref-:3_11-0\" class=\"reference\"><a href=\"#cite_note-:3-11\" rel=\"external_link\">[11]<\/a><\/sup> New designs are emerging and plenty of applications can be derived from the here reported concept.<sup id=\"rdp-ebb-cite_ref-:2_3-1\" class=\"reference\"><a href=\"#cite_note-:2-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:3_11-1\" class=\"reference\"><a href=\"#cite_note-:3-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-:0-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Magdanz, Veronika; Sanchez, Samuel; Schmidt, Oliver G. (2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/adma.201302544\/abstract\" target=\"_blank\">\"Development of a Sperm-Flagella Driven Micro-Bio-Robot\"<\/a>. <i>Advanced Materials<\/i>. <b>25<\/b>: 6581\u20136588. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fadma.201302544\" target=\"_blank\">10.1002\/adma.201302544<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advanced+Materials&rft.atitle=Development+of+a+Sperm-Flagella+Driven+Micro-Bio-Robot&rft.volume=25&rft.pages=6581-6588&rft.date=2013&rft_id=info%3Adoi%2F10.1002%2Fadma.201302544&rft.aulast=Magdanz&rft.aufirst=Veronika&rft.au=Sanchez%2C+Samuel&rft.au=Schmidt%2C+Oliver+G.&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1002%2Fadma.201302544%2Fabstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobotic+sperm\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-:1-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Medina-S\u00e1nchez, Mariana; Schwarz, Lukas; Meyer, Anne K.; Hebenstreit, Franziska; Schmidt, Oliver G. (2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pubs.acs.org\/doi\/abs\/10.1021\/acs.nanolett.5b04221\" target=\"_blank\">\"Cellular Cargo Delivery: Toward Assisted Fertilization by Sperm-Carrying Micromotors\"<\/a>. <i>Nano Letters<\/i>. <b>16<\/b>: 555\u2013561. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2016NanoL..16..555M\" target=\"_blank\">2016NanoL..16..555M<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Facs.nanolett.5b04221\" target=\"_blank\">10.1021\/acs.nanolett.5b04221<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nano+Letters&rft.atitle=Cellular+Cargo+Delivery%3A+Toward+Assisted+Fertilization+by+Sperm-Carrying+Micromotors&rft.volume=16&rft.pages=555-561&rft.date=2016&rft_id=info%3Adoi%2F10.1021%2Facs.nanolett.5b04221&rft_id=info%3Abibcode%2F2016NanoL..16..555M&rft.aulast=Medina-S%C3%A1nchez&rft.aufirst=Mariana&rft.au=Schwarz%2C+Lukas&rft.au=Meyer%2C+Anne+K.&rft.au=Hebenstreit%2C+Franziska&rft.au=Schmidt%2C+Oliver+G.&rft_id=http%3A%2F%2Fpubs.acs.org%2Fdoi%2Fabs%2F10.1021%2Facs.nanolett.5b04221&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobotic+sperm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:2-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:2_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:2_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Magdanz, Veronika; Medina-S\u00e1nchez, Mariana; Schwarz, Lukas; Xu, Haifeng; Elgeti, Jens; Schmidt, Oliver G. 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(2017). \"Sperm-hybrid micromotor for drug delivery in the female reproductive tract\". <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/1703.08510\" target=\"_blank\">1703.08510<\/a><\/span> [<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/archive\/physics.med-ph\" target=\"_blank\">physics.med-ph<\/a>].<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=preprint&rft.jtitle=arXiv&rft.atitle=Sperm-hybrid+micromotor+for+drug+delivery+in+the+female+reproductive+tract&rft.date=2017&rft_id=info%3Aarxiv%2F1703.08510&rft.aulast=Xu&rft.aufirst=Haifeng&rft.au=Medina-S%C3%A1nchez%2C+Mariana&rft.au=Magdanz%2C+Veronika&rft.au=Schwarz%2C+Lukas&rft.au=Hebenstreit%2C+Franziska&rft.au=Schmidt%2C+Oliver+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobotic+sperm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:3-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:3_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Medina-S\u00e1nchez, Mariana; Schmidt, Oliver G. (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nature.com\/news\/medical-microbots-need-better-imaging-and-control-1.22022\" target=\"_blank\">\"Medical microbots need better imaging and control\"<\/a>. <i>Nature<\/i>. <b>545<\/b> (7655): 406\u2013408. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2017Natur.545..406M\" target=\"_blank\">2017Natur.545..406M<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F545406a\" target=\"_blank\">10.1038\/545406a<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28541344\" target=\"_blank\">28541344<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Medical+microbots+need+better+imaging+and+control&rft.volume=545&rft.issue=7655&rft.pages=406-408&rft.date=2017&rft_id=info%3Apmid%2F28541344&rft_id=info%3Adoi%2F10.1038%2F545406a&rft_id=info%3Abibcode%2F2017Natur.545..406M&rft.aulast=Medina-S%C3%A1nchez&rft.aufirst=Mariana&rft.au=Schmidt%2C+Oliver+G.&rft_id=https%3A%2F%2Fwww.nature.com%2Fnews%2Fmedical-microbots-need-better-imaging-and-control-1.22022&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobotic+sperm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1244\nCached time: 20181217184336\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.324 seconds\nReal time usage: 0.379 seconds\nPreprocessor visited node count: 869\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 31571\/2097152 bytes\nTemplate argument size: 1113\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 34468\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.205\/10.000 seconds\nLua memory usage: 3.65 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 333.481 1 -total\n<\/p>\n<pre>75.10% 250.441 1 Template:Reflist\n56.15% 187.262 10 Template:Cite_journal\n20.20% 67.370 1 Template:Orphan\n15.39% 51.330 1 Template:Draft_other\n14.61% 48.737 1 Template:Ambox\n 8.60% 28.671 1 Template:Cite_arxiv\n 0.79% 2.651 1 Template:Monthyear\n 0.79% 2.648 1 Template:Main_other\n 0.78% 2.605 1 Template:Monthyear-1\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:42951933-1!canonical and timestamp 20181217184336 and revision id 825136675\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/AbioCor\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214645\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 152.869 1 - wikipedia:Robotic_sperm\n100.00% 152.869 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8068-0!*!*!*!*!*!* and timestamp 20181217214645 and revision id 24394\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Robotic_sperm\">https:\/\/www.limswiki.org\/index.php\/Robotic_sperm<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3f2190c5a9f58ce59dc4156375104be1_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"3f2190c5a9f58ce59dc4156375104be1_timestamp":1545083205,"49c1a391f24ae60449aafabfecdd4a69_type":"article","49c1a391f24ae60449aafabfecdd4a69_title":"Pharmacy automation","49c1a391f24ae60449aafabfecdd4a69_url":"https:\/\/www.limswiki.org\/index.php\/Pharmacy_automation","49c1a391f24ae60449aafabfecdd4a69_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPharmacy automation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tPharmacy automation involves the mechanical processes of handling and distributing medications. Any pharmacy task may be involved, including counting small objects (e.g., tablets, capsules); measuring and mixing powders and liquids for compounding; tracking and updating customer information in databases (e.g., personally identifiable information (PII), medical history, drug interaction risk detection); and inventory management. This article focuses on the changes that have taken place in the local, or community Pharmacy since the 1960s.\n\nContents \n\n1 History \n\n1.1 Chronology \n\n\n2 Global variations \n3 Current state of the industry \n4 Technological changes and design improvements \n5 Other pharmacy-dispensing concerns besides counting \n\n5.1 Cross-contamination \n\n\n6 Future development \n7 Repackaging process and stability data \n8 See also \n9 References \n10 External links \n\n\nHistory \n Common disk-shaped tablets Manually counting individual pills on a tray\nMain article: History of pharmacy\nDispensing medications in a community pharmacy before the 1970s was a time-consuming operation. The pharmacist dispensed prescriptions in tablet or capsule form with a simple tray and spatula. Many new medications were developed by pharmaceutical manufacturers at an ever-increasing pace, and medications prices were rising steeply. A typical community pharmacist was working longer hours and often forced to hire staff to handle increased workloads which resulted in less time to focus on safety issues. These additional factors led to use of a machine to count medications.[1]\nThe original electronic portable digital tablet counting technology was invented in Manchester, England between 1967 and 1970 by the brothers John and Frank Kirby. \n\n\nI had the original idea of how the machine would work and it was my patent, but it was a joint effort getting it to work in a saleable form. It was 3 years of very hard work. I had originally studied heavy electrical engineering before changing over to Medical School and qualifying as a Medical Doctor in 1968. In fact I was Senior House (Casualty) Officer (A&E or ER) in 1970 at North Manchester General Hospital when I filed the patent. I must have been the only hospital doctor in Britain with an oscilloscope, a soldering iron and a drawing board in his room in the Doctors\u2019 Residence. The housekeepers were bemused by all the wires. Frank originally trained as a Banker but quit to take a job with a local electronics firm during the development. He died in 1987, a terrible loss. [Extract from personal communication received in March 2010 from John Kirby.] \n\n\nFrank and John Kirby and their associate Rodney Lester were pioneers in pharmacy automation and small-object counting technology. In 1967, the Kirbys invented a portable digital tablet counter to count tablets and capsules. With Lester they formed a limited company. In 1970, their invention was patented and put into production in Oldham, England. The tablet counter aided the pharmacy industry with time-consuming manual counting of drug prescriptions.\nA counting machine consistently counted medications accurately and quickly. This aspect of pharmacy automation was quickly adopted, and innovations emerged every decade to aid the pharmacy industry to deliver medications quickly, safely, and economically. Modern pharmacies have many new options to improve their workflow by using the new technology, and can choose intelligently from the many options available.[2]\n\nChronology \n First early 1971 model counter\nOn 1 January 1971 commercial production of the first portable digital tablet counters in the World began. John Kirby had filed U.K. Patent number GB1358378(A) on 8 September 1970[3] and U.S. patent number 3789194 on 9 August 1971.[4] These early electronic counters were designed to help pharmacies replace the common (but often inaccurate) practice of counting medications by hand. \n\n Second generation late 1970s model\nIn 1975, the digital technology was exported to America. In early 1980 a dedicated research, development and production facility was built in Oldham, England at a cost of \u00a3500,000.\nBetween 1982 and 1983, two separate development facilities had been created. In America, overseen by Rodney Lester; and in England, overseen by the Kirby brothers. In 1987, Frank Kirby died. In 1989, John Kirby moved his UK facility to Devon, England.[5]\nA simple to operate machine had been developed to accurately and quickly count prescription medications. Technology improvements soon resulted in a more compact model. The price of such equipment in 1980 was around \u00a31,300. This substantial investment in new technology was a major financial consideration, but the pharmacy community considered the use of a counting machine as a superior method compared to hand-counting medications. These early devices became known as tablet counter, capsule counter, pill counter, or drug counter.\nThe new counting technology replaced manual methods in many industries such as, vitamin and diet supplement manufacturing. Technicians needed a small, affordable device to count and bottle medications. In England and America, the 1980s and 1990s saw new the development of high-speed machines for counting and bottle filling, Like their pharmacy-based counterparts, these industrial units were designed to be fast and simple to operate, yet remain small and cost effective.[6]\n\n Counter and prepackaging device\nIn America, in the late 1990s\/early 2000s a new type of tablet counter appeared. It was simple to use, compact, inexpensive, and had good counting accuracy. At the turn of the millennium technical advances allowed the design of counters with a software verification system. With an onboard computer, displaying photo images of medications to assist the pharmacist or pharmacy technician to verify that the correct medication was being dispensed. In addition, a database for storing all prescriptions that were counted on the device.[7]\nBetween September 2005 and May 2007, an American company undertook major financial investment,[8] and relocated. This move added extra space for product research and development facility (R&D). It allowed the opportunity to develop new advanced technology products that met the pharmacy\u2019s needs for simple, accurate, and cost-effective ways to dispense prescriptions safely.[9]\nPictured here is an early American type of integrated counter and packaging device. This machine was a third generation step in the evolution of pharmacy automated devices. Later models held pre-counted containers of commonly-prescribed medications.\n\nGlobal variations \n Tablets in a blister pack\nIn the EU member states legislation was introduced in 1998 which had a major effect on UK Pharmacy operations. It effectively prohibited the use of tablet counters for counting and dispensing bulk packaged tablets. Both usage and sales of the machines in the UK declined rapidly as a result of the introduction of blister packaging for medicines.[10]\n\nCurrent state of the industry \nA tablet counter has become a standard in more than 30,000 sites in 35 countries (as of 2010) (including many non-pharmacy sites, such as manufacturing facilities that use a counting machine as a check for small items).[11]\nDuring the 1990s through 2012, numerous new pharmacy automation products came to market. During this timeframe, counting technologies, robotics, workflow management software, and interactive voice recognition (IVR) systems for retail (both chain and independent), outpatient, government, and closed-door pharmacies (mail order and central fill) were all introduced. Additionally, the concept of scalability - of migrating from an entry-level product to the next level of automation (e.g., counting technology to robotics) - was introduced and subsequently launched a new product line in 1997.\n\nTechnological changes and design improvements \nConstant developments in technology make the dispensing of prescription medications safer, more accurate and more efficient.\n\n Computer interfaced model counter\nIn America, in 2008, \"next-generation\" counting and verification systems were introduced. Based on the counting technology employed in preceding models, later machines included the ability to help the pharmacy operate more effectively. Equipped with a new computer interface to a pharmacy management system, with workflow and inventory software. It also included \"checks and balances\" to ensure the technician and pharmacist were dispensing the correct medication for each patient. This was a step forward to verify all 100% of prescriptions that were dispensed by pharmacy staff.\n\n Hands-free automated model counter\nIn America, in 2009, further advanced counters were designed that included the ability to dispense hands-free \u2013 a feature that many operators had desired. This allowed pharmacies to automate their most commonly dispensed medications via calibrated cassettes. Thirty of a pharmacy\u2019s common medications would now be dispensed automatically. Another new model doubled that throughput via an enclosed robotic mechanism. Robotics had been employed in pharmacies since the mid-1990s, but later machines dispense and label filled patient vials in a comparatively tiny space (about nine square feet of floor space). These newer technologies allowed pharmacy staff to confidently dispense hundreds of prescriptions per day and still be able to manage the many functions of a busy community pharmacy.\n\nOther pharmacy-dispensing concerns besides counting \n Explaining medication usage to the patient\nThe primary purpose of a tablet counter (also known as a pill counter or drug counter) is to accurately count prescription medications in tablet or capsule form to aid the requirement for patient medication safety, to increase efficiency and reduce costs for the typical pharmacy. Newer versions of this counting device include advanced software to continue to improve safety for the patient who is receiving the prescription, ensuring that the pharmacy staff dispense the right medication at correct dosage strength for the right patient. (see also medication safety). Today\u2019s pharmacy industry recognizes the need for heightened vigilance against medication errors across the entire spectrum. A wealth of research has been conducted regarding the prevalence of medication errors and the ability of technology to decrease or eliminate such errors. (See the March 2003 landmark study by Auburn University\u2019s Center for Pharmacy Operations and Designs).[12] Prescription dispensing safety and accuracy in the pharmacy are an essential part of ensuring the right patient gets the right medication at the right dosage. A trend in pharmacy is to place a greater reliance on technology and pharmacy automation to minimize the chance of human error and speed up the process of dispensing. Pharmacy management generally sees technology as a solution to industry challenges like staffing shortages, prescription volume increases, long and hectic work hours and complicated insurance reimbursement procedures. Instead of adding more staff, pharmacies employ advanced technologies that help to handle an ever-escalating number of prescriptions, while making dispensing safer and more precise.\n\nCross-contamination \nPerhaps the most controversial debate surrounding the use of pharmacy automated tablet counters is the impact of cross-contamination. Automated tablet-counting machines (sometimes better known as \"pill counters\") are designed to sort, count, and dispense drugs at high speeds for quick counting transactions. When more than one drug is exposed to the same surface, leaving seemingly unnoticeable traces of residues, the issue of cross-contamination arises. While one tablet is unlikely to leave enough residues to cause harm to a future patient, the risk of contamination increases sevenfold as the machine processes thousands of varying pills throughout the course of a day. A typical pharmacy may on average process under 100 scripts per day, while other larger dispensaries can accommodate a few hundred scripts in that amount of time.\nThoroughly cleaning pharmacy automated tablet counters is recommended to prevent the chance of cross-contamination. This method is widely preached by manufacturers of these machines, but is not always easily followed. Performing an efficient cleaning of an automated tablet counter significantly increases the amount of time spent on counts by users. Many critics argue that these problems can easily be prevented by taking the proper precautions and following all cleaning procedures, but the increase in time spent makes it hard to justify such an investment.\n\nFuture development \n Remote tablet counter \/ dispenser Remote dispensing Unit\nVarious companies are currently developing a range of remote tablet counters, verification systems and pharmacy automation components to improve the accuracy, safety, speed and efficiency of medication dispensing. Products that are used in retail, mail order, hospital outpatient and specialty pharmacies as well as industrial settings such as manufacturing and component factories. These advanced systems will continue to provide accurate counting without the need for adjustment or calibration when counting in different production environments.\nPictured here is a modern (2010) remote controlled tablet hopper mechanism for use with bulk packaged individual tablets or capsules. In the UK these items are more suited to Hospital Pharmacies, where the issue of E.U. blister packaging regulations relating to medicine packaging does not apply. Also pictured is another version of an automated machine that does not allow unauthorised interference to the internal store of drugs. (A useful security feature in a large pharmacy with public access.)\n\nRepackaging process and stability data \nThe transient or definitive displacement of the solid oral form from the original atmosphere to enter a repackaging process, sometimes automated, is likely to play a primary role in the pharmaceutical controversy in some countries. However, the solid oral dose is to be repackaged in materials with defined quality. Considering these data, a review of the literature for determination of conditions for repackaged drug stability according to different international guidelines is presented by F Lagrange.[13]\n\nSee also \nAutomated dispensing cabinet\nMedical technology\nMedical robots\nRemote dispensing\nReferences \n\n\n^ Melissa Elder (January 2008). \"Pharmacy Automation: Technologies and Global Markets BCC00098\". Report. Business Communications Company. Retrieved 6 March 2010 . \n\n^ Christopher J Thomsen (9 November 2004). \"Pharmacy Automation-Practical Technology Solutions for the Pharmacy\" (PDF) . Business briefing : US Pharmacy review 2004. The Thompson Group. Retrieved 5 March 2010 . \n\n^ John Kirby Filed 8 September 1970 (3 July 1974). \"Patent 1358378\". COUNTING MACHINES - Patent GB1358378(A). DTI Data Networks LLC. Retrieved 18 March 2010 . \n\n^ United States Patent Office (29 January 1974). \"Patent 3789194\". RELATING TO COUNTING MACHINES. Freepatentsonline.com. Retrieved 6 March 2010 . \n\n^ Jordans Business Information Services (2008). \"Basic company details for KIRBY DEVON LIMITED:\". Jordans Ltd. Retrieved 6 March 2010 . \n\n^ Liz Parks (November\u2013December 2003). \"Market Survey of Pharmacy Technology and Automation in Retail and Outpatient Pharmacy\" (PDF) . Retail Pharmacy Management. The Thomsen group. Retrieved 6 March 2010 . \n\n^ \"An Efficiency Analysis of the Kirby Lester KL16df Automatic Tablet and Capsule Counting System\" (PDF) . Pharmacy Automation. The ThomsenGroup Inc. 2004. Retrieved 5 March 2010 . \n\n^ \"American Capital exited its investment in Kirby Lester, LLC in the third quarter of 2007\". American Capital Limited. 19 September 2005. Retrieved 12 March 2010 . \n\n^ Kevin Welch (November\u2013December 2009). \"Looking Ahead: What's Coming in 2010\". Pharmacy Delivery Technology \u2014 A Primer. Computer Talk for the Pharmacist. Retrieved 5 March 2010 . \n\n^ \"Labels, patient information leaflets and packaging for medicines\". The Medicines and Healthcare products Regulatory Agency (MHRA). 2010. Retrieved 8 March 2010 . \n\n^ Melissa Elder (March 2008). \"Pharmacy Automation: Technologies and Global Markets IAS026A\". BCC Research. Retrieved 6 March 2010 . \n\n^ Flynn EA, Barker KN, Carnahan BJ (2003). \"National observational study of prescription dispensing accuracy and safety in 50 pharmacies\". Journal of the American Pharmaceutical Association. 43 (2): 191\u2013200. doi:10.1331\/108658003321480731. PMID 12688437. \n\n^ Lagrange F (Nov 2010). \"[Current perspectives on the repackaging and stability of solid oral doses]\". Ann Pharm Fr. 68 (6): 332\u201358. doi:10.1016\/j.pharma.2010.08.003. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Pharmacy automation.\nRoyal Pharmaceutical Society Victorian pharmacy history\nVictorian Pharmacy\u2014BBC television series 2010\nOnline search tool for pharmecuitical citation \/ references\nPharmacare\u2014Bdtask Pharmacy Management System\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Pharmacy_automation\">https:\/\/www.limswiki.org\/index.php\/Pharmacy_automation<\/a>\n\t\t\t\t\tCategory: Medical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 24 February 2016, at 20:23.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 660 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","49c1a391f24ae60449aafabfecdd4a69_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Pharmacy_automation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Pharmacy automation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Pharmacy automation<\/b> involves the mechanical processes of handling and distributing medications. Any pharmacy task may be involved, including counting small objects (<i>e.g.,<\/i> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tablet_(pharmacy)\" title=\"Tablet (pharmacy)\" rel=\"external_link\" target=\"_blank\">tablets<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsule_(pharmacy)\" title=\"Capsule (pharmacy)\" rel=\"external_link\" target=\"_blank\">capsules<\/a>); measuring and mixing powders and liquids for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compounding\" title=\"Compounding\" rel=\"external_link\" target=\"_blank\">compounding<\/a>; tracking and updating customer information in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Database\" title=\"Database\" rel=\"external_link\" target=\"_blank\">databases<\/a> (<i>e.g.,<\/i> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personally_identifiable_information\" title=\"Personally identifiable information\" rel=\"external_link\" target=\"_blank\">personally identifiable information<\/a> (PII), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_history\" title=\"Medical history\" rel=\"external_link\" target=\"_blank\">medical history<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_interaction\" title=\"Drug interaction\" rel=\"external_link\" target=\"_blank\">drug interaction<\/a> risk detection); and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inventory\" title=\"Inventory\" rel=\"external_link\" target=\"_blank\">inventory management<\/a>. This article focuses on the changes that have taken place in the local, or community Pharmacy since the 1960s.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:FlattenedRoundPills.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/FlattenedRoundPills.jpg\/220px-FlattenedRoundPills.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:FlattenedRoundPills.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Common disk-shaped tablets<\/div><\/div><\/div><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dispensing_pills,_Guantanamo.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7f\/Dispensing_pills%2C_Guantanamo.jpg\/220px-Dispensing_pills%2C_Guantanamo.jpg\" width=\"220\" height=\"331\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dispensing_pills,_Guantanamo.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Manually counting individual pills on a tray<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_pharmacy\" title=\"History of pharmacy\" rel=\"external_link\" target=\"_blank\">History of pharmacy<\/a><\/div>\n<p>Dispensing medications in a community pharmacy before the 1970s was a time-consuming operation. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacist\" title=\"Pharmacist\" rel=\"external_link\" target=\"_blank\">pharmacist<\/a> dispensed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prescription_drug\" title=\"Prescription drug\" rel=\"external_link\" target=\"_blank\">prescriptions<\/a> in tablet or capsule form with a simple tray and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spatula\" title=\"Spatula\" rel=\"external_link\" target=\"_blank\">spatula<\/a>. Many new <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medications\" class=\"mw-redirect\" title=\"Medications\" rel=\"external_link\" target=\"_blank\">medications<\/a> were developed by pharmaceutical manufacturers at an ever-increasing pace, and medications prices were rising steeply. A typical community pharmacist was working longer hours and often forced to hire staff to handle increased workloads which resulted in less time to focus on safety issues. These additional factors led to use of a machine to count medications.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The original electronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motion_(physics)\" title=\"Motion (physics)\" rel=\"external_link\" target=\"_blank\">portable<\/a> digital tablet counting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technology\" title=\"Technology\" rel=\"external_link\" target=\"_blank\">technology<\/a> was invented in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manchester,_England\" class=\"mw-redirect\" title=\"Manchester, England\" rel=\"external_link\" target=\"_blank\">Manchester, England<\/a> between 1967 and 1970 by the brothers John and Frank Kirby. \n<\/p>\n<blockquote>\n<p>I had the original idea of how the machine would work and it was my patent, but it was a joint effort getting it to work in a saleable form. It was 3 years of very hard work. I had originally studied heavy electrical engineering before changing over to Medical School and qualifying as a Medical Doctor in 1968. In fact I was Senior House (Casualty) Officer (A&E or ER) in 1970 at North Manchester General Hospital when I filed the patent. I must have been the only hospital doctor in Britain with an oscilloscope, a soldering iron and a drawing board in his room in the Doctors\u2019 Residence. The housekeepers were bemused by all the wires. Frank originally trained as a Banker but quit to take a job with a local electronics firm during the development. He died in 1987, a terrible loss. [<i>Extract from personal communication received in March 2010 from John Kirby.<\/i>] \n<\/p>\n<\/blockquote>\n<p>Frank and John Kirby and their associate Rodney Lester were <a href=\"https:\/\/en.wikipedia.org\/wiki\/Innovator\" class=\"mw-redirect\" title=\"Innovator\" rel=\"external_link\" target=\"_blank\">pioneers<\/a> in pharmacy automation and small-object counting technology. In 1967, the Kirbys invented a portable digital tablet counter to count tablets and capsules. With Lester they formed a limited company. In 1970, their invention was patented and put into production in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oldham\" title=\"Oldham\" rel=\"external_link\" target=\"_blank\">Oldham, England<\/a>. The tablet counter aided the pharmacy industry with time-consuming manual counting of drug <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prescription_drug\" title=\"Prescription drug\" rel=\"external_link\" target=\"_blank\">prescriptions<\/a>.\n<\/p><p>A counting machine consistently counted medications accurately and quickly. This aspect of pharmacy automation was quickly adopted, and innovations emerged every decade to aid the pharmacy industry to deliver medications quickly, safely, and economically. Modern pharmacies have many new options to improve their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Workflow\" title=\"Workflow\" rel=\"external_link\" target=\"_blank\">workflow<\/a> by using the new technology, and can choose intelligently from the many options available.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chronology\">Chronology<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KL7.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/KL7.jpg\/220px-KL7.jpg\" width=\"220\" height=\"347\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KL7.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>First early 1971 model counter<\/div><\/div><\/div>\n<p>On 1 January 1971 commercial production of the first portable digital tablet counters in the World began. John Kirby had filed U.K. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patent\" title=\"Patent\" rel=\"external_link\" target=\"_blank\">Patent<\/a> number GB1358378(A) on 8 September 1970<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> and U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patent\" title=\"Patent\" rel=\"external_link\" target=\"_blank\">patent<\/a> number 3789194 on 9 August 1971.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> These early electronic counters were designed to help pharmacies replace the common (but often inaccurate) practice of counting medications by hand. \n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL8_Tablet_Counter.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2b\/Kirby_Lester_KL8_Tablet_Counter.jpg\/220px-Kirby_Lester_KL8_Tablet_Counter.jpg\" width=\"220\" height=\"295\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL8_Tablet_Counter.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Second generation late 1970s model<\/div><\/div><\/div>\n<p>In 1975, the digital technology was exported to America. In early 1980 a dedicated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Research\" title=\"Research\" rel=\"external_link\" target=\"_blank\">research<\/a>, development and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manufacturing\" title=\"Manufacturing\" rel=\"external_link\" target=\"_blank\">production<\/a> facility was built in Oldham, England at a cost of \u00a3500,000.\nBetween 1982 and 1983, two separate development facilities had been created. In America, overseen by Rodney Lester; and in England, overseen by the Kirby brothers. In 1987, Frank Kirby died. In 1989, John Kirby moved his UK facility to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Devon,_England\" class=\"mw-redirect\" title=\"Devon, England\" rel=\"external_link\" target=\"_blank\">Devon, England<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>A simple to operate machine had been developed to accurately and quickly count prescription medications. Technology improvements soon resulted in a more compact model. The price of such equipment in 1980 was around \u00a31,300. This substantial investment in new technology was a major financial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Consideration\" title=\"Consideration\" rel=\"external_link\" target=\"_blank\">consideration<\/a>, but the pharmacy community considered the use of a counting machine as a superior method compared to hand-counting medications. These early devices became known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tablet_(pharmacy)\" title=\"Tablet (pharmacy)\" rel=\"external_link\" target=\"_blank\">tablet<\/a> counter, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsule_(pharmacy)\" title=\"Capsule (pharmacy)\" rel=\"external_link\" target=\"_blank\">capsule<\/a> counter, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pill_(pharmacy)\" class=\"mw-redirect\" title=\"Pill (pharmacy)\" rel=\"external_link\" target=\"_blank\">pill<\/a> counter, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug\" title=\"Drug\" rel=\"external_link\" target=\"_blank\">drug<\/a> counter.\n<\/p><p>The new counting technology replaced manual methods in many industries such as, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitamin\" title=\"Vitamin\" rel=\"external_link\" target=\"_blank\">vitamin<\/a> and diet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dietary_supplement\" title=\"Dietary supplement\" rel=\"external_link\" target=\"_blank\">supplement<\/a> manufacturing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technicians\" class=\"mw-redirect\" title=\"Technicians\" rel=\"external_link\" target=\"_blank\">Technicians<\/a> needed a small, affordable device to count and bottle medications. In England and America, the 1980s and 1990s saw new the development of high-speed machines for counting and bottle filling, Like their pharmacy-based counterparts, these <a href=\"https:\/\/en.wikipedia.org\/wiki\/Industry\" title=\"Industry\" rel=\"external_link\" target=\"_blank\">industrial<\/a> units were designed to be fast and simple to operate, yet remain small and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cost_effective\" class=\"mw-redirect\" title=\"Cost effective\" rel=\"external_link\" target=\"_blank\">cost effective<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:217px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL25_tablet_counter_%26_prepackaging_device.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/c9\/Kirby_Lester_KL25_tablet_counter_%26_prepackaging_device.jpg\" width=\"215\" height=\"244\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL25_tablet_counter_%26_prepackaging_device.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Counter and prepackaging device<\/div><\/div><\/div>\n<p>In America, in the late 1990s\/early 2000s a new type of tablet counter appeared. It was simple to use, compact, inexpensive, and had good counting accuracy. At the turn of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Millennium\" title=\"Millennium\" rel=\"external_link\" target=\"_blank\">millennium<\/a> technical advances allowed the design of counters with a software <a href=\"https:\/\/en.wikipedia.org\/wiki\/Verification_and_validation\" title=\"Verification and validation\" rel=\"external_link\" target=\"_blank\">verification<\/a> system. With an onboard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer\" title=\"Computer\" rel=\"external_link\" target=\"_blank\">computer<\/a>, displaying photo images of medications to assist the pharmacist or pharmacy technician to verify that the correct medication was being dispensed. In addition, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Database\" title=\"Database\" rel=\"external_link\" target=\"_blank\">database<\/a> for storing all prescriptions that were counted on the device.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Between September 2005 and May 2007, an American company undertook major financial investment,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> and relocated. This move added extra space for product <a href=\"https:\/\/en.wikipedia.org\/wiki\/Research\" title=\"Research\" rel=\"external_link\" target=\"_blank\">research<\/a> and development facility (<a href=\"https:\/\/en.wikipedia.org\/wiki\/R%26D\" class=\"mw-redirect\" title=\"R&D\" rel=\"external_link\" target=\"_blank\">R&D<\/a>). It allowed the opportunity to develop new advanced technology products that met the pharmacy\u2019s needs for simple, accurate, and cost-effective ways to dispense prescriptions safely.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Pictured here is an early American type of integrated counter and packaging device. This machine was a third generation step in the evolution of pharmacy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Automated\" class=\"mw-redirect\" title=\"Automated\" rel=\"external_link\" target=\"_blank\">automated<\/a> devices. Later models held pre-counted containers of commonly-prescribed medications.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Global_variations\">Global variations<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Risperdal_tablets.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/22\/Risperdal_tablets.jpg\/220px-Risperdal_tablets.jpg\" width=\"220\" height=\"292\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Risperdal_tablets.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tablets in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blister_pack\" title=\"Blister pack\" rel=\"external_link\" target=\"_blank\">blister pack<\/a><\/div><\/div><\/div>\n<p>In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Union\" title=\"European Union\" rel=\"external_link\" target=\"_blank\">EU<\/a> member states legislation was introduced in 1998 which had a major effect on <a href=\"https:\/\/en.wikipedia.org\/wiki\/UK\" class=\"mw-redirect\" title=\"UK\" rel=\"external_link\" target=\"_blank\">UK<\/a> Pharmacy operations. It effectively prohibited the use of tablet counters for counting and dispensing bulk packaged tablets. Both usage and sales of the machines in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/UK\" class=\"mw-redirect\" title=\"UK\" rel=\"external_link\" target=\"_blank\">UK<\/a> declined rapidly as a result of the introduction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blister_packaging\" class=\"mw-redirect\" title=\"Blister packaging\" rel=\"external_link\" target=\"_blank\">blister packaging<\/a> for medicines.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Current_state_of_the_industry\">Current state of the industry<\/span><\/h2>\n<p>A tablet counter has become a standard in more than 30,000 sites in 35 countries (as of 2010) (including many non-pharmacy sites, such as manufacturing facilities that use a counting machine as a check for small items).<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>During the 1990s through 2012, numerous new pharmacy automation products came to market. During this timeframe, counting technologies, robotics, workflow management software, and interactive voice recognition (IVR) systems for retail (both chain and independent), outpatient, government, and closed-door pharmacies (mail order and central fill) were all introduced. Additionally, the concept of scalability - of migrating from an entry-level product to the next level of automation (e.g., counting technology to robotics) - was introduced and subsequently launched a new product line in 1997.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technological_changes_and_design_improvements\">Technological changes and design improvements<\/span><\/h2>\n<p>Constant developments in technology make the dispensing of prescription medications safer, more accurate and more efficient.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL30_pharmacy_automation_counting_%26_verification_system.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/Kirby_Lester_KL30_pharmacy_automation_counting_%26_verification_system.jpg\/220px-Kirby_Lester_KL30_pharmacy_automation_counting_%26_verification_system.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL30_pharmacy_automation_counting_%26_verification_system.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Computer interfaced model counter<\/div><\/div><\/div>\n<p>In America, in 2008, \"next-generation\" counting and verification systems were introduced. Based on the counting technology employed in preceding models, later machines included the ability to help the pharmacy operate more effectively. Equipped with a new computer interface to a pharmacy management system, with workflow and inventory software. It also included \"checks and balances\" to ensure the technician and pharmacist were dispensing the correct medication for each patient. This was a step forward to verify all 100% of prescriptions that were dispensed by pharmacy staff.\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL60_fully-automated_dispensing_system.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Kirby_Lester_KL60_fully-automated_dispensing_system.jpg\/220px-Kirby_Lester_KL60_fully-automated_dispensing_system.jpg\" width=\"220\" height=\"345\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirby_Lester_KL60_fully-automated_dispensing_system.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hands-free automated model counter<\/div><\/div><\/div>\n<p>In America, in 2009, further advanced counters were designed that included the ability to dispense hands-free \u2013 a feature that many operators had desired. This allowed pharmacies to automate their most commonly dispensed medications via calibrated cassettes. Thirty of a pharmacy\u2019s common medications would now be dispensed automatically. Another new model doubled that throughput via an enclosed robotic mechanism. Robotics had been employed in pharmacies since the mid-1990s, but later machines dispense and label filled patient vials in a comparatively tiny space (about nine square feet of floor space). These newer technologies allowed pharmacy staff to confidently dispense hundreds of prescriptions per day and still be able to manage the many functions of a busy community pharmacy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Other_pharmacy-dispensing_concerns_besides_counting\">Other pharmacy-dispensing concerns besides counting<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:US_Navy_060823-N-6501M-114_U.S._Navy_Lt._Cmdr._Sheron_Zellous_of_San_Diego,_explains_to_an_Indonesian_assistant_the_proper_use_of_the_medications_being_dispensed.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/US_Navy_060823-N-6501M-114_U.S._Navy_Lt._Cmdr._Sheron_Zellous_of_San_Diego%2C_explains_to_an_Indonesian_assistant_the_proper_use_of_the_medications_being_dispensed.jpg\/220px-thumbnail.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:US_Navy_060823-N-6501M-114_U.S._Navy_Lt._Cmdr._Sheron_Zellous_of_San_Diego,_explains_to_an_Indonesian_assistant_the_proper_use_of_the_medications_being_dispensed.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Explaining medication usage to the patient<\/div><\/div><\/div>\n<p>The primary purpose of a tablet counter (also known as a pill counter or drug counter) is to accurately count prescription medications in tablet or capsule form to aid the requirement for patient medication safety, to increase efficiency and reduce costs for the typical pharmacy. Newer versions of this counting device include advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Software\" title=\"Software\" rel=\"external_link\" target=\"_blank\">software<\/a> to continue to improve safety for the patient who is receiving the prescription, ensuring that the pharmacy staff dispense the right <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medication\" title=\"Medication\" rel=\"external_link\" target=\"_blank\">medication<\/a> at correct dosage strength for the right patient. <i>(see also <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_safety\" title=\"Patient safety\" rel=\"external_link\" target=\"_blank\">medication safety<\/a>)<\/i>. Today\u2019s pharmacy industry recognizes the need for heightened vigilance against medication errors across the entire spectrum. A wealth of research has been conducted regarding the prevalence of medication errors and the ability of technology to decrease or eliminate such errors. (See the March 2003 landmark study by Auburn University\u2019s Center for Pharmacy Operations and Designs).<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Prescription dispensing safety and accuracy in the pharmacy are an essential part of ensuring the right patient gets the right medication at the right dosage. A trend in pharmacy is to place a greater reliance on technology and pharmacy automation to minimize the chance of human error and speed up the process of dispensing. Pharmacy management generally sees technology as a solution to industry challenges like staffing shortages, prescription volume increases, long and hectic work hours and complicated insurance reimbursement procedures. Instead of adding more staff, pharmacies employ advanced technologies that help to handle an ever-escalating number of prescriptions, while making dispensing safer and more precise.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cross-contamination\">Cross-contamination<\/span><\/h3>\n<p>Perhaps the most controversial debate surrounding the use of pharmacy automated tablet counters is the impact of cross-contamination. Automated tablet-counting machines (sometimes better known as \"pill counters\") are designed to sort, count, and dispense drugs at high speeds for quick counting transactions. When more than one drug is exposed to the same surface, leaving seemingly unnoticeable traces of residues, the issue of cross-contamination arises. While one tablet is unlikely to leave enough residues to cause harm to a future patient, the risk of contamination increases sevenfold as the machine processes thousands of varying pills throughout the course of a day. A typical pharmacy may on average process under 100 scripts per day, while other larger dispensaries can accommodate a few hundred scripts in that amount of time.\n<\/p><p>Thoroughly cleaning pharmacy automated tablet counters is recommended to prevent the chance of cross-contamination. This method is widely preached by manufacturers of these machines, but is not always easily followed. Performing an efficient cleaning of an automated tablet counter significantly increases the amount of time spent on counts by users. Many critics argue that these problems can easily be prevented by taking the proper precautions and following all cleaning procedures, but the increase in time spent makes it hard to justify such an investment.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Future_development\">Future development<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RemoteDispensing_Med-Canister.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/RemoteDispensing_Med-Canister.jpg\/220px-RemoteDispensing_Med-Canister.jpg\" width=\"220\" height=\"193\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RemoteDispensing_Med-Canister.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Remote tablet counter \/ dispenser<\/div><\/div><\/div><div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RemoteDispensing_Unit.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7b\/RemoteDispensing_Unit.jpg\/220px-RemoteDispensing_Unit.jpg\" width=\"220\" height=\"307\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RemoteDispensing_Unit.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Remote dispensing Unit<\/div><\/div><\/div>\n<p>Various companies are currently developing a range of remote tablet counters, verification systems and pharmacy automation components to improve the accuracy, safety, speed and efficiency of medication dispensing. Products that are used in retail, mail order, hospital outpatient and specialty pharmacies as well as industrial settings such as manufacturing and component factories. These advanced systems will continue to provide accurate counting without the need for adjustment or calibration when counting in different production environments.\n<\/p><p>Pictured here is a modern (2010) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_controlled\" class=\"mw-redirect\" title=\"Remote controlled\" rel=\"external_link\" target=\"_blank\">remote controlled<\/a> tablet hopper mechanism for use with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bulk_material_handling\" title=\"Bulk material handling\" rel=\"external_link\" target=\"_blank\">bulk<\/a> packaged individual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tablet_(pharmacy)\" title=\"Tablet (pharmacy)\" rel=\"external_link\" target=\"_blank\">tablets<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsule_(pharmacy)\" title=\"Capsule (pharmacy)\" rel=\"external_link\" target=\"_blank\">capsules<\/a>. In the UK these items are more suited to Hospital Pharmacies, where the issue of <a href=\"https:\/\/en.wikipedia.org\/wiki\/E.U.\" class=\"mw-redirect\" title=\"E.U.\" rel=\"external_link\" target=\"_blank\">E.U.<\/a> blister packaging regulations relating to medicine packaging does not apply. Also pictured is another version of an automated machine that does not allow unauthorised interference to the internal store of drugs. (A useful security feature in a large pharmacy with public access.)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Repackaging_process_and_stability_data\">Repackaging process and stability data<\/span><\/h2>\n<p>The transient or definitive displacement of the solid oral form from the original atmosphere to enter a repackaging process, sometimes automated, is likely to play a primary role in the pharmaceutical controversy in some countries. However, the solid oral dose is to be repackaged in materials with defined quality. Considering these data, a review of the literature for determination of conditions for repackaged drug stability according to different international guidelines is presented by F Lagrange.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Automated_dispensing_cabinet\" title=\"Automated dispensing cabinet\" rel=\"external_link\" target=\"_blank\">Automated dispensing cabinet<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_technology\" class=\"mw-redirect\" title=\"Medical technology\" rel=\"external_link\" target=\"_blank\">Medical technology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_robots\" class=\"mw-redirect\" title=\"Medical robots\" rel=\"external_link\" target=\"_blank\">Medical robots<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_dispensing\" title=\"Remote dispensing\" rel=\"external_link\" target=\"_blank\">Remote dispensing<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Melissa Elder (January 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.piribo.com\/publications\/pharmacy\/pharmacy_automation_technologies_global_markets.html\" target=\"_blank\">\"Pharmacy Automation: Technologies and Global Markets BCC00098\"<\/a>. <i>Report<\/i>. 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Retrieved <span class=\"nowrap\">6 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Report&rft.atitle=Pharmacy+Automation%3A+Technologies+and+Global+Markets+BCC00098&rft.date=2008-01&rft.au=Melissa+Elder&rft_id=http%3A%2F%2Fwww.piribo.com%2Fpublications%2Fpharmacy%2Fpharmacy_automation_technologies_global_markets.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Christopher J Thomsen (9 November 2004). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/thethomsengroup.com\/TTGI%20Pages\/Articles%20Studies%20&%20Presentations\/2005%20Business%20Briefings.pdf\" target=\"_blank\">\"Pharmacy Automation-Practical Technology Solutions for the Pharmacy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Business briefing : US Pharmacy review 2004<\/i>. 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Retrieved <span class=\"nowrap\">5 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Business+briefing+%3A+US+Pharmacy+review+2004&rft.atitle=Pharmacy+Automation-Practical+Technology+Solutions+for+the+Pharmacy&rft.date=2004-11-09&rft.au=Christopher+J+Thomsen&rft_id=http%3A%2F%2Fthethomsengroup.com%2FTTGI%2520Pages%2FArticles%2520Studies%2520%26%2520Presentations%2F2005%2520Business%2520Briefings.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">John Kirby Filed 8 September 1970 (3 July 1974). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.oti.com\/oti\/patent\/19740703-1358378-GB-A\" target=\"_blank\">\"Patent 1358378\"<\/a>. <i>COUNTING MACHINES - Patent GB1358378(A)<\/i>. DTI Data Networks LLC<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=COUNTING+MACHINES+-+Patent+GB1358378%28A%29&rft.atitle=Patent+1358378&rft.date=1974-07-03&rft.au=John+Kirby+Filed+8+September+1970&rft_id=http%3A%2F%2Fwww.oti.com%2Foti%2Fpatent%2F19740703-1358378-GB-A&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">United States Patent Office (29 January 1974). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.freepatentsonline.com\/3789194.html\" target=\"_blank\">\"Patent 3789194\"<\/a>. <i>RELATING TO COUNTING MACHINES<\/i>. 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Jordans Ltd<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">6 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Basic+company+details+for+KIRBY+DEVON+LIMITED%3A&rft.pub=Jordans+Ltd.&rft.date=2008&rft.au=Jordans+Business+Information+Services&rft_id=http%3A%2F%2Fwww.jordans.co.uk%2FCompanyIndex%2Fk%2Fki%2Fkir%2F00998717%2Fkirby_devon_limited.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Liz Parks (November\u2013December 2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thethomsengroup.com\/TTGI%20Pages\/Articles%20Studies%20&%20Presentations\/200402%20Market%20Survey%20RPM.pdf\" target=\"_blank\">\"Market Survey of Pharmacy Technology and Automation in Retail and Outpatient Pharmacy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Retail Pharmacy Management<\/i>. 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Retrieved <span class=\"nowrap\">6 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Retail+Pharmacy+Management&rft.atitle=Market+Survey+of+Pharmacy+Technology+and+Automation+in+Retail+and+Outpatient+Pharmacy&rft.date=2003-11%2F2003-12&rft.au=Liz+Parks&rft_id=http%3A%2F%2Fwww.thethomsengroup.com%2FTTGI%2520Pages%2FArticles%2520Studies%2520%26%2520Presentations%2F200402%2520Market%2520Survey%2520RPM.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/thethomsengroup.com\/TTGI%20Pages\/Articles%20Studies%20&%20Presentations\/ThomsenGroup%20KL%20Study%202004.pdf\" target=\"_blank\">\"An Efficiency Analysis of the Kirby Lester KL16df Automatic Tablet and Capsule Counting System\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Pharmacy Automation<\/i>. 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Retrieved <span class=\"nowrap\">5 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Pharmacy+Automation&rft.atitle=An+Efficiency+Analysis+of+the+Kirby+Lester+KL16df+Automatic+Tablet+and+Capsule+Counting+System&rft.date=2004&rft_id=http%3A%2F%2Fthethomsengroup.com%2FTTGI%2520Pages%2FArticles%2520Studies%2520%26%2520Presentations%2FThomsenGroup%2520KL%2520Study%25202004.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.americancapital.com\/our_portfolio\/companies\/kirby_lester.html\" target=\"_blank\">\"American Capital exited its investment in Kirby Lester, LLC in the third quarter of 2007\"<\/a>. American Capital Limited. 19 September 2005<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=American+Capital+exited+its+investment+in+Kirby+Lester%2C+LLC+in+the+third+quarter+of+2007&rft.pub=American+Capital+Limited&rft.date=2005-09-19&rft_id=http%3A%2F%2Fwww.americancapital.com%2Four_portfolio%2Fcompanies%2Fkirby_lester.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Kevin Welch (November\u2013December 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.computertalk.com\/content\/view\/472\/\" target=\"_blank\">\"Looking Ahead: What's Coming in 2010\"<\/a>. <i>Pharmacy Delivery Technology \u2014 A Primer<\/i>. Computer Talk for the Pharmacist<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Pharmacy+Delivery+Technology+%E2%80%94+A+Primer&rft.atitle=Looking+Ahead%3A+What%27s+Coming+in+2010&rft.date=2009-11%2F2009-12&rft.au=Kevin+Welch&rft_id=http%3A%2F%2Fwww.computertalk.com%2Fcontent%2Fview%2F472%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mhra.gov.uk\/Howweregulate\/Medicines\/Labelspatientinformationleafletsandpackaging\/index.htm\" target=\"_blank\">\"Labels, patient information leaflets and packaging for medicines\"<\/a>. The Medicines and Healthcare products Regulatory Agency (MHRA). 2010<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Labels%2C+patient+information+leaflets+and+packaging+for+medicines&rft.pub=The+Medicines+and+Healthcare+products+Regulatory+Agency+%28MHRA%29&rft.date=2010&rft_id=http%3A%2F%2Fwww.mhra.gov.uk%2FHowweregulate%2FMedicines%2FLabelspatientinformationleafletsandpackaging%2Findex.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Melissa Elder (March 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bccresearch.com\/report\/IAS026A.html\" target=\"_blank\">\"Pharmacy Automation: Technologies and Global Markets IAS026A\"<\/a>. BCC Research<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">6 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pharmacy+Automation%3A+Technologies+and+Global+Markets+IAS026A&rft.pub=BCC+Research&rft.date=2008-03&rft.au=Melissa+Elder&rft_id=http%3A%2F%2Fwww.bccresearch.com%2Freport%2FIAS026A.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Flynn EA, Barker KN, Carnahan BJ (2003). \"National observational study of prescription dispensing accuracy and safety in 50 pharmacies\". <i>Journal of the American Pharmaceutical Association<\/i>. <b>43<\/b> (2): 191\u2013200. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1331%2F108658003321480731\" target=\"_blank\">10.1331\/108658003321480731<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12688437\" target=\"_blank\">12688437<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Pharmaceutical+Association&rft.atitle=National+observational+study+of+prescription+dispensing+accuracy+and+safety+in+50+pharmacies&rft.volume=43&rft.issue=2&rft.pages=191-200&rft.date=2003&rft_id=info%3Adoi%2F10.1331%2F108658003321480731&rft_id=info%3Apmid%2F12688437&rft.aulast=Flynn&rft.aufirst=EA&rft.au=Barker%2C+KN&rft.au=Carnahan%2C+BJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lagrange F (Nov 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0003450910001331\" target=\"_blank\">\"[Current perspectives on the repackaging and stability of solid oral doses]\"<\/a>. <i>Ann Pharm Fr<\/i>. <b>68<\/b> (6): 332\u201358. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.pharma.2010.08.003\" target=\"_blank\">10.1016\/j.pharma.2010.08.003<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+Pharm+Fr&rft.atitle=%5BCurrent+perspectives+on+the+repackaging+and+stability+of+solid+oral+doses%5D&rft.volume=68&rft.issue=6&rft.pages=332-58&rft.date=2010-11&rft_id=info%3Adoi%2F10.1016%2Fj.pharma.2010.08.003&rft.au=Lagrange+F&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0003450910001331&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacy+automation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rpharms.com\/history-of-pharmacy\/victorian-pharmacy.asp\" target=\"_blank\">Royal Pharmaceutical Society Victorian pharmacy history<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bbc.co.uk\/programmes\/b00t3zhy\" target=\"_blank\"><i>Victorian Pharmacy<\/i>\u2014BBC television series 2010<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.is\/20130131123801\/http:\/\/www.pjonline.com\/search\/all\" target=\"_blank\">Online search tool for pharmecuitical citation \/ references<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bdtask.com\/pharmacy-management-system.php\" target=\"_blank\"><i>Pharmacare<\/i>\u2014Bdtask Pharmacy Management System<\/a><\/li><\/ul>\n<p class=\"mw-empty-elt\">\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181205112350\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.288 seconds\nReal time usage: 0.396 seconds\nPreprocessor visited node count: 894\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 26081\/2097152 bytes\nTemplate argument size: 456\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 35510\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.158\/10.000 seconds\nLua memory usage: 3.16 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 325.617 1 -total\n<\/p>\n<pre>54.86% 178.631 1 Template:Reflist\n37.02% 120.529 11 Template:Cite_web\n23.94% 77.964 1 Template:Commons_category\n21.08% 68.632 1 Template:Commons\n20.25% 65.945 1 Template:Sister_project\n18.76% 61.097 1 Template:Side_box\n16.02% 52.169 2 Template:If_then_show\n10.85% 35.323 1 Template:Main\n10.23% 33.308 2 Template:Cite_journal\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:25798453-1!canonical and timestamp 20181205112350 and revision id 864189608\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacy_automation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214645\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.031 seconds\nReal time usage: 0.176 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 168.097 1 - wikipedia:Pharmacy_automation\n100.00% 168.097 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8118-0!*!*!*!*!*!* and timestamp 20181217214645 and revision id 24245\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Pharmacy_automation\">https:\/\/www.limswiki.org\/index.php\/Pharmacy_automation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","49c1a391f24ae60449aafabfecdd4a69_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/FlattenedRoundPills.jpg\/440px-FlattenedRoundPills.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7f\/Dispensing_pills%2C_Guantanamo.jpg\/440px-Dispensing_pills%2C_Guantanamo.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/KL7.jpg\/440px-KL7.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2b\/Kirby_Lester_KL8_Tablet_Counter.jpg\/440px-Kirby_Lester_KL8_Tablet_Counter.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/c9\/Kirby_Lester_KL25_tablet_counter_%26_prepackaging_device.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/22\/Risperdal_tablets.jpg\/440px-Risperdal_tablets.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/d\/db\/Kirby_Lester_KL30_pharmacy_automation_counting_%26_verification_system.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Kirby_Lester_KL60_fully-automated_dispensing_system.jpg\/440px-Kirby_Lester_KL60_fully-automated_dispensing_system.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/US_Navy_060823-N-6501M-114_U.S._Navy_Lt._Cmdr._Sheron_Zellous_of_San_Diego%2C_explains_to_an_Indonesian_assistant_the_proper_use_of_the_medications_being_dispensed.jpg\/440px-thumbnail.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/RemoteDispensing_Med-Canister.jpg\/440px-RemoteDispensing_Med-Canister.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/7b\/RemoteDispensing_Unit.jpg"],"49c1a391f24ae60449aafabfecdd4a69_timestamp":1545083205,"bd8bfd6039f9ddd234b056f1a5b21677_type":"article","bd8bfd6039f9ddd234b056f1a5b21677_title":"NeuroArm","bd8bfd6039f9ddd234b056f1a5b21677_url":"https:\/\/www.limswiki.org\/index.php\/NeuroArm","bd8bfd6039f9ddd234b056f1a5b21677_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNeuroArm\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tNeuroArm is an engineering research surgical robot specifically designed for neurosurgery. It is the first image-guided, MR-compatible surgical robot that has the capability to perform both microsurgery and stereotaxy.[1]\nIMRIS, Inc. acquired NeuroArm assets in 2010, and the company is working to develop a next generation of the technology for worldwide commercialization. It will be integrated with the VISIUS(TM) Surgical Theatre under the name SYMBIS(TM) Surgical System.[2]\n\nContents \n\n1 Design \n2 History \n3 References \n4 External links \n\n4.1 Videos \n4.2 Related patents \n\n\n\n\nDesign \nNeuroArm was designed to be image-guided and can perform procedures inside an MRI. NeuroArm includes two remote detachable manipulators on a mobile base, a workstation and a system control cabinet. For biopsy-stereotaxy, either the left or right arm is transferred to a stereotactic platform that attaches to the MR bore. The procedure is performed with image-guidance, as MR images are acquired in near real-time. The end-effectors interface with surgical tools which are based on standard neurosurgical instruments.\nEnd-effectors are equipped with three-dimensional force-sensors, providing the sense of touch. The surgeon seated at the workstation controls the robot using force feedback hand controllers. The workstation recreates the sight and sensation of microsurgery by displaying the surgical site and 3D MRI displays, with superimposed tools. NeuroArm enables remote manipulation of the surgical tools from a control room adjacent to the surgical suite.[3] It was designed to function within the environment of 1.5 and 3.0 tesla intraoperative MRI systems. As neuroArm is MR-compatible, stereotaxy can be performed inside the bore of the magnet with near real-time image guidance. NeuroArm possesses the dexterity to perform microsurgery, outside of the MRI system.\nTelerobotic operations both inside and outside the magnet are performed using specialized tool sets based on standard neurosurgical instruments, adapted to the end effectors. Using these, NeuroArm is able to cut and manipulate soft tissue, dissect tissue planes, suture, biopsy, electrocauterize, aspirate and irrigate.[4]\n\nHistory \nThe project began in 2002 when Daryl, B.J., and Don Seaman provided $2 million to fund the design efforts. Dr. Sutherland and his group established a collaboration with the Canadian space engineering company MacDonald Dettwiler and Associates (MDA).[5] Close collaboration between MDA's robotic engineers and University of Calgary physicians, nurses, and scientists contributed to the design and development of NeuroArm. Official launch of the project was on April 17, 2007.[6]\nNeuroArm was designed to take full advantage of the imaging environment provided by intraoperative MRI. The ability to couple near real-time, high resolution images to robotic technologies provides the surgeon with image guidance, precision, accuracy, and dexterity.[7] MDA's engineers were immersed in the operating room to study typical tool and surgeon motions in order to use biomimicry for effective design of the computer-assisted surgical device. The OR environment, personnel, surgical rhythm and instrumentation remain unchanged. The surgeon, sitting at the workstation, is provided a virtual environment that recreates the sight, sound, and touch of surgery. Functions like tremor filtering and motion scaling were applied to increase precision and accuracy while functions like no-go zones and linear lock were applied to enhance safety. Surgical tools near the patient's head are incapable of fully independent movement and are slaved to the surgeon\u2019s movement at all times. Pre-planned automatic motions are used to move the robot arms away from the patient's head for manual tool exchange, and then return them to the original position and orientation.\nOn May 12, 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm.[8]\n\nReferences \n\n\n^ Pandya, Shawna; Motkoski, Jason W.; Serrano-Almeida, Cesar; Greer, Alexander D.; Latour, Isabelle; Sutherland, Garnette R. (1 December 2009). \"Advancing neurosurgery with image-guided robotics\". Journal of Neurosurgery. 111 (6): 1141\u20131149. doi:10.3171\/2009.2.JNS081334. Retrieved 2011-05-04 . \n\n^ \"IMRIS SYMBIS Homepage\". Archived from the original on 2013-01-10. \n\n^ \"Canadian robot does better brain surgery\". USA Today. 2007-04-17. Retrieved 2011-05-04 . \n\n^ Jackson, Brian (2008-04-02). \"Canadian robot set to perform brain surgery\". IT Business. Retrieved 2011-05-04 . \n\n^ \"Robot set to revolutionize brain surgery\". CTV. 2007-04-17. Retrieved 2011-05-04 . \n\n^ \"neuroArm - World's first image-guided surgical robot to enhance accuracy and safety of brain surgery\". University of Calgary. Retrieved 2011-05-03 . \n\n^ Dawn, Walton (2007-04-17). \"As a matter of fact, it IS rocket science\". Globe and Mail. Retrieved 2011-05-04 . \n\n^ \"neuroArm : revolutionary procedure a world first\". . www.ucalgary.ca (16 May 2008). Retrieved 14 November 2012. \n\n\nExternal links \nProject neuroArm\nSeaman Family MR Research Centre\nSYMBIS Homepage on IMRIS Website\nVideos \nVideo in press release for NeuroArm unveiling, University of Calgary, April 17, 2007\nRelated patents \nCanadian Patent 2246369 Surgical procedure with magnetic resonance imaging\nUS Patent 5,735,278 (at USPTO) Surgical procedure with magnetic resonance imaging\nUS Patent 5,735,278 (at Google) Surgical procedure with magnetic resonance imaging\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/NeuroArm\">https:\/\/www.limswiki.org\/index.php\/NeuroArm<\/a>\n\t\t\t\t\tCategories: Computer-assisted surgeryHealth informaticsMedical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:33.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 913 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","bd8bfd6039f9ddd234b056f1a5b21677_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-NeuroArm skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">NeuroArm<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>NeuroArm<\/b> is an engineering research <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">surgical robot<\/a> specifically designed for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurosurgery\" title=\"Neurosurgery\" rel=\"external_link\" target=\"_blank\">neurosurgery<\/a>. It is the first <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_surgery\" title=\"Image-guided surgery\" rel=\"external_link\" target=\"_blank\">image-guided<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MR-compatible<\/a> surgical robot that has the capability to perform both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microsurgery\" title=\"Microsurgery\" rel=\"external_link\" target=\"_blank\">microsurgery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotaxy\" title=\"Stereotaxy\" rel=\"external_link\" target=\"_blank\">stereotaxy<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/IMRIS\" title=\"IMRIS\" rel=\"external_link\" target=\"_blank\">IMRIS<\/a>, Inc. acquired NeuroArm assets in 2010, and the company is working to develop a next generation of the technology for worldwide commercialization. It will be integrated with the VISIUS(TM) Surgical Theatre under the name SYMBIS(TM) Surgical System.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<p>NeuroArm was designed to be image-guided and can perform procedures inside an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI<\/a>. NeuroArm includes two remote detachable manipulators on a mobile base, a workstation and a system control cabinet. For biopsy-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotaxy\" title=\"Stereotaxy\" rel=\"external_link\" target=\"_blank\">stereotaxy<\/a>, either the left or right arm is transferred to a stereotactic platform that attaches to the MR bore. The procedure is performed with image-guidance, as MR images are acquired in near real-time. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/End_effector\" class=\"mw-redirect\" title=\"End effector\" rel=\"external_link\" target=\"_blank\">end-effectors<\/a> interface with surgical tools which are based on standard neurosurgical instruments.\n<\/p><p>End-effectors are equipped with three-dimensional force-sensors, providing the sense of touch. The surgeon seated at the workstation controls the robot using force feedback hand controllers. The workstation recreates the sight and sensation of microsurgery by displaying the surgical site and 3D MRI displays, with superimposed tools. NeuroArm enables remote manipulation of the surgical tools from a control room adjacent to the surgical suite.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> It was designed to function within the environment of 1.5 and 3.0 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">tesla<\/a> intraoperative MRI systems. As neuroArm is MR-compatible, stereotaxy can be performed inside the bore of the magnet with near real-time image guidance. NeuroArm possesses the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dexterity\" class=\"mw-redirect\" title=\"Dexterity\" rel=\"external_link\" target=\"_blank\">dexterity<\/a> to perform microsurgery, outside of the MRI system.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">Telerobotic operations<\/a> both inside and outside the magnet are performed using specialized tool sets based on standard neurosurgical instruments, adapted to the end effectors. Using these, NeuroArm is able to cut and manipulate soft tissue, dissect tissue planes, suture, biopsy, electrocauterize, aspirate and irrigate.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The project began in 2002 when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Daryl_Seaman\" title=\"Daryl Seaman\" rel=\"external_link\" target=\"_blank\">Daryl<\/a>, B.J., and Don Seaman provided $2 million to fund the design efforts. Dr. Sutherland and his group established a collaboration with the Canadian space engineering company <a href=\"https:\/\/en.wikipedia.org\/wiki\/MacDonald_Dettwiler\" class=\"mw-redirect\" title=\"MacDonald Dettwiler\" rel=\"external_link\" target=\"_blank\"> MacDonald Dettwiler and Associates<\/a> (MDA).<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Close collaboration between MDA's robotic engineers and University of Calgary physicians, nurses, and scientists contributed to the design and development of NeuroArm. Official launch of the project was on April 17, 2007.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>NeuroArm was designed to take full advantage of the imaging environment provided by intraoperative MRI. The ability to couple near real-time, high resolution images to robotic technologies provides the surgeon with image guidance, precision, accuracy, and dexterity.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> MDA's engineers were immersed in the operating room to study typical tool and surgeon motions in order to use biomimicry for effective design of the computer-assisted surgical device. The OR environment, personnel, surgical rhythm and instrumentation remain unchanged. The surgeon, sitting at the workstation, is provided a virtual environment that recreates the sight, sound, and touch of surgery. Functions like tremor filtering and motion scaling were applied to increase precision and accuracy while functions like no-go zones and linear lock were applied to enhance safety. Surgical tools near the patient's head are incapable of fully independent movement and are slaved to the surgeon\u2019s movement at all times. Pre-planned automatic motions are used to move the robot arms away from the patient's head for manual tool exchange, and then return them to the original position and orientation.\n<\/p><p>On May 12, 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Calgary\" title=\"University of Calgary\" rel=\"external_link\" target=\"_blank\">University of Calgary<\/a> by Dr. Garnette Sutherland using the NeuroArm.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pandya, Shawna; Motkoski, Jason W.; Serrano-Almeida, Cesar; Greer, Alexander D.; Latour, Isabelle; Sutherland, Garnette R. (1 December 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/thejns.org\/doi\/abs\/10.3171\/2009.2.JNS081334?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed\" target=\"_blank\">\"Advancing neurosurgery with image-guided robotics\"<\/a>. <i>Journal of Neurosurgery<\/i>. <b>111<\/b> (6): 1141\u20131149. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3171%2F2009.2.JNS081334\" target=\"_blank\">10.3171\/2009.2.JNS081334<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurosurgery&rft.atitle=Advancing+neurosurgery+with+image-guided+robotics&rft.volume=111&rft.issue=6&rft.pages=1141-1149&rft.date=2009-12-01&rft_id=info%3Adoi%2F10.3171%2F2009.2.JNS081334&rft.aulast=Pandya&rft.aufirst=Shawna&rft.au=Motkoski%2C+Jason+W.&rft.au=Serrano-Almeida%2C+Cesar&rft.au=Greer%2C+Alexander+D.&rft.au=Latour%2C+Isabelle&rft.au=Sutherland%2C+Garnette+R.&rft_id=http%3A%2F%2Fthejns.org%2Fdoi%2Fabs%2F10.3171%2F2009.2.JNS081334%3Furl_ver%3DZ39.88-2003%26rfr_id%3Dori%3Arid%3Acrossref.org%26rfr_dat%3Dcr_pub%253dpubmed&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130110223407\/http:\/\/www.imris.com\/product\/symbis-surgical-system\" target=\"_blank\">\"IMRIS SYMBIS Homepage\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.imris.com\/product\/symbis-surgical-system\" target=\"_blank\">the original<\/a> on 2013-01-10.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=IMRIS+SYMBIS+Homepage&rft_id=http%3A%2F%2Fwww.imris.com%2Fproduct%2Fsymbis-surgical-system&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.usatoday.com\/tech\/news\/robotics\/2007-04-17-robot-brain-surgeon_N.htm\" target=\"_blank\">\"Canadian robot does better brain surgery\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/USA_Today\" title=\"USA Today\" rel=\"external_link\" target=\"_blank\">USA Today<\/a>. 2007-04-17<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Canadian+robot+does+better+brain+surgery&rft.pub=USA+Today&rft.date=2007-04-17&rft_id=https%3A%2F%2Fwww.usatoday.com%2Ftech%2Fnews%2Frobotics%2F2007-04-17-robot-brain-surgeon_N.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Jackson, Brian (2008-04-02). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.itbusiness.ca\/it\/client\/en\/home\/News.asp?id=47785\" target=\"_blank\">\"Canadian robot set to perform brain surgery\"<\/a>. IT Business<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Canadian+robot+set+to+perform+brain+surgery&rft.pub=IT+Business&rft.date=2008-04-02&rft.aulast=Jackson&rft.aufirst=Brian&rft_id=http%3A%2F%2Fwww.itbusiness.ca%2Fit%2Fclient%2Fen%2Fhome%2FNews.asp%3Fid%3D47785&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ctv.ca\/CTVNews\/TopStories\/20070417\/surgical_robot_070417\/\" target=\"_blank\">\"Robot set to revolutionize brain surgery\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CTV_Television_Network\" title=\"CTV Television Network\" rel=\"external_link\" target=\"_blank\">CTV<\/a>. 2007-04-17<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Robot+set+to+revolutionize+brain+surgery&rft.pub=CTV&rft.date=2007-04-17&rft_id=http%3A%2F%2Fwww.ctv.ca%2FCTVNews%2FTopStories%2F20070417%2Fsurgical_robot_070417%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ucalgary.ca\/news\/april2007\/neuroarm\" target=\"_blank\">\"neuroArm - World's first image-guided surgical robot to enhance accuracy and safety of brain surgery\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Calgary\" title=\"University of Calgary\" rel=\"external_link\" target=\"_blank\">University of Calgary<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-05-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=neuroArm+-+World%E2%80%99s+first+image-guided+surgical+robot+to+enhance+accuracy+and+safety+of+brain+surgery&rft.pub=University+of+Calgary&rft_id=https%3A%2F%2Fwww.ucalgary.ca%2Fnews%2Fapril2007%2Fneuroarm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Dawn, Walton (2007-04-17). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theglobeandmail.com\/life\/article753999.ece\" target=\"_blank\">\"As a matter of fact, it IS rocket science\"<\/a>. Globe and Mail<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=As+a+matter+of+fact%2C+it+IS+rocket+science&rft.pub=Globe+and+Mail&rft.date=2007-04-17&rft.aulast=Dawn&rft.aufirst=Walton&rft_id=https%3A%2F%2Fwww.theglobeandmail.com%2Flife%2Farticle753999.ece&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ucalgary.ca\/news\/may2008\/neuroArm\" target=\"_blank\">\"neuroArm : revolutionary procedure a world first\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=neuroArm+%3A+revolutionary+procedure+a+world+first&rft_id=https%3A%2F%2Fwww.ucalgary.ca%2Fnews%2Fmay2008%2FneuroArm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroArm\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>. www.ucalgary.ca (16 May 2008). Retrieved 14 November 2012.<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neuroarm.org\" target=\"_blank\">Project neuroArm<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.med.ucalgary.ca\/mrcentre\" target=\"_blank\">Seaman Family MR Research Centre<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130110223407\/http:\/\/www.imris.com\/product\/symbis-surgical-system\" target=\"_blank\">SYMBIS Homepage on IMRIS Website<\/a><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Videos\">Videos<\/span><\/h3>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ucalgary.ca\/news\/files\/news\/neuroArm.wmv\" target=\"_blank\">Video in press release for NeuroArm unveiling<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Calgary\" title=\"University of Calgary\" rel=\"external_link\" target=\"_blank\">University of Calgary<\/a>, April 17, 2007<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Related_patents\">Related patents<\/span><\/h3>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/patents1.ic.gc.ca\/details?patent_number=2246369&language=EN\" target=\"_blank\">Canadian Patent 2246369 Surgical procedure with magnetic resonance imaging<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/patft.uspto.gov\/netacgi\/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.htm&r=54&f=G&l=50&d=PTXT&s1=5,735,278&p=2&OS=5,735,278&RS=5,735,278\" target=\"_blank\">US Patent 5,735,278 (at USPTO) Surgical procedure with magnetic resonance imaging<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.google.com\/patents?vid=USPAT5735278\" target=\"_blank\">US Patent 5,735,278 (at Google) Surgical procedure with magnetic resonance imaging<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181129074906\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.148 seconds\nReal time usage: 0.182 seconds\nPreprocessor visited node count: 405\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 12524\/2097152 bytes\nTemplate argument size: 89\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 20867\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.093\/10.000 seconds\nLua memory usage: 2.39 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.056 1 Template:Reflist\n100.00% 158.056 1 -total\n<\/p>\n<pre>68.10% 107.635 1 Template:Cite_journal\n18.38% 29.058 7 Template:Cite_web\n 1.73% 2.731 1 Template:Main_other\n 1.20% 1.892 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:10764126-1!canonical and timestamp 20181129074906 and revision id 866513523\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/NeuroArm\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214644\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.135 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 129.469 1 - wikipedia:NeuroArm\n100.00% 129.469 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8549-0!*!*!*!*!*!* and timestamp 20181217214644 and revision id 27026\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/NeuroArm\">https:\/\/www.limswiki.org\/index.php\/NeuroArm<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","bd8bfd6039f9ddd234b056f1a5b21677_images":[],"bd8bfd6039f9ddd234b056f1a5b21677_timestamp":1545083204,"2c95b3737df0fa3bc33f54a79413364a_type":"article","2c95b3737df0fa3bc33f54a79413364a_title":"MRI robot","2c95b3737df0fa3bc33f54a79413364a_url":"https:\/\/www.limswiki.org\/index.php\/MRI_robot","2c95b3737df0fa3bc33f54a79413364a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMRI robot\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAn MRI robot is a medical robot capable of operating within a magnetic resonance imaging (MRI) scanner for the purpose of performing or assisting in image-guided interventions (IGI).\nIGI are commonly performed manually by physicians operating instruments, such as needles, based on medical images and are used in most medical fields, particularly in the specialty area of interventional radiology. IGI robots assist in manipulating the instrument or provide guidance for image-navigation. These robots have the potential to improve the performance of IGI because unlike humans, robots are digital devices that may directly communicate with the digital imagers.\n\nContents \n\n1 MRI compatibility \n\n1.1 Testing \n\n\n2 Advantages \n3 Disadvantages \n4 Potential uses \n5 Examples \n6 See also \n7 References \n\n\nMRI compatibility \nTo be MRI compatible, a robot needs to safely operate and perform its functions within the magnetic field of the MRI without deteriorating the image quality. Thus, the development of MRI robots is a very challenging engineering task because MRI scanners use magnetic fields of very high density (3 teslas is now common), and most of the components commonly used in robotics may not be used in close proximity of the magnet.\nResearchers have attempted to overcome the difficulties of robotic components in MRI in a variety of ways; some have placed controls and other magnetic sensitive units outside the shielded room of the MRI.[1] These controls will be connected to the robot by either hydraulic or pneumatic transmission lines.[2] \nAside from the difficulties of robotics use in the large magnetic fields found with MRI, the small gap between the MRI and the patient limits the physical size of robots used as the inner radius of an MRI is typically 55 cm.[1]\nIn addition to the robot itself, there must be a way to track the position, orientation and force being applied to the instrument.[3] Though this may potentially be done with continuous MRI, some uses of MRI robots may make continuous MRI undesirable due to potential interference between the MRI robot and the changing magnetic fields used in MRI. Many times this tracking is done using some sort of optical system which may include fiber optics.[2][3][4]\n\nTesting \nBefore an MRI robot can be used in a clinical setting, various tests must be performed and at various stages. Testing must be performed both during the engineering stages and through clinical trials. The tests performed will change dependent on the usage of the MRI robot. Some robots will be used under continuous imaging while others may only be imaged in intervals.\nSome of the tests performed while engineering a MRI robot would include material tests and signal-to-noise ratio (SNR). In a material test, the materials used for the robot are tested in magnetic fields to insure no interference exists between the material and magnetic field. One form of interference would be inducing a current in the robot's wires. This current could inhibit robot control-ability. Additionally, certain materials could cause an artifact or distortion on MR images. Some metals that have been shown to not produce artifacts on MR images include titanium and brass.[2][5]\nAfter an MRI robot has been constructed, tests must be done while imaging. One measurement to be made is SNR. SNR is a very important measurement in imaging. If the noise is too high compared to the signal, the image quality will suffer. SNR will be measured both when the MRI robot is moving and while stationary. There can be a noticeable difference in SNR between a stationary and moving robot.\nBefore testing on human patients, MRI robots are typically tested using an imaging phantom, a typical test \"subject\" used in imaging. These tests can be used to assure instrument placement accuracy.[3]\n\nAdvantages \nThough engineering MRI robots can be challenging, MRI robots have many advantages. One large advantage of using MRI as the imaging modality is the patient isn't exposed to radiation as they would be from computed tomography (CT scan) and x-ray imaging. MRI also has better image quality than other imaging modalities and is better able to distinguish between cancerous and health cells then ultrasound imaging.[2][3]\nMRI compatible robots could greatly change IGI. Currently, most IGIs are a multi-step process. Initially the patient must be imaged in order to decide the best location to begin the procedure. After this scan, the patient is moved to make any necessary incisions and prepare for their operation. The patient is then scanned again to ensure proper alignment of the instruments. If the instruments aren't properly aligned, the instrument must be moved, followed by another scan. This process of moving and scanning continues until the correct location and alignment of instruments is obtained. During each scan, the images must be registered again.[6] \nWhile using an MRI robot, the instrument could be implemented under continual imaging. As a result, real-time changes in instrument path could be made. Making real-time changes in path would be helpful in correcting needle bending. Needle bending can occur from patient movement and breathing and even from the needle moving through tissue.[4] By not moving the patient, potential sources of needle bending and need for image registration would be minimized.\n\nDisadvantages \nOne issue with MRI robots is the potential use of transmission lines. Hydraulic transmission lines can leak and potentially ruin sensitive equipment. Pneumatic transmission lines can have issues with maintaining the necessary pressure to insure adequate response times due to long transmission lines. Aside from the transmission method used, potential differences in the size and shape of MRI rooms could limit the universality of MRI robots, even within multiple MRI rooms in one hospital. Additionally, the length of transmission lines would make setup and removal of MRI robots time consuming.[2]\n\nPotential uses \nMRI robots have many potential uses. These include brachytherapy, biopsy, neuroscience research and tumor removal. One type of tumor removal that would greatly benefit from MRI robots is brain tumor removal. Brain tumors are extremely difficult to remove. There is also the potential to not completely remove the tumor.[5] By using real-time imaging, the whole brain tumor would have a greater chance of being removed.\nWithin neuroscience, MRI robots could be used to help better understand if a stroke victim will be responsive to robot-aided rehabilitation and other rehabilitation methodologies. Using functional MRI (fMRI) or other forms of functional neuroimaging methods, researchers can monitor and notice changes in functional connectivity within the brain. When using fMRI, a MRI robot would be used to help mimic everyday tasks such as shoulder and elbow movement.[7] \nAnother area where MRI robots could be extremely helpful is in prostate biopsies. Currently, most prostate biopsies are performed using transrectal ultrasonography (TRUS). However, approximately 20% of people with prostate cancer who have a biopsy done with TRUS will be told they do not have cancer.[3] One issue with TRUS is that it is unable to differentiate between healthy and cancerous cells. Differentiating between cell types is one of the advantages of MRI. Thus, an MRI robot used for prostate biopsies would assist in correctly diagnosing prostate cancer.\n\nExamples \nThe URobotics research group at Johns Hopkins University has developed an electricity-free, non-magnetic, and dielectric robot known as MrBot. This operates with air for the motors and light for its sensors ([1] YouTube movie). This achievement was possible through the invention of a new type of pneumatic motor, the PneuStep, which allows for simple, fail-safe precision controlled motion.\nThe Automation and Interventional Medicine Robotics Lab at Worcester Polytechnic Institute (WPI) has been developing enabling technologies for MRI-guided interventions. This work includes MR-compatible sensors, actuators, software, and controllers. The group has also developed various types of fully MRI-compatible robots for percutaneous prostate interventions and another one for guiding deep brain stimulation (DBS) electrode placement under real-time MR image guidance for the treatment of Parkinson's Disease.\n\nSee also \nComputer-assisted surgery\nImage-guided radiation therapy\nImage-guided surgery\nRobotic surgery\nReferences \n\n\n^ a b Gassert, Roger; Roland Moser; Etienne Burdet; Hannes Bleuler (April 2006). \"MRI\/fMRI-Compatible Robotic System With Force Feedback for Interaction With Human Motion\". IEEE\/ASME Transactions on Mechatronics. 11 (2): 216\u2013224. doi:10.1109\/TMECH.2006.871897. \n\n^ a b c d e Yang B, Tan UX, McMillan A, Gullapalli R, Desai JP (December 2011). \"Design and Control of a 1-DOF MRI Compatible Pneumatically Actuated Robot with Long Transmission Lines\". IEEE ASME Trans Mechatron. 16 (6): 1040\u20131048. doi:10.1109\/TMECH.2010.2071393. PMC 3205926 . PMID 22058649. \n\n^ a b c d e Krieger A, Iordachita II, Guion P, Singh AK, Kaushal A, M\u00e9nard C, Pinto PA, Camphausen K, Fichtinger G, Whitcomb LL (November 2011). \"An MRI-compatible robotic system with hybrid tracking for MRI-guided prostate intervention\". IEEE Trans Biomed Eng. 58 (11): 3049\u201360. doi:10.1109\/TBME.2011.2134096. PMC 3299494 . PMID 22009867. \n\n^ a b Su, Hao; Michael Zervas; Gregory A. Cole; Cosme Furlong; Gregory S. Fisher (2011). \"Real-time MRI-Guided Needle Placement Robot with Integrated Fiber Optic Force Sensing\". 2011 IEEE International Conference on Robotics and Automation (ICRA): 1583\u20131588. doi:10.1109\/IRCA.2011.5979539. \n\n^ a b Ho M, McMillan A, Simard JM, Gullapalli R, Desai JP (October 2011). \"Towards a Meso-Scale SMA-Actuated MRI-Compatible Neurosurgical Robot\". IEEE Trans Robot. 2011 (99): 1\u201310. doi:10.1109\/TRO.2011.2165371. PMC 3260790 . PMID 22267960. \n\n^ Tsekos NV (2009). \"MRI-guided robotics at the U of Houston: evolving methodologies for interventions and surgeries\". Conf Proc IEEE Eng Med Biol Soc. 2009: 5637\u201340. doi:10.1109\/IEMBS.2009.5333681. PMID 19964404. \n\n^ Sergi F, Krebs HI, Groissier B, Rykman A, Guglielmelli E, Volpe BT, Schaechter JD (2011). \"Predicting efficacy of robot-aided rehabilitation in chronic stroke patients using an MRI-compatible robotic device\". Conf Proc IEEE Eng Med Biol Soc. 2011: 7470\u20133. doi:10.1109\/IEMBS.2011.6091843. PMC 5583722 . PMID 22256066. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/MRI_robot\">https:\/\/www.limswiki.org\/index.php\/MRI_robot<\/a>\n\t\t\t\t\tCategories: Medical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:38.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 619 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","2c95b3737df0fa3bc33f54a79413364a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-MRI_robot skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">MRI robot<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>An <b>MRI robot<\/b> is a medical robot capable of operating within a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">magnetic resonance imaging<\/a> (MRI) scanner for the purpose of performing or assisting in image-guided interventions (IGI).\n<\/p><p>IGI are commonly performed manually by physicians operating instruments, such as needles, based on medical images and are used in most medical fields, particularly in the specialty area of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">interventional radiology<\/a>. IGI robots assist in manipulating the instrument or provide guidance for image-navigation. These robots have the potential to improve the performance of IGI because unlike humans, robots are digital devices that may directly communicate with the digital imagers.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"MRI_compatibility\">MRI compatibility<\/span><\/h2>\n<p>To be MRI compatible, a robot needs to safely operate and perform its functions within the magnetic field of the MRI without deteriorating the image quality. Thus, the development of MRI robots is a very challenging engineering task because MRI scanners use magnetic fields of very high density (3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">teslas<\/a> is now common), and most of the components commonly used in robotics may not be used in close proximity of the magnet.\n<\/p><p>Researchers have attempted to overcome the difficulties of robotic components in MRI in a variety of ways; some have placed controls and other magnetic sensitive units outside the shielded room of the MRI.<sup id=\"rdp-ebb-cite_ref-gassert_1-0\" class=\"reference\"><a href=\"#cite_note-gassert-1\" rel=\"external_link\">[1]<\/a><\/sup> These controls will be connected to the robot by either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydraulics\" title=\"Hydraulics\" rel=\"external_link\" target=\"_blank\">hydraulic<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumatics\" title=\"Pneumatics\" rel=\"external_link\" target=\"_blank\">pneumatic<\/a> transmission lines.<sup id=\"rdp-ebb-cite_ref-yang_2-0\" class=\"reference\"><a href=\"#cite_note-yang-2\" rel=\"external_link\">[2]<\/a><\/sup> \n<\/p><p>Aside from the difficulties of robotics use in the large magnetic fields found with MRI, the small gap between the MRI and the patient limits the physical size of robots used as the inner radius of an MRI is typically 55 cm.<sup id=\"rdp-ebb-cite_ref-gassert_1-1\" class=\"reference\"><a href=\"#cite_note-gassert-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>In addition to the robot itself, there must be a way to track the position, orientation and force being applied to the instrument.<sup id=\"rdp-ebb-cite_ref-krieger_3-0\" class=\"reference\"><a href=\"#cite_note-krieger-3\" rel=\"external_link\">[3]<\/a><\/sup> Though this may potentially be done with continuous MRI, some uses of MRI robots may make continuous MRI undesirable due to potential interference between the MRI robot and the changing magnetic fields used in MRI. Many times this tracking is done using some sort of optical system which may include fiber optics.<sup id=\"rdp-ebb-cite_ref-yang_2-1\" class=\"reference\"><a href=\"#cite_note-yang-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-krieger_3-1\" class=\"reference\"><a href=\"#cite_note-krieger-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-su_4-0\" class=\"reference\"><a href=\"#cite_note-su-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Testing\">Testing<\/span><\/h3>\n<p>Before an MRI robot can be used in a clinical setting, various tests must be performed and at various stages. Testing must be performed both during the engineering stages and through clinical trials. The tests performed will change dependent on the usage of the MRI robot. Some robots will be used under continuous imaging while others may only be imaged in intervals.\n<\/p><p>Some of the tests performed while engineering a MRI robot would include material tests and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Signal-to-noise_ratio\" title=\"Signal-to-noise ratio\" rel=\"external_link\" target=\"_blank\">signal-to-noise ratio<\/a> (SNR). In a material test, the materials used for the robot are tested in magnetic fields to insure no interference exists between the material and magnetic field. One form of interference would be inducing a current in the robot's wires. This current could inhibit robot control-ability. Additionally, certain materials could cause an artifact or distortion on MR images. Some metals that have been shown to not produce artifacts on MR images include titanium and brass.<sup id=\"rdp-ebb-cite_ref-yang_2-2\" class=\"reference\"><a href=\"#cite_note-yang-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ho_5-0\" class=\"reference\"><a href=\"#cite_note-ho-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>After an MRI robot has been constructed, tests must be done while imaging. One measurement to be made is SNR. SNR is a very important measurement in imaging. If the noise is too high compared to the signal, the image quality will suffer. SNR will be measured both when the MRI robot is moving and while stationary. There can be a noticeable difference in SNR between a stationary and moving robot.\n<\/p><p>Before testing on human patients, MRI robots are typically tested using an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Imaging_phantom\" title=\"Imaging phantom\" rel=\"external_link\" target=\"_blank\">imaging phantom<\/a>, a typical test \"subject\" used in imaging. These tests can be used to assure instrument placement accuracy.<sup id=\"rdp-ebb-cite_ref-krieger_3-2\" class=\"reference\"><a href=\"#cite_note-krieger-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h2>\n<p>Though engineering MRI robots can be challenging, MRI robots have many advantages. One large advantage of using MRI as the imaging modality is the patient isn't exposed to radiation as they would be from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">computed tomography<\/a> (CT scan) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_imaging\" class=\"mw-redirect\" title=\"X-ray imaging\" rel=\"external_link\" target=\"_blank\">x-ray imaging<\/a>. MRI also has better image quality than other imaging modalities and is better able to distinguish between cancerous and health cells then <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound_imaging\" class=\"mw-redirect\" title=\"Ultrasound imaging\" rel=\"external_link\" target=\"_blank\">ultrasound imaging<\/a>.<sup id=\"rdp-ebb-cite_ref-yang_2-3\" class=\"reference\"><a href=\"#cite_note-yang-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-krieger_3-3\" class=\"reference\"><a href=\"#cite_note-krieger-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>MRI compatible robots could greatly change IGI. Currently, most IGIs are a multi-step process. Initially the patient must be imaged in order to decide the best location to begin the procedure. After this scan, the patient is moved to make any necessary incisions and prepare for their operation. The patient is then scanned again to ensure proper alignment of the instruments. If the instruments aren't properly aligned, the instrument must be moved, followed by another scan. This process of moving and scanning continues until the correct location and alignment of instruments is obtained. During each scan, the images must be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">registered<\/a> again.<sup id=\"rdp-ebb-cite_ref-tsekos_6-0\" class=\"reference\"><a href=\"#cite_note-tsekos-6\" rel=\"external_link\">[6]<\/a><\/sup> \n<\/p><p>While using an MRI robot, the instrument could be implemented under continual imaging. As a result, real-time changes in instrument path could be made. Making real-time changes in path would be helpful in correcting needle bending. Needle bending can occur from patient movement and breathing and even from the needle moving through tissue.<sup id=\"rdp-ebb-cite_ref-su_4-1\" class=\"reference\"><a href=\"#cite_note-su-4\" rel=\"external_link\">[4]<\/a><\/sup> By not moving the patient, potential sources of needle bending and need for image registration would be minimized.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Disadvantages\">Disadvantages<\/span><\/h2>\n<p>One issue with MRI robots is the potential use of transmission lines. Hydraulic transmission lines can leak and potentially ruin sensitive equipment. Pneumatic transmission lines can have issues with maintaining the necessary pressure to insure adequate response times due to long transmission lines. Aside from the transmission method used, potential differences in the size and shape of MRI rooms could limit the universality of MRI robots, even within multiple MRI rooms in one hospital. Additionally, the length of transmission lines would make setup and removal of MRI robots time consuming.<sup id=\"rdp-ebb-cite_ref-yang_2-4\" class=\"reference\"><a href=\"#cite_note-yang-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_uses\">Potential uses<\/span><\/h2>\n<p>MRI robots have many potential uses. These include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brachytherapy\" title=\"Brachytherapy\" rel=\"external_link\" target=\"_blank\">brachytherapy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biopsy\" title=\"Biopsy\" rel=\"external_link\" target=\"_blank\">biopsy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroscience\" title=\"Neuroscience\" rel=\"external_link\" target=\"_blank\">neuroscience<\/a> research and tumor removal. One type of tumor removal that would greatly benefit from MRI robots is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_tumor\" title=\"Brain tumor\" rel=\"external_link\" target=\"_blank\">brain tumor<\/a> removal. Brain tumors are extremely difficult to remove. There is also the potential to not completely remove the tumor.<sup id=\"rdp-ebb-cite_ref-ho_5-1\" class=\"reference\"><a href=\"#cite_note-ho-5\" rel=\"external_link\">[5]<\/a><\/sup> By using real-time imaging, the whole brain tumor would have a greater chance of being removed.\n<\/p><p>Within neuroscience, MRI robots could be used to help better understand if a stroke victim will be responsive to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rehabilitation_robotics\" title=\"Rehabilitation robotics\" rel=\"external_link\" target=\"_blank\">robot-aided rehabilitation<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rehabilitation_(neuropsychology)\" title=\"Rehabilitation (neuropsychology)\" rel=\"external_link\" target=\"_blank\">rehabilitation<\/a> methodologies. Using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_magnetic_resonance_imaging\" title=\"Functional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">functional MRI<\/a> (fMRI) or other forms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_neuroimaging\" title=\"Functional neuroimaging\" rel=\"external_link\" target=\"_blank\">functional neuroimaging<\/a> methods, researchers can monitor and notice changes in functional connectivity within the brain. When using fMRI, a MRI robot would be used to help mimic everyday tasks such as shoulder and elbow movement.<sup id=\"rdp-ebb-cite_ref-sergi_7-0\" class=\"reference\"><a href=\"#cite_note-sergi-7\" rel=\"external_link\">[7]<\/a><\/sup> \n<\/p><p>Another area where MRI robots could be extremely helpful is in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transrectal_biopsy\" title=\"Transrectal biopsy\" rel=\"external_link\" target=\"_blank\">prostate biopsies<\/a>. Currently, most prostate biopsies are performed using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transrectal_ultrasonography\" title=\"Transrectal ultrasonography\" rel=\"external_link\" target=\"_blank\">transrectal ultrasonography<\/a> (TRUS). However, approximately 20% of people with prostate cancer who have a biopsy done with TRUS will be told they do not have cancer.<sup id=\"rdp-ebb-cite_ref-krieger_3-4\" class=\"reference\"><a href=\"#cite_note-krieger-3\" rel=\"external_link\">[3]<\/a><\/sup> One issue with TRUS is that it is unable to differentiate between healthy and cancerous cells. Differentiating between cell types is one of the advantages of MRI. Thus, an MRI robot used for prostate biopsies would assist in correctly diagnosing prostate cancer.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Examples\">Examples<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/URobotics\" class=\"mw-redirect\" title=\"URobotics\" rel=\"external_link\" target=\"_blank\">URobotics<\/a> research group at Johns Hopkins University has developed an electricity-free, non-magnetic, and dielectric robot known as <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/urology.jhu.edu\/urobotics\/projects\/MrBot\" target=\"_blank\">MrBot<\/a>. This operates with air for the motors and light for its sensors (<a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/www.youtube.com\/watch?v=sdESnc-oDZo\" target=\"_blank\">[1]<\/a> YouTube movie). This achievement was possible through the invention of a new type of pneumatic motor, the <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/urology.jhu.edu\/urobotics\/projects\/PneuStep\/\" target=\"_blank\">PneuStep<\/a>, which allows for simple, fail-safe precision controlled motion.\n<\/p><p>The <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110720120206\/http:\/\/aimlab.wpi.edu\/AIM-lab\/index.php\/Research\" target=\"_blank\">Automation and Interventional Medicine Robotics Lab<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Worcester_Polytechnic_Institute\" title=\"Worcester Polytechnic Institute\" rel=\"external_link\" target=\"_blank\">Worcester Polytechnic Institute (WPI)<\/a> has been developing enabling technologies for MRI-guided interventions. This work includes <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120315045617\/http:\/\/aimlab.wpi.edu\/AIM-lab\/index.php\/MRI-Compatible_Sensors\" target=\"_blank\">MR-compatible sensors<\/a>, actuators, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120329221217\/http:\/\/aimlab.wpi.edu\/AIM-lab\/index.php\/Software_Interfaces_and_Communication_Protocols_for_Surgical_Robots_-_OpenIGTLink\" target=\"_blank\">software<\/a>, and controllers. The group has also developed various types of fully MRI-compatible robots for <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120329221048\/http:\/\/aimlab.wpi.edu\/AIM-lab\/index.php\/MRI_Robot_for_Prostate_Interventions\" target=\"_blank\">percutaneous prostate interventions<\/a> and another one for guiding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" title=\"Deep brain stimulation\" rel=\"external_link\" target=\"_blank\">deep brain stimulation (DBS)<\/a> electrode placement under real-time MR image guidance for the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson_disease\" class=\"mw-redirect\" title=\"Parkinson disease\" rel=\"external_link\" target=\"_blank\">Parkinson's Disease<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer-assisted surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_radiation_therapy\" title=\"Image-guided radiation therapy\" rel=\"external_link\" target=\"_blank\">Image-guided radiation therapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_surgery\" title=\"Image-guided surgery\" rel=\"external_link\" target=\"_blank\">Image-guided surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-gassert-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-gassert_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-gassert_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gassert, Roger; Roland Moser; Etienne Burdet; Hannes Bleuler (April 2006). \"MRI\/fMRI-Compatible Robotic System With Force Feedback for Interaction With Human Motion\". <i>IEEE\/ASME Transactions on Mechatronics<\/i>. <b>11<\/b> (2): 216\u2013224. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FTMECH.2006.871897\" target=\"_blank\">10.1109\/TMECH.2006.871897<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE%2FASME+Transactions+on+Mechatronics&rft.atitle=MRI%2FfMRI-Compatible+Robotic+System+With+Force+Feedback+for+Interaction+With+Human+Motion&rft.volume=11&rft.issue=2&rft.pages=216-224&rft.date=2006-04&rft_id=info%3Adoi%2F10.1109%2FTMECH.2006.871897&rft.aulast=Gassert&rft.aufirst=Roger&rft.au=Roland+Moser&rft.au=Etienne+Burdet&rft.au=Hannes+Bleuler&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMRI+Robot\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-yang-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-yang_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-yang_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-yang_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-yang_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-yang_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Yang B, Tan UX, McMillan A, Gullapalli R, Desai JP (December 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3205926\" target=\"_blank\">\"Design and Control of a 1-DOF MRI Compatible Pneumatically Actuated Robot with Long Transmission Lines\"<\/a>. <i>IEEE ASME Trans Mechatron<\/i>. <b>16<\/b> (6): 1040\u20131048. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FTMECH.2010.2071393\" target=\"_blank\">10.1109\/TMECH.2010.2071393<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3205926\" target=\"_blank\">3205926<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22058649\" target=\"_blank\">22058649<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+ASME+Trans+Mechatron&rft.atitle=Design+and+Control+of+a+1-DOF+MRI+Compatible+Pneumatically+Actuated+Robot+with+Long+Transmission+Lines&rft.volume=16&rft.issue=6&rft.pages=1040-1048&rft.date=2011-12&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3205926&rft_id=info%3Apmid%2F22058649&rft_id=info%3Adoi%2F10.1109%2FTMECH.2010.2071393&rft.aulast=Yang&rft.aufirst=B&rft.au=Tan%2C+UX&rft.au=McMillan%2C+A&rft.au=Gullapalli%2C+R&rft.au=Desai%2C+JP&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3205926&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMRI+Robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-krieger-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-krieger_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-krieger_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-krieger_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-krieger_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-krieger_3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Krieger A, Iordachita II, Guion P, Singh AK, Kaushal A, M\u00e9nard C, Pinto PA, Camphausen K, Fichtinger G, Whitcomb LL (November 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3299494\" target=\"_blank\">\"An MRI-compatible robotic system with hybrid tracking for MRI-guided prostate intervention\"<\/a>. <i>IEEE Trans Biomed Eng<\/i>. <b>58<\/b> (11): 3049\u201360. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FTBME.2011.2134096\" target=\"_blank\">10.1109\/TBME.2011.2134096<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3299494\" target=\"_blank\">3299494<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22009867\" target=\"_blank\">22009867<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+Trans+Biomed+Eng&rft.atitle=An+MRI-compatible+robotic+system+with+hybrid+tracking+for+MRI-guided+prostate+intervention&rft.volume=58&rft.issue=11&rft.pages=3049-60&rft.date=2011-11&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3299494&rft_id=info%3Apmid%2F22009867&rft_id=info%3Adoi%2F10.1109%2FTBME.2011.2134096&rft.aulast=Krieger&rft.aufirst=A&rft.au=Iordachita%2C+II&rft.au=Guion%2C+P&rft.au=Singh%2C+AK&rft.au=Kaushal%2C+A&rft.au=M%C3%A9nard%2C+C&rft.au=Pinto%2C+PA&rft.au=Camphausen%2C+K&rft.au=Fichtinger%2C+G&rft.au=Whitcomb%2C+LL&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3299494&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMRI+Robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-su-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-su_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-su_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Su, Hao; Michael Zervas; Gregory A. Cole; Cosme Furlong; Gregory S. Fisher (2011). \"Real-time MRI-Guided Needle Placement Robot with Integrated Fiber Optic Force Sensing\". <i>2011 IEEE International Conference on Robotics and Automation (ICRA)<\/i>: 1583\u20131588. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FIRCA.2011.5979539\" target=\"_blank\">10.1109\/IRCA.2011.5979539<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=2011+IEEE+International+Conference+on+Robotics+and+Automation+%28ICRA%29&rft.atitle=Real-time+MRI-Guided+Needle+Placement+Robot+with+Integrated+Fiber+Optic+Force+Sensing&rft.pages=1583-1588&rft.date=2011&rft_id=info%3Adoi%2F10.1109%2FIRCA.2011.5979539&rft.aulast=Su&rft.aufirst=Hao&rft.au=Michael+Zervas&rft.au=Gregory+A.+Cole&rft.au=Cosme+Furlong&rft.au=Gregory+S.+Fisher&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMRI+Robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ho-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ho_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ho_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ho M, McMillan A, Simard JM, Gullapalli R, Desai JP (October 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3260790\" target=\"_blank\">\"Towards a Meso-Scale SMA-Actuated MRI-Compatible Neurosurgical Robot\"<\/a>. <i>IEEE Trans Robot<\/i>. <b>2011<\/b> (99): 1\u201310. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FTRO.2011.2165371\" target=\"_blank\">10.1109\/TRO.2011.2165371<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3260790\" target=\"_blank\">3260790<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22267960\" target=\"_blank\">22267960<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+Trans+Robot&rft.atitle=Towards+a+Meso-Scale+SMA-Actuated+MRI-Compatible+Neurosurgical+Robot&rft.volume=2011&rft.issue=99&rft.pages=1-10&rft.date=2011-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3260790&rft_id=info%3Apmid%2F22267960&rft_id=info%3Adoi%2F10.1109%2FTRO.2011.2165371&rft.aulast=Ho&rft.aufirst=M&rft.au=McMillan%2C+A&rft.au=Simard%2C+JM&rft.au=Gullapalli%2C+R&rft.au=Desai%2C+JP&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3260790&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMRI+Robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-tsekos-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-tsekos_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tsekos NV (2009). \"MRI-guided robotics at the U of Houston: evolving methodologies for interventions and surgeries\". <i>Conf Proc IEEE Eng Med Biol Soc<\/i>. <b>2009<\/b>: 5637\u201340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FIEMBS.2009.5333681\" target=\"_blank\">10.1109\/IEMBS.2009.5333681<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19964404\" target=\"_blank\">19964404<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Conf+Proc+IEEE+Eng+Med+Biol+Soc&rft.atitle=MRI-guided+robotics+at+the+U+of+Houston%3A+evolving+methodologies+for+interventions+and+surgeries&rft.volume=2009&rft.pages=5637-40&rft.date=2009&rft_id=info%3Adoi%2F10.1109%2FIEMBS.2009.5333681&rft_id=info%3Apmid%2F19964404&rft.aulast=Tsekos&rft.aufirst=NV&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMRI+Robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-sergi-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-sergi_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sergi F, Krebs HI, Groissier B, Rykman A, Guglielmelli E, Volpe BT, Schaechter JD (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5583722\" target=\"_blank\">\"Predicting efficacy of robot-aided rehabilitation in chronic stroke patients using an MRI-compatible robotic device\"<\/a>. <i>Conf Proc IEEE Eng Med Biol Soc<\/i>. <b>2011<\/b>: 7470\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FIEMBS.2011.6091843\" target=\"_blank\">10.1109\/IEMBS.2011.6091843<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5583722\" target=\"_blank\">5583722<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22256066\" target=\"_blank\">22256066<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Conf+Proc+IEEE+Eng+Med+Biol+Soc&rft.atitle=Predicting+efficacy+of+robot-aided+rehabilitation+in+chronic+stroke+patients+using+an+MRI-compatible+robotic+device&rft.volume=2011&rft.pages=7470-3&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5583722&rft_id=info%3Apmid%2F22256066&rft_id=info%3Adoi%2F10.1109%2FIEMBS.2011.6091843&rft.aulast=Sergi&rft.aufirst=F&rft.au=Krebs%2C+HI&rft.au=Groissier%2C+B&rft.au=Rykman%2C+A&rft.au=Guglielmelli%2C+E&rft.au=Volpe%2C+BT&rft.au=Schaechter%2C+JD&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5583722&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMRI+Robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1331\nCached time: 20181216070816\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.220 seconds\nReal time usage: 0.268 seconds\nPreprocessor visited node count: 563\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17999\/2097152 bytes\nTemplate argument size: 214\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 24405\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.138\/10.000 seconds\nLua memory usage: 2.95 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 222.858 1 -total\n<\/p>\n<pre>92.87% 206.971 1 Template:Reflist\n81.35% 181.287 7 Template:Cite_journal\n 6.17% 13.741 1 Template:Prone_to_spam\n 3.38% 7.534 1 Template:Ambox\/category\n 1.89% 4.222 1 Template:Namespace_detect_showall\n 1.28% 2.863 2 Template:Main_other\n 0.90% 2.001 1 Template:Z148\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:17690378-1!canonical and timestamp 20181216070816 and revision id 863096188\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_Robot\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214644\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.026 seconds\nReal time usage: 0.189 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 183.317 1 - wikipedia:MRI_Robot\n100.00% 183.317 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8548-0!*!*!*!*!*!* and timestamp 20181217214644 and revision id 24974\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/MRI_robot\">https:\/\/www.limswiki.org\/index.php\/MRI_robot<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","2c95b3737df0fa3bc33f54a79413364a_images":[],"2c95b3737df0fa3bc33f54a79413364a_timestamp":1545083204,"90ec5c8b38e09953fa9a890e80755961_type":"article","90ec5c8b38e09953fa9a890e80755961_title":"HAL (robot)","90ec5c8b38e09953fa9a890e80755961_url":"https:\/\/www.limswiki.org\/index.php\/HAL_(robot)","90ec5c8b38e09953fa9a890e80755961_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHAL (robot)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\nHybrid Assistive Limb (HAL)A man wearing a 2005 prototype version of the HAL suit (left)ManufacturerCyberdyneCountryJapanYear of creation1997 (earliest prototype)\r\n2012 (full HAL-5 suit)TypePowered exoskeletonPurposeMedical \/ search and rescueWebsitecyberdyne.jp \nThe Hybrid Assistive Limb (also known as HAL) is a powered exoskeleton suit developed by Japan's Tsukuba University and the robotics company Cyberdyne. It is designed to support and expand the physical capabilities of its users, particularly people with physical disabilities. There are two primary versions of the system: HAL 3, which only provides leg function, and HAL 5, which is a full-body exoskeleton for the arms, legs, and torso.\nIn 2011, Cyberdyne and Tsukuba University jointly announced that hospital trials of the full HAL suit would begin in 2012, with tests to continue until 2014 or 2015.[1] By October 2012, HAL suits were in use by 130 different medical institutions across Japan.[2] In February 2013, the HAL system became the first powered exoskeleton to receive global safety certification.[3] In August 2013, HAL received EC certification for clinical use in Europe as the world's first non-surgical medical treatment robot.[4][5] In addition to its medical applications, the HAL exoskeleton has been used in construction and disaster response work.[6][7]\n\nContents \n\n1 History \n2 Design and mechanics \n3 Users \n4 See also \n5 References \n6 External links \n\n\nHistory \nThe first HAL prototype was proposed by Yoshiyuki Sankai, a professor at Tsukuba University. Fascinated with robots since he was in the third grade, Sankai had striven to make a robotic suit in order \u201cto support humans.\u201d[8] In 1989, after receiving his Ph.D. in robotics, he began the development of HAL. Sankai spent three years, from 1990 to 1993, mapping out the neurons that govern leg movement. It took him and his team an additional four years to make a prototype of the hardware.[9]\nThe third HAL prototype, developed in the early 2000s, was attached to a computer. Its battery alone weighed nearly 22 kilograms (49 lb) and required two helpers to put on, making it very impractical. By contrast, later HAL-5 model weighs only 10 kilograms (22 lb) and has its battery and control computer strapped around the waist of the wearer.\nCyberdyne began renting the HAL suit out for medical purposes in 2008. By October 2012, over 300 HAL suits were in use by 130 medical facilities and nursing homes across Japan. The suit is available for institutional rental, in Japan only, for a monthly fee of US$2,000.[2] In December 2012, Cyberdyne was certified ISO 13485 \u2013 an international quality standard for design and manufacture of medical devices \u2013 by Underwriters Laboratories.[10] In late February 2013, the HAL suit received a global safety certificate, becoming the first powered exoskeleton to do so.[3] In August 2013, the suit received an EC certificate, permitting its use for medical purposes in Europe as the first medical treatment robot of its kind.[4][5]\n\nDesign and mechanics \nWhen a person attempts to move their body, nerve signals are sent from the brain to the muscles through the motor neurons, moving the musculoskeletal system. When this happens, small biosignals can be detected on the surface of the skin. The HAL suit registers these signals through a sensor attached to the skin of the wearer. Based on the signals obtained, the power unit moves the joint to support and amplify the wearer's motion. The HAL suit possesses a cybernic control system consisting of both a user-activated \u201cvoluntary control system\" known as Cybernic Voluntary Control (CVC) and a \u201crobotic autonomous control system\" known as Cybernic Autonomous Control (CAC) for automatic motion support.[11][12][13]\n\nUsers \nHAL is designed to assist the disabled and elderly in their daily tasks, but can also be used to support workers with physically demanding jobs such as disaster rescue or construction. HAL is mainly used by disabled patients in hospitals, and can be modified so that patients can use it for longer-term rehabilitation. In addition, scientific studies have shown that, in combination with specially-created therapeutic games, powered exoskeletons like the HAL-5 can stimulate cognitive activities and help disabled children walk while playing.[14][15] Further scientific studies have shown that HAL Therapy can be effectively used for rehabilitation after spinal cord injury or stroke.[16]\nDuring the 2011 Consumer Electronics Show, it was announced that the United States government had expressed interest in purchasing HAL suits.[17] In March 2011, Cyberdyne presented a legs-only HAL version for the disabled, health care professionals and factory workers.[18] In November 2011, HAL was selected to be used for cleanup work at the site of the Fukushima nuclear accident.[19] During the Japan Robot Week exhibition in Tokyo in October 2012, a redesigned version of HAL was presented, designed specifically for the Fukushima cleanup.[7] In March 2013, ten Japanese hospitals conducted clinical tests of the newer legs-only HAL system.[20] In late 2014, HAL exoskeletons modified for construction use entered service with the Japanese construction contractor Obayashi Corporation.[6]\n\nSee also \n\n\n Robotics portal \n Disability portal \nAtlas (robot), a humanoid robot designed for search and rescue\nEkso Bionics\nReWalk\nVanderbilt exoskeleton\nReferences \n\n\n^ \"Robot suit offers glimmer of hope to the paralysed\". Times of Malta. 11 March 2011. Retrieved 26 August 2012 . \n\n^ a b \"Robots to the rescue as an aging Japan looks for help\". The Australian. 13 October 2012. Retrieved 17 October 2012 . \n\n^ a b \"Japan robot suit gets global safety certificate\". AFP via Google. 27 February 2013. Retrieved 28 February 2013 . \n\n^ a b \"T\u00dcV Rheinland Issues EC certificate for Cyberdyne's Medical Robot Suit HAL\u00ae\". T\u00dcV Rheinland. 7 August 2013. Retrieved 14 August 2013 . \n\n^ a b \"Global Companies from Japan\". Weekly Toyo Keizai. 14 September 2013. Retrieved 17 March 2014 . \n\n^ a b \"Smart walkers lead the way for Japanese elder-care robots\". ITWorld.com. 16 October 2014. Retrieved 22 October 2014 . \n\n^ a b \"New HAL Exoskeleton: Brain-Controlled Full Body Suit to Be Used In Fukushima Cleanup\". Neurogadget.com. 18 October 2012. Retrieved 22 October 2012 . \n\n^ \"Cyberdyne power suit\". YouTube. 31 July 2009. Retrieved 26 August 2012 . \n\n^ \"HAL, a friend for people with disabilities\". Nipponia. Web Japan. 15 September 2006. Retrieved 16 July 2013 . \n\n^ \"The design, manufacture and servicing of wearable lower limb exoskeleton devices for rehabilitation and physical training\" (pdf) . Underwriters Laboratories. 11 December 2012. Retrieved 16 July 2013 . \n\n^ \"Intention-based walking support for paraplegia patients with Robot Suit HAL\". Advanced Robotics. 2007, vol. 21, pp1441-1469. Taylor & Francis. 2007. doi:10.1163\/156855307781746061. Retrieved 17 March 2014 . \n\n^ \"Pilot study of locomotion improvement using hybrid assistive limb in chronic stroke patients\". BMC Neurology. 2013, vol. 13, p141. BMC. 2013. Retrieved 17 March 2014 . \n\n^ \"Research Program Cybernics University of Tsukuba\". Global COE Program, Cybernics. University of Tsukuba. 1 April 2007. Archived from the original on 27 October 2014. Retrieved 17 March 2014 . \n\n^ \"Computers for the Development of Young Disabled Children \u2013 Introduction to the Special Thematic Session\". ACM.org. 2002. Retrieved 26 November 2012 . \n\n^ \"Influence of Virtual Reality Soccer Game on Walking Performance in Robotic Assisted Gait Training for Children\". AbleData.com. April 2010. Retrieved 26 November 2012 . \n\n^ \"Current scientific studies to exoskeleton therapy with Hybrid Assistive Limb\". WALK AGAIN Center. Retrieved 2016-01-28 . \n\n^ \"CES Spotlight: Japanese Robot Exoskeletons\". 12 January 2011. Retrieved 28 February 2013 . \n\n^ \"Cyberdyne demos lower-body HAL exoskeleton for helping the disabled, not eradicating mankind (video)\". 15 March 2011. Retrieved 28 February 2013 . \n\n^ \"Robotic Exoskeletons from Cyberdyne Could Help Workers Clean Up Fukushima Nuclear Mess\". Scientific American. 9 November 2011. Retrieved 27 November 2011 . \n\n^ \"Hospitals to test robot suit to help patients walk\". The Asahi Shimbun. 9 February 2013. Archived from the original on 13 February 2013. Retrieved 17 February 2013 . \n\n\nExternal links \nOfficial website (in English) (in Japanese) \n\"The Rise of the Body Bots\". IEEE Spectrum. October 2005. Archived from the original on 4 May 2009. Retrieved 18 February 2013 . \nWALK AGAIN Center \u2014 HAL Training Center\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/HAL_(robot)\">https:\/\/www.limswiki.org\/index.php\/HAL_(robot)<\/a>\n\t\t\t\t\tCategories: Medical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:36.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,037 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","90ec5c8b38e09953fa9a890e80755961_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-HAL_robot skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">HAL (robot)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n\n<p>The <b>Hybrid Assistive Limb<\/b> (also known as <b>HAL<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Powered_exoskeleton\" title=\"Powered exoskeleton\" rel=\"external_link\" target=\"_blank\">powered exoskeleton<\/a> suit developed by Japan's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tsukuba_University\" class=\"mw-redirect\" title=\"Tsukuba University\" rel=\"external_link\" target=\"_blank\">Tsukuba University<\/a> and the robotics company <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyberdyne_Inc._(Japanese_company)\" class=\"mw-redirect\" title=\"Cyberdyne Inc. (Japanese company)\" rel=\"external_link\" target=\"_blank\">Cyberdyne<\/a>. It is designed to support and expand the physical capabilities of its users, particularly people with physical disabilities. There are two primary versions of the system: HAL 3, which only provides leg function, and HAL 5, which is a full-body exoskeleton for the arms, legs, and torso.\n<\/p><p>In 2011, Cyberdyne and Tsukuba University jointly announced that hospital trials of the full HAL suit would begin in 2012, with tests to continue until 2014 or 2015.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> By October 2012, HAL suits were in use by 130 different medical institutions across Japan.<sup id=\"rdp-ebb-cite_ref-October2012_2-0\" class=\"reference\"><a href=\"#cite_note-October2012-2\" rel=\"external_link\">[2]<\/a><\/sup> In February 2013, the HAL system became the first powered exoskeleton to receive global safety certification.<sup id=\"rdp-ebb-cite_ref-Certified2013_3-0\" class=\"reference\"><a href=\"#cite_note-Certified2013-3\" rel=\"external_link\">[3]<\/a><\/sup> In August 2013, HAL received <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Commission\" title=\"European Commission\" rel=\"external_link\" target=\"_blank\">EC<\/a> certification for clinical use in Europe as the world's first non-surgical medical treatment robot.<sup id=\"rdp-ebb-cite_ref-EcAug2013_4-0\" class=\"reference\"><a href=\"#cite_note-EcAug2013-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-TK2013_5-0\" class=\"reference\"><a href=\"#cite_note-TK2013-5\" rel=\"external_link\">[5]<\/a><\/sup> In addition to its medical applications, the HAL exoskeleton has been used in construction and disaster response work.<sup id=\"rdp-ebb-cite_ref-ConstructOb_6-0\" class=\"reference\"><a href=\"#cite_note-ConstructOb-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18October2012_7-0\" class=\"reference\"><a href=\"#cite_note-18October2012-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first HAL prototype was proposed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yoshiyuki_Sankai\" title=\"Yoshiyuki Sankai\" rel=\"external_link\" target=\"_blank\">Yoshiyuki Sankai<\/a>, a professor at Tsukuba University. Fascinated with robots since he was in the third grade, Sankai had striven to make a robotic suit in order \u201cto support humans.\u201d<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> In 1989, after receiving his Ph.D. in robotics, he began the development of HAL. Sankai spent three years, from 1990 to 1993, mapping out the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurons\" class=\"mw-redirect\" title=\"Neurons\" rel=\"external_link\" target=\"_blank\">neurons<\/a> that govern leg movement. It took him and his team an additional four years to make a prototype of the hardware.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>The third HAL prototype, developed in the early 2000s, was attached to a computer. Its battery alone weighed nearly 22 kilograms (49 lb) and required two helpers to put on, making it very impractical. By contrast, later HAL-5 model weighs only 10 kilograms (22 lb) and has its battery and control computer strapped around the waist of the wearer.\n<\/p><p>Cyberdyne began renting the HAL suit out for medical purposes in 2008. By October 2012, over 300 HAL suits were in use by 130 medical facilities and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nursing_home\" class=\"mw-redirect\" title=\"Nursing home\" rel=\"external_link\" target=\"_blank\">nursing homes<\/a> across Japan. The suit is available for institutional rental, in Japan only, for a monthly fee of US$2,000.<sup id=\"rdp-ebb-cite_ref-October2012_2-1\" class=\"reference\"><a href=\"#cite_note-October2012-2\" rel=\"external_link\">[2]<\/a><\/sup> In December 2012, Cyberdyne was certified <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_13485\" title=\"ISO 13485\" rel=\"external_link\" target=\"_blank\">ISO 13485<\/a> \u2013 an international quality standard for design and manufacture of medical devices \u2013 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/UL_(safety_organization)\" title=\"UL (safety organization)\" rel=\"external_link\" target=\"_blank\">Underwriters Laboratories<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In late February 2013, the HAL suit received a global safety certificate, becoming the first powered exoskeleton to do so.<sup id=\"rdp-ebb-cite_ref-Certified2013_3-1\" class=\"reference\"><a href=\"#cite_note-Certified2013-3\" rel=\"external_link\">[3]<\/a><\/sup> In August 2013, the suit received an EC certificate, permitting its use for medical purposes in Europe as the first medical treatment robot of its kind.<sup id=\"rdp-ebb-cite_ref-EcAug2013_4-1\" class=\"reference\"><a href=\"#cite_note-EcAug2013-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-TK2013_5-1\" class=\"reference\"><a href=\"#cite_note-TK2013-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Design_and_mechanics\">Design and mechanics<\/span><\/h2>\n<p>When a person attempts to move their body, nerve signals are sent from the brain to the muscles through the motor neurons, moving the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Musculoskeletal_system\" class=\"mw-redirect\" title=\"Musculoskeletal system\" rel=\"external_link\" target=\"_blank\">musculoskeletal system<\/a>. When this happens, small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biosignal\" title=\"Biosignal\" rel=\"external_link\" target=\"_blank\">biosignals<\/a> can be detected on the surface of the skin. The HAL suit registers these signals through a sensor attached to the skin of the wearer. Based on the signals obtained, the power unit moves the joint to support and amplify the wearer's motion. The HAL suit possesses a cybernic control system consisting of both a user-activated \u201cvoluntary control system\" known as Cybernic Voluntary Control (CVC) and a \u201crobotic autonomous control system\" known as Cybernic Autonomous Control (CAC) for automatic motion support.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Users\">Users<\/span><\/h2>\n<p>HAL is designed to assist the disabled and elderly in their daily tasks, but can also be used to support workers with physically demanding jobs such as disaster rescue or construction. HAL is mainly used by disabled patients in hospitals, and can be modified so that patients can use it for longer-term rehabilitation. In addition, scientific studies have shown that, in combination with specially-created therapeutic games, powered exoskeletons like the HAL-5 can stimulate cognitive activities and help disabled children walk while playing.<sup id=\"rdp-ebb-cite_ref-computerdisabled2002_14-0\" class=\"reference\"><a href=\"#cite_note-computerdisabled2002-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-abledata2010JNERv7n15_15-0\" class=\"reference\"><a href=\"#cite_note-abledata2010JNERv7n15-15\" rel=\"external_link\">[15]<\/a><\/sup> Further scientific studies have shown that can be effectively used for rehabilitation after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord injury<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>.<sup id=\"rdp-ebb-cite_ref-HalResearch_16-0\" class=\"reference\"><a href=\"#cite_note-HalResearch-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>During the 2011 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Consumer_Electronics_Show\" title=\"Consumer Electronics Show\" rel=\"external_link\" target=\"_blank\">Consumer Electronics Show<\/a>, it was announced that the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> government had expressed interest in purchasing HAL suits.<sup id=\"rdp-ebb-cite_ref-January2011_17-0\" class=\"reference\"><a href=\"#cite_note-January2011-17\" rel=\"external_link\">[17]<\/a><\/sup> In March 2011, Cyberdyne presented a legs-only HAL version for the disabled, health care professionals and factory workers.<sup id=\"rdp-ebb-cite_ref-March2011_18-0\" class=\"reference\"><a href=\"#cite_note-March2011-18\" rel=\"external_link\">[18]<\/a><\/sup> In November 2011, HAL was selected to be used for cleanup work at the site of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fukushima_Daiichi_nuclear_disaster\" title=\"Fukushima Daiichi nuclear disaster\" rel=\"external_link\" target=\"_blank\">Fukushima nuclear accident<\/a>.<sup id=\"rdp-ebb-cite_ref-November2011_19-0\" class=\"reference\"><a href=\"#cite_note-November2011-19\" rel=\"external_link\">[19]<\/a><\/sup> During the Japan Robot Week exhibition in Tokyo in October 2012, a redesigned version of HAL was presented, designed specifically for the Fukushima cleanup.<sup id=\"rdp-ebb-cite_ref-18October2012_7-1\" class=\"reference\"><a href=\"#cite_note-18October2012-7\" rel=\"external_link\">[7]<\/a><\/sup> In March 2013, ten Japanese hospitals conducted clinical tests of the newer legs-only HAL system.<sup id=\"rdp-ebb-cite_ref-AsahiShimbunJ201302090058_20-0\" class=\"reference\"><a href=\"#cite_note-AsahiShimbunJ201302090058-20\" rel=\"external_link\">[20]<\/a><\/sup> In late 2014, HAL exoskeletons modified for construction use entered service with the Japanese construction contractor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obayashi_Corporation\" title=\"Obayashi Corporation\" rel=\"external_link\" target=\"_blank\">Obayashi Corporation<\/a>.<sup id=\"rdp-ebb-cite_ref-ConstructOb_6-1\" class=\"reference\"><a href=\"#cite_note-ConstructOb-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Animation2.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/17px-Animation2.gif\" width=\"17\" height=\"28\" class=\"noviewer\" \/><\/a><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Robotics\" title=\"Portal:Robotics\" rel=\"external_link\" target=\"_blank\">Robotics portal<\/a><\/span><\/li>\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Handicapped_Accessible_sign.svg\/28px-Handicapped_Accessible_sign.svg.png\" width=\"28\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Disability\" title=\"Portal:Disability\" rel=\"external_link\" target=\"_blank\">Disability portal<\/a><\/span><\/li><\/ul><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atlas_(robot)\" title=\"Atlas (robot)\" rel=\"external_link\" target=\"_blank\">Atlas (robot)<\/a>, a humanoid robot designed for search and rescue<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ekso_Bionics\" title=\"Ekso Bionics\" rel=\"external_link\" target=\"_blank\">Ekso Bionics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ReWalk\" title=\"ReWalk\" rel=\"external_link\" target=\"_blank\">ReWalk<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vanderbilt_exoskeleton\" title=\"Vanderbilt exoskeleton\" rel=\"external_link\" target=\"_blank\">Vanderbilt exoskeleton<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li 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Retrieved <span class=\"nowrap\">26 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Computers+for+the+Development+of+Young+Disabled+Children+%E2%80%93+Introduction+to+the+Special+Thematic+Session&rft.pub=ACM.org&rft.date=2002&rft_id=http%3A%2F%2Fdl.acm.org%2Fcitation.cfm%3Fid%3D646269.684335&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-abledata2010JNERv7n15-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-abledata2010JNERv7n15_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.abledata.com\/abledata.cfm?pageid=160377&ksectionid=160164&atlitid=198393\" target=\"_blank\">\"Influence of Virtual Reality Soccer Game on Walking Performance in Robotic Assisted Gait Training for Children\"<\/a>. AbleData.com. April 2010<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Influence+of+Virtual+Reality+Soccer+Game+on+Walking+Performance+in+Robotic+Assisted+Gait+Training+for+Children&rft.pub=AbleData.com&rft.date=2010-04&rft_id=http%3A%2F%2Fwww.abledata.com%2Fabledata.cfm%3Fpageid%3D160377%26ksectionid%3D160164%26atlitid%3D198393&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HalResearch-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HalResearch_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/walk-again.com\/research\/\" target=\"_blank\">\"Current scientific studies to exoskeleton therapy with Hybrid Assistive Limb\"<\/a>. WALK AGAIN Center<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-01-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Current+scientific+studies+to+exoskeleton+therapy+with+Hybrid+Assistive+Limb&rft.pub=WALK+AGAIN+Center&rft_id=http%3A%2F%2Fwalk-again.com%2Fresearch%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-January2011-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-January2011_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/mylifescoop.com\/2011\/01\/12\/ces-spotlight-japanese-robot-exoskeletons\/\" target=\"_blank\">\"CES Spotlight: Japanese Robot Exoskeletons\"<\/a>. 12 January 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 February<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=CES+Spotlight%3A+Japanese+Robot+Exoskeletons&rft.date=2011-01-12&rft_id=http%3A%2F%2Fmylifescoop.com%2F2011%2F01%2F12%2Fces-spotlight-japanese-robot-exoskeletons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-March2011-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-March2011_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.engadget.com\/2011\/03\/15\/cyberdyne-demos-lower-body-hal-exoskeleton-for-helping-the-disab\/\" target=\"_blank\">\"Cyberdyne demos lower-body HAL exoskeleton for helping the disabled, not eradicating mankind (video)\"<\/a>. 15 March 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 February<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Cyberdyne+demos+lower-body+HAL+exoskeleton+for+helping+the+disabled%2C+not+eradicating+mankind+%28video%29&rft.date=2011-03-15&rft_id=https%3A%2F%2Fwww.engadget.com%2F2011%2F03%2F15%2Fcyberdyne-demos-lower-body-hal-exoskeleton-for-helping-the-disab%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-November2011-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-November2011_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/blogs.scientificamerican.com\/observations\/2011\/11\/09\/robotic-exoskeletons-from-cyberdyne-could-help-workers-clean-up-fukushima-nuclear-mess\/\" target=\"_blank\">\"Robotic Exoskeletons from Cyberdyne Could Help Workers Clean Up Fukushima Nuclear Mess\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Scientific_American\" title=\"Scientific American\" rel=\"external_link\" target=\"_blank\">Scientific American<\/a><\/i>. 9 November 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">27 November<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Scientific+American&rft.atitle=Robotic+Exoskeletons+from+Cyberdyne+Could+Help+Workers+Clean+Up+Fukushima+Nuclear+Mess&rft.date=2011-11-09&rft_id=http%3A%2F%2Fblogs.scientificamerican.com%2Fobservations%2F2011%2F11%2F09%2Frobotic-exoskeletons-from-cyberdyne-could-help-workers-clean-up-fukushima-nuclear-mess%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AsahiShimbunJ201302090058-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AsahiShimbunJ201302090058_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130213231852\/http:\/\/ajw.asahi.com\/article\/economy\/technology\/AJ201302090058\" target=\"_blank\">\"Hospitals to test robot suit to help patients walk\"<\/a>. <i>The Asahi Shimbun<\/i>. 9 February 2013. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ajw.asahi.com\/article\/economy\/technology\/AJ201302090058\" target=\"_blank\">the original<\/a> on 13 February 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">17 February<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+Asahi+Shimbun&rft.atitle=Hospitals+to+test+robot+suit+to+help+patients+walk&rft.date=2013-02-09&rft_id=http%3A%2F%2Fajw.asahi.com%2Farticle%2Feconomy%2Ftechnology%2FAJ201302090058&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><span class=\"official-website\"><span class=\"url\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cyberdyne.jp\/english\/index.html\" target=\"_blank\">Official website<\/a><\/span><\/span> <span class=\"languageicon\">(in English)<\/span> <span class=\"languageicon\">(in Japanese)<\/span><\/li>\n<li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090504142710\/http:\/\/www.spectrum.ieee.org\/oct05\/1901\" target=\"_blank\">\"The Rise of the Body Bots\"<\/a>. <i>IEEE Spectrum<\/i>. October 2005. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.spectrum.ieee.org\/oct05\/1901\" target=\"_blank\">the original<\/a> on 4 May 2009<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=IEEE+Spectrum&rft.atitle=The+Rise+of+the+Body+Bots&rft.date=2005-10&rft_id=http%3A%2F%2Fwww.spectrum.ieee.org%2Foct05%2F1901&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHAL+%28robot%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/walk-again.com\/\" target=\"_blank\">WALK AGAIN Center<\/a> \u2014 HAL Training Center<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1255\nCached time: 20181215165935\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.456 seconds\nReal time usage: 0.587 seconds\nPreprocessor visited node count: 1239\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 40295\/2097152 bytes\nTemplate argument size: 711\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 56603\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.309\/10.000 seconds\nLua memory usage: 11.64 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 538.319 1 -total\n<\/p>\n<pre>38.49% 207.217 1 Template:Reflist\n30.69% 165.210 2 Template:Link_language\n30.47% 164.050 1 Template:En_icon\n28.32% 152.477 20 Template:Cite_web\n 9.44% 50.844 1 Template:Infobox_robot\n 8.59% 46.243 1 Template:Infobox\n 5.69% 30.650 2 Template:Convert\n 5.48% 29.484 1 Template:Use_dmy_dates\n 4.85% 26.117 2 Template:Category_handler\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2371149-1!canonical and timestamp 20181215165935 and revision id 842283711\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/HAL_%28robot%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214644\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.146 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.974 1 - wikipedia:HAL_(robot)\n100.00% 138.974 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8547-0!*!*!*!*!*!* and timestamp 20181217214644 and revision id 24972\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/HAL_(robot)\">https:\/\/www.limswiki.org\/index.php\/HAL_(robot)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","90ec5c8b38e09953fa9a890e80755961_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2a\/Hybrid_Assistive_Limb.jpg\/440px-Hybrid_Assistive_Limb.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/34px-Animation2.gif"],"90ec5c8b38e09953fa9a890e80755961_timestamp":1545083203,"7df9e90b4bef9d592ce747d6127bb602_type":"article","7df9e90b4bef9d592ce747d6127bb602_title":"Diagnostic robot","7df9e90b4bef9d592ce747d6127bb602_url":"https:\/\/www.limswiki.org\/index.php\/Diagnostic_robot","7df9e90b4bef9d592ce747d6127bb602_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDiagnostic robot\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (February 2009)\nIn medicine and robotics, diagnostic robots are diagnosis tools in the form of a physical robot or a software expert system. Developed in the 1970s near the height of the AI boom, automatic diagnosis systems are capable of gathering data for medical diagnosis with its knowledge based subsystem, and tools such as a tendon-actuated, anthropomorphic finger, skin-like sensors for tactile perception, etc.[1][2]\nIn February 2013, IBM announced that Watson software system's first commercial application would be for utilization management decisions in lung cancer treatment at Memorial Sloan\u2013Kettering Cancer Center in conjunction with health insurance company WellPoint. In 2013, IBM Watson's business chief Manoj Saxena says that 90% of nurses in the field who use Watson now follow its guidance.[3][4]\n\nSee also \nComputer-aided diagnosis\nMycin\nRobotic surgery\nReferences \n\n\n^ Salcudean, S. E.; Bell, G.; Bachmann, S.; Zhu, W. H.; Abolmaesumi, P.; Lawrence, P. D., \"Robot-Assisted Diagnostic Ultrasound - Design and Feasibility Experiments\" (PDF) , Miccai99, Springer \n\n^ Dario, P.; Bergamasco, M. (1988), \"An advanced robot system for automated diagnostic tasks through palpation\", IEEE Transactions on Biomedical Engineering, 35 (2): 118\u2013126, doi:10.1109\/10.1349, PMID 3350538 \n\n^ Upbin, Bruce (2013-02-08). \"IBM's Watson Gets Its First Piece Of Business In Healthcare\". Forbes. Retrieved March 10, 2013 . \n\n^ Cohn, Jonathan (March 2013). \"The Robot Will See You Now\". The Atlantic. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Diagnostic_robot\">https:\/\/www.limswiki.org\/index.php\/Diagnostic_robot<\/a>\n\t\t\t\t\tCategories: Medical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:35.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 369 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7df9e90b4bef9d592ce747d6127bb602_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Diagnostic_robot skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Diagnostic robot<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotics\" title=\"Robotics\" rel=\"external_link\" target=\"_blank\">robotics<\/a>, <b>diagnostic robots<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnosis_(medical)\" class=\"mw-redirect\" title=\"Diagnosis (medical)\" rel=\"external_link\" target=\"_blank\">diagnosis<\/a> tools in the form of a physical robot or a software <a href=\"https:\/\/en.wikipedia.org\/wiki\/Expert_system\" title=\"Expert system\" rel=\"external_link\" target=\"_blank\">expert system<\/a>. Developed in the 1970s near the height of the AI boom, automatic diagnosis systems are capable of gathering data for medical diagnosis with its knowledge based subsystem, and tools such as a tendon-actuated, anthropomorphic finger, skin-like sensors for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tactile_sensor\" title=\"Tactile sensor\" rel=\"external_link\" target=\"_blank\">tactile perception<\/a>, etc.<sup id=\"rdp-ebb-cite_ref-Salcudean_1-0\" class=\"reference\"><a href=\"#cite_note-Salcudean-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Dario1988_2-0\" class=\"reference\"><a href=\"#cite_note-Dario1988-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In February 2013, IBM announced that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Watson_(computer)\" title=\"Watson (computer)\" rel=\"external_link\" target=\"_blank\">Watson software system<\/a>'s first commercial application would be for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Utilization_management\" title=\"Utilization management\" rel=\"external_link\" target=\"_blank\">utilization management<\/a> decisions in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung_cancer\" title=\"Lung cancer\" rel=\"external_link\" target=\"_blank\">lung cancer<\/a> treatment at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Memorial_Sloan%E2%80%93Kettering_Cancer_Center\" class=\"mw-redirect\" title=\"Memorial Sloan\u2013Kettering Cancer Center\" rel=\"external_link\" target=\"_blank\">Memorial Sloan\u2013Kettering Cancer Center<\/a> in conjunction with health insurance company <a href=\"https:\/\/en.wikipedia.org\/wiki\/WellPoint\" class=\"mw-redirect\" title=\"WellPoint\" rel=\"external_link\" target=\"_blank\">WellPoint<\/a>. In 2013, IBM Watson's business chief says that 90% of nurses in the field who use Watson now follow its guidance.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-aided_diagnosis\" title=\"Computer-aided diagnosis\" rel=\"external_link\" target=\"_blank\">Computer-aided diagnosis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mycin\" title=\"Mycin\" rel=\"external_link\" target=\"_blank\">Mycin<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Salcudean-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Salcudean_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFSalcudean,_S._E.Bell,_G.Bachmann,_S.Zhu,_W._H.\" class=\"citation\">Salcudean, S. E.; Bell, G.; Bachmann, S.; Zhu, W. H.; Abolmaesumi, P.; Lawrence, P. D., <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.springerlink.com\/index\/x07201782px81x22.pdf\" target=\"_blank\">\"Robot-Assisted Diagnostic Ultrasound - Design and Feasibility Experiments\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>, <i>Miccai99<\/i>, Springer<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Miccai99&rft.atitle=Robot-Assisted+Diagnostic+Ultrasound+-+Design+and+Feasibility+Experiments&rft.au=Salcudean%2C+S.+E.&rft.au=Bell%2C+G.&rft.au=Bachmann%2C+S.&rft.au=Zhu%2C+W.+H.&rft.au=Abolmaesumi%2C+P.&rft.au=Lawrence%2C+P.+D.&rft_id=http%3A%2F%2Fwww.springerlink.com%2Findex%2Fx07201782px81x22.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiagnostic+robot\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Dario1988-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Dario1988_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFDario,_P.Bergamasco,_M.1988\" class=\"citation\">Dario, P.; Bergamasco, M. (1988), \"An advanced robot system for automated diagnostic tasks through palpation\", <i>IEEE Transactions on Biomedical Engineering<\/i>, <b>35<\/b> (2): 118\u2013126, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2F10.1349\" target=\"_blank\">10.1109\/10.1349<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3350538\" target=\"_blank\">3350538<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+Transactions+on+Biomedical+Engineering&rft.atitle=An+advanced+robot+system+for+automated+diagnostic+tasks+through+palpation&rft.volume=35&rft.issue=2&rft.pages=118-126&rft.date=1988&rft_id=info%3Adoi%2F10.1109%2F10.1349&rft_id=info%3Apmid%2F3350538&rft.au=Dario%2C+P.&rft.au=Bergamasco%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiagnostic+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Upbin, Bruce (2013-02-08). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.forbes.com\/sites\/bruceupbin\/2013\/02\/08\/ibms-watson-gets-its-first-piece-of-business-in-healthcare\/\" target=\"_blank\">\"IBM's Watson Gets Its First Piece Of Business In Healthcare\"<\/a>. <i>Forbes<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">March 10,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Forbes&rft.atitle=IBM%27s+Watson+Gets+Its+First+Piece+Of+Business+In+Healthcare&rft.date=2013-02-08&rft.aulast=Upbin&rft.aufirst=Bruce&rft_id=https%3A%2F%2Fwww.forbes.com%2Fsites%2Fbruceupbin%2F2013%2F02%2F08%2Fibms-watson-gets-its-first-piece-of-business-in-healthcare%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiagnostic+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Cohn, Jonathan (March 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theatlantic.com\/magazine\/archive\/2013\/03\/the-robot-will-see-you-now\/309216\/?single_page=true\" target=\"_blank\">\"The Robot Will See You Now\"<\/a>. <i>The Atlantic<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Atlantic&rft.atitle=The+Robot+Will+See+You+Now&rft.date=2013-03&rft.aulast=Cohn&rft.aufirst=Jonathan&rft_id=https%3A%2F%2Fwww.theatlantic.com%2Fmagazine%2Farchive%2F2013%2F03%2Fthe-robot-will-see-you-now%2F309216%2F%3Fsingle_page%3Dtrue&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiagnostic+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181217055900\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.188 seconds\nReal time usage: 0.262 seconds\nPreprocessor visited node count: 349\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 14978\/2097152 bytes\nTemplate argument size: 1052\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11030\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.122\/10.000 seconds\nLua memory usage: 2.67 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 242.389 1 -total\n<\/p>\n<pre>63.29% 153.407 1 Template:Reflist\n48.88% 118.480 2 Template:Citation\n35.08% 85.022 1 Template:Orphan\n24.80% 60.105 1 Template:Draft_other\n23.20% 56.239 1 Template:Ambox\n 6.50% 15.749 2 Template:Cite_news\n 1.49% 3.621 1 Template:Monthyear\n 1.47% 3.551 1 Template:Monthyear-1\n 1.10% 2.662 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:18818775-1!canonical and timestamp 20181217055900 and revision id 872917526\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnostic_robot\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214643\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.024 seconds\nReal time usage: 0.139 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 133.836 1 - wikipedia:Diagnostic_robot\n100.00% 133.836 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8546-0!*!*!*!*!*!* and timestamp 20181217214643 and revision id 24971\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Diagnostic_robot\">https:\/\/www.limswiki.org\/index.php\/Diagnostic_robot<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7df9e90b4bef9d592ce747d6127bb602_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"7df9e90b4bef9d592ce747d6127bb602_timestamp":1545083203,"063da80316fd7d92210db60034a6b06f_type":"article","063da80316fd7d92210db60034a6b06f_title":"Da Vinci Surgical System","063da80316fd7d92210db60034a6b06f_url":"https:\/\/www.limswiki.org\/index.php\/Da_Vinci_Surgical_System","063da80316fd7d92210db60034a6b06f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tda Vinci Surgical System\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t \n\nA robotic surgical system\n\n \n\nDa Vinci Surgical SystemManufacturerIntuitive SurgicalCountryUnited StatesYear of creation2000 (initial FDA clearance)TypeMedicalPurposeMedical\nThe da Vinci Surgical System is a robotic surgical system made by the American company Intuitive Surgical. Approved by the Food and Drug Administration (FDA) in 2000, it is designed to facilitate complex surgery using a minimally invasive approach, and is controlled by a surgeon from a console. The system is commonly used for prostatectomies, and increasingly for cardiac valve repair and gynecologic surgical procedures.[1][2] According to the manufacturer, the da Vinci System is called \"da Vinci\" in part because Leonardo da Vinci's \"study of human anatomy eventually led to the design of the first known robot in history.\"[3]\nDa Vinci Surgical Systems operate in hospitals worldwide, with an estimated 200,000 surgeries conducted in 2012, most commonly for hysterectomies and prostate removals.[4] As of September 30, 2017, there was an installed base of 4,271 units worldwide \u2013 2,770 in the United States, 719 in Europe, 561 in Asia, and 221 in the rest of the world.[5] The \"Si\" version of the system costs on average slightly under US$2 million, in addition to several hundred thousand dollars of annual maintenance fees.[6] The da Vinci system has been criticised for its cost and for a number of issues with its surgical performance.[2][7]\n\nContents \n\n1 Overview \n2 FDA clearance \n3 Medical uses \n4 Future applications \n5 Criticism \n6 In popular culture \n7 See also \n8 References \n9 External links \n\n\nOverview \n da Vinci patient-side component (left) and surgeon console (right)\n A surgeon console at the treatment centre of Addenbrooke's Hospital\nThe da Vinci System consists of a surgeon's console that is typically in the same room as the patient, and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, and can also act as scalpels, scissors, bovies, or graspers. The surgeon uses the console's master controls to maneuver the patient-side cart's three or four robotic arms (depending on the model). The instruments\u2019 jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon's hand movements. The da Vinci System always requires a human operator, and incorporates multiple redundant safety features designed to minimize opportunities for human error when compared with traditional approaches.\nThe da Vinci System has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on a patient-side assistant to position the camera correctly. In contrast, the da Vinci System's design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments and using controls at the console to move the instruments and camera.\nBy providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction.[citation needed ] For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions.[citation needed ] Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.[8]\n\nFDA clearance \nThe Food and Drug Administration (FDA) cleared the da Vinci Surgical System in 2000 for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures and thoracoscopically assisted cardiotomy procedures. The FDA also cleared the da Vinci System to be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization.[9]\n\nMedical uses \nThe da Vinci System has been successfully used in the following procedures:[9]\n\nRadical prostatectomy, pyeloplasty, cystectomy, nephrectomy and ureteral reimplantation;[10]\nHysterectomy, myomectomy and sacrocolpopexy;\nHiatal hernia repair;\nSpleen-sparing distal pancreatectomy, cholecystectomy, Nissen fundoplication, Heller myotomy, gastric bypass, donor nephrectomy, adrenalectomy, splenectomy and bowel resection;\nInternal mammary artery mobilization and cardiac tissue ablation;\nMitral valve repair and endoscopic atrial septal defect closure;\nMammary to left anterior descending coronary artery anastomosis for cardiac revascularization with adjunctive mediastinotomy;\nTransoral resection of tumors of the upper aerodigestive tract (tonsil, tongue base, larynx) and transaxillary thyroidectomy\nResection of spindle cell tumors originating in the lung\nFuture applications \nAlthough the general term \"robotic surgery\" is often used to refer to the technology, this term can give the impression that the da Vinci System is performing the surgery autonomously. In contrast, the current da Vinci Surgical System cannot \u2013 in any manner \u2013 function on its own, as it was not designed as an autonomous system and lacks decision making software. Instead, it relies on a human operator for all input; however, all operations \u2013 including vision and motor functions - are performed through remote human-computer interaction, and thus with the appropriate weak AI software, the system could in principle perform partially or completely autonomously. The difficulty with creating an autonomous system of this kind is not trivial; a major obstacle is that surgery per se is not an engineered process \u2013 a requirement for weak AI. The current system is designed merely to replicate seamlessly the movement of the surgeon's hands with the tips of micro-instruments, not to make decisions or move without the surgeon's direct input.\nThe possibility of long-distance operations depends on the patient having access to a da Vinci System, but technically the system could allow a doctor to perform telesurgery on a patient in another country. In 2001, Dr. Marescaux and a team from IRCAD used a combination of high-speed fiber-optic connection with an average delay of 155 ms with advanced asynchronous transfer mode (ATM) and a Zeus telemanipulator to successfully perform the first transatlantic surgical procedure, covering the distance between New York and Strasbourg. The event was considered a milestone of global telesurgery, and was dubbed \"Operation Lindbergh\".[11]\n\nCriticism \nMain article: Robotic surgery \u00a7 Comparison to traditional methods\nCritics of robotic surgery assert that it is difficult for users to learn and that it has not been shown to be more effective than traditional laparoscopic surgery.[2] The da Vinci system uses proprietary software, which cannot be modified by physicians, thereby limiting the freedom to modify the operation system.[4] Furthermore, its $2 million cost places it beyond the reach of many institutions.[6]\nThe manufacturer of the system, Intuitive Surgical, has been criticized for short-cutting FDA approval by a process known as \"premarket notification,\" which claims the product is similar to already-approved products. Intuitive has also been accused of providing inadequate training, and encouraging health care providers to reduce the number of supervised procedures required before a doctor is allowed to use the system without supervision.[12] There have also been claims of patient injuries caused by stray electrical currents released from inappropriate parts of the surgical tips used by the system. Intuitive counters that the same type of stray currents can occur in non-robotic laparoscopic procedures.[13] A study published in the Journal of the American Medical Association found that side effects and blood loss in robotically-performed hysterectomies are no better than those performed by traditional surgery, despite the significantly greater cost of the system.[14][15] As of 2013, the FDA is investigating problems with the da Vinci robot, including deaths during surgeries that used the device; a number of related lawsuits are also underway.[7]\nFrom a social analysis, a disadvantage is the potential for this technology to dissolve the creative freedoms of the surgeon, once hailed by scholar Timothy Lenoir as one of the most professional individual autonomous occupations to exist. Lenoir claims that in the \"heroic age of medicine,\" the surgeon was hailed as a hero for his intuitive knowledge of human anatomy and his well-crafted techniques in repairing vital body systems. Lenoir argues that the da Vinci's 3D console and robotic arms create a mediating form of action called medialization, in which internal knowledge of images and routes within the body become external knowledge mapped into simplistic computer coding.[16]\n\nIn popular culture \n \n\nSee also: Internet meme \u00a7 They did surgery on a grape\nOn the August 11, 2018 Edward Hospital released a video on YouTube of them demonstrating the Da Vinci Si Surgical System's precision by performing the task of peeling the skin of the grape off of a grape.[17][18] In 2017, a clip of the original video was added to a video created by Cheddar's YouTube channel with the caption \u201cThey did surgery on a grape.\u201d. People began sharing the post with the same caption \u201cThey did surgery on a grape\u201d. The initial versions of the meme made fun of the dry caption in the Cheddar video, by adding the caption \u201cThey did surgery on a grape\u201d as many times as they could to their post.[19] The phrase has also become very popular on Twitter, with many tweets tying to use the phrase in as many creative ways as possible.[20]\n\nSee also \nZEUS robotic surgical system, a rival system discontinued in 2003.\nReferences \n\n\n^ \"Robots as surgical enablers\". MarketWatch. 3 February 2005. Retrieved 17 March 2013. \n\n^ a b c \"Prepping Robots to Perform Surgery\". The New York Times. 4 May 2008. Retrieved 17 March 2013. \n\n^ \"Company \u2013 Past Present Future\". Intuitive Surgical. Retrieved 14 January 2015 . \n\n^ a b Babbage Science and technology (18 January 2012). \"Surgical robots: The kindness of strangers\". The Economist. Retrieved 21 February 2013 . \n\n^ \"da Vinci Products FAQ\". Intuitive Surgical. Retrieved 7 April 2017 . \n\n^ a b \"The Slow Rise of the Robot Surgeon\". MIT Technology Review. 24 March 2010. Retrieved 23 March 2013. \n\n^ a b \"da Vinci Robot Allegedly Marketed to Less-Skilled Doctors\". LawyersandSettlements.com. 23 April 2013. Retrieved 24 April 2013 . \n\n^ Payne TN, Dauterive FR (2008). \"A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice\". J. Minim. Invasive Gynecol. 15 (3): 286\u201391. doi:10.1016\/j.jmig.2008.01.008. PMID 18439499. \n\n^ a b \"Surgical Specialties \u2013 Regulatory Clearance\". Intuitive Surgical. Archived from the original on 16 January 2013. Retrieved 21 February 2013 . \n\n^ Dorian Block (25 June 2006). \"Robot Does Quick Fix on Prostate; interview with Dr. Michael Palese\". New York Daily News. Retrieved 23 February 2011 . \n\n^ Marescaux, Jacques; Leroy, Joel; Gagner, Michel; Rubino, Francesco; Mutter, Didier; Vix, Michel; Butner, Steven E.; Smith, Michelle K. (27 September 2001). \"Transatlantic robot-assisted telesurgery\". Nature. 413 (6854): 379\u2013380. doi:10.1038\/35096636 – via www.nature.com. \n\n^ \"Salesmen in the Surgical Suite\". The New York Times. 25 March 2013. Retrieved 24 April 2013 . \n\n^ \"Patients Scarred After Robotic Surgery\". CNBC. 19 April 2013. Retrieved 24 April 2013 . \n\n^ \"Questions About Robotic Hysterectomy\". The New York Times. 25 February 2013. Retrieved 24 April 2013 . \n\n^ Wright, Jason (20 February 2013). \"Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease\". The Journal of the American Medical Association. 309 (7). doi:10.1001\/jama.2013.186. PMID 23423414. Retrieved 5 September 2015 . \n\n^ Lenoir, Timothy [1], in Phillip Thurtle, ed., Semiotic Flesh: Information and the Human Body, Seattle, WA: University of Washington Press, 2002, pp. 28-51. Accessed 27 October 2013 \n\n^ EdwardHospital, da Vinci Surgical System: Surgery on a grape, retrieved 2018-12-05 \n\n^ Feldman, Brian (November 26, 2018). \"They Did Surgery on a Grape\". Intelligencer. Retrieved December 5, 2018 . \n\n^ Hess, Peter. \"\" They Did Surgery on a Grape\" Meme Began With Legally Suspect Medical Tool\". Inverse. Retrieved 2018-12-05 . \n\n^ Santiago, Amanda Luz Henning. \"' They did surgery on a grape' is the weird meme that's your new obsession\". Mashable. Retrieved 2018-12-05 . \n\n\nExternal links \n\"Live robotic da Vinci radical prostatectomy during EAU congress\" on YouTube by European Urological Association.\n\"India's 1st Da vinci Robotic Live Surgery\" on YouTube by Muljibhai Patel Urological Hospital.\n\"da Vinci Robotic Hysterectomies \/ Uterine Fibroids\" on YouTube\n\"da Vinci Surgical System: Surgery on a grape\" 's channel on YouTube\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Da_Vinci_Surgical_System\">https:\/\/www.limswiki.org\/index.php\/Da_Vinci_Surgical_System<\/a>\n\t\t\t\t\tCategories: Computer-assisted surgeryHealth informaticsMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:32.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,626 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","063da80316fd7d92210db60034a6b06f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Da_Vinci_Surgical_System skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">da Vinci Surgical System<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><p><span><\/span>\n<\/p>\n<div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">A robotic surgical system<\/div>\n<p>\n<span><\/span>\n<\/p>\n\n<p>The <b>da Vinci Surgical System<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">robotic surgical<\/a> system made by the American company <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intuitive_Surgical\" title=\"Intuitive Surgical\" rel=\"external_link\" target=\"_blank\">Intuitive Surgical<\/a>. Approved by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) in 2000, it is designed to facilitate complex <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_procedure\" class=\"mw-redirect\" title=\"Minimally invasive procedure\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a> approach, and is controlled by a surgeon from a console. The system is commonly used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostatectomy\" title=\"Prostatectomy\" rel=\"external_link\" target=\"_blank\">prostatectomies<\/a>, and increasingly for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valve\" title=\"Heart valve\" rel=\"external_link\" target=\"_blank\">cardiac valve<\/a> repair and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gynecology\" class=\"mw-redirect\" title=\"Gynecology\" rel=\"external_link\" target=\"_blank\">gynecologic<\/a> surgical procedures.<sup id=\"rdp-ebb-cite_ref-mw_1-0\" class=\"reference\"><a href=\"#cite_note-mw-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-nyt_2-0\" class=\"reference\"><a href=\"#cite_note-nyt-2\" rel=\"external_link\">[2]<\/a><\/sup> According to the manufacturer, the da Vinci System is called \"da Vinci\" in part because <a href=\"https:\/\/en.wikipedia.org\/wiki\/Leonardo_da_Vinci\" title=\"Leonardo da Vinci\" rel=\"external_link\" target=\"_blank\">Leonardo da Vinci<\/a>'s \"study of human anatomy eventually led to the design of the first known <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot\" title=\"Robot\" rel=\"external_link\" target=\"_blank\">robot<\/a> in history.\"<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Da Vinci Surgical Systems operate in hospitals worldwide, with an estimated 200,000 surgeries conducted in 2012, most commonly for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hysterectomies\" class=\"mw-redirect\" title=\"Hysterectomies\" rel=\"external_link\" target=\"_blank\">hysterectomies<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate\" title=\"Prostate\" rel=\"external_link\" target=\"_blank\">prostate<\/a> removals.<sup id=\"rdp-ebb-cite_ref-economist_4-0\" class=\"reference\"><a href=\"#cite_note-economist-4\" rel=\"external_link\">[4]<\/a><\/sup> As of September 30, 2017, there was an installed base of 4,271 units worldwide \u2013 2,770 in the United States, 719 in Europe, 561 in Asia, and 221 in the rest of the world.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> The \"Si\" version of the system costs on average slightly under US$2 million, in addition to several hundred thousand dollars of annual maintenance fees.<sup id=\"rdp-ebb-cite_ref-techreview_6-0\" class=\"reference\"><a href=\"#cite_note-techreview-6\" rel=\"external_link\">[6]<\/a><\/sup> The da Vinci system has been criticised for its cost and for a number of issues with its surgical performance.<sup id=\"rdp-ebb-cite_ref-nyt_2-1\" class=\"reference\"><a href=\"#cite_note-nyt-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-LawyerSkill_7-0\" class=\"reference\"><a href=\"#cite_note-LawyerSkill-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Overview\">Overview<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cmglee_Cambridge_Science_Festival_2015_da_Vinci.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/Cmglee_Cambridge_Science_Festival_2015_da_Vinci.jpg\/220px-Cmglee_Cambridge_Science_Festival_2015_da_Vinci.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cmglee_Cambridge_Science_Festival_2015_da_Vinci.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>da Vinci patient-side component (left) and surgeon console (right)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cmglee_Cambridge_Science_Festival_2015_da_Vinci_console.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/68\/Cmglee_Cambridge_Science_Festival_2015_da_Vinci_console.jpg\/220px-Cmglee_Cambridge_Science_Festival_2015_da_Vinci_console.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cmglee_Cambridge_Science_Festival_2015_da_Vinci_console.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A surgeon console at the treatment centre of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Addenbrooke%27s_Hospital\" title=\"Addenbrooke's Hospital\" rel=\"external_link\" target=\"_blank\">Addenbrooke's Hospital<\/a><\/div><\/div><\/div>\n<p>The da Vinci System consists of a surgeon's console that is typically in the same room as the patient, and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, and can also act as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpels<\/a>, scissors, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovie\" class=\"mw-redirect\" title=\"Bovie\" rel=\"external_link\" target=\"_blank\">bovies<\/a>, or graspers. The surgeon uses the console's master controls to maneuver the patient-side cart's three or four robotic arms (depending on the model). The instruments\u2019 jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon's hand movements. The da Vinci System always requires a human operator, and incorporates multiple redundant safety features designed to minimize opportunities for human error when compared with traditional approaches.\n<\/p><p>The da Vinci System has been designed to improve upon conventional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopy\" title=\"Laparoscopy\" rel=\"external_link\" target=\"_blank\">laparoscopy<\/a>, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on a patient-side assistant to position the camera correctly. In contrast, the da Vinci System's design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments and using controls at the console to move the instruments and camera.\n<\/p><p>By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This line makes a lot of claims regarding the da Vinci Surgical System that read like an advertisement and have no citations. (January 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"A reliable source is needed to back this claim. (January 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"FDA_clearance\">FDA clearance<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) cleared the da Vinci Surgical System in 2000 for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures and thoracoscopically assisted cardiotomy procedures. The FDA also cleared the da Vinci System to be employed with adjunctive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mediastinotomy\" class=\"mw-redirect\" title=\"Mediastinotomy\" rel=\"external_link\" target=\"_blank\">mediastinotomy<\/a> to perform coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomosis<\/a> during cardiac <a href=\"https:\/\/en.wikipedia.org\/wiki\/Revascularization\" title=\"Revascularization\" rel=\"external_link\" target=\"_blank\">revascularization<\/a>.<sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_9-0\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>The da Vinci System has been successfully used in the following procedures:<sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_9-1\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<ul><li>Radical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostatectomy\" title=\"Prostatectomy\" rel=\"external_link\" target=\"_blank\">prostatectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyeloplasty\" title=\"Pyeloplasty\" rel=\"external_link\" target=\"_blank\">pyeloplasty<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystectomy\" title=\"Cystectomy\" rel=\"external_link\" target=\"_blank\">cystectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrectomy\" title=\"Nephrectomy\" rel=\"external_link\" target=\"_blank\">nephrectomy<\/a> and ureteral reimplantation;<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hysterectomy\" title=\"Hysterectomy\" rel=\"external_link\" target=\"_blank\">Hysterectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myomectomy\" class=\"mw-redirect\" title=\"Myomectomy\" rel=\"external_link\" target=\"_blank\">myomectomy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrocolpopexy\" class=\"mw-redirect\" title=\"Sacrocolpopexy\" rel=\"external_link\" target=\"_blank\">sacrocolpopexy<\/a>;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hiatal_hernia\" title=\"Hiatal hernia\" rel=\"external_link\" target=\"_blank\">Hiatal hernia<\/a> repair;<\/li>\n<li>Spleen-sparing distal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatectomy\" title=\"Pancreatectomy\" rel=\"external_link\" target=\"_blank\">pancreatectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nissen_fundoplication\" title=\"Nissen fundoplication\" rel=\"external_link\" target=\"_blank\">Nissen fundoplication<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heller_myotomy\" title=\"Heller myotomy\" rel=\"external_link\" target=\"_blank\">Heller myotomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastric_bypass\" class=\"mw-redirect\" title=\"Gastric bypass\" rel=\"external_link\" target=\"_blank\">gastric bypass<\/a>, donor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrectomy\" title=\"Nephrectomy\" rel=\"external_link\" target=\"_blank\">nephrectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adrenalectomy\" title=\"Adrenalectomy\" rel=\"external_link\" target=\"_blank\">adrenalectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Splenectomy\" title=\"Splenectomy\" rel=\"external_link\" target=\"_blank\">splenectomy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel_resection\" title=\"Bowel resection\" rel=\"external_link\" target=\"_blank\">bowel resection<\/a>;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_mammary_artery\" class=\"mw-redirect\" title=\"Internal mammary artery\" rel=\"external_link\" target=\"_blank\">Internal mammary artery<\/a> mobilization and cardiac tissue <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ablation\" title=\"Ablation\" rel=\"external_link\" target=\"_blank\">ablation<\/a>;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve_repair\" title=\"Mitral valve repair\" rel=\"external_link\" target=\"_blank\">Mitral valve repair<\/a> and endoscopic atrial septal defect closure;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_mammary_artery\" class=\"mw-redirect\" title=\"Internal mammary artery\" rel=\"external_link\" target=\"_blank\">Mammary<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_interventricular_branch_of_left_coronary_artery\" class=\"mw-redirect\" title=\"Anterior interventricular branch of left coronary artery\" rel=\"external_link\" target=\"_blank\">left anterior descending coronary artery<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomosis<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/CABG\" class=\"mw-redirect\" title=\"CABG\" rel=\"external_link\" target=\"_blank\">cardiac revascularization<\/a> with adjunctive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mediastinotomy\" class=\"mw-redirect\" title=\"Mediastinotomy\" rel=\"external_link\" target=\"_blank\">mediastinotomy<\/a>;<\/li>\n<li>Transoral resection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumors<\/a> of the upper aerodigestive tract (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tonsil\" title=\"Tonsil\" rel=\"external_link\" target=\"_blank\">tonsil<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongue\" title=\"Tongue\" rel=\"external_link\" target=\"_blank\">tongue<\/a> base, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Larynx\" title=\"Larynx\" rel=\"external_link\" target=\"_blank\">larynx<\/a>) and transaxillary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thyroidectomy\" title=\"Thyroidectomy\" rel=\"external_link\" target=\"_blank\">thyroidectomy<\/a><\/li>\n<li>Resection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spindle_cell\" class=\"mw-redirect\" title=\"Spindle cell\" rel=\"external_link\" target=\"_blank\">spindle cell<\/a> tumors originating in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lung<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Future_applications\">Future applications<\/span><\/h2>\n<p>Although the general term \"robotic surgery\" is often used to refer to the technology, this term can give the impression that the da Vinci System is performing the surgery autonomously. In contrast, the current da Vinci Surgical System cannot \u2013 in any manner \u2013 function on its own, as it was not designed as an autonomous system and lacks decision making software. Instead, it relies on a human operator for all input; however, all operations \u2013 including vision and motor functions - are performed through remote human-computer interaction, and thus with the appropriate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weak_AI\" title=\"Weak AI\" rel=\"external_link\" target=\"_blank\">weak AI<\/a> software, the system could in principle perform partially or completely autonomously. The difficulty with creating an autonomous system of this kind is not trivial; a major obstacle is that surgery <i>per se<\/i> is not an engineered process \u2013 a requirement for weak AI. The current system is designed merely to replicate seamlessly the movement of the surgeon's hands with the tips of micro-instruments, not to make decisions or move without the surgeon's direct input.\n<\/p><p>The possibility of long-distance operations depends on the patient having access to a da Vinci System, but technically the system could allow a doctor to perform telesurgery on a patient in another country. In 2001, Dr. Marescaux and a team from IRCAD used a combination of high-speed fiber-optic connection with an average delay of 155 ms with advanced asynchronous transfer mode (ATM) and a Zeus telemanipulator to successfully perform the first transatlantic surgical procedure, covering the distance between New York and <a href=\"https:\/\/en.wikipedia.org\/wiki\/H%C3%B4pital_civil,_Strasbourg\" title=\"H\u00f4pital civil, Strasbourg\" rel=\"external_link\" target=\"_blank\">Strasbourg<\/a>. The event was considered a milestone of global telesurgery, and was dubbed \"Operation Lindbergh\".<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Criticism\">Criticism<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery#Comparison_to_traditional_methods\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery \u00a7 Comparison to traditional methods<\/a><\/div>\n<p>Critics of robotic surgery assert that it is difficult for users to learn and that it has not been shown to be more effective than traditional laparoscopic surgery.<sup id=\"rdp-ebb-cite_ref-nyt_2-2\" class=\"reference\"><a href=\"#cite_note-nyt-2\" rel=\"external_link\">[2]<\/a><\/sup> The da Vinci system uses <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proprietary_software\" title=\"Proprietary software\" rel=\"external_link\" target=\"_blank\">proprietary software<\/a>, which cannot be modified by physicians, thereby limiting the freedom to modify the operation system.<sup id=\"rdp-ebb-cite_ref-economist_4-1\" class=\"reference\"><a href=\"#cite_note-economist-4\" rel=\"external_link\">[4]<\/a><\/sup> Furthermore, its $2 million cost places it beyond the reach of many institutions.<sup id=\"rdp-ebb-cite_ref-techreview_6-1\" class=\"reference\"><a href=\"#cite_note-techreview-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The manufacturer of the system, Intuitive Surgical, has been criticized for short-cutting FDA approval by a process known as \"premarket notification,\" which claims the product is similar to already-approved products. Intuitive has also been accused of providing inadequate training, and encouraging health care providers to reduce the number of supervised procedures required before a doctor is allowed to use the system without supervision.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> There have also been claims of patient injuries caused by stray electrical currents released from inappropriate parts of the surgical tips used by the system. Intuitive counters that the same type of stray currents can occur in non-robotic laparoscopic procedures.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> A study published in the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_the_American_Medical_Association\" class=\"mw-redirect\" title=\"Journal of the American Medical Association\" rel=\"external_link\" target=\"_blank\">Journal of the American Medical Association<\/a><\/i> found that side effects and blood loss in robotically-performed hysterectomies are no better than those performed by traditional surgery, despite the significantly greater cost of the system.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-WrightJAMA_15-0\" class=\"reference\"><a href=\"#cite_note-WrightJAMA-15\" rel=\"external_link\">[15]<\/a><\/sup> As of 2013, the FDA is investigating problems with the da Vinci robot, including deaths during surgeries that used the device; a number of related lawsuits are also underway.<sup id=\"rdp-ebb-cite_ref-LawyerSkill_7-1\" class=\"reference\"><a href=\"#cite_note-LawyerSkill-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>From a social analysis, a disadvantage is the potential for this technology to dissolve the creative freedoms of the surgeon, once hailed by scholar Timothy Lenoir as one of the most professional individual autonomous occupations to exist. Lenoir claims that in the \"heroic age of medicine,\" the surgeon was hailed as a hero for his intuitive knowledge of human anatomy and his well-crafted techniques in repairing vital body systems. Lenoir argues that the da Vinci's 3D console and robotic arms create a mediating form of action called medialization, in which internal knowledge of images and routes within the body become external knowledge mapped into simplistic computer coding.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_popular_culture\">In popular culture<\/span><\/h2>\n<p><span id=\"rdp-ebb-They_did_surgery_on_a_grape\"><\/span>\n<\/p>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internet_meme#They_did_surgery_on_a_grape\" title=\"Internet meme\" rel=\"external_link\" target=\"_blank\">Internet meme \u00a7 They did surgery on a grape<\/a><\/div>\n<p>On the August 11, 2018 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edward_Hospital\" title=\"Edward Hospital\" rel=\"external_link\" target=\"_blank\">Edward Hospital<\/a> released a video on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a> of them demonstrating the Da Vinci Si Surgical System's precision by performing the task of peeling the skin of the grape off of a grape.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> In 2017, a clip of the original video was added to a video created by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cheddar_(TV_channel)\" title=\"Cheddar (TV channel)\" rel=\"external_link\" target=\"_blank\">Cheddar<\/a>'s YouTube channel with the caption \u201cThey did surgery on a grape.\u201d. People began sharing the post with the same caption \u201cThey did surgery on a grape\u201d. The initial versions of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internet_meme\" title=\"Internet meme\" rel=\"external_link\" target=\"_blank\">meme<\/a> made fun of the dry caption in the Cheddar video, by adding the caption \u201cThey did surgery on a grape\u201d as many times as they could to their post.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> The phrase has also become very popular on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Twitter\" title=\"Twitter\" rel=\"external_link\" target=\"_blank\">Twitter<\/a>, with many tweets tying to use the phrase in as many creative ways as possible.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ZEUS_robotic_surgical_system\" title=\"ZEUS robotic surgical system\" rel=\"external_link\" target=\"_blank\">ZEUS robotic surgical system<\/a>, a rival system discontinued in 2003.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-mw-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-mw_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.marketwatch.com\/news\/story\/fascinating-visit-high-tech-operating-room\/story.aspx?guid={2BE812BD-BE91-492C-A0B2-65A0C8324430}&dist=msr_2\" target=\"_blank\">\"Robots as surgical enablers\"<\/a>. <i>MarketWatch<\/i>. 3 February 2005. Retrieved 17 March 2013.<\/span>\n<\/li>\n<li id=\"cite_note-nyt-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-nyt_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nyt_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nyt_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2008\/05\/04\/business\/04moll.html\" target=\"_blank\">\"Prepping Robots to Perform Surgery<\/a>\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times\" title=\"The New York Times\" rel=\"external_link\" target=\"_blank\">The New York Times<\/a><\/i>. 4 May 2008. Retrieved 17 March 2013.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.intuitivesurgical.com\/company\/history\/\" target=\"_blank\">\"Company \u2013 Past Present Future\"<\/a>. Intuitive Surgical<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">14 January<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Company+%E2%80%93+Past+Present+Future&rft.pub=Intuitive+Surgical&rft_id=http%3A%2F%2Fwww.intuitivesurgical.com%2Fcompany%2Fhistory%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADa+Vinci+Surgical+System\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-economist-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-economist_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-economist_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Babbage Science and technology (18 January 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.economist.com\/blogs\/babbage\/2012\/01\/surgical-robots\" target=\"_blank\">\"Surgical robots: The kindness of strangers\"<\/a>. <i>The Economist<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 February<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+Economist&rft.atitle=Surgical+robots%3A+The+kindness+of+strangers&rft.date=2012-01-18&rft.au=Babbage+Science+and+technology&rft_id=https%3A%2F%2Fwww.economist.com%2Fblogs%2Fbabbage%2F2012%2F01%2Fsurgical-robots&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADa+Vinci+Surgical+System\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/phx.corporate-ir.net\/phoenix.zhtml?c=122359&p=irol-faq\" target=\"_blank\">\"da Vinci Products FAQ\"<\/a>. Intuitive Surgical<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">7 April<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=da+Vinci+Products+FAQ&rft.pub=Intuitive+Surgical&rft_id=http%3A%2F%2Fphx.corporate-ir.net%2Fphoenix.zhtml%3Fc%3D122359%26p%3Dirol-faq&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADa+Vinci+Surgical+System\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-techreview-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-techreview_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-techreview_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.technologyreview.com\/biomedicine\/24850\/\" target=\"_blank\">\"The Slow Rise of the Robot Surgeon\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/MIT_Technology_Review\" title=\"MIT Technology Review\" rel=\"external_link\" target=\"_blank\">MIT Technology Review<\/a><\/i>. 24 March 2010. Retrieved 23 March 2013.<\/span>\n<\/li>\n<li id=\"cite_note-LawyerSkill-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-LawyerSkill_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LawyerSkill_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#.UXbJQytVTeI\">\"da Vinci Robot Allegedly Marketed to Less-Skilled Doctors\"<\/a>. LawyersandSettlements.com. 23 April 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 April<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=da+Vinci+Robot+Allegedly+Marketed+to+Less-Skilled+Doctors&rft.pub=LawyersandSettlements.com&rft.date=2013-04-23&rft_id=http%3A%2F%2Fwww.lawyersandsettlements.com%2Farticles%2Fda-Vinci-robot%2Fdavinci-lawsuit-robot-2-18655.html%23.UXbJQytVTeI&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADa+Vinci+Surgical+System\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Payne TN, Dauterive FR (2008). \"A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice\". <i>J. Minim. 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Retrieved <span class=\"nowrap\">December 5,<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Intelligencer&rft.atitle=They+Did+Surgery+on+a+Grape&rft.date=2018-11-26&rft.aulast=Feldman&rft.aufirst=Brian&rft_id=http%3A%2F%2Fnymag.com%2Fintelligencer%2F2018%2F11%2Fwhy-is-everyone-saying-they-did-surgery-on-a-grape.html%23comments&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADa+Vinci+Surgical+System\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Hess, Peter. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.inverse.com\/article\/51209-they-did-surgery-on-a-grape-but-is-the-grape-okay\" target=\"_blank\">\"<span class=\"cs1-kern-left\">\"<\/span>They Did Surgery on a Grape\" Meme Began With Legally Suspect Medical Tool\"<\/a>. <i>Inverse<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-12-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Inverse&rft.atitle=%22They+Did+Surgery+on+a+Grape%22+Meme+Began+With+Legally+Suspect+Medical+Tool&rft.aulast=Hess&rft.aufirst=Peter&rft_id=https%3A%2F%2Fwww.inverse.com%2Farticle%2F51209-they-did-surgery-on-a-grape-but-is-the-grape-okay&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADa+Vinci+Surgical+System\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Santiago, Amanda Luz Henning. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/mashable.com\/article\/they-did-surgery-on-a-grape-meme\/\" target=\"_blank\">\"<span class=\"cs1-kern-left\">'<\/span>They did surgery on a grape' is the weird meme that's your new obsession\"<\/a>. <i>Mashable<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-12-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Mashable&rft.atitle=%27They+did+surgery+on+a+grape%27+is+the+weird+meme+that%27s+your+new+obsession&rft.aulast=Santiago&rft.aufirst=Amanda+Luz+Henning&rft_id=https%3A%2F%2Fmashable.com%2Farticle%2Fthey-did-surgery-on-a-grape-meme%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADa+Vinci+Surgical+System\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=6At3zIwwk7Q\" target=\"_blank\"><span class=\"plainlinks\">\"Live robotic da Vinci radical prostatectomy during EAU congress\"<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a> by European Urological Association.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=ahyyGdNFWkg\" target=\"_blank\"><span class=\"plainlinks\">\"India's 1st Da vinci Robotic Live Surgery\"<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muljibhai_Patel_Urological_Hospital\" title=\"Muljibhai Patel Urological Hospital\" rel=\"external_link\" target=\"_blank\">Muljibhai Patel Urological Hospital<\/a>.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=9JOxJptXhdI\" target=\"_blank\"><span class=\"plainlinks\">\"da Vinci Robotic Hysterectomies \/ Uterine Fibroids\"<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/user\/EdwardHospital\" target=\"_blank\"><span class=\"plainlinks\">\"da Vinci Surgical System: Surgery on a grape\"<\/span>'s channel<\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1320\nCached time: 20181217030620\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.404 seconds\nReal time usage: 0.519 seconds\nPreprocessor visited node count: 1889\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 38143\/2097152 bytes\nTemplate argument size: 2448\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 46345\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.224\/10.000 seconds\nLua memory usage: 5.79 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 468.715 1 -total\n<\/p>\n<pre>45.39% 212.735 1 Template:Reflist\n25.43% 119.212 11 Template:Cite_web\n15.45% 72.413 2 Template:Citation_needed\n14.14% 66.277 2 Template:Fix\n 9.16% 42.915 1 Template:Infobox_robot\n 9.11% 42.721 3 Template:Cite_journal\n 7.91% 37.071 1 Template:Short_description\n 7.74% 36.287 1 Template:Infobox\n 7.31% 34.258 1 Template:Pagetype\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:18005554-1!canonical and timestamp 20181217030619 and revision id 874083907\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214643\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 15\/1000000\nPreprocessor generated node count: 66\/1000000\nPost\u2010expand include size: 81\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 4\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.155 1 - -total\n 97.26% 140.206 1 - wikipedia:Da_Vinci_Surgical_System\n 1.86% 2.684 1 - Template:Lowercase_title\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8093-0!*!*!*!*!*!* and timestamp 20181217214643 and revision id 27025\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Da_Vinci_Surgical_System\">https:\/\/www.limswiki.org\/index.php\/Da_Vinci_Surgical_System<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","063da80316fd7d92210db60034a6b06f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/Cmglee_Cambridge_Science_Festival_2015_da_Vinci.jpg\/440px-Cmglee_Cambridge_Science_Festival_2015_da_Vinci.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/68\/Cmglee_Cambridge_Science_Festival_2015_da_Vinci_console.jpg\/440px-Cmglee_Cambridge_Science_Festival_2015_da_Vinci_console.jpg"],"063da80316fd7d92210db60034a6b06f_timestamp":1545083203,"65d8fcedd73bd89ea2f154b7d5a60606_type":"article","65d8fcedd73bd89ea2f154b7d5a60606_title":"Cyberknife","65d8fcedd73bd89ea2f154b7d5a60606_url":"https:\/\/www.limswiki.org\/index.php\/Cyberknife","65d8fcedd73bd89ea2f154b7d5a60606_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCyberknife\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n This article is written like a manual or guidebook. Please help rewrite this article from a descriptive, neutral point of view, and remove advice or instruction. (September 2015) (Learn how and when to remove this template message)\nThis article contains content that is written like an advertisement. Please help improve it by removing promotional content and inappropriate external links, and by adding encyclopedic content written from a neutral point of view. (April 2017) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\n\n\n The CyberKnife M6 System, European CyberKnife Center Munich-Gro\u00dfhadern, Germany (as of 2015)\nThe CyberKnife System is a radiation therapy device manufactured by Accuray Incorporated. The system is used for treating benign tumors, malignant tumors and other medical conditions.[1] \n\nDevice \nThis device combines a lightweight linear accelerator mounted on a robotic manipulator and an integrated image guidance system. The image guidance system continually acquires stereoscopic kV images during treatment, tracks tumor motion, and guide the robotic manipulator to precisely and accurately align the treatment beam to the moving tumor. The system is designed for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). The system is also used for select 3D conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT). The CyberKnife System is designed to deliver radiotherapy more accurately than standard radiotherapy devices.\n\nHistory \nThe system was invented by John R. Adler, a Stanford University professor of neurosurgery and radiation oncology, and Peter and Russell Schonberg of Schonberg Research Corporation. The first system was installed at Stanford University in 1991 and was cleared by the FDA for clinical investigation in 1994. After years of clinical investigation the FDA cleared the system for the treatment of intracranial tumors in 1999 and for the treatment of tumors anywhere in the body in 2001. Since the original design, Accuray Incorporated released six CyberKnife System models over the years: the CyberKnife G3 System in 2005, the CyberKnife G4 System in 2007, the CyberKnife VSI System in 2009, and the CyberKnife M6 System in 2012\n\nSee also \nImage-guided radiation therapy\nHorsley\u2013Clarke apparatus\nGamma knife\nNovalis radiosurgery\nRobotic surgery\nReferences \n\n\n^ Radiosurgery\/Cyberknife. Stanford School of Medicine \n\n\nFurther reading \nKilby, W; et al. (2010). \"The CyberKnife\u00ae Robotic Radiosurgery System in 2010\". TCRT. 9 (5): 433\u2013452. CS1 maint: Explicit use of et al. (link) \nPrinciples and Practice of Stereotactic Radiosurgery, Lawrence Chin, MD and William Regine, MD, Editors (2008)\n\r\n\n\nvteRadiation oncology\r\n (ICD-9-CM V3 92.2-92.3 ICD-10-PCS D) Specific\r\ntherapiesTeletherapy1by photon\nSuperficial X-rays\nOrthovoltage X-rays\nMegavoltage X-rays\nRadiosurgery \/ Stereotactic radiation therapy\nCyberknife\nGamma Knife\nCobalt therapy\nby electron\nElectron therapy\nby hadron\nParticle therapy\nfast neutron\nneutron-capture\nproton\nBrachytherapy2\nProstate\n125I\n103Pd\nPlaque radiotherapy (125I)\nSelective internal radiation therapy \/ SIR-Spheres \/ TheraSphere (90Y)\nUnsealed source\r\nradiotherapy3 \nIobenguane (131I)\n90Y\nLexidronam (153Sm)\n89Sr\nRadioimmunotherapy\nibritumomab tiuxetan\nOther\nIntraoperative radiation therapy\nelectron\nTARGIT\nTomotherapy\nConditions\nRadiation burn\nRadiation proctitis\nRadiation-induced lung injury\nFeatures and\r\nequipment\nBEAMnrc\nBolus\nBragg peak\nD50\nDose profile\nDose verification system\nDose-volume histogram\nDosimetry\nIsocenter\nMobetron\nMonitor unit\nMultileaf collimator\nNanoimpellers\nNeutron generator\nOxygen enhancement ratio\nPencil\nPencil-beam scanning\nPercentage depth dose curve\nRadiation oncologist\nRadiation Therapist\nRadiation treatment planning\nRadiopharmacology\nTissue to Air Ratio (TAR)\n\n1 Also known as external-beam radiotherapy.    \n2 Also known as sealed-source radiation therapy.    \n3 Also known as systemic radioisotope therapy.\n\n#WHO-EM\n\u2021Withdrawn from market\nClinical trials:\n\u2020Phase III\n\u00a7Never to phase III\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cyberknife\">https:\/\/www.limswiki.org\/index.php\/Cyberknife<\/a>\n\t\t\t\t\tCategories: Computer-assisted surgeryHealth informaticsMedical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated 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noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","65d8fcedd73bd89ea2f154b7d5a60606_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Cyberknife skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Cyberknife<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p class=\"mw-empty-elt\">\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:307px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cyberknife_M6_und_MLC.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/Cyberknife_M6_und_MLC.jpg\/305px-Cyberknife_M6_und_MLC.jpg\" width=\"305\" height=\"204\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cyberknife_M6_und_MLC.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The CyberKnife M6 System, European CyberKnife Center Munich-Gro\u00dfhadern, Germany (as of 2015)<\/div><\/div><\/div>\n<p>The <b>CyberKnife<\/b> System is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiation_therapy\" title=\"Radiation therapy\" rel=\"external_link\" target=\"_blank\">radiation therapy<\/a> device manufactured by Accuray Incorporated. The system is used for treating benign tumors, malignant tumors and other medical conditions.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> \n<\/p>\n<h2><span class=\"mw-headline\" id=\"Device\">Device<\/span><\/h2>\n<p>This device combines a lightweight <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linear_particle_accelerator\" title=\"Linear particle accelerator\" rel=\"external_link\" target=\"_blank\">linear accelerator<\/a> mounted on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_robot\" title=\"Medical robot\" rel=\"external_link\" target=\"_blank\">robotic<\/a> manipulator and an integrated image guidance system. The image guidance system continually acquires <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereoscopy\" title=\"Stereoscopy\" rel=\"external_link\" target=\"_blank\">stereoscopic<\/a> kV images during treatment, tracks tumor motion, and guide the robotic manipulator to precisely and accurately align the treatment beam to the moving tumor. The system is designed for stereotactic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiosurgery\" title=\"Radiosurgery\" rel=\"external_link\" target=\"_blank\">radiosurgery<\/a> (SRS) and stereotactic body radiation therapy (SBRT). The system is also used for select 3D conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT). The CyberKnife System is designed to deliver radiotherapy more accurately than standard radiotherapy devices.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The system was invented by <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_R._Adler\" title=\"John R. Adler\" rel=\"external_link\" target=\"_blank\">John R. Adler<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stanford_University\" title=\"Stanford University\" rel=\"external_link\" target=\"_blank\">Stanford University<\/a> professor of neurosurgery and radiation oncology, and Peter and Russell Schonberg of Schonberg Research Corporation. The first system was installed at Stanford University in 1991 and was cleared by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> for clinical investigation in 1994. After years of clinical investigation the FDA cleared the system for the treatment of intracranial tumors in 1999 and for the treatment of tumors anywhere in the body in 2001. Since the original design, Accuray Incorporated released six CyberKnife System models over the years: the CyberKnife G3 System in 2005, the CyberKnife G4 System in 2007, the CyberKnife VSI System in 2009, and the CyberKnife M6 System in 2012\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_radiation_therapy\" title=\"Image-guided radiation therapy\" rel=\"external_link\" target=\"_blank\">Image-guided radiation therapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Horsley%E2%80%93Clarke_apparatus\" class=\"mw-redirect\" title=\"Horsley\u2013Clarke apparatus\" rel=\"external_link\" target=\"_blank\">Horsley\u2013Clarke apparatus<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gamma_knife\" class=\"mw-redirect\" title=\"Gamma knife\" rel=\"external_link\" target=\"_blank\">Gamma knife<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Novalis_radiosurgery\" class=\"mw-redirect\" title=\"Novalis radiosurgery\" rel=\"external_link\" target=\"_blank\">Novalis radiosurgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070903152109\/http:\/\/med.stanford.edu\/neurosurgery\/patient_care\/radiosurgery.html\" target=\"_blank\">Radiosurgery\/Cyberknife<\/a>. Stanford School of Medicine<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Kilby, W; et al. (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/dx.doi.org\/10.1177\/153303461000900502\" target=\"_blank\">\"The CyberKnife\u00ae Robotic Radiosurgery System in 2010\"<\/a>. <i>TCRT<\/i>. <b>9<\/b> (5): 433\u2013452.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=TCRT&rft.atitle=The+CyberKnife%C2%AE+Robotic+Radiosurgery+System+in+2010&rft.volume=9&rft.issue=5&rft.pages=433-452&rft.date=2010&rft.aulast=Kilby&rft.aufirst=W&rft_id=https%3A%2F%2Fdx.doi.org%2F10.1177%2F153303461000900502&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACyberknife\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.springer.com\/medicine\/surgery\/book\/978-0-387-71069-3\" target=\"_blank\">Principles and Practice of Stereotactic Radiosurgery<\/a>, Lawrence Chin, MD and William Regine, MD, Editors (2008)<\/li><\/ul>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1264\nCached time: 20181129162617\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.204 seconds\nReal time usage: 0.317 seconds\nPreprocessor visited node count: 808\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 60667\/2097152 bytes\nTemplate argument size: 7705\/2097152 bytes\nHighest expansion depth: 16\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 2312\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.095\/10.000 seconds\nLua memory usage: 2.38 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 265.918 1 -total\n<\/p>\n<pre>48.22% 128.215 3 Template:Ambox\n40.58% 107.912 1 Template:Multiple_issues\n29.22% 77.706 3 Template:Navbox\n28.74% 76.433 1 Template:Cite_journal\n23.72% 63.085 1 Template:Radiation_oncology\n11.80% 31.373 1 Template:Advert\n10.28% 27.339 1 Template:Manual\n 9.59% 25.512 4 Template:Longitem\n 7.66% 20.367 1 Template:Hlist\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:12418153-1!canonical and timestamp 20181129162616 and revision id 869023602\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cyberknife\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214643\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.031 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.048 1 - wikipedia:Cyberknife\n100.00% 160.048 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8545-0!*!*!*!*!*!* and timestamp 20181217214642 and revision id 27024\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cyberknife\">https:\/\/www.limswiki.org\/index.php\/Cyberknife<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","65d8fcedd73bd89ea2f154b7d5a60606_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/Cyberknife_M6_und_MLC.jpg\/610px-Cyberknife_M6_und_MLC.jpg"],"65d8fcedd73bd89ea2f154b7d5a60606_timestamp":1545083202,"8501d0edd9eb01e6d12e12e663f15848_type":"article","8501d0edd9eb01e6d12e12e663f15848_title":"Care-Providing Robot FRIEND","8501d0edd9eb01e6d12e12e663f15848_url":"https:\/\/www.limswiki.org\/index.php\/Care-Providing_Robot_FRIEND","8501d0edd9eb01e6d12e12e663f15848_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCare-Providing Robot FRIEND\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t[Template fetch failed for https:\/\/en.wikipedia.org\/wiki\/Care-Providing_Robot_FRIEND?action=render: HTTP 404]\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Care-Providing_Robot_FRIEND\">https:\/\/www.limswiki.org\/index.php\/Care-Providing_Robot_FRIEND<\/a>\n\t\t\t\t\tCategories: Medical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:32.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 456 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8501d0edd9eb01e6d12e12e663f15848_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Care-Providing_Robot_FRIEND skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Care-Providing Robot FRIEND<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><p>[Template fetch failed for https:\/\/en.wikipedia.org\/wiki\/Care-Providing_Robot_FRIEND?action=render: HTTP 404]\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Care-Providing_Robot_FRIEND\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214642\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.008 seconds\nReal time usage: 0.280 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 275.477 1 - wikipedia:Care-Providing_Robot_FRIEND\n100.00% 275.477 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8544-0!*!*!*!*!*!* and timestamp 20181217214642 and revision id 24969\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Care-Providing_Robot_FRIEND\">https:\/\/www.limswiki.org\/index.php\/Care-Providing_Robot_FRIEND<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8501d0edd9eb01e6d12e12e663f15848_images":[],"8501d0edd9eb01e6d12e12e663f15848_timestamp":1545083202,"ee345c211e8182e32bd5e64c6c61308d_type":"article","ee345c211e8182e32bd5e64c6c61308d_title":"Visual prosthesis","ee345c211e8182e32bd5e64c6c61308d_url":"https:\/\/www.limswiki.org\/index.php\/Visual_prosthesis","ee345c211e8182e32bd5e64c6c61308d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVisual prosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor non-functional prostheses or glass eyes, see Ocular prosthesis and Craniofacial prosthesis.\n\nA visual prosthesis, often referred to as a bionic eye, is an experimental visual device intended to restore functional vision in those suffering from partial or total blindness. Many devices have been developed, usually modeled on the cochlear implant or bionic ear devices, a type of neural prosthesis in use since the mid-1980s. The idea of using electrical current (e.g., electrically stimulating the retina or the visual cortex) to provide sight dates back to the 18th century, discussed by Benjamin Franklin,[1] Tiberius Cavallo,[2] and Charles LeRoy.[3]\n\nContents \n\n1 Biological considerations \n2 Technological considerations \n3 Ongoing projects \n\n3.1 Argus retinal prosthesis \n3.2 Microsystem-based visual prosthesis (MIVP) \n3.3 Implantable miniature telescope \n3.4 T\u00fcbingen MPDA Project Alpha IMS \n3.5 Harvard\/MIT Retinal Implant \n3.6 Artificial silicon retina (ASR) \n3.7 Photovoltaic retinal prosthesis (PRIMA) \n3.8 Bionic Vision Australia \n3.9 Dobelle Eye \n3.10 Intracortical visual prosthesis \n\n\n4 See also \n5 References \n6 External links \n\n\nBiological considerations \nThe ability to give sight to a blind person via a bionic eye depends on the circumstances surrounding the loss of sight. For retinal prostheses, which are the most prevalent visual prosthetic under development (due to ease of access to the retina among other considerations), patients with vision loss due to degeneration of photoreceptors (retinitis pigmentosa, choroideremia, geographic atrophy macular degeneration) are the best candidate for treatment. Candidates for visual prosthetic implants find the procedure most successful if the optic nerve was developed prior to the onset of blindness. Persons born with blindness may lack a fully developed optical nerve, which typically develops prior to birth[4], though neuroplasticity makes it possible for the nerve, and sight, to develop after implantation.[citation needed ]\n\nTechnological considerations \nVisual prosthetics are being developed as a potentially valuable aid for individuals with visual degradation. Argus II, co-developed at the University of Southern California (USC) Eye Institute[5] and manufactured by Second Sight Medical Products Inc., is now the only such device to have received marketing approval (CE Mark in Europe in 2011). Most other efforts remain investigational; the Retina Implant AG's Alpha IMS won a CE Mark July 2013 and is a significant improvement in resolution. It is not, however, FDA-approved in the US.[6]\n\nOngoing projects \nArgus retinal prosthesis \nMain article: Argus retinal prosthesis\nMark Humayun, who joined the faculty of the Keck School of Medicine of USC Department of Ophthalmology in 2001;[7] Eugene Dejuan, now at the University of California San Francisco; engineer Howard D. Phillips; bio-electronics engineer Wentai Liu, now at University of California Los Angeles; and Robert Greenberg, now of Second Sight, were the original inventors of the active epi-retinal prosthesis[8] and demonstrated proof of principle in acute patient investigations at Johns Hopkins University in the early 1990s. In the late 1990s the company Second Sight[9] was formed by Greenberg along with medical device entrepreneur, Alfred E. Mann,[10]:35 Their first-generation implant had 16 electrodes and was implanted in six subjects by Humayun at University of Southern California between 2002 and 2004.[10]:35 [11] In 2007, the company began a trial of its second-generation, 60-electrode implant, dubbed the Argus II, in the US and in Europe.[12][13] In total 30 subjects participated in the studies spanning 10 sites in four countries. In the spring of 2011, based on the results of the clinical study which were published in 2012,[14] Argus II was approved for commercial use in Europe, and Second Sight launched the product later that same year. The Argus II was approved by the United States FDA on 14 February 2013. Three US government funding agencies (National Eye Institute, Department of Energy, and National Science Foundation) have supported the work at Second Sight, USC, UCSC, Caltech, and other research labs.[15]\n\n Microsystem-based visual prosthesis (MIVP) \nDesigned by Claude Veraart at the University of Louvain, this is a spiral cuff electrode around the optic nerve at the back of the eye. It is connected to a stimulator implanted in a small depression in the skull. The stimulator receives signals from an externally worn camera, which are translated into electrical signals that stimulate the optic nerve directly.[16]\n\nImplantable miniature telescope \nAlthough not truly an active prosthesis, an Implantable Miniature Telescope is one type of visual implant that has met with some success in the treatment of end-stage age-related macular degeneration.[17][18][19] This type of device is implanted in the eye's posterior chamber and works by increasing (by about three times) the size of the image projected onto the retina in order to overcome a centrally located scotoma or blind spot.[18][19]\nCreated by VisionCare Ophthalmic Technologies in conjunction with the CentraSight Treatment Program, the telescope is about the size of a pea and is implanted behind the iris of one eye. Images are projected onto healthy areas of the central retina, outside the degenerated macula, and is enlarged to reduce the effect the blind spot has on central vision. 2.2x or 2.7x magnification strengths make it possible to see or discern the central vision object of interest while the other eye is used for peripheral vision because the eye that has the implant will have limited peripheral vision as a side effect. Unlike a telescope which would be hand-held, the implant moves with the eye which is the main advantage. Patients using the device may however still need glasses for optimal vision and for close work. Before surgery, patients should first try out a hand-held telescope to see if they would benefit from image enlargement. One of the main drawbacks is that it cannot be used for patients who have had cataract surgery as the intraocular lens would obstruct insertion of the telescope. It also requires a large incision in the cornea to insert.[20]\n\n T\u00fcbingen MPDA Project Alpha IMS \nA Southern German team led by the University Eye Hospital in T\u00fcbingen, was formed in 1995 by Eberhart Zrenner to develop a subretinal prosthesis.\nThe chip is located behind the retina and utilizes microphotodiode arrays (MPDA) which collect incident light and transform it into electrical current stimulating the retinal ganglion cells.\nAs natural photoreceptors are far more efficient than photodiodes, visible light is not powerful enough to stimulate the MPDA. Therefore, an external power supply is used to enhance the stimulation current. The German team commenced in vivo experiments in 2000, when evoked cortical potentials were measured from Yucat\u00e1n micropigs and rabbits. At 14 months post implantation, the implant and retina surrounding it were examined and there were no noticeable changes to anatomical integrity. The implants were successful in producing evoked cortical potentials in half of the animals tested. The thresholds identified in this study were similar to those required in epiretinal stimulation.\nLater reports from this group concern the results of a clinical pilot study on 11 participants suffering from RP. Some blind patients were able to read letters, recognize unknown objects, localize a plate, a cup and cutlery.[21] Two of the patients were found to make microsaccades similar to those of healthy control participants, and the properties of the eye movements depended on the stimuli that the patients were viewing--suggesting that eye movements might be useful measures for evaluating vision restored by implants.[22][23] \nIn 2010 a new multicenter Study has been started using a fully implantable device with 1500 Electrodes Alpha IMS (produced by Retina Implant AG, Reutlingen, Germany), 10 patients included so far; first results have been presented at ARVO 2011.[citation needed ] The first UK implantations took place in March 2012 and were led by Robert MacLaren at the University of Oxford and Tim Jackson at King's College Hospital in London.[24][25] David Wong also implanted the T\u00fcbingen device in a patient in Hong Kong.[26] In all cases previously blind patients had some degree of sight restored.[citation needed ]\n\n Harvard\/MIT Retinal Implant \nJoseph Rizzo and John Wyatt at the Massachusetts Eye and Ear Infirmary and MIT began researching the feasibility of a retinal prosthesis in 1989, and performed a number of proof-of-concept epiretinal stimulation trials on blind volunteers between 1998 and 2000. They have since developed a subretinal stimulator, an array of electrodes, that is placed beneath the retina in the subretinal space and receives image signals beamed from a camera mounted on a pair of glasses. The stimulator chip decodes the picture information beamed from the camera and stimulates retinal ganglion cells accordingly. Their second generation prosthesis collects data and sends it to the implant through RF fields from transmitter coils that are mounted on the glasses. A secondary receiver coil is sutured around the iris.[27]\n\n Artificial silicon retina (ASR) \nThe brothers Alan Chow and Vincent Chow have developed a microchip containing 3500 photodiodes, which detect light and convert it into electrical impulses, which stimulate healthy retinal ganglion cells. The ASR requires no externally worn devices.[16]\nThe original Optobionics Corp. stopped operations, but Chow acquired the Optobionics name, the ASR implants and plans to reorganize a new company under the same name.[28] The ASR microchip is a 2mm in diameter silicon chip (same concept as computer chips) containing ~5,000 microscopic solar cells called \"microphotodiodes\" that each have their own stimulating electrode.[29]\n\n Photovoltaic retinal prosthesis (PRIMA) \nDaniel Palanker and his group at Stanford University have developed a photovoltaic retinal prosthesis[30] that includes a subretinal photodiode array and an infrared image projection system mounted on video goggles. Images captured by video camera are processed in a pocket PC and displayed on video goggles using pulsed near-infrared (IR, 880\u2013915 nm) light. These images are projected onto the retina via natural eye optics, and photodiodes in the subretinal implant convert light into pulsed bi-phasic electric current in each pixel.[31] Electric current flowing through the tissue between the active and return electrode in each pixel stimulates the nearby inner retinal neurons, primarily the bipolar cells, which transmit excitatory responses to the retinal ganglion cells. \nThis technology is being commercialized by Pixium Vision (PRIMA), and is being evaluated in a clinical trial (2018).\nFollowing this proof of concept, Palanker group is focusing now on developing pixels smaller than 50\u03bcm using 3-D electrodes and utilizing the effect of retinal migration into voids in the subretinal implant.\n\nBionic Vision Australia \nAn Australian team led by Professor Anthony Burkitt is developing two retinal prostheses. The Wide-View device combines novel technologies with materials that have been successfully used in other clinical implants. This approach incorporates a microchip with 98 stimulating electrodes and aims to provide increased mobility for patients to help them move safely in their environment. This implant will be placed in the suprachoroidal space. Researchers expect the first patient tests to begin with this device in 2013.\nThe Bionic Vision Australia consortium is concurrently developing the High-Acuity device, which incorporates a number of new technologies to bring together a microchip and an implant with 1024 electrodes. The device aims to provide functional central vision to assist with tasks such as face recognition and reading large print. This high-acuity implant will be inserted epiretinally. Patient tests are planned for this device in 2014 once preclinical testing has been completed.\nPatients with retinitis pigmentosa will be the first to participate in the studies, followed by age-related macular degeneration. Each prototype consists of a camera, attached to a pair of glasses which sends the signal to the implanted microchip, where it is converted into electrical impulses to stimulate the remaining healthy neurons in the retina. This information is then passed on to the optic nerve and the vision processing centres of the brain.\nThe Australian Research Council awarded Bionic Vision Australia a $42 million grant in December 2009 and the consortium was officially launched in March 2010. Bionic Vision Australia brings together a multidisciplinary team, many of whom have extensive experience developing medical devices such as the cochlear implant (or 'bionic ear').[32]\n\nDobelle Eye \nMain article: William H. Dobelle\nSimilar in function to the Harvard\/MIT device, except the stimulator chip sits in the primary visual cortex, rather than on the retina. Many subjects have been implanted with a high success rate and limited negative effects. Still in the developmental phase, upon the death of Dobelle, selling the eye for profit was ruled against[by whom? ] in favor of donating it to a publicly funded research team.[16][33]\n\nIntracortical visual prosthesis \nThe Laboratory of Neural Prosthetics at Illinois Institute Of Technology (IIT), Chicago, is developing a visual prosthetic using intracortical electrode arrays. While similar in principle to the Dobelle system, the use of intracortical electrodes allow for greatly increased spatial resolution in the stimulation signals (more electrodes per unit area). In addition, a wireless telemetry system is being developed[34] to eliminate the need for transcranial wires. Arrays of activated iridium oxide film (AIROF)-coated electrodes will be implanted in the visual cortex, located on the occipital lobe of the brain. External hardware will capture images, process them, and generate instructions which will then be transmitted to implanted circuitry via a telemetry link. The circuitry will decode the instructions and stimulate the electrodes, in turn stimulating the visual cortex. The group is developing a wearable external image capture and processing system to accompany the implanted circuitry. Studies on animals and psyphophysical studies on humans are being conducted[35] to test the feasibility of a human volunteer implant.[citation needed ]\n\nSee also \nBionic contact lens\nHuman echolocation\nReferences \n\n\n^ Dobelle WH (2000). \"Artificial vision for the blind by connecting a television camera to the visual cortex\" (PDF) . Asaio J. 46 (1): 3\u20139. doi:10.1097\/00002480-200001000-00002. PMID 10667705. Archived from the original (PDF) on 27 March 2014. Retrieved 21 July 2013 . \n\n^ Fodstad, H.; Hariz, M. (2007). \"Electricity in the treatment of nervous system disease\". In Sakas, Damianos E.; Krames, Elliot S.; Simpson, Brian A. Operative Neuromodulation. Springer. p. 11. ISBN 9783211330791. Retrieved 21 July 2013 . \n\n^ Sekirnjak C; Hottowy P; Sher A; Dabrowski W; et al. (2008). \"High-resolution electrical stimulation of primate retina for epiretinal implant design\". J Neurosci. 28 (17): 4446\u201356. doi:10.1523\/jneurosci.5138-07.2008. PMC 2681084 . PMID 18434523. Retrieved 21 July 2013 . \n\n^ Provis, Jan M; Van Driel, Diana; Billson, Frank A; Russell, Peter (1985). \"Human fetal optic nerve: Overproduction and elimination of retinal axons during development\". The Journal of Comparative Neurology. 238 (1): 92\u2013100. doi:10.1002\/cne.902380108. PMID 4044906. \n\n^ \"USC Eye Institute ophthalmologists implant first FDA-approved Argus II retinal prosthesis in western United States\". Reuters. 27 August 2014. Archived from the original on 5 January 2015. Retrieved 5 January 2015 . \n\n^ Chuang AT, Margo CE, Greenberg PB (Jul 2014). \"Retinal implants: a systematic review\". Br J Ophthalmol. 98 (7): 852\u201356. doi:10.1136\/bjophthalmol-2013-303708. PMID 24403565. \n\n^ \"Humayun faculty page at USC Keck\". Retrieved February 15, 2015 . \n\n^ U.S. Department of Energy Office of Science. \"Overview of the Artificial Retina Project\". \n\n^ \"Second Sight official website\". 2-sight.com. 2015-05-21. Retrieved 2018-06-12 . \n\n^ a b Second Sight. November 14, 2014 Second Sight Amendment No. 3 to Form S-1: Registration Statement \n\n^ Miriam Karmel (March 2012). \"Clinical Update: Retina. Retinal Prostheses: Progress and Problems\". Eyenet Magazine. \n\n^ Second Sight (9 January 2007). \"Press Release: Ending the Journey through Darkness: Innovative Technology Offers New Hope for Treating Blindness due to Retinitis Pigmentosa\" (PDF) . \n\n^ Jonathan Fildes (16 February 2007). \"Trials for bionic eye implants\". BBC. \n\n^ Humayun (April 2012). \"Interim Results from the International Trial of Second Sight's Visual Prosthesis\". Ophthalmology. \n\n^ Sifferlin, Alexandra (19 February 2013). \"FDA approves first bionic eye\". CNN. TIME. Retrieved 22 February 2013 . \n\n^ a b c James Geary (2002). The Body Electric. Phoenix. \n\n^ Chun DW; Heier JS; Raizman MB (2005). \"Visual prosthetic device for bilateral end-stage macular degeneration\". Expert Rev Med Devices. 2 (6): 657\u201365. doi:10.1586\/17434440.2.6.657. PMID 16293092. \n\n^ a b Lane SS; Kuppermann BD; Fine IH; Hamill MB; et al. (2004). \"A prospective multicenter clinical trial to evaluate the safety and effectiveness of the implantable miniature telescope\". Am J Ophthalmol. 137 (6): 993\u20131001. doi:10.1016\/j.ajo.2004.01.030. PMID 15183782. \n\n^ a b Lane SS; Kuppermann BD (2006). \"The Implantable Miniature Telescope for macular degeneration\". Current Opinion in Ophthalmology. 17 (1): 94\u201398. doi:10.1097\/01.icu.0000193067.86627.a1. PMID 16436930. \n\n^ Lipshitz, Isaac. \"Implantable Telescope Technology\". VisionCare Ophthalmic Technologies, Inc. Retrieved 20 March 2011 . \n\n^ Eberhart Zrenner; et al. (2010). \"Subretinal electronic chips allow blind patients to read letters and combine them to words\". Proceedings of the Royal Society B. 278 (1711): 1489\u201397. doi:10.1098\/rspb.2010.1747. PMC 3081743 . PMID 21047851. \n\n^ Alexander, Robert; Macknik, Stephen; Martinez-Conde, Susana (2018). \"Microsaccade Characteristics in Neurological and Ophthalmic Disease\". Frontiers in Neurology. 9 (144). doi:10.3389\/fneur.2018.00144. \n\n^ Hafed, Z; Stingl, K; Bartz-Schmidt, K; Gekeler, F; Zrenner, E. \"Oculomotor behavior of blind patients seeing with a subretinal visual implant\". Vision Research. doi:10.1016\/j.visres.2015.04.006. \n\n^ \"Blind man 'excited' at retina implant\". BBC News. 3 May 2012. Retrieved May 23, 2016 . \n\n^ Fergus Walsh (3 May 2012). \"Two blind British men have electronic retinas fitted\". BBC News. Retrieved May 23, 2016 . \n\n^ \"HKU performed the first subretinal microchip implantation in Asia Patient regained eyesight after the surgery\". HKU.hk (Press release). The University of Hong Kong. 3 May 2012. Retrieved May 23, 2016 . \n\n^ Wyatt, Jr., J.L. \"The Retinal Implant Project\" (PDF) . Research Laboratory of Electronics (RLE) at the Massachusetts Institute of Technology (MIT). Retrieved 20 March 2011 . \n\n^ \"ASR\u00ae Device\". Optobionics. Retrieved 20 March 2011 . \n\n^ \"ASR\u00ae Device\". Optobionics. Retrieved 20 March 2011 . \n\n^ Palanker Group. \"Photovoltaic Retinal Prosthesis\". \n\n^ K. Mathieson; J. Loudin; G. Goetz; P. Huie; L. Wang; T. Kamins; L. Galambos; R. Smith; J.S. Harris; A. Sher; D. Palanker (2012). \"Photovoltaic retinal prosthesis with high pixel density\". Nature Photonics. 6 (6): 391\u201397. doi:10.1038\/nphoton.2012.104. PMC 3462820 . PMID 23049619. \n\n^ \"Bionic Vision Australia's progress of the bionic eye\". Retrieved 23 July 2012 . (Subscription required (help )) . \n\n^ Simon Ings (2007). \"Chapter 10(3): Making eyes to see\". The Eye: a natural history. London: Bloomsbury. pp. 276\u201383. \n\n^ Rush, Alexander; PR Troyk (November 2012). \"A Power and Data Link for a Wireless-Implanted Neural Recording System\". Transactions on Biomedical Engineering. 59 (11): 3255\u201362. doi:10.1109\/tbme.2012.2214385. PMID 22922687. Retrieved 26 September 2013 . \n\n^ Srivastava, Nishant; PR Troyk; G Dagnelie (June 2009). \"Detection, eye-hand coordination and virtual mobility performance in simulated vision for a cortical visual prosthesis device\". Journal of Neural Engineering. 6 (3): 035008. doi:10.1088\/1741-2560\/6\/3\/035008. PMC 3902177 . 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:32.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 664 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ee345c211e8182e32bd5e64c6c61308d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Visual_prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Visual prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For non-functional prostheses or glass eyes, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ocular_prosthesis\" title=\"Ocular prosthesis\" rel=\"external_link\" target=\"_blank\">Ocular prosthesis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniofacial_prosthesis\" title=\"Craniofacial prosthesis\" rel=\"external_link\" target=\"_blank\">Craniofacial prosthesis<\/a>.<\/div>\n<p class=\"mw-empty-elt\">\n<\/p><p>A <b>visual prosthesis<\/b>, often referred to as a <b>bionic eye<\/b>, is an experimental visual device intended to restore functional vision in those suffering from partial or total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blindness\" class=\"mw-redirect\" title=\"Blindness\" rel=\"external_link\" target=\"_blank\">blindness<\/a>. Many devices have been developed, usually modeled on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implant<\/a> or bionic ear devices, a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">neural prosthesis<\/a> in use since the mid-1980s. The idea of using electrical current (e.g., electrically stimulating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_cortex\" title=\"Visual cortex\" rel=\"external_link\" target=\"_blank\">visual cortex<\/a>) to provide sight dates back to the 18th century, discussed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benjamin_Franklin\" title=\"Benjamin Franklin\" rel=\"external_link\" target=\"_blank\">Benjamin Franklin<\/a>,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tiberius_Cavallo\" title=\"Tiberius Cavallo\" rel=\"external_link\" target=\"_blank\">Tiberius Cavallo<\/a>,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> and Charles LeRoy.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Biological_considerations\">Biological considerations<\/span><\/h2>\n<p>The ability to give sight to a blind person via a bionic eye depends on the circumstances surrounding the loss of sight. For retinal prostheses, which are the most prevalent visual prosthetic under development (due to ease of access to the retina among other considerations), patients with vision loss due to degeneration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoreceptor_cell\" title=\"Photoreceptor cell\" rel=\"external_link\" target=\"_blank\">photoreceptors<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">retinitis pigmentosa<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Choroideremia\" title=\"Choroideremia\" rel=\"external_link\" target=\"_blank\">choroideremia<\/a>, geographic atrophy macular degeneration) are the best candidate for treatment. Candidates for visual prosthetic implants find the procedure most successful if the optic nerve was developed prior to the onset of blindness. Persons born with blindness may lack a fully developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_nerve\" class=\"mw-redirect\" title=\"Optical nerve\" rel=\"external_link\" target=\"_blank\">optical nerve<\/a>, which typically develops prior to birth<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>, though <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroplasticity\" title=\"Neuroplasticity\" rel=\"external_link\" target=\"_blank\">neuroplasticity<\/a> makes it possible for the nerve, and sight, to develop after implantation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technological_considerations\">Technological considerations<\/span><\/h2>\n<p>Visual prosthetics are being developed as a potentially valuable aid for individuals with visual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradation\" title=\"Biodegradation\" rel=\"external_link\" target=\"_blank\">degradation<\/a>. Argus II, co-developed at the University of Southern California (USC) Eye Institute<sup id=\"rdp-ebb-cite_ref-Reuters_5-0\" class=\"reference\"><a href=\"#cite_note-Reuters-5\" rel=\"external_link\">[5]<\/a><\/sup> and manufactured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Second_Sight_Medical_Products\" class=\"mw-redirect\" title=\"Second Sight Medical Products\" rel=\"external_link\" target=\"_blank\">Second Sight Medical Products<\/a> Inc., is now the only such device to have received marketing approval (CE Mark in Europe in 2011). Most other efforts remain investigational; the Retina Implant AG's Alpha IMS won a CE Mark July 2013 and is a significant improvement in resolution. It is not, however, FDA-approved in the US.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Ongoing_projects\">Ongoing projects<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Argus_retinal_prosthesis\">Argus retinal prosthesis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argus_retinal_prosthesis\" title=\"Argus retinal prosthesis\" rel=\"external_link\" target=\"_blank\">Argus retinal prosthesis<\/a><\/div>\n<p>Mark Humayun, who joined the faculty of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keck_School_of_Medicine_of_USC\" title=\"Keck School of Medicine of USC\" rel=\"external_link\" target=\"_blank\">Keck School of Medicine of USC<\/a> Department of Ophthalmology in 2001;<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Eugene Dejuan, now at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California_San_Francisco\" class=\"mw-redirect\" title=\"University of California San Francisco\" rel=\"external_link\" target=\"_blank\">University of California San Francisco<\/a>; engineer Howard D. Phillips; bio-electronics engineer Wentai Liu, now at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California_Los_Angeles\" class=\"mw-redirect\" title=\"University of California Los Angeles\" rel=\"external_link\" target=\"_blank\">University of California Los Angeles<\/a>; and Robert Greenberg, now of Second Sight, were the original inventors of the active epi-retinal prosthesis<sup id=\"rdp-ebb-cite_ref-ERP_8-0\" class=\"reference\"><a href=\"#cite_note-ERP-8\" rel=\"external_link\">[8]<\/a><\/sup> and demonstrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proof_of_principle\" class=\"mw-redirect\" title=\"Proof of principle\" rel=\"external_link\" target=\"_blank\">proof of principle<\/a> in acute patient investigations at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johns_Hopkins_University\" title=\"Johns Hopkins University\" rel=\"external_link\" target=\"_blank\">Johns Hopkins University<\/a> in the early 1990s. In the late 1990s the company Second Sight<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> was formed by Greenberg along with medical device entrepreneur, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alfred_E._Mann\" title=\"Alfred E. Mann\" rel=\"external_link\" target=\"_blank\">Alfred E. Mann<\/a>,<sup id=\"rdp-ebb-cite_ref-S1_10-0\" class=\"reference\"><a href=\"#cite_note-S1-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>35<\/span><\/sup> Their first-generation implant had 16 electrodes and was implanted in six subjects by Humayun at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Southern_California\" title=\"University of Southern California\" rel=\"external_link\" target=\"_blank\">University of Southern California<\/a> between 2002 and 2004.<sup id=\"rdp-ebb-cite_ref-S1_10-1\" class=\"reference\"><a href=\"#cite_note-S1-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>35<\/span><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> In 2007, the company began a trial of its second-generation, 60-electrode implant, dubbed the Argus II, in the US and in Europe.<sup id=\"rdp-ebb-cite_ref-SSannounce_12-0\" class=\"reference\"><a href=\"#cite_note-SSannounce-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BBC_13-0\" class=\"reference\"><a href=\"#cite_note-BBC-13\" rel=\"external_link\">[13]<\/a><\/sup> In total 30 subjects participated in the studies spanning 10 sites in four countries. In the spring of 2011, based on the results of the clinical study which were published in 2012,<sup id=\"rdp-ebb-cite_ref-Ophthalmology_14-0\" class=\"reference\"><a href=\"#cite_note-Ophthalmology-14\" rel=\"external_link\">[14]<\/a><\/sup> Argus II was approved for commercial use in Europe, and Second Sight launched the product later that same year. The Argus II was approved by the United States FDA on 14 February 2013. Three US government funding agencies (National Eye Institute, Department of Energy, and National Science Foundation) have supported the work at Second Sight, USC, UCSC, Caltech, and other research labs.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Microsystem-based_visual_prosthesis_.28MIVP.29\"><\/span><span class=\"mw-headline\" id=\"Microsystem-based_visual_prosthesis_(MIVP)\">Microsystem-based visual prosthesis (MIVP)<\/span><\/h3>\n<p>Designed by Claude Veraart at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Universit%C3%A9_catholique_de_Louvain\" title=\"Universit\u00e9 catholique de Louvain\" rel=\"external_link\" target=\"_blank\">University of Louvain<\/a>, this is a spiral cuff electrode around the optic nerve at the back of the eye. It is connected to a stimulator implanted in a small depression in the skull. The stimulator receives signals from an externally worn camera, which are translated into electrical signals that stimulate the optic nerve directly.<sup id=\"rdp-ebb-cite_ref-Geary_16-0\" class=\"reference\"><a href=\"#cite_note-Geary-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Implantable_miniature_telescope\">Implantable miniature telescope<\/span><\/h3>\n<p>Although not truly an active prosthesis, an Implantable Miniature Telescope is one type of visual implant that has met with some success in the treatment of end-stage <a href=\"https:\/\/en.wikipedia.org\/wiki\/Age-related_macular_degeneration\" class=\"mw-redirect\" title=\"Age-related macular degeneration\" rel=\"external_link\" target=\"_blank\">age-related macular degeneration<\/a>.<sup id=\"rdp-ebb-cite_ref-Chun_17-0\" class=\"reference\"><a href=\"#cite_note-Chun-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Lane_1_18-0\" class=\"reference\"><a href=\"#cite_note-Lane_1-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Lane_2_19-0\" class=\"reference\"><a href=\"#cite_note-Lane_2-19\" rel=\"external_link\">[19]<\/a><\/sup> This type of device is implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_chamber\" class=\"mw-redirect\" title=\"Posterior chamber\" rel=\"external_link\" target=\"_blank\">posterior chamber<\/a> and works by increasing (by about three times) the size of the image projected onto the retina in order to overcome a centrally located <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scotoma\" title=\"Scotoma\" rel=\"external_link\" target=\"_blank\">scotoma<\/a> or blind spot.<sup id=\"rdp-ebb-cite_ref-Lane_1_18-1\" class=\"reference\"><a href=\"#cite_note-Lane_1-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Lane_2_19-1\" class=\"reference\"><a href=\"#cite_note-Lane_2-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>Created by VisionCare Ophthalmic Technologies in conjunction with the CentraSight Treatment Program, the telescope is about the size of a pea and is implanted behind the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iris_(anatomy)\" title=\"Iris (anatomy)\" rel=\"external_link\" target=\"_blank\">iris<\/a> of one eye. Images are projected onto healthy areas of the central retina, outside the degenerated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Macula\" class=\"mw-redirect\" title=\"Macula\" rel=\"external_link\" target=\"_blank\">macula<\/a>, and is enlarged to reduce the effect the blind spot has on central vision. 2.2x or 2.7x magnification strengths make it possible to see or discern the central vision object of interest while the other eye is used for peripheral vision because the eye that has the implant will have limited peripheral vision as a side effect. Unlike a telescope which would be hand-held, the implant moves with the eye which is the main advantage. Patients using the device may however still need glasses for optimal vision and for close work. Before surgery, patients should first try out a hand-held telescope to see if they would benefit from image enlargement. One of the main drawbacks is that it cannot be used for patients who have had <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract_surgery\" title=\"Cataract surgery\" rel=\"external_link\" target=\"_blank\">cataract surgery<\/a> as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraocular_lens\" title=\"Intraocular lens\" rel=\"external_link\" target=\"_blank\">intraocular lens<\/a> would obstruct insertion of the telescope. It also requires a large incision in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a> to insert.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-T.C3.BCbingen_MPDA_Project_Alpha_IMS\"><\/span><span class=\"mw-headline\" id=\"T\u00fcbingen_MPDA_Project_Alpha_IMS\">T\u00fcbingen MPDA Project Alpha IMS<\/span><\/h3>\n<p>A Southern German team led by the University Eye Hospital in T\u00fcbingen, was formed in 1995 by Eberhart Zrenner to develop a subretinal prosthesis.\nThe chip is located behind the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a> and utilizes microphotodiode arrays (MPDA) which collect incident light and transform it into electrical current stimulating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_ganglion_cell\" title=\"Retinal ganglion cell\" rel=\"external_link\" target=\"_blank\">retinal ganglion cells<\/a>.\nAs natural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoreceptor_cell\" title=\"Photoreceptor cell\" rel=\"external_link\" target=\"_blank\">photoreceptors<\/a> are far more efficient than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photodiode\" title=\"Photodiode\" rel=\"external_link\" target=\"_blank\">photodiodes<\/a>, visible light is not powerful enough to stimulate the MPDA. Therefore, an external power supply is used to enhance the stimulation current. The German team commenced in vivo experiments in 2000, when evoked cortical potentials were measured from Yucat\u00e1n micropigs and rabbits. At 14 months post implantation, the implant and retina surrounding it were examined and there were no noticeable changes to anatomical integrity. The implants were successful in producing evoked cortical potentials in half of the animals tested. The thresholds identified in this study were similar to those required in epiretinal stimulation.\nLater reports from this group concern the results of a clinical pilot study on 11 participants suffering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">RP<\/a>. Some blind patients were able to read letters, recognize unknown objects, localize a plate, a cup and cutlery.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> Two of the patients were found to make similar to those of healthy control participants, and the properties of the eye movements depended on the stimuli that the patients were viewing--suggesting that eye movements might be useful measures for evaluating vision restored by implants.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> \nIn 2010 a new multicenter Study has been started using a fully implantable device with 1500 Electrodes Alpha IMS (produced by Retina Implant AG, Reutlingen, Germany), 10 patients included so far; first results have been presented at ARVO 2011.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2018)\">citation needed<\/span><\/a><\/i>]<\/sup> The first UK implantations took place in March 2012 and were led by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_MacLaren\" title=\"Robert MacLaren\" rel=\"external_link\" target=\"_blank\">Robert MacLaren<\/a> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Oxford\" title=\"University of Oxford\" rel=\"external_link\" target=\"_blank\">University of Oxford<\/a> and at <a href=\"https:\/\/en.wikipedia.org\/wiki\/King%27s_College_Hospital\" title=\"King's College Hospital\" rel=\"external_link\" target=\"_blank\">King's College Hospital<\/a> in London.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> also implanted the T\u00fcbingen device in a patient in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hong_Kong\" title=\"Hong Kong\" rel=\"external_link\" target=\"_blank\">Hong Kong<\/a>.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> In all cases previously blind patients had some degree of sight restored.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Harvard.2FMIT_Retinal_Implant\"><\/span><span class=\"mw-headline\" id=\"Harvard\/MIT_Retinal_Implant\">Harvard\/MIT Retinal Implant<\/span><\/h3>\n<p>Joseph Rizzo and John Wyatt at the Massachusetts Eye and Ear Infirmary and MIT began researching the feasibility of a retinal prosthesis in 1989, and performed a number of proof-of-concept epiretinal stimulation trials on blind volunteers between 1998 and 2000. They have since developed a subretinal stimulator, an array of electrodes, that is placed beneath the retina in the subretinal space and receives image signals beamed from a camera mounted on a pair of glasses. The stimulator chip decodes the picture information beamed from the camera and stimulates retinal ganglion cells accordingly. Their second generation prosthesis collects data and sends it to the implant through RF fields from transmitter coils that are mounted on the glasses. A secondary receiver coil is sutured around the iris.<sup id=\"rdp-ebb-cite_ref-RLE_Progress_Report_151_27-0\" class=\"reference\"><a href=\"#cite_note-RLE_Progress_Report_151-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Artificial_silicon_retina_.28ASR.29\"><\/span><span class=\"mw-headline\" id=\"Artificial_silicon_retina_(ASR)\">Artificial silicon retina (ASR)<\/span><\/h3>\n<p>The brothers Alan Chow and Vincent Chow have developed a microchip containing 3500 photodiodes, which detect light and convert it into electrical impulses, which stimulate healthy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_ganglion_cell\" title=\"Retinal ganglion cell\" rel=\"external_link\" target=\"_blank\">retinal ganglion cells<\/a>. The ASR requires no externally worn devices.<sup id=\"rdp-ebb-cite_ref-Geary_16-1\" class=\"reference\"><a href=\"#cite_note-Geary-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>The original Optobionics Corp. stopped operations, but Chow acquired the Optobionics name, the ASR implants and plans to reorganize a new company under the same name.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> The ASR microchip is a 2mm in diameter silicon chip (same concept as computer chips) containing ~5,000 microscopic solar cells called \"microphotodiodes\" that each have their own stimulating electrode.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Photovoltaic_retinal_prosthesis_.28PRIMA.29\"><\/span><span class=\"mw-headline\" id=\"Photovoltaic_retinal_prosthesis_(PRIMA)\">Photovoltaic retinal prosthesis (PRIMA)<\/span><\/h3>\n<p><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/web.stanford.edu\/~palanker\/lab\/retinalpros.html\" target=\"_blank\">Daniel Palanker and his group<\/a> at Stanford University have developed a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photovoltaic_retinal_prosthesis\" title=\"Photovoltaic retinal prosthesis\" rel=\"external_link\" target=\"_blank\">photovoltaic<\/a> retinal prosthesis<sup id=\"rdp-ebb-cite_ref-Palanker_30-0\" class=\"reference\"><a href=\"#cite_note-Palanker-30\" rel=\"external_link\">[30]<\/a><\/sup> that includes a subretinal photodiode array and an infrared image projection system mounted on video goggles. Images captured by video camera are processed in a pocket PC and displayed on video goggles using pulsed near-infrared (IR, 880\u2013915 nm) light. These images are projected onto the retina via natural eye optics, and photodiodes in the subretinal implant convert light into pulsed bi-phasic electric current in each pixel.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> Electric current flowing through the tissue between the active and return electrode in each pixel stimulates the nearby inner retinal neurons, primarily the bipolar cells, which transmit excitatory responses to the retinal ganglion cells. \nThis technology is being commercialized by Pixium Vision (<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pixium-vision.com\/en\/technology-1\/prima-vision-restoration-system\" target=\"_blank\">PRIMA<\/a>), and is being evaluated in a clinical trial (2018).\nFollowing this proof of concept, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/web.stanford.edu\/~palanker\/lab\/index.html\" target=\"_blank\">Palanker group<\/a> is focusing now on developing pixels smaller than 50\u03bcm using 3-D electrodes and utilizing the effect of retinal migration into voids in the subretinal implant.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bionic_Vision_Australia\">Bionic Vision Australia<\/span><\/h3>\n<p>An Australian team led by Professor Anthony Burkitt is developing two retinal prostheses. The Wide-View device combines novel technologies with materials that have been successfully used in other clinical implants. This approach incorporates a microchip with 98 stimulating electrodes and aims to provide increased mobility for patients to help them move safely in their environment. This implant will be placed in the suprachoroidal space. Researchers expect the first patient tests to begin with this device in 2013.\n<\/p><p>The Bionic Vision Australia consortium is concurrently developing the High-Acuity device, which incorporates a number of new technologies to bring together a microchip and an implant with 1024 electrodes. The device aims to provide functional central vision to assist with tasks such as face recognition and reading large print. This high-acuity implant will be inserted epiretinally. Patient tests are planned for this device in 2014 once preclinical testing has been completed.\n<\/p><p>Patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">retinitis pigmentosa<\/a> will be the first to participate in the studies, followed by age-related macular degeneration. Each prototype consists of a camera, attached to a pair of glasses which sends the signal to the implanted microchip, where it is converted into electrical impulses to stimulate the remaining healthy neurons in the retina. This information is then passed on to the optic nerve and the vision processing centres of the brain.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Australian_Research_Council\" title=\"Australian Research Council\" rel=\"external_link\" target=\"_blank\">Australian Research Council<\/a> awarded Bionic Vision Australia a $42 million grant in December 2009 and the consortium was officially launched in March 2010. Bionic Vision Australia brings together a multidisciplinary team, many of whom have extensive experience developing medical devices such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implant<\/a> (or 'bionic ear').<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dobelle_Eye\">Dobelle Eye<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_H._Dobelle\" title=\"William H. Dobelle\" rel=\"external_link\" target=\"_blank\">William H. Dobelle<\/a><\/div>\n<p>Similar in function to the Harvard\/MIT device, except the stimulator chip sits in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Primary_visual_cortex\" class=\"mw-redirect\" title=\"Primary visual cortex\" rel=\"external_link\" target=\"_blank\">primary visual cortex<\/a>, rather than on the retina. Many subjects have been implanted with a high success rate and limited negative effects. Still in the developmental phase, upon the death of Dobelle, selling the eye for profit was ruled against<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\" title=\"Wikipedia:Manual of Style\/Words to watch\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag may use weasel words or too-vague attribution. (September 2018)\">by whom?<\/span><\/a><\/i>]<\/sup> in favor of donating it to a publicly funded research team.<sup id=\"rdp-ebb-cite_ref-Geary_16-2\" class=\"reference\"><a href=\"#cite_note-Geary-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ings_33-0\" class=\"reference\"><a href=\"#cite_note-Ings-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Intracortical_visual_prosthesis\">Intracortical visual prosthesis<\/span><\/h3>\n<p>The Laboratory of Neural Prosthetics at Illinois Institute Of Technology (IIT), Chicago, is developing a visual prosthetic using intracortical electrode arrays. While similar in principle to the Dobelle system, the use of intracortical electrodes allow for greatly increased spatial resolution in the stimulation signals (more electrodes per unit area). In addition, a wireless telemetry system is being developed<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> to eliminate the need for transcranial wires. Arrays of activated iridium oxide film (AIROF)-coated electrodes will be implanted in the visual cortex, located on the occipital lobe of the brain. External hardware will capture images, process them, and generate instructions which will then be transmitted to implanted circuitry via a telemetry link. The circuitry will decode the instructions and stimulate the electrodes, in turn stimulating the visual cortex. The group is developing a wearable external image capture and processing system to accompany the implanted circuitry. Studies on animals and psyphophysical studies on humans are being conducted<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> to test the feasibility of a human volunteer implant.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"Almost a decade has past. Are these studies ongoing or have they completed? (September 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bionic_contact_lens\" title=\"Bionic contact lens\" rel=\"external_link\" target=\"_blank\">Bionic contact lens<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_echolocation\" title=\"Human echolocation\" rel=\"external_link\" target=\"_blank\">Human echolocation<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dobelle WH (2000). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140327220911\/http:\/\/biomed.brown.edu\/Courses\/BI108\/2006-108websites\/group03retinalimplants\/multimedia\/article.pdf\" target=\"_blank\">\"Artificial vision for the blind by connecting a television camera to the visual cortex\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Asaio J<\/i>. <b>46<\/b> (1): 3\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00002480-200001000-00002\" target=\"_blank\">10.1097\/00002480-200001000-00002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10667705\" target=\"_blank\">10667705<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/biomed.brown.edu\/Courses\/BI108\/2006-108websites\/group03retinalimplants\/multimedia\/article.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 27 March 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Asaio+J&rft.atitle=Artificial+vision+for+the+blind+by+connecting+a+television+camera+to+the+visual+cortex&rft.volume=46&rft.issue=1&rft.pages=3-9&rft.date=2000&rft_id=info%3Adoi%2F10.1097%2F00002480-200001000-00002&rft_id=info%3Apmid%2F10667705&rft.au=Dobelle+WH&rft_id=http%3A%2F%2Fbiomed.brown.edu%2FCourses%2FBI108%2F2006-108websites%2Fgroup03retinalimplants%2Fmultimedia%2Farticle.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Fodstad, H.; Hariz, M. (2007). \"Electricity in the treatment of nervous system disease\". In Sakas, Damianos E.; Krames, Elliot S.; Simpson, Brian A. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=electricity%20blindness%20Cavallo&f=false\"><i>Operative Neuromodulation<\/i><\/a>. Springer. p. 11. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783211330791<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Electricity+in+the+treatment+of+nervous+system+disease&rft.btitle=Operative+Neuromodulation&rft.pages=11&rft.pub=Springer&rft.date=2007&rft.isbn=9783211330791&rft.aulast=Fodstad&rft.aufirst=H.&rft.au=Hariz%2C+M.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D2uJ5jYdNXKQC%26pg%3DPA11%26dq%3Delectricity%2Bblindness%2BCavallo%23v%3Donepage%26q%3Delectricity%2520blindness%2520Cavallo%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sekirnjak C; Hottowy P; Sher A; Dabrowski W; et al. (2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jneurosci.org\/content\/28\/17\/4446.full\" target=\"_blank\">\"High-resolution electrical stimulation of primate retina for epiretinal implant design\"<\/a>. <i>J Neurosci<\/i>. <b>28<\/b> (17): 4446\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2Fjneurosci.5138-07.2008\" target=\"_blank\">10.1523\/jneurosci.5138-07.2008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2681084\" target=\"_blank\">2681084<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18434523\" target=\"_blank\">18434523<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Neurosci&rft.atitle=High-resolution+electrical+stimulation+of+primate+retina+for+epiretinal+implant+design&rft.volume=28&rft.issue=17&rft.pages=4446-56&rft.date=2008&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2681084&rft_id=info%3Apmid%2F18434523&rft_id=info%3Adoi%2F10.1523%2Fjneurosci.5138-07.2008&rft.au=Sekirnjak+C&rft.au=Hottowy+P&rft.au=Sher+A&rft.au=Dabrowski+W&rft.au=Litke+AM&rft.au=Chichilnisky+EJ&rft_id=http%3A%2F%2Fwww.jneurosci.org%2Fcontent%2F28%2F17%2F4446.full&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Provis, Jan M; Van Driel, Diana; Billson, Frank A; Russell, Peter (1985). \"Human fetal optic nerve: Overproduction and elimination of retinal axons during development\". <i>The Journal of Comparative Neurology<\/i>. <b>238<\/b> (1): 92\u2013100. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fcne.902380108\" target=\"_blank\">10.1002\/cne.902380108<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4044906\" target=\"_blank\">4044906<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Comparative+Neurology&rft.atitle=Human+fetal+optic+nerve%3A+Overproduction+and+elimination+of+retinal+axons+during+development&rft.volume=238&rft.issue=1&rft.pages=92-100&rft.date=1985&rft_id=info%3Adoi%2F10.1002%2Fcne.902380108&rft_id=info%3Apmid%2F4044906&rft.aulast=Provis&rft.aufirst=Jan+M&rft.au=Van+Driel%2C+Diana&rft.au=Billson%2C+Frank+A&rft.au=Russell%2C+Peter&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Reuters-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Reuters_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150105222606\/http:\/\/www.reuters.com\/article\/2014\/08\/27\/usc-eye-institute-fda-idUSnPn6JGDrT+9d+PRN20140827\" target=\"_blank\">\"USC Eye Institute ophthalmologists implant first FDA-approved Argus II retinal prosthesis in western United States\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Reuters\" title=\"Reuters\" rel=\"external_link\" target=\"_blank\">Reuters<\/a><\/i>. 27 August 2014. Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.reuters.com\/article\/2014\/08\/27\/usc-eye-institute-fda-idUSnPn6JGDrT+9d+PRN20140827\" target=\"_blank\">the original<\/a> on 5 January 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 January<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Reuters&rft.atitle=USC+Eye+Institute+ophthalmologists+implant+first+FDA-approved+Argus+II+retinal+prosthesis+in+western+United+States&rft.date=2014-08-27&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2F2014%2F08%2F27%2Fusc-eye-institute-fda-idUSnPn6JGDrT%2B9d%2BPRN20140827&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chuang AT, Margo CE, Greenberg PB (Jul 2014). \"Retinal implants: a systematic review\". <i>Br J Ophthalmol<\/i>. <b>98<\/b> (7): 852\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbjophthalmol-2013-303708\" target=\"_blank\">10.1136\/bjophthalmol-2013-303708<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24403565\" target=\"_blank\">24403565<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Br+J+Ophthalmol&rft.atitle=Retinal+implants%3A+a+systematic+review&rft.volume=98&rft.issue=7&rft.pages=852-56&rft.date=2014-07&rft_id=info%3Adoi%2F10.1136%2Fbjophthalmol-2013-303708&rft_id=info%3Apmid%2F24403565&rft.aulast=Chuang&rft.aufirst=AT&rft.au=Margo%2C+CE&rft.au=Greenberg%2C+PB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.keckmedicine.org\/doctor\/mark-s-humayun\/\" target=\"_blank\">\"Humayun faculty page at USC Keck\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 15,<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Humayun+faculty+page+at+USC+Keck&rft_id=http%3A%2F%2Fwww.keckmedicine.org%2Fdoctor%2Fmark-s-humayun%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ERP-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ERP_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">U.S. Department of Energy Office of Science. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/artificialretina.energy.gov\/about.shtml\" target=\"_blank\">\"Overview of the Artificial Retina Project\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Overview+of+the+Artificial+Retina+Project&rft.au=U.S.+Department+of+Energy+Office+of+Science&rft_id=http%3A%2F%2Fartificialretina.energy.gov%2Fabout.shtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.2-sight.com\" target=\"_blank\">\"Second Sight official website\"<\/a>. 2-sight.com. 2015-05-21<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-06-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Second+Sight+official+website&rft.pub=2-sight.com&rft.date=2015-05-21&rft_id=http%3A%2F%2Fwww.2-sight.com&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-S1-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-S1_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-S1_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Second Sight. November 14, 2014 <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.sec.gov\/Archives\/edgar\/data\/1266806\/000161577414000310\/s100457_s1a.htm\" target=\"_blank\">Second Sight Amendment No. 3 to Form S-1: Registration Statement<\/a><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Miriam Karmel (March 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.aao.org\/publications\/eyenet\/201203\/retina.cfm?RenderForPrint=1&\" target=\"_blank\">\"Clinical Update: Retina. Retinal Prostheses: Progress and Problems\"<\/a>. <i>Eyenet Magazine<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Eyenet+Magazine&rft.atitle=Clinical+Update%3A+Retina.+Retinal+Prostheses%3A+Progress+and+Problems&rft.date=2012-03&rft.au=Miriam+Karmel&rft_id=http%3A%2F%2Fwww.aao.org%2Fpublications%2Feyenet%2F201203%2Fretina.cfm%3FRenderForPrint%3D1%26&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SSannounce-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SSannounce_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Second Sight (9 January 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.2-sight.com\/assets\/pdfs\/20070109%20second%20sight%20release.pdf\" target=\"_blank\">\"Press Release: Ending the Journey through Darkness: Innovative Technology Offers New Hope for Treating Blindness due to Retinitis Pigmentosa\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Press+Release%3A+Ending+the+Journey+through+Darkness%3A+Innovative+Technology+Offers+New+Hope+for+Treating+Blindness+due+to+Retinitis+Pigmentosa&rft.date=2007-01-09&rft.au=Second+Sight&rft_id=http%3A%2F%2Fwww.2-sight.com%2Fassets%2Fpdfs%2F20070109%2520second%2520sight%2520release.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BBC-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BBC_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Jonathan Fildes (16 February 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/sci\/tech\/6368089.stm\" target=\"_blank\">\"Trials for bionic eye implants\"<\/a>. BBC.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Trials+for+bionic+eye+implants&rft.date=2007-02-16&rft.au=Jonathan+Fildes&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F1%2Fhi%2Fsci%2Ftech%2F6368089.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ophthalmology-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ophthalmology_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Humayun (April 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ophsource.org\/periodicals\/ophtha\/article\/S0161-6420(11)00884-0\/abstract\" target=\"_blank\">\"Interim Results from the International Trial of Second Sight's Visual Prosthesis\"<\/a>. Ophthalmology.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Interim+Results+from+the+International+Trial+of+Second+Sight%27s+Visual+Prosthesis&rft.date=2012-04&rft.au=Humayun&rft_id=http%3A%2F%2Fwww.ophsource.org%2Fperiodicals%2Fophtha%2Farticle%2FS0161-6420%2811%2900884-0%2Fabstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Sifferlin, Alexandra (19 February 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cnn.com\/2013\/02\/19\/health\/fda-bionic-eye\/index.html?hpt=us_bn1\" target=\"_blank\">\"FDA approves first bionic eye\"<\/a>. <i>CNN<\/i>. TIME<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">22 February<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CNN&rft.atitle=FDA+approves+first+bionic+eye&rft.date=2013-02-19&rft.aulast=Sifferlin&rft.aufirst=Alexandra&rft_id=http%3A%2F%2Fwww.cnn.com%2F2013%2F02%2F19%2Fhealth%2Ffda-bionic-eye%2Findex.html%3Fhpt%3Dus_bn1&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Geary-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Geary_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Geary_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Geary_16-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/James_Geary\" title=\"James Geary\" rel=\"external_link\" target=\"_blank\">James Geary<\/a> (2002). <i>The Body Electric<\/i>. Phoenix.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Body+Electric&rft.pub=Phoenix&rft.date=2002&rft.au=James+Geary&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Chun-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Chun_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chun DW; Heier JS; Raizman MB (2005). \"Visual prosthetic device for bilateral end-stage macular degeneration\". <i>Expert Rev Med Devices<\/i>. <b>2<\/b> (6): 657\u201365. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1586%2F17434440.2.6.657\" target=\"_blank\">10.1586\/17434440.2.6.657<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16293092\" target=\"_blank\">16293092<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Expert+Rev+Med+Devices&rft.atitle=Visual+prosthetic+device+for+bilateral+end-stage+macular+degeneration&rft.volume=2&rft.issue=6&rft.pages=657-65&rft.date=2005&rft_id=info%3Adoi%2F10.1586%2F17434440.2.6.657&rft_id=info%3Apmid%2F16293092&rft.au=Chun+DW&rft.au=Heier+JS&rft.au=Raizman+MB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lane_1-18\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Lane_1_18-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Lane_1_18-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lane SS; Kuppermann BD; Fine IH; Hamill MB; et al. (2004). \"A prospective multicenter clinical trial to evaluate the safety and effectiveness of the implantable miniature telescope\". <i>Am J Ophthalmol<\/i>. <b>137<\/b> (6): 993\u20131001. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ajo.2004.01.030\" target=\"_blank\">10.1016\/j.ajo.2004.01.030<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15183782\" target=\"_blank\">15183782<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am+J+Ophthalmol&rft.atitle=A+prospective+multicenter+clinical+trial+to+evaluate+the+safety+and+effectiveness+of+the+implantable+miniature+telescope&rft.volume=137&rft.issue=6&rft.pages=993-1001&rft.date=2004&rft_id=info%3Adoi%2F10.1016%2Fj.ajo.2004.01.030&rft_id=info%3Apmid%2F15183782&rft.au=Lane+SS&rft.au=Kuppermann+BD&rft.au=Fine+IH&rft.au=Hamill+MB&rft.au=Gordon+JF&rft.au=Chuck+RS&rft.au=Hoffman+RS&rft.au=Packer+M&rft.au=Koch+DD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lane_2-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Lane_2_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Lane_2_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lane SS; Kuppermann BD (2006). \"The Implantable Miniature Telescope for macular degeneration\". <i>Current Opinion in Ophthalmology<\/i>. <b>17<\/b> (1): 94\u201398. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.icu.0000193067.86627.a1\" target=\"_blank\">10.1097\/01.icu.0000193067.86627.a1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16436930\" target=\"_blank\">16436930<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Ophthalmology&rft.atitle=The+Implantable+Miniature+Telescope+for+macular+degeneration&rft.volume=17&rft.issue=1&rft.pages=94-98&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.icu.0000193067.86627.a1&rft_id=info%3Apmid%2F16436930&rft.au=Lane+SS&rft.au=Kuppermann+BD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Lipshitz, Isaac. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.centrasight.com\/centrasight_technology\" target=\"_blank\">\"Implantable Telescope Technology\"<\/a>. VisionCare Ophthalmic Technologies, Inc<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 March<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Implantable+Telescope+Technology&rft.pub=VisionCare+Ophthalmic+Technologies%2C+Inc.&rft.aulast=Lipshitz&rft.aufirst=Isaac&rft_id=http%3A%2F%2Fwww.centrasight.com%2Fcentrasight_technology&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eberhart Zrenner; et al. 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Retrieved <span class=\"nowrap\">May 23,<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=BBC+News&rft.atitle=Two+blind+British+men+have+electronic+retinas+fitted&rft.date=2012-05-03&rft.au=Fergus+Walsh&rft_id=https%3A%2F%2Fwww.bbc.com%2Fnews%2Fhealth-17936302&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hku.hk\/press\/news_detail_6815.html\" target=\"_blank\">\"HKU performed the first subretinal microchip implantation in Asia Patient regained eyesight after the surgery\"<\/a>. <i>HKU.hk<\/i> (Press release). The University of Hong Kong. 3 May 2012<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">May 23,<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=HKU.hk&rft.atitle=HKU+performed+the+first+subretinal+microchip+implantation+in+Asia+Patient+regained+eyesight+after+the+surgery&rft.date=2012-05-03&rft_id=http%3A%2F%2Fwww.hku.hk%2Fpress%2Fnews_detail_6815.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-RLE_Progress_Report_151-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-RLE_Progress_Report_151_27-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Wyatt, Jr., J.L. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rle.mit.edu\/media\/pr151\/19.pdf\" target=\"_blank\">\"The Retinal Implant Project\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Research Laboratory of Electronics (RLE) at the Massachusetts Institute of Technology (MIT)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 March<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Retinal+Implant+Project&rft.pub=Research+Laboratory+of+Electronics+%28RLE%29+at+the+Massachusetts+Institute+of+Technology+%28MIT%29&rft.aulast=Wyatt%2C+Jr.&rft.aufirst=J.L.&rft_id=http%3A%2F%2Fwww.rle.mit.edu%2Fmedia%2Fpr151%2F19.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/optobionics.com\/asrdevice.shtml\" target=\"_blank\">\"ASR\u00ae Device\"<\/a>. Optobionics<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 March<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ASR%C2%AE+Device&rft.pub=Optobionics&rft_id=http%3A%2F%2Foptobionics.com%2Fasrdevice.shtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/optobionics.com\/asrdevice.shtml\" target=\"_blank\">\"ASR\u00ae Device\"<\/a>. Optobionics<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 March<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ASR%C2%AE+Device&rft.pub=Optobionics&rft_id=http%3A%2F%2Foptobionics.com%2Fasrdevice.shtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Palanker-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Palanker_30-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Palanker Group. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.stanford.edu\/~palanker\/lab\/retinalpros.html\" target=\"_blank\">\"Photovoltaic Retinal Prosthesis\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Photovoltaic+Retinal+Prosthesis&rft.au=Palanker+Group&rft_id=http%3A%2F%2Fwww.stanford.edu%2F~palanker%2Flab%2Fretinalpros.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">K. Mathieson; J. Loudin; G. Goetz; P. Huie; L. Wang; T. Kamins; L. Galambos; R. Smith; J.S. Harris; A. Sher; D. Palanker (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/232226717_Photovoltaic_Retinal_Prosthesis_with_High_Pixel_Density\" target=\"_blank\">\"Photovoltaic retinal prosthesis with high pixel density\"<\/a>. <i>Nature Photonics<\/i>. <b>6<\/b> (6): 391\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnphoton.2012.104\" target=\"_blank\">10.1038\/nphoton.2012.104<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3462820\" target=\"_blank\">3462820<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23049619\" target=\"_blank\">23049619<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Photonics&rft.atitle=Photovoltaic+retinal+prosthesis+with+high+pixel+density&rft.volume=6&rft.issue=6&rft.pages=391-97&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3462820&rft_id=info%3Apmid%2F23049619&rft_id=info%3Adoi%2F10.1038%2Fnphoton.2012.104&rft.au=K.+Mathieson&rft.au=J.+Loudin&rft.au=G.+Goetz&rft.au=P.+Huie&rft.au=L.+Wang&rft.au=T.+Kamins&rft.au=L.+Galambos&rft.au=R.+Smith&rft.au=J.S.+Harris&rft.au=A.+Sher&rft.au=D.+Palanker&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F232226717_Photovoltaic_Retinal_Prosthesis_with_High_Pixel_Density&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bionicvision.org.au\/eye\/progress\" target=\"_blank\">\"Bionic Vision Australia's progress of the bionic eye\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 July<\/span> 2012<\/span>. <span class=\"cs1-subscription\">(Subscription required (<span title=\"The site requires a paid subscription to access this page.\">help<\/span>))<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Bionic+Vision+Australia%27s+progress+of+the+bionic+eye&rft_id=http%3A%2F%2Fwww.bionicvision.org.au%2Feye%2Fprogress&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ings-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ings_33-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Simon Ings (2007). \"Chapter 10(3): Making eyes to see\". <i>The Eye: a natural history<\/i>. London: Bloomsbury. pp. 276\u201383.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+10%283%29%3A+Making+eyes+to+see&rft.btitle=The+Eye%3A+a+natural+history&rft.place=London&rft.pages=276-83&rft.pub=Bloomsbury&rft.date=2007&rft.au=Simon+Ings&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rush, Alexander; PR Troyk (November 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/xpl\/articleDetails.jsp?arnumber=6276242\" target=\"_blank\">\"A Power and Data Link for a Wireless-Implanted Neural Recording System\"<\/a>. <i>Transactions on Biomedical Engineering<\/i>. <b>59<\/b> (11): 3255\u201362. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2Ftbme.2012.2214385\" target=\"_blank\">10.1109\/tbme.2012.2214385<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22922687\" target=\"_blank\">22922687<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 September<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Transactions+on+Biomedical+Engineering&rft.atitle=A+Power+and+Data+Link+for+a+Wireless-Implanted+Neural+Recording+System&rft.volume=59&rft.issue=11&rft.pages=3255-62&rft.date=2012-11&rft_id=info%3Adoi%2F10.1109%2Ftbme.2012.2214385&rft_id=info%3Apmid%2F22922687&rft.aulast=Rush&rft.aufirst=Alexander&rft.au=PR+Troyk&rft_id=http%3A%2F%2Fieeexplore.ieee.org%2Fxpl%2FarticleDetails.jsp%3Farnumber%3D6276242&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Srivastava, Nishant; PR Troyk; G Dagnelie (June 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3902177\" target=\"_blank\">\"Detection, eye-hand coordination and virtual mobility performance in simulated vision for a cortical visual prosthesis device\"<\/a>. <i>Journal of Neural Engineering<\/i>. <b>6<\/b> (3): 035008. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F1741-2560%2F6%2F3%2F035008\" target=\"_blank\">10.1088\/1741-2560\/6\/3\/035008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3902177\" target=\"_blank\">3902177<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19458397\" target=\"_blank\">19458397<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neural+Engineering&rft.atitle=Detection%2C+eye-hand+coordination+and+virtual+mobility+performance+in+simulated+vision+for+a+cortical+visual+prosthesis+device&rft.volume=6&rft.issue=3&rft.pages=035008&rft.date=2009-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3902177&rft_id=info%3Apmid%2F19458397&rft_id=info%3Adoi%2F10.1088%2F1741-2560%2F6%2F3%2F035008&rft.aulast=Srivastava&rft.aufirst=Nishant&rft.au=PR+Troyk&rft.au=G+Dagnelie&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3902177&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ffb.ca\/patient_resources\/factsheets\/retinal_protheses.html\" target=\"_blank\">Research Fact Sheet ~ Retinal Prostheses<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1254\nCached time: 20181126024121\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.616 seconds\nReal time usage: 0.745 seconds\nPreprocessor visited node count: 2657\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 172442\/2097152 bytes\nTemplate argument size: 2905\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 95251\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.309\/10.000 seconds\nLua memory usage: 5.3 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 560.949 1 -total\n<\/p>\n<pre>57.66% 323.454 1 Template:Reflist\n30.72% 172.340 13 Template:Cite_journal\n15.50% 86.965 5 Template:Fix\n15.13% 84.886 4 Template:Citation_needed\n11.98% 67.195 6 Template:Navbox\n11.16% 62.595 15 Template:Cite_web\n 8.33% 46.743 1 Template:Emerging_technologies\n 7.46% 41.819 9 Template:Category_handler\n 6.63% 37.210 5 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:17198736-1!canonical and timestamp 20181126024121 and revision id 859247266\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214642\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.029 seconds\nReal time usage: 0.180 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 171.380 1 - wikipedia:Visual_prosthesis\n100.00% 171.380 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8285-0!*!*!*!*!*!* and timestamp 20181217214642 and revision id 24497\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Visual_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Visual_prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ee345c211e8182e32bd5e64c6c61308d_images":[],"ee345c211e8182e32bd5e64c6c61308d_timestamp":1545083201,"ee147bb776310ab4a9865038bcc69a57_type":"article","ee147bb776310ab4a9865038bcc69a57_title":"Tympanostomy tube","ee147bb776310ab4a9865038bcc69a57_url":"https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube","ee147bb776310ab4a9865038bcc69a57_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTympanostomy tube\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tTympanostomy tubeThe grommet is less than 2 mm tall, smaller than a match head.SynonymsGrommet, T-tube, ear tube, pressure equalization tube, vent, PE tube, myringotomy tube[edit on Wikidata]\nTympanostomy tube, also known as a grommet or myringotomy tube, is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The operation to insert the tube involves a myringotomy and is performed under local or general anesthesia. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. When it is necessary to keep the middle ear ventilated for a very long period, a \"T\"-shaped tube may be used, as these \"T-tubes\" can stay in place for 2\u20134 years. Materials used to construct the tube are most often plastics such as silicone or Teflon. Stainless steel tubes exist, but are no longer in frequent use.\n\nContents \n\n1 Medical uses \n2 Procedure \n3 Outcome \n4 References \n\n\nMedical uses \n Tubes of a more permanent style, unlike those typically used in the United States. These tubes remained in place for four years until one spontaneously left the ear drum. The other was removed with tweezers after having partially disengaged from the ear drum. The removal process can cause significant pain for several minutes. \nGuidelines state that tubes are an option in:\n\nRecurrent acute otitis media: three ear infections in six months or four infections in a year.[1] The evidence for this recommendation; however, is weak.[1]\nChronic otitis media with persistent effusion for six months (one ear) or three months (both ears).[citation needed ]\nPersistent eustachian tube dysfunction[citation needed ]\nBarotrauma: Especially for prevention of recurrent episodes (e.g., after air travel, hyperbaric chamber treatment).[citation needed ]\nProcedure \nAlthough myringotomy with tube insertion can be performed under local anesthesia during a regular doctor's appointment in co-operative adults, patients requiring tube insertion are very often young children. Since damage to the ear is possible unless the patient stays quite still while being manipulated, any patient who may have difficulty lying still during the procedure typically undergoes myringotomy and tube insertion under general anesthesia.\nThe insertion of tympanostomy tubes is one of the most common surgical procedures performed on children. In the United States, it is the most common reason for a child to undergo a general anesthetic.[2]\n\nOutcome \n Ear tube\nTympanostomy tubes generally remain in the eardrum for six months to two years, with T-tubes lasting up to four years. They generally spontaneously fall out of the eardrum as the skin of the eardrum slowly migrates out towards the ear canal wall over time. The eardrum usually closes without a residual hole at the tube site but in a small number of cases a perforation can persist. There is debate among clinicians as to whether long-lasting tubes are associated with a higher incidence of adverse outcomes, such as persistent perforation, cholesteatoma, tympanosclerosis and others, as opposed to tubes designed to last for shorter durations.\nA common complication of getting a tympanostomy tube is experiencing otorrhea, which is a discharge from the ear.[3] Oral antibiotics should not be used to treat uncomplicated acute tympanostomy tube otorrhea.[3] Oral antibiotics are not a sufficient response to bacteria which cause this condition and have significant side effects including increased risk of opportunistic infection.[3] In contrast, topical antibiotic eardrops can treat this condition.[3]\n\nReferences \n\n^ a b Lieberthal, AS; Carroll, AE; Chonmaitree, T; Ganiats, TG; Hoberman, A; Jackson, MA; Joffe, MD; Miller, DT; Rosenfeld, RM; Sevilla, XD; Schwartz, RH; Thomas, PA; Tunkel, DE (March 2013). \"The diagnosis and management of acute otitis media\". Pediatrics. 131 (3): e964\u201399. doi:10.1542\/peds.2012-3488. PMID 23439909. \n\n^ Vaile L. Williamson T. Waddell A. Taylor G. Interventions for ear discharge associated with grommets (ventilation tubes) \n\n^ a b c d American Academy of Otolaryngology\u2013Head and Neck Surgery, \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Otolaryngology\u2013Head and Neck Surgery, retrieved August 1, 2013 , which cites\nRosenfeld, R. M.; Schwartz, S. R.; Pynnonen, M. A.; Tunkel, D. E.; Hussey, H. M.; Fichera, J. S.; Grimes, A. M.; Hackell, J. M.; Harrison, M. F.; Haskell, H.; Haynes, D. S.; Kim, T. W.; Lafreniere, D. C.; LeBlanc, K.; Mackey, W. L.; Netterville, J. L.; Pipan, M. E.; Raol, N. P.; Schellhase, K. G. (2013). \"Clinical Practice Guideline: Tympanostomy Tubes in Children\". Otolaryngology\u2013Head and Neck Surgery. 149 (1 Suppl): S1\u2013S35. doi:10.1177\/0194599813487302. ISSN 0194-5998. PMID 23818543. \n \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube\">https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 518 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ee147bb776310ab4a9865038bcc69a57_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Tympanostomy_tube skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Tympanostomy tube<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Tympanostomy tube<\/b>, also known as a <b>grommet<\/b> or <b>myringotomy tube<\/b>, is a small tube inserted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eardrum\" title=\"Eardrum\" rel=\"external_link\" target=\"_blank\">eardrum<\/a> in order to keep the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_ear\" title=\"Middle ear\" rel=\"external_link\" target=\"_blank\">middle ear<\/a> aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The operation to insert the tube involves a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myringotomy\" title=\"Myringotomy\" rel=\"external_link\" target=\"_blank\">myringotomy<\/a> and is performed under local or <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>. The tube itself is made in a variety of designs. The most commonly used type is shaped like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grommet\" title=\"Grommet\" rel=\"external_link\" target=\"_blank\">grommet<\/a>. When it is necessary to keep the middle ear ventilated for a very long period, a \"T\"-shaped tube may be used, as these \"T-tubes\" can stay in place for 2\u20134 years. Materials used to construct the tube are most often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastics\" class=\"mw-redirect\" title=\"Plastics\" rel=\"external_link\" target=\"_blank\">plastics<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon\" class=\"mw-redirect\" title=\"Teflon\" rel=\"external_link\" target=\"_blank\">Teflon<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">Stainless steel<\/a> tubes exist, but are no longer in frequent use.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:210px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Typmanostomy_tubes,_permanent_style,_2006-2011_(cropped).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/84\/Typmanostomy_tubes%2C_permanent_style%2C_2006-2011_%28cropped%29.jpg\" width=\"208\" height=\"244\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Typmanostomy_tubes,_permanent_style,_2006-2011_(cropped).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tubes of a more permanent style, unlike those typically used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>. These tubes remained in place for four years until one spontaneously left the ear drum. The other was removed with tweezers after having partially disengaged from the ear drum. The removal process can cause significant pain for several minutes.<\/div><\/div><\/div> \n<p>Guidelines state that tubes are an option in:\n<\/p>\n<ul><li>Recurrent acute otitis media: three ear infections in six months or four infections in a year.<sup id=\"rdp-ebb-cite_ref-Peads2013_1-0\" class=\"reference\"><a href=\"#cite_note-Peads2013-1\" rel=\"external_link\">[1]<\/a><\/sup> The evidence for this recommendation; however, is weak.<sup id=\"rdp-ebb-cite_ref-Peads2013_1-1\" class=\"reference\"><a href=\"#cite_note-Peads2013-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>Chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otitis media<\/a> with persistent effusion for six months (one ear) or three months (both ears).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2015)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li>Persistent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eustachian_tube\" title=\"Eustachian tube\" rel=\"external_link\" target=\"_blank\">eustachian tube<\/a> dysfunction<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2015)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barotrauma\" title=\"Barotrauma\" rel=\"external_link\" target=\"_blank\">Barotrauma<\/a>: Especially for prevention of recurrent episodes (e.g., after air travel, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperbaric_chamber\" class=\"mw-redirect\" title=\"Hyperbaric chamber\" rel=\"external_link\" target=\"_blank\">hyperbaric chamber<\/a> treatment).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2015)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<p>Although myringotomy with tube insertion can be performed under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anesthesia\" title=\"Local anesthesia\" rel=\"external_link\" target=\"_blank\">local anesthesia<\/a> during a regular doctor's appointment in co-operative adults, patients requiring tube insertion are very often young children. Since damage to the ear is possible unless the patient stays quite still while being manipulated, any patient who may have difficulty lying still during the procedure typically undergoes myringotomy and tube insertion under general anesthesia.\n<\/p><p>The insertion of tympanostomy tubes is one of the most common surgical procedures performed on children. In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>, it is the most common reason for a child to undergo a general anesthetic.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Outcome\">Outcome<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:122px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ear_Tube.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Ear_Tube.png\/120px-Ear_Tube.png\" width=\"120\" height=\"160\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ear_Tube.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Ear tube<\/div><\/div><\/div>\n<p>Tympanostomy tubes generally remain in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eardrum\" title=\"Eardrum\" rel=\"external_link\" target=\"_blank\">eardrum<\/a> for six months to two years, with T-tubes lasting up to four years. They generally spontaneously fall out of the eardrum as the skin of the eardrum slowly migrates out towards the ear canal wall over time. The eardrum usually closes without a residual hole at the tube site but in a small number of cases a perforation can persist. There is debate among clinicians as to whether long-lasting tubes are associated with a higher incidence of adverse outcomes, such as persistent perforation, cholesteatoma, tympanosclerosis and others, as opposed to tubes designed to last for shorter durations.\n<\/p><p>A common complication of getting a tympanostomy tube is experiencing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media#Otorrhea:_infected_drainage_from_the_middle_ear\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otorrhea<\/a>, which is a discharge from the ear.<sup id=\"rdp-ebb-cite_ref-AANfive_3-0\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup> Oral antibiotics should not be used to treat uncomplicated acute tympanostomy tube otorrhea.<sup id=\"rdp-ebb-cite_ref-AANfive_3-1\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup> Oral antibiotics are not a sufficient response to bacteria which cause this condition and have significant side effects including increased risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Opportunistic_infection\" title=\"Opportunistic infection\" rel=\"external_link\" target=\"_blank\">opportunistic infection<\/a>.<sup id=\"rdp-ebb-cite_ref-AANfive_3-2\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup> In contrast, topical antibiotic eardrops can treat this condition.<sup id=\"rdp-ebb-cite_ref-AANfive_3-3\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Peads2013-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Peads2013_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Peads2013_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lieberthal, AS; Carroll, AE; Chonmaitree, T; Ganiats, TG; Hoberman, A; Jackson, MA; Joffe, MD; Miller, DT; Rosenfeld, RM; Sevilla, XD; Schwartz, RH; Thomas, PA; Tunkel, DE (March 2013). \"The diagnosis and management of acute otitis media\". <i>Pediatrics<\/i>. <b>131<\/b> (3): e964\u201399. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1542%2Fpeds.2012-3488\" target=\"_blank\">10.1542\/peds.2012-3488<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23439909\" target=\"_blank\">23439909<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=The+diagnosis+and+management+of+acute+otitis+media.&rft.volume=131&rft.issue=3&rft.pages=e964-99&rft.date=2013-03&rft_id=info%3Adoi%2F10.1542%2Fpeds.2012-3488&rft_id=info%3Apmid%2F23439909&rft.aulast=Lieberthal&rft.aufirst=AS&rft.au=Carroll%2C+AE&rft.au=Chonmaitree%2C+T&rft.au=Ganiats%2C+TG&rft.au=Hoberman%2C+A&rft.au=Jackson%2C+MA&rft.au=Joffe%2C+MD&rft.au=Miller%2C+DT&rft.au=Rosenfeld%2C+RM&rft.au=Sevilla%2C+XD&rft.au=Schwartz%2C+RH&rft.au=Thomas%2C+PA&rft.au=Tunkel%2C+DE&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATympanostomy+tube\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Vaile L. Williamson T. Waddell A. Taylor G. <i>Interventions for ear discharge associated with grommets (ventilation tubes)<\/i><\/span>\n<\/li>\n<li id=\"cite_note-AANfive-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AANfive_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AANfive_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AANfive_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AANfive_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Academy_of_Otolaryngology\u2013Head_and_Neck_Surgery\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Otolaryngology%E2%80%93Head_and_Neck_Surgery\" title=\"American Academy of Otolaryngology\u2013Head and Neck Surgery\" rel=\"external_link\" target=\"_blank\">American Academy of Otolaryngology\u2013Head and Neck Surgery<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-academy-of-otolaryngology-head-and-neck-surgery-foundation\/\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Otolaryngology%E2%80%93Head_and_Neck_Surgery\" title=\"American Academy of Otolaryngology\u2013Head and Neck Surgery\" rel=\"external_link\" target=\"_blank\">American Academy of Otolaryngology\u2013Head and Neck Surgery<\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">August 1,<\/span> 2013<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.au=American+Academy+of+Otolaryngology%E2%80%93Head+and+Neck+Surgery&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-academy-of-otolaryngology-head-and-neck-surgery-foundation%2F%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATympanostomy+tube\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, which cites\n<ul><li><cite class=\"citation journal\">Rosenfeld, R. M.; Schwartz, S. R.; Pynnonen, M. A.; Tunkel, D. E.; Hussey, H. M.; Fichera, J. S.; Grimes, A. M.; Hackell, J. M.; Harrison, M. F.; Haskell, H.; Haynes, D. S.; Kim, T. W.; Lafreniere, D. C.; LeBlanc, K.; Mackey, W. L.; Netterville, J. L.; Pipan, M. E.; Raol, N. P.; Schellhase, K. G. (2013). \"Clinical Practice Guideline: Tympanostomy Tubes in Children\". <i>Otolaryngology\u2013Head and Neck Surgery<\/i>. <b>149<\/b> (1 Suppl): S1\u2013S35. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F0194599813487302\" target=\"_blank\">10.1177\/0194599813487302<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0194-5998\" target=\"_blank\">0194-5998<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23818543\" target=\"_blank\">23818543<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Otolaryngology%E2%80%93Head+and+Neck+Surgery&rft.atitle=Clinical+Practice+Guideline%3A+Tympanostomy+Tubes+in+Children&rft.volume=149&rft.issue=1+Suppl&rft.pages=S1-S35&rft.date=2013&rft.issn=0194-5998&rft_id=info%3Apmid%2F23818543&rft_id=info%3Adoi%2F10.1177%2F0194599813487302&rft.aulast=Rosenfeld&rft.aufirst=R.+M.&rft.au=Schwartz%2C+S.+R.&rft.au=Pynnonen%2C+M.+A.&rft.au=Tunkel%2C+D.+E.&rft.au=Hussey%2C+H.+M.&rft.au=Fichera%2C+J.+S.&rft.au=Grimes%2C+A.+M.&rft.au=Hackell%2C+J.+M.&rft.au=Harrison%2C+M.+F.&rft.au=Haskell%2C+H.&rft.au=Haynes%2C+D.+S.&rft.au=Kim%2C+T.+W.&rft.au=Lafreniere%2C+D.+C.&rft.au=LeBlanc%2C+K.&rft.au=Mackey%2C+W.+L.&rft.au=Netterville%2C+J.+L.&rft.au=Pipan%2C+M.+E.&rft.au=Raol%2C+N.+P.&rft.au=Schellhase%2C+K.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATympanostomy+tube\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/span><\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1258\nCached time: 20181212013249\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.232 seconds\nReal time usage: 0.303 seconds\nPreprocessor visited node count: 877\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17251\/2097152 bytes\nTemplate argument size: 1641\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 10791\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.143\/10.000 seconds\nLua memory usage: 3.05 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 270.344 1 -total\n<\/p>\n<pre>32.39% 87.558 2 Template:Cite_journal\n31.48% 85.111 3 Template:Citation_needed\n28.48% 76.997 1 Template:Infobox_medical_intervention\n27.78% 75.106 3 Template:Fix\n26.55% 71.784 1 Template:Infobox\n14.21% 38.423 6 Template:Category_handler\n11.43% 30.891 3 Template:Delink\n 3.62% 9.775 1 Template:Citation\n 2.49% 6.726 1 Template:PAGENAMEBASE\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2015316-1!canonical and timestamp 20181212013248 and revision id 862773554\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tympanostomy_tube\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214641\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.136 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 130.034 1 - wikipedia:Tympanostomy_tube\n100.00% 130.034 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8018-0!*!*!*!*!*!* and timestamp 20181217214641 and revision id 24129\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube\">https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ee147bb776310ab4a9865038bcc69a57_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/3\/3a\/Grommet.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/84\/Typmanostomy_tubes%2C_permanent_style%2C_2006-2011_%28cropped%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Ear_Tube.png\/240px-Ear_Tube.png"],"ee147bb776310ab4a9865038bcc69a57_timestamp":1545083201,"66f306a9b1671f4ccef0b68b1ee54d12_type":"article","66f306a9b1671f4ccef0b68b1ee54d12_title":"Port (medical)","66f306a9b1671f4ccef0b68b1ee54d12_url":"https:\/\/www.limswiki.org\/index.php\/Port_(medical)","66f306a9b1671f4ccef0b68b1ee54d12_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPort (medical)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2015) (Learn how and when to remove this template message)\n Port-a-Cath with needle assembly inserted.\nIn medicine, a port is a small medical appliance that is installed beneath the skin. A catheter connects the port to a vein. Under the skin, the port has a septum through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical \"needle stick\".\nPorts are used mostly to treat hematology and oncology patients. Ports were previously adapted for use in hemodialysis patients, but were found to be associated with increased rate of infections and are no longer available in the US.[1]\nThe port is usually inserted in the upper chest (known as a \"chest port\"), just below the clavicle or collar bone, leaving the patient's hands free.\n\nContents \n\n1 Terminology \n2 How it works \n3 Uses \n4 Insertion \n5 Models \n6 Risks \n7 Manufacturers \n8 Use \n9 Alternatives \n10 In popular culture \n11 See also \n12 References \n13 Further reading \n14 External links \n\n\nTerminology \n Chest X-ray showing an implanted port.\nA port is more correctly known as a \"totally implantable venous access device\". Brand Names include Eco Port, Clip-a-Port, SmartPort, Microport, Bardport, PowerPort, Passport, Port-a-Cath, Infuse-a-Port, Medi-Port, and Bioflo.\n\nHow it works \n The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein, subclavian vein, or superior vena cava). Ideally, the catheter terminates in the superior vena cava, just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.\nA port consists of a reservoir compartment (the portal) that has a silicone bubble for needle insertion (the septum), with an attached plastic tube (the catheter). The device is surgically inserted under the skin in the upper chest or in the arm and appears as a bump under the skin. It requires no special maintenance and is completely internal so swimming and bathing are not a problem. The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein or less optimally the subclavian vein). Ideally, the catheter terminates in the superior vena cava or the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.\nThe septum is made of a special self-sealing silicone; it can be punctured hundreds of times before it weakens significantly. To administer treatment or to withdraw blood, a health care professional will first locate the port and disinfect the area, then access the port by puncturing the overlying skin with a Huber point needle. Due to its design, there is a very low infection risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the Hickman line. Negative pressure is created to withdraw blood into the vacuumized needle, to check for blood return and see if the port is functioning normally. Next, the port is flushed with a saline solution. Then, treatment will begin.\nThe implantation procedure itself is considered minor, and is typically performed with both local anaesthesia and moderate sedation. Patients often have post-procedure discomfort at the insertion site which is most often managed by administration of acetaminophen or a non-steroidal anti-inflammatory drug such as ibuprofen.\nA port is most commonly inserted as an outpatient surgery procedure in a hospital or clinic by an interventional radiologist or surgeon, under moderate sedation. Implantation is increasingly performed by interventional radiologists due to advancements in techniques and their facile use of imaging technologies. When no longer needed, the port can be removed in the interventional radiology suite or an operating room.\n\nUses \nPorts have many uses:\n\nTo deliver chemotherapy to cancer patients who must undergo treatment frequently. Chemotherapy is often toxic, and can damage skin and muscle tissue, and therefore should not be delivered through these tissues. Ports provide a solution, delivering drugs quickly and efficiently through the entire body via the circulatory system.\nTo deliver coagulation factors in patients with severe hemophilia.\nTo withdraw (and\/or return) blood to the body in patients who require frequent blood tests, and in hemodialysis patients.\nTo deliver antibiotics to patients requiring them for a long time or frequently, such as those with cystic fibrosis and bronchiectasis.\nDelivering medications to patients with immune disorders.\nFor treating alpha 1-antitrypsin deficiency with replacement therapy\nFor delivering radiopaque contrast agents, which enhance contrast in CT imaging.\nTo fill or withdraw fluid from the Lap-Band or Realize gastric bands used in Bariatric surgeries.\nTo administer analgesics to patients with chronic pain, such as cancer patients and those with sickle-cell disease\nInsertion \n Follow-up chest X-ray after insertion of a port, with a malpositioned tip in the azygos vein.\n CT scan confirming a tip in the azygos vein.\nFluoroscopy is useful in guiding the insertion of ports.[2]\nA follow-up chest radiograph can immediately detect complications associated with the procedure in the form of pneumothorax, hemothorax and malpositions of the catheter (see Risks below for further details). However, it is suggested that chest radiography is not mandatory as a routine method after fluoroscopy-guided port insertion that is mainly performed by venous cutdown.[2]\nThe side of the patients' chest the port is implanted in will usually be chosen to avoid damage to the port and the veins by the seat belt in case of accident when seated as the driver. Thus, there is a potential conflict by left- and right-hand traffic as the rule of the road.[3][4]\n\nModels \nThere are many different models of ports. The particular model selected is based on the patient's specific medical conditions.\nPortals: \n\ncan be made of plastic, stainless steel, or titanium\ncan be single chamber or dual chamber\nvary in height, width and shape.\nCatheters:\n\ncan be made of biocompatible, medical-grade polyurethane or silicone\ncan vary in length and diameter\nPorts can be put in the upper chest or arm. The exact positioning itself is variable as it can be inserted to avoid visibility when wearing low cut shirts, and to avoid excess contact due to a backpack or bra strap. The most common placement is on the upper right portion of the chest, with the catheter itself looping through the right jugular vein, and down towards the patient's heart.\nFor applications as CT scan, high pressure infusion allowing ports are needed.[5][6]\n\nRisks \nAge: If the device is put into a child, the child's growth means that the catheter becomes relatively shorter and will move towards the head. It may become necessary to remove or replace it.\nArterial injury: The subclavian artery can be inadvertently punctured while attempting a subclavian vein access, leading to a subcutaneous hematoma and occasionally a pseudoaneurysm. An alternative site may need to be used for port placement. Puncture of the carotid artery is significantly more rare, since attempts to access the nearby jugular vein are increasingly done with ultrasound guidance.\nInfection: An infection may develop in the line or around the port. This may require antibiotic treatment or removal of the device.\nMechanical failure is uncommon. Ports placed through the subclavian vein may suffer from \"pinch-off syndrome\" where the catheter fractures as it passes into the vein. Ports placed via the jugular vein do not suffer from this problem. The catheter fragment then travels through the venous system and typically lodges in the right heart or the lungs. Many patients are asymptomatic but the mechanical failure is discovered because of an inability to flush or withdraw fluids from the port. In those instances, an interventional radiologist can usually retrieve the fragment and place a new port.\nPneumothorax: Attempts to gain access to the subclavian vein or jugular vein can injure the lung, potentially causing a pneumothorax. If the pneumothorax is large enough, a chest tube might need to be placed. In experienced hands, the incidence of this complication is about 1% when accessing the subclavian vein. When accessing the jugular vein the pneumothorax rate is virtually nonexistent.\nThrombosis: formation of a blood clot in the catheter may block the device irrevocably. To prevent clotting the port is flushed with saline and heparin, usually by a nurse or other medical professional, or someone properly trained that is a family member or the patient, at least once every four weeks, or more often in conjunction with administering medication.\nManufacturers \nThe major manufacturers of ports are AngioDynamics, B. Braun Medical,[7] Bard Access Systems,[6] Cook Medical, MedComp, Navilyst Medical, Norfolk Medical Products, and Smiths Medical.\n\nUse \nTo reduce damage or coring of the septum during use, low or non coring needles are to be used.[8]\nAfter each use, a heparin lock is made by injecting a small amount of heparinized saline (an anticoagulant) into the device, preventing development of clots within the port or catheter. In some catheter designs where there is a self-sealing valve at the far end, the system is locked with just saline. The port can be left accessed for as long as required. The port is covered in a dressing to protect the site from infection and to secure the needle in position.\nIf a port is used infrequently, it may be necessary to access the port, flush it with saline, and inject a new heparin lock to prevent clotting between uses.\n\nAlternatives \nSometimes, the physical condition of the patient, especially the structure of his veins, does not allow for the insertion of a port. An alternative is the PICC line, despite drawbacks such as external entry point and limited lifespan of the device.[9]\n\nIn popular culture \nIn the 1984 cyberpunk novel Neuromancer, a minor character, Peter Riviera, has a kind of medical port placed in his arm to facilitate his recreational drug use.[10]\n\nSee also \nHickman line\nPeripherally inserted central catheter or \"PICC\"\nGroshong line\nReferences \n\n\n^ \"Gastroenterology-Urology Devices; Reclassification of Implanted Blood Access Devices\". Food and Drug Administration. 25 July 2014. \n\n^ a b Thomopoulos, Theodoros; Meyer, Jeremy; Staszewicz, Wojciech; Bagetakos, Ilias; Scheffler, Max; Lomessy, Antoine; Toso, Christian; Becker, Christoph D.; Morel, Philippe (2014). \"Routine Chest X-ray is not Mandatory after Fluoroscopy-Guided Totally Implantable Venous Access Device Insertion\". Annals of Vascular Surgery. 28 (2): 345\u2013350. doi:10.1016\/j.avsg.2013.08.003. ISSN 0890-5096. \n\n^ Julia Lederbogen-H\u00fclsen (2009). Erleichterung der Chemotherapie durch implantierbare Portkatheter-Systeme bei Patientinnen mit gyn\u00e4kologischen Tumoren (in German). M\u00fcnster: Universit\u00e4tsklinikum M\u00fcnster. p. 91. Verlauf des Autosicherheitsgurts in die \u00dcberlegungen mit einzubeziehen (to include the place of the safety belt into the planning) \n\n^ \"Celsite\u00ae Portkatheter-Systeme\" (PDF) (in German). B. Braun Melsungen. 2012. Auf welcher Seite wird der Sicherheitsgurt angebracht? (which side is the safety belt) \n\n^ \"C-Port\u00aeCT\". Retrieved 25 November 2017 . \n\n^ a b \"IMPLANTABLE PORT DEVICES\". Retrieved 23 November 2017 . \n\n^ \"Celsite\u00ae Access Ports\" (PDF) . Retrieved 23 November 2017 . \n\n^ \"Choice of the Needles\" (PDF) . p. 7. Retrieved 25 November 2017 . \n\n^ Michaela Hans. \"Pflegeleitfaden\" (PDF) (in German). CHARIT\u00c9. p. 22. Retrieved 2017-12-03 . Liegedauer von 4 Monaten \n\n^ Gibson, William (July 2000) [July 1983]. \"Chapter Eight\". Neuromancer (Ace trade paperback ed.). p. 105. Riviera loosened and removed the elastic length of surgical tubing from his arm. 'Yes. It's more fun.' He smiled, his eyes distant now, cheeks flushed. 'I've a membrane set in, just over the vein, so I never have to worry about the condition of the needle.' 'Doesn't hurt?' [said Case] The bright eyes met his. 'Of course it does. That's part of it, isn't it?' \n\n\nFurther reading \nMallon, William (March 2001). \"Is It Acceptable to Discharge a Heroin User with an Intravenous Line to Complete His Antibiotic Therapy for Cellulitis at Home under a Nurse's Supervision?\". Point-Counterpoint (column). The Western Journal of Medicine. 174 (3): 157. doi:10.1136\/ewjm.174.3.157. PMC 1071292 . PMID 11238332. \nExternal links \nwww.breastcancer.org: Ports for Chemo\nA photo-essay on what it's like to have a port\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Port_(medical)\">https:\/\/www.limswiki.org\/index.php\/Port_(medical)<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 582 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","66f306a9b1671f4ccef0b68b1ee54d12_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Port_medical skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Port (medical)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAC_met_Gripper_erin.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/PAC_met_Gripper_erin.JPG\/220px-PAC_met_Gripper_erin.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAC_met_Gripper_erin.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Port-a-Cath with needle assembly inserted.<\/div><\/div><\/div>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, a <b>port<\/b> is a small medical appliance that is installed beneath the skin. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> connects the port to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a>. Under the skin, the port has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Septum\" title=\"Septum\" rel=\"external_link\" target=\"_blank\">septum<\/a> through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical \"needle stick\".\n<\/p><p>Ports are used mostly to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hematology\" title=\"Hematology\" rel=\"external_link\" target=\"_blank\">hematology<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oncology\" title=\"Oncology\" rel=\"external_link\" target=\"_blank\">oncology<\/a> patients. Ports were previously adapted for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> patients, but were found to be associated with increased rate of infections and are no longer available in the US.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The port is usually inserted in the upper chest (known as a \"chest port\"), just below the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clavicle\" title=\"Clavicle\" rel=\"external_link\" target=\"_blank\">clavicle<\/a> or collar bone, leaving the patient's hands free.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Terminology\">Terminology<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portkatheter_R%C3%B6ntgen.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Portkatheter_R%C3%B6ntgen.JPG\/220px-Portkatheter_R%C3%B6ntgen.JPG\" width=\"220\" height=\"249\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portkatheter_R%C3%B6ntgen.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Chest X-ray showing an implanted port.<\/div><\/div><\/div>\n<p>A port is more correctly known as a \"totally implantable venous access device\". Brand Names include Eco Port, Clip-a-Port, SmartPort, Microport, Bardport, PowerPort, Passport, Port-a-Cath, Infuse-a-Port, Medi-Port, and Bioflo.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"How_it_works\">How it works<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray576.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e9\/Gray576.png\/220px-Gray576.png\" width=\"220\" height=\"177\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray576.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> runs from the portal and is surgically inserted into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> (usually the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subclavian_vein\" title=\"Subclavian vein\" rel=\"external_link\" target=\"_blank\">subclavian vein<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_vena_cava\" title=\"Superior vena cava\" rel=\"external_link\" target=\"_blank\">superior vena cava<\/a>). Ideally, the catheter terminates in the superior vena cava, just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.<\/div><\/div><\/div>\n<p>A port consists of a reservoir compartment (the portal) that has a silicone bubble for needle insertion (the septum), with an attached plastic tube (the catheter). The device is surgically inserted under the skin in the upper chest or in the arm and appears as a bump under the skin. It requires no special maintenance and is completely internal so swimming and bathing are not a problem. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> runs from the portal and is surgically inserted into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> (usually the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a> or less optimally the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subclavian_vein\" title=\"Subclavian vein\" rel=\"external_link\" target=\"_blank\">subclavian vein<\/a>). Ideally, the catheter terminates in the superior vena cava or the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.\n<\/p><p>The septum is made of a special self-sealing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>; it can be punctured hundreds of times before it weakens significantly. To administer treatment or to withdraw blood, a health care professional will first locate the port and disinfect the area, then access the port by puncturing the overlying skin with a Huber point needle. Due to its design, there is a very low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hickman_line\" title=\"Hickman line\" rel=\"external_link\" target=\"_blank\">Hickman line<\/a>. Negative pressure is created to withdraw blood into the vacuumized needle, to check for blood return and see if the port is functioning normally. Next, the port is flushed with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_solution\" class=\"mw-redirect\" title=\"Saline solution\" rel=\"external_link\" target=\"_blank\">saline solution<\/a>. Then, treatment will begin.\n<\/p><p>The implantation procedure itself is considered minor, and is typically performed with both local anaesthesia and moderate sedation. Patients often have post-procedure discomfort at the insertion site which is most often managed by administration of acetaminophen or a non-steroidal anti-inflammatory drug such as ibuprofen.\n<\/p><p>A port is most commonly inserted as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Outpatient_surgery\" title=\"Outpatient surgery\" rel=\"external_link\" target=\"_blank\">outpatient surgery<\/a> procedure in a hospital or clinic by an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiologist\" class=\"mw-redirect\" title=\"Interventional radiologist\" rel=\"external_link\" target=\"_blank\">interventional radiologist<\/a> or surgeon, under moderate sedation. Implantation is increasingly performed by interventional radiologists due to advancements in techniques and their facile use of imaging technologies. When no longer needed, the port can be removed in the interventional radiology suite or an operating room.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<p>Ports have many uses:\n<\/p>\n<ul><li>To deliver <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemotherapy\" title=\"Chemotherapy\" rel=\"external_link\" target=\"_blank\">chemotherapy<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancer<\/a> patients who must undergo treatment frequently. Chemotherapy is often toxic, and can damage skin and muscle tissue, and therefore should not be delivered through these tissues. Ports provide a solution, delivering drugs quickly and efficiently through the entire body via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">circulatory system<\/a>.<\/li>\n<li>To deliver <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">coagulation factors<\/a> in patients with severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemophilia\" class=\"mw-redirect\" title=\"Hemophilia\" rel=\"external_link\" target=\"_blank\">hemophilia<\/a>.<\/li>\n<li>To withdraw (and\/or return) blood to the body in patients who require frequent blood tests, and in hemodialysis patients.<\/li>\n<li>To deliver <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotic\" title=\"Antibiotic\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a> to patients requiring them for a long time or frequently, such as those with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystic_fibrosis\" title=\"Cystic fibrosis\" rel=\"external_link\" target=\"_blank\">cystic fibrosis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchiectasis\" title=\"Bronchiectasis\" rel=\"external_link\" target=\"_blank\">bronchiectasis<\/a>.<\/li>\n<li>Delivering medications to patients with immune disorders.<\/li>\n<li>For treating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alpha_1-antitrypsin_deficiency\" title=\"Alpha 1-antitrypsin deficiency\" rel=\"external_link\" target=\"_blank\">alpha 1-antitrypsin deficiency<\/a> with replacement therapy<\/li>\n<li>For delivering radiopaque contrast agents, which enhance contrast in CT imaging.<\/li>\n<li>To fill or withdraw fluid from the Lap-Band or Realize gastric bands used in Bariatric surgeries.<\/li>\n<li>To administer analgesics to patients with chronic pain, such as cancer patients and those with sickle-cell disease<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Insertion\">Insertion<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\/220px-X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\" width=\"220\" height=\"204\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Follow-up <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_radiograph\" title=\"Chest radiograph\" rel=\"external_link\" target=\"_blank\">chest X-ray<\/a> after insertion of a port, with a malpositioned tip in the azygos vein.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CT_of_port-a-cath_in_azygos_vein.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/CT_of_port-a-cath_in_azygos_vein.jpg\/220px-CT_of_port-a-cath_in_azygos_vein.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CT_of_port-a-cath_in_azygos_vein.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a> confirming a tip in the azygos vein.<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">Fluoroscopy<\/a> is useful in guiding the insertion of ports.<sup id=\"rdp-ebb-cite_ref-ThomopoulosMeyer2014_2-0\" class=\"reference\"><a href=\"#cite_note-ThomopoulosMeyer2014-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>A follow-up <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_radiograph\" title=\"Chest radiograph\" rel=\"external_link\" target=\"_blank\">chest radiograph<\/a> can immediately detect complications associated with the procedure in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumothorax\" title=\"Pneumothorax\" rel=\"external_link\" target=\"_blank\">pneumothorax<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemothorax\" title=\"Hemothorax\" rel=\"external_link\" target=\"_blank\">hemothorax<\/a> and malpositions of the catheter (see Risks below for further details). However, it is suggested that chest radiography is not mandatory as a routine method after fluoroscopy-guided port insertion that is mainly performed by venous cutdown.<sup id=\"rdp-ebb-cite_ref-ThomopoulosMeyer2014_2-1\" class=\"reference\"><a href=\"#cite_note-ThomopoulosMeyer2014-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The side of the patients' chest the port is implanted in will usually be chosen to avoid damage to the port and the veins by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seat_belt\" title=\"Seat belt\" rel=\"external_link\" target=\"_blank\">seat belt<\/a> in case of accident when seated as the driver. Thus, there is a potential conflict by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left-_and_right-hand_traffic\" title=\"Left- and right-hand traffic\" rel=\"external_link\" target=\"_blank\">left- and right-hand traffic<\/a> as the rule of the road.<sup id=\"rdp-ebb-cite_ref-SIGU1_3-0\" class=\"reference\"><a href=\"#cite_note-SIGU1-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SIGU2_4-0\" class=\"reference\"><a href=\"#cite_note-SIGU2-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Models\">Models<\/span><\/h2>\n<p>There are many different models of ports. The particular model selected is based on the patient's specific medical conditions.\n<\/p><p>Portals: \n<\/p>\n<ul><li>can be made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">plastic<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a><\/li>\n<li>can be single chamber or dual chamber<\/li>\n<li>vary in height, width and shape.<\/li><\/ul>\n<p>Catheters:\n<\/p>\n<ul><li>can be made of biocompatible, medical-grade <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a><\/li>\n<li>can vary in length and diameter<\/li><\/ul>\n<p>Ports can be put in the upper chest or arm. The exact positioning itself is variable as it can be inserted to avoid visibility when wearing low cut shirts, and to avoid excess contact due to a backpack or bra strap. The most common placement is on the upper right portion of the chest, with the catheter itself looping through the right jugular vein, and down towards the patient's heart.\n<\/p><p>For applications as <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a>, high pressure infusion allowing ports are needed.<sup id=\"rdp-ebb-cite_ref-HPPM1_5-0\" class=\"reference\"><a href=\"#cite_note-HPPM1-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MMS5_6-0\" class=\"reference\"><a href=\"#cite_note-MMS5-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<ul><li>Age: If the device is put into a child, the child's growth means that the catheter becomes relatively shorter and will move towards the head. It may become necessary to remove or replace it.<\/li>\n<li>Arterial injury: The subclavian artery can be inadvertently punctured while attempting a subclavian vein access, leading to a subcutaneous hematoma and occasionally a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pseudoaneurysm\" title=\"Pseudoaneurysm\" rel=\"external_link\" target=\"_blank\">pseudoaneurysm<\/a>. An alternative site may need to be used for port placement. Puncture of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carotid_artery\" title=\"Carotid artery\" rel=\"external_link\" target=\"_blank\">carotid artery<\/a> is significantly more rare, since attempts to access the nearby <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a> are increasingly done with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasound<\/a> guidance.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">Infection<\/a>: An infection may develop in the line or around the port. This may require antibiotic treatment or removal of the device.<\/li>\n<li>Mechanical failure is uncommon. Ports placed through the subclavian vein may suffer from \"pinch-off syndrome\" where the catheter fractures as it passes into the vein. Ports placed via the jugular vein do not suffer from this problem. The catheter fragment then travels through the venous system and typically lodges in the right heart or the lungs. Many patients are asymptomatic but the mechanical failure is discovered because of an inability to flush or withdraw fluids from the port. In those instances, an interventional radiologist can usually retrieve the fragment and place a new port.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumothorax\" title=\"Pneumothorax\" rel=\"external_link\" target=\"_blank\">Pneumothorax<\/a>: Attempts to gain access to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subclavian_vein\" title=\"Subclavian vein\" rel=\"external_link\" target=\"_blank\">subclavian vein<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a> can injure the lung, potentially causing a pneumothorax. If the pneumothorax is large enough, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_tube\" title=\"Chest tube\" rel=\"external_link\" target=\"_blank\">chest tube<\/a> might need to be placed. In experienced hands, the incidence of this complication is about 1% when accessing the subclavian vein. When accessing the jugular vein the pneumothorax rate is virtually nonexistent.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombosis\" title=\"Thrombosis\" rel=\"external_link\" target=\"_blank\">Thrombosis<\/a>: formation of a blood clot in the catheter may block the device irrevocably. To prevent clotting the port is flushed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heparin\" title=\"Heparin\" rel=\"external_link\" target=\"_blank\">heparin<\/a>, usually by a nurse or other medical professional, or someone properly trained that is a family member or the patient, at least once every four weeks, or more often in conjunction with administering medication.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Manufacturers\">Manufacturers<\/span><\/h2>\n<p>The major manufacturers of ports are , <a href=\"https:\/\/en.wikipedia.org\/wiki\/B._Braun_Melsungen\" title=\"B. Braun Melsungen\" rel=\"external_link\" target=\"_blank\">B. Braun Medical<\/a>,<sup id=\"rdp-ebb-cite_ref-MMS4_7-0\" class=\"reference\"><a href=\"#cite_note-MMS4-7\" rel=\"external_link\">[7]<\/a><\/sup> ,<sup id=\"rdp-ebb-cite_ref-MMS5_6-1\" class=\"reference\"><a href=\"#cite_note-MMS5-6\" rel=\"external_link\">[6]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cook_Medical\" class=\"mw-redirect\" title=\"Cook Medical\" rel=\"external_link\" target=\"_blank\">Cook Medical<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Navilyst_Medical\" title=\"Navilyst Medical\" rel=\"external_link\" target=\"_blank\">Navilyst Medical<\/a>, , and .\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use\">Use<\/span><\/h2>\n<p>To reduce damage or coring of the septum during use, low or non coring needles are to be used.<sup id=\"rdp-ebb-cite_ref-NEED1_8-0\" class=\"reference\"><a href=\"#cite_note-NEED1-8\" rel=\"external_link\">[8]<\/a><\/sup>\nAfter each use, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heparin\" title=\"Heparin\" rel=\"external_link\" target=\"_blank\">heparin<\/a> lock is made by injecting a small amount of heparinized saline (an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticoagulant\" title=\"Anticoagulant\" rel=\"external_link\" target=\"_blank\">anticoagulant<\/a>) into the device, preventing development of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombus\" title=\"Thrombus\" rel=\"external_link\" target=\"_blank\">clots<\/a> within the port or catheter. In some catheter designs where there is a self-sealing valve at the far end, the system is locked with just saline. The port can be left accessed for as long as required. The port is covered in a dressing to protect the site from infection and to secure the needle in position.\n<\/p><p>If a port is used infrequently, it may be necessary to access the port, flush it with saline, and inject a new heparin lock to prevent clotting between uses.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternatives\">Alternatives<\/span><\/h2>\n<p>Sometimes, the physical condition of the patient, especially the structure of his veins, does not allow for the insertion of a port. An alternative is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripherally_inserted_central_catheter\" title=\"Peripherally inserted central catheter\" rel=\"external_link\" target=\"_blank\">PICC line<\/a>, despite drawbacks such as external entry point and limited lifespan of the device.<sup id=\"rdp-ebb-cite_ref-PICC1_9-0\" class=\"reference\"><a href=\"#cite_note-PICC1-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_popular_culture\">In popular culture<\/span><\/h2>\n<p>In the 1984 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyberpunk\" title=\"Cyberpunk\" rel=\"external_link\" target=\"_blank\">cyberpunk<\/a> novel <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromancer\" title=\"Neuromancer\" rel=\"external_link\" target=\"_blank\">Neuromancer<\/a><\/i>, a minor character, Peter Riviera, has a kind of medical port placed in his arm to facilitate his <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recreational_drug_use\" title=\"Recreational drug use\" rel=\"external_link\" target=\"_blank\">recreational drug use<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hickman_line\" title=\"Hickman line\" rel=\"external_link\" target=\"_blank\">Hickman line<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripherally_inserted_central_catheter\" title=\"Peripherally inserted central catheter\" rel=\"external_link\" target=\"_blank\">Peripherally inserted central catheter<\/a> or \"PICC\"<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Groshong_line\" title=\"Groshong line\" rel=\"external_link\" target=\"_blank\">Groshong line<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.federalregister.gov\/documents\/2014\/07\/25\/2014-17477\/gastroenterology-urology-devices-reclassification-of-implanted-blood-access-devices\" target=\"_blank\">\"Gastroenterology-Urology Devices; Reclassification of Implanted Blood Access Devices\"<\/a>. Food and Drug Administration. 25 July 2014.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Gastroenterology-Urology+Devices%3B+Reclassification+of+Implanted+Blood+Access+Devices&rft.pub=Food+and+Drug+Administration&rft.date=2014-07-25&rft_id=https%3A%2F%2Fwww.federalregister.gov%2Fdocuments%2F2014%2F07%2F25%2F2014-17477%2Fgastroenterology-urology-devices-reclassification-of-implanted-blood-access-devices&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-ThomopoulosMeyer2014-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ThomopoulosMeyer2014_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ThomopoulosMeyer2014_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomopoulos, Theodoros; Meyer, Jeremy; Staszewicz, Wojciech; Bagetakos, Ilias; Scheffler, Max; Lomessy, Antoine; Toso, Christian; Becker, Christoph D.; Morel, Philippe (2014). \"Routine Chest X-ray is not Mandatory after Fluoroscopy-Guided Totally Implantable Venous Access Device Insertion\". <i>Annals of Vascular Surgery<\/i>. <b>28<\/b> (2): 345\u2013350. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.avsg.2013.08.003\" target=\"_blank\">10.1016\/j.avsg.2013.08.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0890-5096\" target=\"_blank\">0890-5096<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Vascular+Surgery&rft.atitle=Routine+Chest+X-ray+is+not+Mandatory+after+Fluoroscopy-Guided+Totally+Implantable+Venous+Access+Device+Insertion&rft.volume=28&rft.issue=2&rft.pages=345-350&rft.date=2014&rft_id=info%3Adoi%2F10.1016%2Fj.avsg.2013.08.003&rft.issn=0890-5096&rft.aulast=Thomopoulos&rft.aufirst=Theodoros&rft.au=Meyer%2C+Jeremy&rft.au=Staszewicz%2C+Wojciech&rft.au=Bagetakos%2C+Ilias&rft.au=Scheffler%2C+Max&rft.au=Lomessy%2C+Antoine&rft.au=Toso%2C+Christian&rft.au=Becker%2C+Christoph+D.&rft.au=Morel%2C+Philippe&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SIGU1-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SIGU1_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Julia Lederbogen-H\u00fclsen (2009). <i>Erleichterung der Chemotherapie durch implantierbare Portkatheter-Systeme bei Patientinnen mit gyn\u00e4kologischen Tumoren<\/i> (in German). M\u00fcnster: Universit\u00e4tsklinikum M\u00fcnster. p. 91. <q>Verlauf des Autosicherheitsgurts in die \u00dcberlegungen mit einzubeziehen (to include the place of the safety belt into the planning)<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Erleichterung+der+Chemotherapie+durch+implantierbare+Portkatheter-Systeme+bei+Patientinnen+mit+gyn%C3%A4kologischen+Tumoren&rft.place=M%C3%BCnster&rft.pages=91&rft.pub=Universit%C3%A4tsklinikum+M%C3%BCnster&rft.date=2009&rft.au=Julia+Lederbogen-H%C3%BClsen&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SIGU2-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SIGU2_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sichereinfusionstherapie.de\/documents\/french\/OPM_9994688_Celsite_Portkath_Syst_Pflegebroschuere_Version_07-2012.pdf\" target=\"_blank\">\"Celsite\u00ae Portkatheter-Systeme\"<\/a> <span class=\"cs1-format\">(PDF)<\/span> (in German). B. Braun Melsungen. 2012. <q>Auf welcher Seite wird der Sicherheitsgurt angebracht? (which side is the safety belt)<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Celsite%C2%AE++Portkatheter-Systeme&rft.pub=B.+Braun+Melsungen&rft.date=2012&rft_id=http%3A%2F%2Fwww.sichereinfusionstherapie.de%2Fdocuments%2Ffrench%2FOPM_9994688_Celsite_Portkath_Syst_Pflegebroschuere_Version_07-2012.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HPPM1-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HPPM1_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.phs-medical.de\/en\/ports\/c-port-ct\/product-information\/\" target=\"_blank\">\"C-Port\u00aeCT\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=C-Port%C2%AECT&rft_id=http%3A%2F%2Fwww.phs-medical.de%2Fen%2Fports%2Fc-port-ct%2Fproduct-information%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MMS5-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-MMS5_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MMS5_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bardaccess.com\/products\/ports\" target=\"_blank\">\"IMPLANTABLE PORT DEVICES\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=IMPLANTABLE+PORT+DEVICES&rft_id=https%3A%2F%2Fwww.bardaccess.com%2Fproducts%2Fports&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MMS4-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MMS4_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.safeinfusiontherapy.com\/documents\/6050198_0613_Nursing_Guideline_low.pdf\" target=\"_blank\">\"Celsite\u00ae Access Ports\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Celsite%C2%AE+Access+Ports&rft_id=http%3A%2F%2Fwww.safeinfusiontherapy.com%2Fdocuments%2F6050198_0613_Nursing_Guideline_low.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NEED1-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NEED1_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.safeinfusiontherapy.com\/documents\/6050198_0613_Nursing_Guideline_low.pdf\" target=\"_blank\">\"Choice of the Needles\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. p. 7<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Choice+of+the+Needles&rft.pages=7&rft_id=http%3A%2F%2Fwww.safeinfusiontherapy.com%2Fdocuments%2F6050198_0613_Nursing_Guideline_low.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PICC1-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-PICC1_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Michaela Hans. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/radiologie.charite.de\/pflegeleitfaden\/leitfaden_picc_pflege.pdf\" target=\"_blank\">\"Pflegeleitfaden\"<\/a> <span class=\"cs1-format\">(PDF)<\/span> (in German). CHARIT\u00c9. p. 22<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-12-03<\/span><\/span>. <q>Liegedauer von 4 Monaten<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pflegeleitfaden&rft.pages=22&rft.pub=CHARIT%C3%89&rft.au=Michaela+Hans&rft_id=http%3A%2F%2Fradiologie.charite.de%2Fpflegeleitfaden%2Fleitfaden_picc_pflege.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Gibson\" title=\"William Gibson\" rel=\"external_link\" target=\"_blank\">Gibson, William<\/a> (July 2000) [July 1983]. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\">\"Chapter Eight\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromancer\" title=\"Neuromancer\" rel=\"external_link\" target=\"_blank\">Neuromancer<\/a><\/i> (Ace trade paperback ed.). p. 105. <q>Riviera loosened and removed the elastic length of surgical tubing from his arm. 'Yes. It's more fun.' He smiled, his eyes distant now, cheeks flushed. 'I've a membrane set in, just over the vein, so I never have to worry about the condition of the needle.' 'Doesn't hurt?' [said Case] The bright eyes met his. 'Of course it does. That's part of it, isn't it?'<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+Eight&rft.btitle=Neuromancer&rft.pages=105&rft.edition=Ace+trade+paperback&rft.date=2000-07&rft.aulast=Gibson&rft.aufirst=William&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DIDFfMPW32hQC%26pg%3DPA105%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Mallon, William (March 2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1071292\" target=\"_blank\">\"Is It Acceptable to Discharge a Heroin User with an Intravenous Line to Complete His Antibiotic Therapy for Cellulitis at Home under a Nurse's Supervision?\"<\/a>. Point-Counterpoint (column). <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wjm_(journal)\" class=\"mw-redirect\" title=\"Wjm (journal)\" rel=\"external_link\" target=\"_blank\">The Western Journal of Medicine<\/a><\/i>. <b>174<\/b> (3): 157. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fewjm.174.3.157\" target=\"_blank\">10.1136\/ewjm.174.3.157<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1071292\" target=\"_blank\">1071292<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11238332\" target=\"_blank\">11238332<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Western+Journal+of+Medicine&rft.atitle=Is+It+Acceptable+to+Discharge+a+Heroin+User+with+an+Intravenous+Line+to+Complete+His+Antibiotic+Therapy+for+Cellulitis+at+Home+under+a+Nurse%27s+Supervision%3F&rft.volume=174&rft.issue=3&rft.pages=157&rft.date=2001-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1071292&rft_id=info%3Apmid%2F11238332&rft_id=info%3Adoi%2F10.1136%2Fewjm.174.3.157&rft.aulast=Mallon&rft.aufirst=William&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1071292&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.breastcancer.org\/treatment\/chemotherapy\/process\/how.jsp\" target=\"_blank\">www.breastcancer.org: Ports for Chemo<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/diehlmartin.com\/infusion\/\" target=\"_blank\">A photo-essay on what it's like to have a port<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1253\nCached time: 20181206084945\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.288 seconds\nReal time usage: 0.360 seconds\nPreprocessor visited node count: 668\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 23612\/2097152 bytes\nTemplate argument size: 91\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 28887\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.158\/10.000 seconds\nLua memory usage: 4.08 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 271.958 1 -total\n<\/p>\n<pre>69.22% 188.258 1 Template:Reflist\n36.05% 98.053 7 Template:Cite_web\n23.07% 62.751 2 Template:Cite_journal\n20.40% 55.482 1 Template:More_citations_needed\n14.71% 40.006 1 Template:Ambox\n 6.37% 17.320 2 Template:Cite_book\n 1.29% 3.508 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:14047065-1!canonical and timestamp 20181206084944 and revision id 872246448\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Port_%28medical%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214641\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.027 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 150.037 1 - wikipedia:Port_(medical)\n100.00% 150.037 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8055-0!*!*!*!*!*!* and timestamp 20181217214641 and revision id 24166\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Port_(medical)\">https:\/\/www.limswiki.org\/index.php\/Port_(medical)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","66f306a9b1671f4ccef0b68b1ee54d12_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/PAC_met_Gripper_erin.JPG\/440px-PAC_met_Gripper_erin.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Portkatheter_R%C3%B6ntgen.JPG\/440px-Portkatheter_R%C3%B6ntgen.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e9\/Gray576.png\/440px-Gray576.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\/440px-X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/CT_of_port-a-cath_in_azygos_vein.jpg\/440px-CT_of_port-a-cath_in_azygos_vein.jpg"],"66f306a9b1671f4ccef0b68b1ee54d12_timestamp":1545083201,"6f82a58abdc5f62be708c1c05caa09c3_type":"article","6f82a58abdc5f62be708c1c05caa09c3_title":"Microchip implant (human)","6f82a58abdc5f62be708c1c05caa09c3_url":"https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)","6f82a58abdc5f62be708c1c05caa09c3_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMicrochip implant (human)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor use in animals, see Microchip implant (animal).\n A surgeon implants British scientist Dr Mark Gasson in his left hand with an RFID microchip (March 16, 2009)A human microchip implant is typically an identifying integrated circuit device or RFID transponder encased in silicate glass and implanted in the body of a human being. This type of subdermal implant usually contains a unique ID number that can be linked to information contained in an external database, such as personal identification, law enforcement, medical history, medications, allergies, and contact information.\nContents \n\n1 History \n2 Hobbyists \n3 Commercial implants \n\n3.1 Medical records \n3.2 Building access and security \n3.3 Possible future applications \n\n\n4 Potential problems \n\n4.1 Cancer \n4.2 Security risks \n\n\n5 Legislation \n\n5.1 United States \n\n\n6 In popular culture \n7 See also \n8 References \n9 Further reading \n\n\nHistory \nThe first experiments with an RFID implant were carried out in 1998 by the British scientist Kevin Warwick.[1][2][3][4][5] His implant was used to open doors, switch on lights, and cause verbal output within a building. After nine days the implant was removed and has since been held in the Science Museum (London).[citation needed ]\nOn 16 March 2009 British scientist Mark Gasson had an advanced glass capsule RFID device surgically implanted into his left hand. In April 2010 Gasson's team demonstrated how a computer virus could wirelessly infect his implant and then be transmitted on to other systems.[6] Gasson reasoned that with implanted technology the separation between man and machine can become theoretical because the technology can be perceived by the human as being a part of their body. Because of this development in our understanding of what constitutes our body and its boundaries he became credited as being the first human infected by a computer virus. He has no plans to remove his implant.[7]\n\nHobbyists \n An RFID tag visible under the skin soon after being implanted.\nSeveral hobbyists have placed RFID microchip implants into their hands or had them inserted by others.\nAmal Graafstra,[8] author of the book RFID Toys,[9] asked doctors to place implants in his hands in March 2005. A cosmetic surgeon used a scalpel to place a microchip in his left hand, and his family doctor injected a chip into his right hand using a veterinary Avid injector kit. Graafstra uses the implants to access his home, open car doors, and to log on to his computer. With public interest growing, in 2013 he launched biohacking company Dangerous Things[10] and crowdfunded the world's first implantable NFC transponder in 2014.[11] He has also spoken at various events and promotional gigs[12] including TEDx,[13] and built a smartgun that only fires after reading his implant.[14]\nAlejandro Hernandez CEO of Futura is known to be the first in Central America to have Dangerous Things' transponder installed in his left hand by Federico Cortes in November 2017.\nMikey Sklar had a chip implanted into his left hand and filmed the procedure.[15]\nJonathan Oxer self-implanted an RFID chip in his arm using a veterinary implantation tool.[16]\nMartijn Wismeijer, Dutch marketing manager for Bitcoin ATM manufacturer General Bytes, placed RFID chips in both of his hands to store his Bitcoin private keys and business card.[17]\nPatric Lanhed sent a \u201cbio-payment\u201d of one euro worth of Bitcoin using a chip embedded in his hand.\n[18]\n\n<\/p>Marcel Varallo had an NXP chip coated in Bioglass 8625 inserted into his hand between his forefinger and thumb allowing him to open secure elevators and doors at work, print from secure printers, unlock his mobile phone and home, and store his digital business card for transfer to mobile phones enabled for NFC.\n[19]\n\n<\/p>Biohacker Hannes Sj\u00f6blad has been experimenting with NFC (Near Field Communication) chip implants since 2015. During his talk at Echapp\u00e9e Vol\u00e9\u00e9 2016 in Paris, Sj\u00f6blad disclosed that he has also implanted himself between his forefinger and thumb and uses it to unlock doors, make payments, and unlock his phone (essentially replacing anything you can put in your pockets).[20] Additionally, Sj\u00f6blad has hosted several \"implant parties,\" where interested individuals can also be implanted with the chip.[21]\n\nCommercial implants \nMedical records \nResearchers have examined microchip implants in humans in the medical field and they indicate that there are potential benefits and risks to incorporating the device in the medical field. For example, it could be beneficial for noncompliant patients but still poses great risks for potential misuse of the device.[22]\nDestron Fearing, a subsidiary of Digital Angel, initially developed the technology for the VeriChip.[23]\nIn 2004, the VeriChip implanted device and reader were classified as Class II: General controls with special controls by the FDA;[24] that year the FDA also published a draft guidance describing the special controls required to market such devices.[25]\nAbout the size of a grain of rice, the device was typically implanted between the shoulder and elbow area of an individual\u2019s right arm. Once scanned at the proper frequency, the chip responded with a unique 16-digit number which could be then linked with information about the user held on a database for identity verification, medical records access and other uses. The insertion procedure was performed under local anesthetic in a physician's office.[26][27]\nPrivacy advocates raised concerns regarding potential abuse of the chip, with some warning that adoption by governments as a compulsory identification program could lead to erosion of civil liberties, as well as identity theft if the device should be hacked.[27][28][29] Another ethical dilemma posed by the technology, is that people with dementia could possibly benefit the most from an implanted device that contained their medical records, but issues of informed consent are the most difficult in precisely such people.[30]\nIn June 2007, the American Medical Association declared that \"implantable radio frequency identification (RFID) devices may help to identify patients, thereby improving the safety and efficiency of patient care, and may be used to enable secure access to patient clinical information\",[31] but in the same year, news reports linking similar devices to cancer caused in laboratory animals had a devastating impact on the company's stock price and sales.[32]\nIn 2010, the company, by then called \"PositiveID\", withdrew the product from the market due to poor sales.[33]\nIn January 2012, PositiveID sold the chip assets to a company called VeriTeQ that was owned by Scott Silverman, the former CEO of Positive ID.[34]\nIn 2016, JAMM Technologies acquired the chip assets from VeriTeQ; JAMM's business plan was to partner with companies selling implanted medical devices and use the RfID tags to monitor and identify the devices.[35] JAMM Technologies is co-located in the same Plymouth, Minnesota building as Geissler Corporation with Randolph K. Geissler and Donald R. Brattain[36][37] listed as its principals. \nThe website also claims that Geissler was CEO of PositiveID Corporation, Destron Fearing Corporation, and Digital Angel Corporation.[38]\n\n<\/p>In 2018, A Danish firm called BiChip released a new generation of microchip implant that is intended to be readable from distance and connected to Internet. The company released an update for its microchip implant to associate it with the Ripple cryptocurrency to allow payments to be made using the implanted microchip.[39]\n\nBuilding access and security \nIn February 2006, CityWatcher, Inc. of Cincinnati, OH became the first company in the world to implant microchips into their employees as part of their building access control and security system. The workers needed the implants to access the company's secure video tape room, as documented in USA Today.[40] The project was initiated and implemented by Six Sigma Security, Inc. The VeriChip Corporation had originally marketed the implant as a way to restrict access to secure facilities such as power plants.\nA major drawback for such systems is the relative ease with which the 16-digit ID number contained in a chip implant can be obtained and cloned using a hand-held device, a problem that has been demonstrated publicly by security researcher Jonathan Westhues[41] and documented in the May 2006 issue of Wired magazine,[42] among other places.\n\nThe Baja Beach Club, a nightclub in Rotterdam, the Netherlands, once used VeriChip implants for identifying VIP guests.[43]\nThe Epicenter in Stockholm, Sweden is using RFID implants for employees to operate security doors, copiers, and pay for lunch.[44]\nPossible future applications \nIn 2017 Mike Miller, chief executive of the World Olympians Association, was widely reported as suggesting the use of such implants in athletes in an attempt to reduce problems in sport due to drug taking.[45]\nTheoretically, a GPS-enabled chip could one day make it possible for individuals to be physically located by latitude, longitude, altitude, speed, and direction of movement. Such implantable GPS devices are not technically feasible at this time. However, if widely deployed at some future point, implantable GPS devices could conceivably allow authorities to locate missing persons and\/or fugitives and those who fled from a crime scene. Critics contend, however, that the technology could lead to political repression as governments could use implants to track and persecute human rights activists, labor activists, civil dissidents, and political opponents; criminals and domestic abusers could use them to stalk and harass their victims; and child abusers could use them to locate and abduct children.\nAnother suggested application for a tracking implant, discussed in 2008 by the legislature of Indonesia's Irian Jaya would be to monitor the activities of persons infected with HIV, aimed at reducing their chances of infecting other people.[46][47] The microchipping section was not, however, included into the final version of the provincial HIV\/AIDS Handling bylaw passed by the legislature in December 2008.[48] With current technology, this would not be workable anyway, since there is no implantable device on the market with GPS tracking capability.\nSince modern payment methods rely upon RFID\/NFC, it is thought that implantable microchips, if they were to ever become popular in use, would form a part of the cashless society.[49] Verichip implants have already been used in nightclubs such as the Baja club for such a purpose, allowing patrons to purchase drinks with their implantable microchip.\n\nPotential problems \nCancer \nIn a self-published report[50] anti-RFID advocate Katherine Albrecht, who refers to RFID devices as \"spy chips\", cites veterinary and toxicological studies carried out from 1996 to 2006 which found lab rodents injected with microchips as an incidental part of unrelated experiments and dogs implanted with identification microchips sometimes developed cancerous tumors at the injection site (subcutaneous sarcomas) as evidence of a human implantation risk.[51] However, the link between foreign-body tumorigenesis in lab animals and implantation in humans has been publicly refuted as erroneous and misleading[52] and the report's author has been criticized over the use of \"provocative\" language \"not based in scientific fact\".[53] Notably, none of the studies cited specifically set out to investigate the cancer risk of implanted microchips and so none of the studies had a control group of animals that did not get implanted. While the issue is considered worthy of further investigation, one of the studies cited cautioned \"Blind leaps from the detection of tumors to the prediction of human health risk should be avoided\".[54][55][56]\n\nSecurity risks \nThe Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association published a report in 2007 alleging that RFID implanted chips may compromise privacy because there is no assurance that the information contained in the chip can be properly protected.[57]\n\nLegislation \nThe examples and perspective in this article may not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (August 2017) (Learn how and when to remove this template message)\nUnited States \nFollowing Wisconsin and North Dakota,[58] California issued Senate Bill 362 in 2007, which makes it illegal to force a person to have a microchip implanted, and provide for an assessment of civil penalties against violators of the bill.[58]\nIn 2008, Oklahoma passed 63 OK Stat \u00a7 63-1-1430 (2008 S.B. 47), that bans involuntary microchip implants in humans.[59][60]\nOn April 5, 2010, the Georgia Senate passed Senate Bill 235 that prohibits forced microchip implants in humans and that would make it a misdemeanor for anyone to require them, including employers.[61] The bill would allow voluntary microchip implants, as long as they are performed by a physician and regulated by the Georgia Composite Medical Board. The state's House of Representatives did not take up the measure.[citation needed ]\nOn February 10, 2010, Virginia's House of Delegates also passed a bill that forbids companies from forcing their employees to be implanted with tracking devices.[62]\nWashington State House Bill 1142-2009-10 orders a study using implanted radio frequency identification or other similar technology to electronically monitor sex offenders and other felons.[63]\n\nIn popular culture \nThe general public are most familiar with microchips in the context of tracking their pets. In the U.S., some Christian activists, including conspiracy theorist Mark Dice, the author of a book titled The Resistance Manifesto[64], make a link between the PositiveID and the Biblical Mark of the Beast,[65][66] prophesied to be a future requirement for buying and selling,[67] and a key element of the Book of Revelation.[68][69] Gary Wohlscheid, president of These Last Days Ministries, has argued that \"Out of all the technologies with potential to be the mark of the beast, VeriChip has got the best possibility right now\".[70]\n\nSee also \nRFID\nAmbient intelligence\nReferences \n\n\n^ \"Is human chip implant wave of the future?\". CNN. January 13, 1999. Retrieved May 12, 2010 . \n\n^ \"Professor has world's first silicon chip implant\". independent.co.uk. 26 August 1998. \n\n^ \"Professor Cyborg\". wired.com. \n\n^ \"BBC News - Sci\/Tech - Technology gets under the skin\". news.bbc.co.uk. \n\n^ Sanchez-Klein, Jana. \"CNN - Cyberfuturist plants chip in arm to test human-computer interaction - August 28, 1998\". edition.cnn.com. \n\n^ Gasson, M. N. (2010). \"Human Enhancement: Could you become infected with a computer virus?\". 2010 IEEE International Symposium on Technology and Society. p. 61. doi:10.1109\/ISTAS.2010.5514651. ISBN 978-1-4244-7777-7. \n\n^ http:\/\/www.personal.reading.ac.uk\/~sis04mng\/research\/ FAQ: Could you become infected with a computer virus? \n\n^ \"Amal Graafstra - Technologist, Author & Double RFID Implantee\". amal.net. Retrieved 2017-05-26 . \n\n^ \"RFID Toys Forum\". Dangerous Things Forum. Retrieved 2017-05-26 . \n\n^ \"Dangerous Things\". Dangerous Things. Retrieved 2017-05-26 . \n\n^ \"The xNT implantable NFC chip\". Indiegogo. Retrieved 2017-05-26 . \n\n^ bpg (2017-03-09), PRMT | Ghost In the Shell | Live Stream, retrieved 2017-05-26 \n\n^ TEDx Talks (2013-10-17), Biohacking - the forefront of a new kind of human evolution: Amal Graafstra at TEDxSFU, retrieved 2017-05-26 \n\n^ Motherboard (2017-03-23), Who Killed the Smart Gun?, retrieved 2017-05-26 \n\n^ https:\/\/www.youtube.com\/watch?v=w2gKJeM6Ihw link Fox News Interviews Mikey Sklar \n\n^ \"Jondo the Mandroid is RFID enabled\". \n\n^ Clark, Liat (November 11, 2014). \"Hand-implanted NFC chips open this man's bitcoin wallet\". Retrieved February 15, 2015 . \n\n^ Pearson, Jordan (October 30, 2015). \"This Guy Implanted His Bitcoin Wallet and Made a Payment With His Hand\". Retrieved November 2, 2015 . \n\n^ \"Heraldsun.com.au - Subscribe to the Herald Sun for exclusive stories\". www.heraldsun.com.au. \n\n^ \"Au pays des esp\u00e8ces en voie de disparition\". lesechos.fr. 2016-02-19. Retrieved 2016-07-07 . \n\n^ \"The rise of the Swedish cyborgs - BBC News\". Retrieved 2016-07-07 . \n\n^ Eltorai, Adam E. M.; Fox, Henry; McGurrin, Emily; Guang, Stephanie (2016). \"Microchips in Medicine: Current and Future Applications\". BioMed Research International. 2016: 1\u20137. doi:10.1155\/2016\/1743472. ISSN 2314-6133. \n\n^ Smith, Richard M. \u201cTough Sell Ahead for the VeriChip Implant ID System.\u201dArchived October 25, 2007, at the Wayback Machine., Computer Bytes Man. 27 Dec. 2001. 16 Oct. 2007 \n\n^ \"KO33440: Designation of VeriChip as Class II with special controls\" (PDF) . FDA. October 12, 2004. \n\n^ \"Class II Special Controls Guidance Document: Implantable Radiofrequency Transponder System for Patient Identification and Health Information\" (PDF) . FDA. December 10, 2004. \n\n^ \"Verichip Consumer FAQ\". Archived from the original on August 2, 2009. Retrieved 2009-08-16 . \n\n^ a b Halamka, J; Juels, A; Stubblefield, A; Westhues, J (2006). \"The security implications of VeriChip cloning\". Journal of the American Medical Informatics Association : JAMIA. 13 (6): 601\u20137. doi:10.1197\/jamia.M2143. PMC 1656959 . PMID 16929037. \n\n^ \"Human-implantable RFID chips: Some ethical and privacy concerns\". Healthcare IT News. 30 July 2007. \n\n^ Westra, BL (March 2009). \"Radio frequency identification\". The American journal of nursing. 109 (3): 34\u20136. doi:10.1097\/01.NAJ.0000346925.67498.a4. PMID 19240491. \n\n^ Mordini, E; Ottolini, C (2007). \"Body identification, biometrics and medicine: ethical and social considerations\" (PDF) . Annali dell'Istituto Superiore di Sanit\u00e0. 43 (1): 51\u201360. PMID 17536154. \n\n^ \"American Medical Association CEJA Report 5-A-07\". \n\n^ Lewan, Todd (September 8, 2007). \"Chip Implants Linked to Animal Tumours\". The Washington Post. Retrieved 2010-06-08 . \n\n^ Edwards, Jim. \"Down With the Chip: PositiveID Axes Its Scary Medical Records\". bNET. July 15, 2010. Retrieved March 2, 2017 \n\n^ \"VeriTeQ Acquisition Corporation Acquires Implantable, FDA-Cleared VeriChip Technology and Health Link Personal Health Record from PositiveID Corporation\". VeriTeQ via BusinessWire. January 17, 2012. \n\n^ Geissler, Randy (April 4, 2016). \"JAMM Technologies Acquires the Veriteq RFID Technology Platform and Enters into Supply Agreement with Establishment Labs\". JAMM via PRWeb. \n\n^ \"Don Brattain, OSU SPEARS SCHOOL TRIBUTES: 100 FOR 100\". Oklahoma State University. Retrieved April 21, 2018 . \n\n^ \"Tyler Technologies, Inc., Tyler Investor Community, Directors, Donald R. Brattain, Independent Director\". Tyler Technologies, Inc. Retrieved April 21, 2018 . \n\n^ \"Geissler Corporation - Management\". Geissler Corporation. Retrieved April 21, 2018 . \n\n^ Hamill, Jasper (January 2018). \"Would you store Ripple and Bitcoin in microchip?\". Metro. \n\n^ Lewan, Todd. USA Today. July 2007. \"Microchips in humans spark privacy debate.\". \n\n^ Westhues, Jonathan. \"Demo: Cloning a VeriChip.\" Demo: Cloning a VeriChip. \n\n^ Newitz, Annalee (May 2006). \"The RFID Hacking Underground\". Wired. Retrieved July 13, 2011 . \n\n^ http:\/\/www.baja.nl\/vipform.aspx \n\n^ Mearian, Lucas (February 6, 2015). \"Office complex implants RFID chips in employees' hands\". Computerworld. Retrieved February 15, 2015 . \n\n^ http:\/\/home.bt.com\/tech-gadgets\/future-tech\/microchips-in-humans-to-prevent-doping-11364220161232 \n\n^ \"Indonesia's Papua plans to tag AIDS sufferers\", Mon Nov 24, 2008. \n\n^ Jason Tedjasukmana (Nov 26, 2008), \"Papua Proposal: A Microchip to Track the HIV-Positive\", Time \n\n^ Government Of Indonesian Province Rejects Plan To Implant Microchips In Some HIV-Positive People Archived 2013-12-25 at the Wayback Machine., 2008-12-08 \n\n^ \"Cashless Society\" This is a dead link. \n\n^ http:\/\/www.antichips.com\/cancer\/ Microchip-Induced Tumors in Laboratory Rodents and Dogs: A Review of the Literature 1990\u20132006 \n\n^ Lewan, Todd (September 8, 2007), \"Chip Implants Linked to Animal Tumours\", The Washington Post, retrieved 2010-06-08 \n\n^ RFID Journal. \"VeriChip Defends the Safety of Implanted RFID Tags\". rfidjournal.com. Retrieved 13 April 2016 . \n\n^ https:\/\/www.youtube.com\/watch?v=CS13kFWQIYM#t=60m53s Tumours, Tracking, and Tyranny: The Downside to Implantable Microchip \n\n^ Blanchard, K. T.; Barthel, C.; French, J. E.; Holden, H. E.; Moretz, R.; Pack, F. D.; Tennant, R. W.; Stoll, R. E. (1999). \"Transponder-Induced Sarcoma in the Heterozygous p53+\/- Mouse\". Toxicologic Pathology. 27 (5): 519. doi:10.1177\/019262339902700505. \n\n^ \"Lewan, Todd. The Associated Press, September 8, 2007. \"Chip Implants Linked to Animal Tumors\" \". washingtonpost.com. \n\n^ Studies Linking Microchips and Cancer \n\n^ CEJA of the American Medical Association, CEJA Report 5-A-07, Radio Frequency ID Devices in Humans, presented by Robert M. Sade, MD, Chair. 2007 \n\n^ a b California Bans Forced RFID Tagging of Humans, Government Technology website, October 17, 2007 \n\n^ \nTim Talley.\n\"Bill bans involuntary microchip implants\".\n2008. \n\n^ \n\"Radio Frequency Identification (RFID) Privacy Laws\".\n2015. \n\n^ \"Georgia SB 235 - Ban on Required Human Microchip Implantation - Key Vote - The Voter's Self Defense System - Vote Smart\". Project Vote Smart. Retrieved 13 April 2016 . \n\n^ Virginia delegates pass bill banning chip implants as \u2018mark of the beast\u2019, The Raw Story, By Daniel Tencer, Wednesday, February 10, 2010 retrieved April 23, 2010 \n\n^ HB 1142-2009-10 to study requiring the use of implanted RFID in certain felons. \n\n^ Dice, Mark (July 26, 2006). The Resistance Manifesto. The Resistance. ISBN 0967346649. \n\n^ Streitfield, David (9 May 2002). \"First Humans to Receive ID Chips; Technology: Device injected under the skin will provide identification and medical information\". Los Angeles Times. Retrieved 13 September 2010 . \n\n^ Gilbert, Alorie (16 February 2005). \"Is RFID the mark of the beast?\". CNET News. Retrieved 13 September 2010 . \n\n^ \"Revelation 14:9-11\". Bible Gateway. Retrieved 2010-07-03 . \n\n^ Albrecht, Katherine; McIntyre, Liz (2006-01-31). The Spychips Threat: Why Christians Should Resist RFID and Electronic Surveillance. Nelson Current. ISBN 1-59555-021-6. \n\n^ Baard, Mark (2006-06-06). \"RFID: Sign of the (End) Times?\". Wired.com. Retrieved 2009-10-13 . \n\n^ Scheeres, Julia (6 February 2002). \"They Want Their ID Chips Now\". Wired News. Retrieved 13 September 2010 . \n\n\nFurther reading \nHaag, Stephen; Cummings, Maeve,; McCubbrey, Donald (2004). Management Information Systems for the Information Age (4th ed.). New York City, New York: McGraw-Hill. ISBN 0-07-281947-2. CS1 maint: Multiple names: authors list (link) \nGraafstra, Amal (2004). RFID Toys: 11 Cool Projects for Home, Office and Entertainment (4th ed.). New York City, New York: (ExtremeTech) Ziff Davis Publishing Holdings Inc. ISBN 0-471-77196-1. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)\">https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:14.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,230 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6f82a58abdc5f62be708c1c05caa09c3_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Microchip_implant_human skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Microchip implant (human)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For use in animals, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_(animal)\" title=\"Microchip implant (animal)\" rel=\"external_link\" target=\"_blank\">Microchip implant (animal)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_(March_16_2009).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg\/220px-Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_(March_16_2009).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A surgeon implants British scientist Dr <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Gasson\" title=\"Mark Gasson\" rel=\"external_link\" target=\"_blank\">Mark Gasson<\/a> in his left hand with an RFID microchip (March 16, 2009)<\/div><\/div><\/div><p>A human <b>microchip implant<\/b> is typically an identifying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_circuit\" title=\"Integrated circuit\" rel=\"external_link\" target=\"_blank\">integrated circuit<\/a> device or <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transponder\" title=\"Transponder\" rel=\"external_link\" target=\"_blank\">transponder<\/a> encased in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicate_glass\" class=\"mw-redirect\" title=\"Silicate glass\" rel=\"external_link\" target=\"_blank\">silicate glass<\/a> and implanted in the body of a human being. This type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subdermal_implant\" title=\"Subdermal implant\" rel=\"external_link\" target=\"_blank\">subdermal implant<\/a> usually contains a unique <a href=\"https:\/\/en.wikipedia.org\/wiki\/Identification_(information)\" title=\"Identification (information)\" rel=\"external_link\" target=\"_blank\">ID number<\/a> that can be linked to information contained in an external database, such as personal identification, law enforcement, medical history, medications, allergies, and contact information.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first experiments with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> implant were carried out in 1998 by the British scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kevin_Warwick\" title=\"Kevin Warwick\" rel=\"external_link\" target=\"_blank\">Kevin Warwick<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> His implant was used to open doors, switch on lights, and cause verbal output within a building. After nine days the implant was removed and has since been held in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Science_Museum_(London)\" class=\"mw-redirect\" title=\"Science Museum (London)\" rel=\"external_link\" target=\"_blank\">Science Museum (London)<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>On 16 March 2009 British scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Gasson\" title=\"Mark Gasson\" rel=\"external_link\" target=\"_blank\">Mark Gasson<\/a> had an advanced glass capsule RFID device surgically implanted into his left hand. In April 2010 Gasson's team demonstrated how a computer virus could wirelessly infect his implant and then be transmitted on to other systems.<sup id=\"rdp-ebb-cite_ref-istas_6-0\" class=\"reference\"><a href=\"#cite_note-istas-6\" rel=\"external_link\">[6]<\/a><\/sup> Gasson reasoned that with implanted technology the separation between man and machine can become theoretical because the technology can be perceived by the human as being a part of their body. Because of this development in our understanding of what constitutes our body and its boundaries he became credited as being the first human infected by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_virus\" title=\"Computer virus\" rel=\"external_link\" target=\"_blank\">computer virus<\/a>. He has no plans to remove his implant.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hobbyists\">Hobbyists<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RFID_hand.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/RFID_hand.jpg\/220px-RFID_hand.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RFID_hand.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An RFID tag visible under the skin soon after being implanted.<\/div><\/div><\/div>\n<p>Several hobbyists have placed RFID microchip implants into their hands or had them inserted by others.\n<\/p><p>Amal Graafstra,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> author of the book RFID Toys,<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> asked doctors to place implants in his hands in March 2005. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmetic_surgeon\" class=\"mw-redirect\" title=\"Cosmetic surgeon\" rel=\"external_link\" target=\"_blank\">cosmetic surgeon<\/a> used a scalpel to place a microchip in his left hand, and his family doctor injected a chip into his right hand using a veterinary Avid injector kit. Graafstra uses the implants to access his home, open car doors, and to log on to his computer. With public interest growing, in 2013 he launched biohacking company Dangerous Things<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> and crowdfunded the world's first implantable NFC transponder in 2014.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> He has also spoken at various events and promotional gigs<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> including TEDx,<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> and built a smartgun that only fires after reading his implant.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Alejandro Hernandez CEO of Futura is known to be the first in Central America to have Dangerous Things' transponder installed in his left hand by Federico Cortes in November 2017.\n<\/p><p>Mikey Sklar had a chip implanted into his left hand and filmed the procedure.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jonathan_Oxer\" title=\"Jonathan Oxer\" rel=\"external_link\" target=\"_blank\">Jonathan Oxer<\/a> self-implanted an RFID chip in his arm using a veterinary implantation tool.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Martijn Wismeijer, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dutch_people\" title=\"Dutch people\" rel=\"external_link\" target=\"_blank\">Dutch<\/a> marketing manager for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bitcoin_ATM\" title=\"Bitcoin ATM\" rel=\"external_link\" target=\"_blank\">Bitcoin ATM<\/a> manufacturer <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_Bytes\" title=\"General Bytes\" rel=\"external_link\" target=\"_blank\">General Bytes<\/a>, placed RFID chips in both of his hands to store his <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bitcoin\" title=\"Bitcoin\" rel=\"external_link\" target=\"_blank\">Bitcoin<\/a> private keys and business card.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>Patric Lanhed sent a \u201cbio-payment\u201d of one euro worth of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bitcoin\" title=\"Bitcoin\" rel=\"external_link\" target=\"_blank\">Bitcoin<\/a> using a chip embedded in his hand.\n<p><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<\/p><p>Marcel Varallo had an NXP chip coated in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">Bioglass<\/a> 8625 inserted into his hand between his forefinger and thumb allowing him to open secure elevators and doors at work, print from secure printers, unlock his mobile phone and home, and store his digital business card for transfer to mobile phones enabled for NFC.\n<p><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Do-it-yourself_biology\" title=\"Do-it-yourself biology\" rel=\"external_link\" target=\"_blank\">Biohacker<\/a> Hannes Sj\u00f6blad has been experimenting with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Near_field_communication\" class=\"mw-redirect\" title=\"Near field communication\" rel=\"external_link\" target=\"_blank\">NFC<\/a> (Near Field Communication) chip implants since 2015. During his talk at Echapp\u00e9e Vol\u00e9\u00e9 2016 in Paris, Sj\u00f6blad disclosed that he has also implanted himself between his forefinger and thumb and uses it to unlock doors, make payments, and unlock his phone (essentially replacing anything you can put in your pockets).<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Additionally, Sj\u00f6blad has hosted several \"implant parties,\" where interested individuals can also be implanted with the chip.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Commercial_implants\">Commercial implants<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Medical_records\">Medical records<\/span><\/h3>\n<p>Researchers have examined microchip implants in humans in the medical field and they indicate that there are potential benefits and risks to incorporating the device in the medical field. For example, it could be beneficial for noncompliant patients but still poses great risks for potential misuse of the device.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Destron Fearing, a subsidiary of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_Angel\" title=\"Digital Angel\" rel=\"external_link\" target=\"_blank\">Digital Angel<\/a>, initially developed the technology for the VeriChip.<sup id=\"rdp-ebb-cite_ref-ComputerBytesMan_23-0\" class=\"reference\"><a href=\"#cite_note-ComputerBytesMan-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>In 2004, the VeriChip implanted device and reader were classified as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device#Class_II:_General_controls_with_special_controls\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Class II: General controls with special controls<\/a> by the FDA;<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> that year the FDA also published a draft guidance describing the special controls required to market such devices.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>About the size of a grain of rice, the device was typically implanted between the shoulder and elbow area of an individual\u2019s right arm. Once scanned at the proper frequency, the chip responded with a unique 16-digit number which could be then linked with information about the user held on a database for identity verification, medical records access and other uses. The insertion procedure was performed under local anesthetic in a physician's office.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Halamka_27-0\" class=\"reference\"><a href=\"#cite_note-Halamka-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p><p>Privacy advocates raised concerns regarding potential abuse of the chip, with some warning that adoption by governments as a compulsory identification program could lead to erosion of civil liberties, as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Identity_theft\" title=\"Identity theft\" rel=\"external_link\" target=\"_blank\">identity theft<\/a> if the device should be hacked.<sup id=\"rdp-ebb-cite_ref-Halamka_27-1\" class=\"reference\"><a href=\"#cite_note-Halamka-27\" rel=\"external_link\">[27]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> Another ethical dilemma posed by the technology, is that people with dementia could possibly benefit the most from an implanted device that contained their medical records, but issues of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informed_consent\" title=\"Informed consent\" rel=\"external_link\" target=\"_blank\">informed consent<\/a> are the most difficult in precisely such people.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>In June 2007, the American Medical Association declared that \"implantable radio frequency identification (RFID) devices may help to identify patients, thereby improving the safety and efficiency of patient care, and may be used to enable secure access to patient clinical information\",<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> but in the same year, news reports linking similar devices to cancer caused in laboratory animals had a devastating impact on the company's stock price and sales.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>In 2010, the company, by then called \"PositiveID\", withdrew the product from the market due to poor sales.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p><p>In January 2012, PositiveID sold the chip assets to a company called VeriTeQ that was owned by Scott Silverman, the former CEO of Positive ID.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>In 2016, JAMM Technologies acquired the chip assets from VeriTeQ; JAMM's business plan was to partner with companies selling <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">implanted medical devices<\/a> and use the RfID tags to monitor and identify the devices.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> JAMM Technologies is co-located in the same <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plymouth,_Minnesota\" title=\"Plymouth, Minnesota\" rel=\"external_link\" target=\"_blank\">Plymouth, Minnesota<\/a> building as Geissler Corporation with Randolph K. Geissler and Donald R. Brattain<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> listed as its principals. \n<p>The website also claims that Geissler was CEO of PositiveID Corporation, Destron Fearing Corporation, and Digital Angel Corporation.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<\/p><p>In 2018, A Danish firm called BiChip released a new generation of microchip implant that is intended to be readable from distance and connected to Internet. The company released an update for its microchip implant to associate it with the Ripple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryptocurrency\" title=\"Cryptocurrency\" rel=\"external_link\" target=\"_blank\">cryptocurrency<\/a> to allow payments to be made using the implanted microchip.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Building_access_and_security\">Building access and security<\/span><\/h3>\n<p>In February 2006, CityWatcher, Inc. of Cincinnati, OH became the first company in the world to implant microchips into their employees as part of their building access control and security system. The workers needed the implants to access the company's secure video tape room, as documented in <a href=\"https:\/\/en.wikipedia.org\/wiki\/USA_Today\" title=\"USA Today\" rel=\"external_link\" target=\"_blank\">USA Today<\/a>.<sup id=\"rdp-ebb-cite_ref-USAToday2_40-0\" class=\"reference\"><a href=\"#cite_note-USAToday2-40\" rel=\"external_link\">[40]<\/a><\/sup> The project was initiated and implemented by Six Sigma Security, Inc. The VeriChip Corporation had originally marketed the implant as a way to restrict access to secure facilities such as power plants.\n<\/p><p>A major drawback for such systems is the relative ease with which the 16-digit ID number contained in a chip implant can be obtained and cloned using a hand-held device, a problem that has been demonstrated publicly by security researcher <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jonathan_Westhues\" title=\"Jonathan Westhues\" rel=\"external_link\" target=\"_blank\">Jonathan Westhues<\/a><sup id=\"rdp-ebb-cite_ref-clone_41-0\" class=\"reference\"><a href=\"#cite_note-clone-41\" rel=\"external_link\">[41]<\/a><\/sup> and documented in the May 2006 issue of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wired_magazine\" class=\"mw-redirect\" title=\"Wired magazine\" rel=\"external_link\" target=\"_blank\"><i>Wired<\/i> magazine<\/a>,<sup id=\"rdp-ebb-cite_ref-wired_42-0\" class=\"reference\"><a href=\"#cite_note-wired-42\" rel=\"external_link\">[42]<\/a><\/sup> among other places.\n<\/p>\n<ul><li>The Baja Beach Club, a nightclub in Rotterdam, the Netherlands, once used VeriChip implants for identifying VIP guests.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li>\n<li>The Epicenter in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stockholm,_Sweden\" class=\"mw-redirect\" title=\"Stockholm, Sweden\" rel=\"external_link\" target=\"_blank\">Stockholm, Sweden<\/a> is using RFID implants for employees to operate security doors, copiers, and pay for lunch.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Possible_future_applications\">Possible future applications<\/span><\/h3>\n<p>In 2017 Mike Miller, chief executive of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_Olympians_Association\" title=\"World Olympians Association\" rel=\"external_link\" target=\"_blank\">World Olympians Association<\/a>, was widely reported as suggesting the use of such implants in athletes in an attempt to reduce problems in sport due to drug taking.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p><p>Theoretically, a GPS-enabled chip could one day make it possible for individuals to be physically located by latitude, longitude, altitude, speed, and direction of movement. Such implantable GPS devices are not technically feasible at this time. However, if widely deployed at some future point, implantable GPS devices could conceivably allow authorities to locate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Missing_person\" title=\"Missing person\" rel=\"external_link\" target=\"_blank\">missing persons<\/a> and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fugitive\" title=\"Fugitive\" rel=\"external_link\" target=\"_blank\">fugitives<\/a> and those who fled from a crime scene. Critics contend, however, that the technology could lead to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Political_repression\" title=\"Political repression\" rel=\"external_link\" target=\"_blank\">political repression<\/a> as governments could use implants to track and persecute human rights activists, labor activists, civil dissidents, and political opponents; criminals and domestic abusers could use them to stalk and harass their victims; and child abusers could use them to locate and abduct children.\n<\/p><p>Another suggested application for a tracking implant, discussed in 2008 by the legislature of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Indonesia\" title=\"Indonesia\" rel=\"external_link\" target=\"_blank\">Indonesia<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Irian_Jaya\" class=\"mw-redirect\" title=\"Irian Jaya\" rel=\"external_link\" target=\"_blank\">Irian Jaya<\/a> would be to monitor the activities of persons infected with <a href=\"https:\/\/en.wikipedia.org\/wiki\/HIV\" title=\"HIV\" rel=\"external_link\" target=\"_blank\">HIV<\/a>, aimed at reducing their chances of infecting other people.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> The microchipping section was not, however, included into the final version of the provincial <i>HIV\/AIDS Handling bylaw<\/i> passed by the legislature in December 2008.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> With current technology, this would not be workable anyway, since there is no implantable device on the market with <a href=\"https:\/\/en.wikipedia.org\/wiki\/GPS_tracking_unit\" title=\"GPS tracking unit\" rel=\"external_link\" target=\"_blank\">GPS tracking<\/a> capability.\n<\/p><p>Since modern payment methods rely upon RFID\/NFC, it is thought that implantable microchips, if they were to ever become popular in use, would form a part of the cashless society.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup> Verichip implants have already been used in nightclubs such as the Baja club for such a purpose, allowing patrons to purchase drinks with their implantable microchip.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_problems\">Potential problems<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Cancer\">Cancer<\/span><\/h3>\n<p>In a self-published report<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> anti-RFID advocate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Katherine_Albrecht\" title=\"Katherine Albrecht\" rel=\"external_link\" target=\"_blank\">Katherine Albrecht<\/a>, who refers to RFID devices as \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Spy_chips\" class=\"mw-redirect\" title=\"Spy chips\" rel=\"external_link\" target=\"_blank\">spy chips<\/a>\", cites <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinary\" class=\"mw-redirect\" title=\"Veterinary\" rel=\"external_link\" target=\"_blank\">veterinary<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicology\" title=\"Toxicology\" rel=\"external_link\" target=\"_blank\">toxicological<\/a> studies carried out from 1996 to 2006 which found lab rodents injected with microchips as an incidental part of unrelated experiments and dogs implanted with identification microchips sometimes developed cancerous tumors at the injection site (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_tissue\" title=\"Subcutaneous tissue\" rel=\"external_link\" target=\"_blank\">subcutaneous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sarcoma\" title=\"Sarcoma\" rel=\"external_link\" target=\"_blank\">sarcomas<\/a>) as evidence of a human implantation risk.<sup id=\"rdp-ebb-cite_ref-WashingPost_51-0\" class=\"reference\"><a href=\"#cite_note-WashingPost-51\" rel=\"external_link\">[51]<\/a><\/sup> However, the link between foreign-body tumorigenesis in lab animals and implantation in humans has been publicly refuted as erroneous and misleading<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup> and the report's author has been criticized over the use of \"provocative\" language \"not based in scientific fact\".<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> Notably, none of the studies cited specifically set out to investigate the cancer risk of implanted microchips and so none of the studies had a control group of animals that did not get implanted. While the issue is considered worthy of further investigation, one of the studies cited cautioned \"Blind leaps from the detection of tumors to the prediction of human health risk should be avoided\".<sup id=\"rdp-ebb-cite_ref-blanchard_54-0\" class=\"reference\"><a href=\"#cite_note-blanchard-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Security_risks\">Security risks<\/span><\/h3>\n<p>The Council on Ethical and Judicial Affairs (CEJA) of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Medical_Association\" title=\"American Medical Association\" rel=\"external_link\" target=\"_blank\">American Medical Association<\/a> published a report in 2007 alleging that RFID implanted chips may compromise <a href=\"https:\/\/en.wikipedia.org\/wiki\/Privacy\" title=\"Privacy\" rel=\"external_link\" target=\"_blank\">privacy<\/a> because there is no assurance that the information contained in the chip can be properly protected.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Legislation\">Legislation<\/span><\/h2>\n\n<h3><span class=\"mw-headline\" id=\"United_States\">United States<\/span><\/h3>\n<p>Following <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wisconsin\" title=\"Wisconsin\" rel=\"external_link\" target=\"_blank\">Wisconsin<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/North_Dakota\" title=\"North Dakota\" rel=\"external_link\" target=\"_blank\">North Dakota<\/a>,<sup id=\"rdp-ebb-cite_ref-Cal_58-0\" class=\"reference\"><a href=\"#cite_note-Cal-58\" rel=\"external_link\">[58]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/California\" title=\"California\" rel=\"external_link\" target=\"_blank\">California<\/a> issued <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.leginfo.ca.gov\/pub\/07-08\/bill\/sen\/sb_0351-0400\/sb_362_bill_20071012_chaptered.html\" target=\"_blank\">Senate Bill 362<\/a> in 2007, which makes it illegal to force a person to have a microchip implanted, and provide for an assessment of civil penalties against violators of the bill.<sup id=\"rdp-ebb-cite_ref-Cal_58-1\" class=\"reference\"><a href=\"#cite_note-Cal-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p><p>In 2008, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oklahoma\" title=\"Oklahoma\" rel=\"external_link\" target=\"_blank\">Oklahoma<\/a> passed 63 OK Stat \u00a7 63-1-1430 (2008 S.B. 47), that bans involuntary microchip implants in humans.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p><p>On April 5, 2010, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_(U.S._state)\" title=\"Georgia (U.S. state)\" rel=\"external_link\" target=\"_blank\">Georgia<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_Senate\" class=\"mw-redirect\" title=\"Georgia Senate\" rel=\"external_link\" target=\"_blank\">Senate<\/a> passed Senate Bill 235 that prohibits forced microchip implants in humans and that would make it a misdemeanor for anyone to require them, including employers.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup> The bill would allow voluntary microchip implants, as long as they are performed by a physician and regulated by the Georgia Composite Medical Board. The state's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_House_of_Representatives\" title=\"Georgia House of Representatives\" rel=\"external_link\" target=\"_blank\">House of Representatives<\/a> did not take up the measure.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>On February 10, 2010, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virginia\" title=\"Virginia\" rel=\"external_link\" target=\"_blank\">Virginia<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virginia_House_of_Delegates\" title=\"Virginia House of Delegates\" rel=\"external_link\" target=\"_blank\">House of Delegates<\/a> also passed a bill that forbids companies from forcing their employees to be implanted with tracking devices.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Washington_(state)\" title=\"Washington (state)\" rel=\"external_link\" target=\"_blank\">Washington State<\/a> House Bill 1142-2009-10 orders a study using implanted radio frequency identification or other similar technology to electronically monitor sex offenders and other felons.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_popular_culture\">In popular culture<\/span><\/h2>\n<p>The general public are most familiar with microchips in the context of tracking their pets. In the U.S., some Christian activists, including conspiracy theorist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Dice\" title=\"Mark Dice\" rel=\"external_link\" target=\"_blank\">Mark Dice<\/a>, the author of a book titled <i>The Resistance Manifesto<\/i><sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup>, make a link between the PositiveID and the Biblical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Number_of_the_Beast#Mark_of_the_Beast\" title=\"Number of the Beast\" rel=\"external_link\" target=\"_blank\">Mark of the Beast<\/a>,<sup id=\"rdp-ebb-cite_ref-65\" class=\"reference\"><a href=\"#cite_note-65\" rel=\"external_link\">[65]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup> prophesied to be a future requirement for buying and selling,<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup> and a key element of the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Book_of_Revelation\" title=\"Book of Revelation\" rel=\"external_link\" target=\"_blank\">Book of Revelation<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-68\" class=\"reference\"><a href=\"#cite_note-68\" rel=\"external_link\">[68]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup> Gary Wohlscheid, president of These Last Days Ministries, has argued that \"Out of all the technologies with potential to be the mark of the beast, VeriChip has got the best possibility right now\".<sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ambient_intelligence\" title=\"Ambient intelligence\" rel=\"external_link\" target=\"_blank\">Ambient intelligence<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cnn.com\/TECH\/computing\/9901\/14\/chipman.idg\/\" target=\"_blank\">\"Is human chip implant wave of the future?\"<\/a>. <i>CNN<\/i>. January 13, 1999<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">May 12,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CNN&rft.atitle=Is+human+chip+implant+wave+of+the+future%3F&rft.date=1999-01-13&rft_id=http%3A%2F%2Fwww.cnn.com%2FTECH%2Fcomputing%2F9901%2F14%2Fchipman.idg%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.independent.co.uk\/news\/professor-has-worlds-first-silicon-chip-implant-1174101.html\" target=\"_blank\">\"Professor has world's first silicon chip implant\"<\/a>. <i>independent.co.uk<\/i>. 26 August 1998.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=independent.co.uk&rft.atitle=Professor+has+world%27s+first+silicon+chip+implant&rft.date=1998-08-26&rft_id=https%3A%2F%2Fwww.independent.co.uk%2Fnews%2Fprofessor-has-worlds-first-silicon-chip-implant-1174101.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/1998\/08\/professor-cyborg\/\" target=\"_blank\">\"Professor Cyborg\"<\/a>. <i>wired.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=wired.com&rft.atitle=Professor+Cyborg&rft_id=https%3A%2F%2Fwww.wired.com%2F1998%2F08%2Fprofessor-cyborg%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/sci\/tech\/158007.stm\" target=\"_blank\">\"BBC News - Sci\/Tech - Technology gets under the skin\"<\/a>. <i>news.bbc.co.uk<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=news.bbc.co.uk&rft.atitle=BBC+News+-+Sci%2FTech+-+Technology+gets+under+the+skin&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F1%2Fhi%2Fsci%2Ftech%2F158007.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Sanchez-Klein, Jana. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/edition.cnn.com\/TECH\/computing\/9808\/28\/armchip.idg\/index.html?eref=sitesearch\" target=\"_blank\">\"CNN - Cyberfuturist plants chip in arm to test human-computer interaction - August 28, 1998\"<\/a>. <i>edition.cnn.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=edition.cnn.com&rft.atitle=CNN+-+Cyberfuturist+plants+chip+in+arm+to+test+human-computer+interaction+-+August+28%2C+1998&rft.aulast=Sanchez-Klein&rft.aufirst=Jana&rft_id=http%3A%2F%2Fedition.cnn.com%2FTECH%2Fcomputing%2F9808%2F28%2Farmchip.idg%2Findex.html%3Feref%3Dsitesearch&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-istas-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-istas_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Gasson, M. N. (2010). \"Human Enhancement: Could you become infected with a computer virus?\". <i>2010 IEEE International Symposium on Technology and Society<\/i>. p. 61. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FISTAS.2010.5514651\" target=\"_blank\">10.1109\/ISTAS.2010.5514651<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4244-7777-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Human+Enhancement%3A+Could+you+become+infected+with+a+computer+virus%3F&rft.btitle=2010+IEEE+International+Symposium+on+Technology+and+Society&rft.pages=61&rft.date=2010&rft_id=info%3Adoi%2F10.1109%2FISTAS.2010.5514651&rft.isbn=978-1-4244-7777-7&rft.aulast=Gasson&rft.aufirst=M.+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.personal.reading.ac.uk\/~sis04mng\/research\/\" target=\"_blank\">http:\/\/www.personal.reading.ac.uk\/~sis04mng\/research\/<\/a> FAQ: Could you become infected with a computer virus?<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amal.net\/\" target=\"_blank\">\"Amal Graafstra - Technologist, Author & Double RFID Implantee\"<\/a>. <i>amal.net<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=amal.net&rft.atitle=Amal+Graafstra+-+Technologist%2C+Author+%26+Double+RFID+Implantee&rft_id=http%3A%2F%2Famal.net%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/rfidtoys.com\/\" target=\"_blank\">\"RFID Toys Forum\"<\/a>. <i>Dangerous Things Forum<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dangerous+Things+Forum&rft.atitle=RFID+Toys+Forum&rft_id=http%3A%2F%2Frfidtoys.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dangerousthings.com\/\" target=\"_blank\">\"Dangerous Things\"<\/a>. <i>Dangerous Things<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dangerous+Things&rft.atitle=Dangerous+Things&rft_id=http%3A%2F%2Fdangerousthings.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.indiegogo.com\/projects\/the-xnt-implantable-nfc-chip\" target=\"_blank\">\"The xNT implantable NFC chip\"<\/a>. <i>Indiegogo<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Indiegogo&rft.atitle=The+xNT+implantable+NFC+chip&rft_id=https%3A%2F%2Fwww.indiegogo.com%2Fprojects%2Fthe-xnt-implantable-nfc-chip&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFbpg2017\" class=\"citation\">bpg (2017-03-09), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/vimeo.com\/207688901\" target=\"_blank\"><i>PRMT | Ghost In the Shell | Live Stream<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=PRMT+%7C+Ghost+In+the+Shell+%7C+Live+Stream&rft.date=2017-03-09&rft.au=bpg&rft_id=https%3A%2F%2Fvimeo.com%2F207688901&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFTEDx_Talks2013\" class=\"citation\">TEDx Talks (2013-10-17), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=7DxVWhFLI6E\" target=\"_blank\"><i>Biohacking - the forefront of a new kind of human evolution: Amal Graafstra at TEDxSFU<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biohacking+-+the+forefront+of+a+new+kind+of+human+evolution%3A+Amal+Graafstra+at+TEDxSFU&rft.date=2013-10-17&rft.au=TEDx+Talks&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3D7DxVWhFLI6E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFMotherboard2017\" class=\"citation\">Motherboard (2017-03-23), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=sXtqBVbxmto&t=33m39s\" target=\"_blank\"><i>Who Killed the Smart Gun?<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Who+Killed+the+Smart+Gun%3F&rft.date=2017-03-23&rft.au=Motherboard&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DsXtqBVbxmto%26t%3D33m39s&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=w2gKJeM6Ihw\" target=\"_blank\">https:\/\/www.youtube.com\/watch?v=w2gKJeM6Ihw<\/a> link Fox News Interviews Mikey Sklar<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/jon.oxer.com.au\/blog\/id\/86\" target=\"_blank\">\"Jondo the Mandroid is RFID enabled\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Jondo+the+Mandroid+is+RFID+enabled&rft_id=http%3A%2F%2Fjon.oxer.com.au%2Fblog%2Fid%2F86&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Clark, Liat (November 11, 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.co.uk\/news\/archive\/2014-11\/11\/mr-bitcoin-nfc-implant\" target=\"_blank\">\"Hand-implanted NFC chips open this man's bitcoin wallet\"<\/a><span class=\"reference-accessdate\">. 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target=\"_blank\">http:\/\/www.antichips.com\/cancer\/<\/a> Microchip-Induced Tumors in Laboratory Rodents and Dogs: A Review of the Literature 1990\u20132006<\/span>\n<\/li>\n<li id=\"cite_note-WashingPost-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-WashingPost_51-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLewan2007\" class=\"citation\">Lewan, Todd (September 8, 2007), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2007\/09\/08\/AR2007090800997_pf.html\" target=\"_blank\">\"Chip Implants Linked to Animal Tumours\"<\/a>, <i>The Washington Post<\/i><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2010-06-08<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Washington+Post&rft.atitle=Chip+Implants+Linked+to+Animal+Tumours&rft.date=2007-09-08&rft.aulast=Lewan&rft.aufirst=Todd&rft_id=https%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2007%2F09%2F08%2FAR2007090800997_pf.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">RFID Journal. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rfidjournal.com\/articles\/view?3609\" target=\"_blank\">\"VeriChip Defends the Safety of Implanted RFID Tags\"<\/a>. <i>rfidjournal.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=rfidjournal.com&rft.atitle=VeriChip+Defends+the+Safety+of+Implanted+RFID+Tags&rft.au=RFID+Journal&rft_id=http%3A%2F%2Fwww.rfidjournal.com%2Farticles%2Fview%3F3609&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"#t=60m53s\">https:\/\/www.youtube.com\/watch?v=CS13kFWQIYM#t=60m53s<\/a> Tumours, Tracking, and Tyranny: The Downside to Implantable Microchip<\/span>\n<\/li>\n<li id=\"cite_note-blanchard-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-blanchard_54-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blanchard, K. T.; Barthel, C.; French, J. E.; Holden, H. E.; Moretz, R.; Pack, F. D.; Tennant, R. W.; Stoll, R. E. (1999). \"Transponder-Induced Sarcoma in the Heterozygous p53+\/- Mouse\". <i>Toxicologic Pathology<\/i>. <b>27<\/b> (5): 519. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F019262339902700505\" target=\"_blank\">10.1177\/019262339902700505<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Toxicologic+Pathology&rft.atitle=Transponder-Induced+Sarcoma+in+the+Heterozygous+p53%2B%2F-+Mouse&rft.volume=27&rft.issue=5&rft.pages=519&rft.date=1999&rft_id=info%3Adoi%2F10.1177%2F019262339902700505&rft.aulast=Blanchard&rft.aufirst=K.+T.&rft.au=Barthel%2C+C.&rft.au=French%2C+J.+E.&rft.au=Holden%2C+H.+E.&rft.au=Moretz%2C+R.&rft.au=Pack%2C+F.+D.&rft.au=Tennant%2C+R.+W.&rft.au=Stoll%2C+R.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2007\/09\/08\/AR2007090800997_pf.html\/\" target=\"_blank\">\"Lewan, Todd. The Associated Press, September 8, 2007. \"Chip Implants Linked to Animal Tumors<span class=\"cs1-kern-right\">\"<\/span>\"<\/a>. <i>washingtonpost.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=washingtonpost.com&rft.atitle=Lewan%2C+Todd.+The+Associated+Press%2C+September+8%2C+2007.+%22Chip+Implants+Linked+to+Animal+Tumors%22&rft_id=https%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2007%2F09%2F08%2FAR2007090800997_pf.html%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-56\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-56\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.antichips.com\/cancer\/index.html\" target=\"_blank\">Studies Linking Microchips and Cancer<\/a><\/span>\n<\/li>\n<li id=\"cite_note-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-57\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">CEJA of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Medical_Association\" title=\"American Medical Association\" rel=\"external_link\" target=\"_blank\">American Medical Association<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ama-assn.org\/ama1\/pub\/upload\/mm\/467\/ceja5a07.doc\" target=\"_blank\">CEJA Report 5-A-07<\/a>, Radio Frequency ID Devices in Humans, presented by Robert M. Sade, MD, Chair. 2007<\/span>\n<\/li>\n<li id=\"cite_note-Cal-58\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cal_58-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cal_58-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.govtech.com\/gt\/156351?topic=117688\" target=\"_blank\">California Bans Forced RFID Tagging of Humans<\/a>, <i>Government Technology<\/i> website, October 17, 2007<\/span>\n<\/li>\n<li id=\"cite_note-59\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-59\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nTim Talley.\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/newsok.com\/article\/3247279\" target=\"_blank\">\"Bill bans involuntary microchip implants\"<\/a>.\n2008.<\/span>\n<\/li>\n<li id=\"cite_note-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-60\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ncsl.org\/research\/telecommunications-and-information-technology\/radio-frequency-identification-rfid-privacy-laws.aspx\" target=\"_blank\">\"Radio Frequency Identification (RFID) Privacy Laws\"<\/a>.\n2015.<\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#.U49ngS_O63U\">\"Georgia SB 235 - Ban on Required Human Microchip Implantation - Key Vote - The Voter's Self Defense System - Vote Smart\"<\/a>. <i>Project Vote Smart<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Project+Vote+Smart&rft.atitle=Georgia+SB+235+-+Ban+on+Required+Human+Microchip+Implantation+-+Key+Vote+-+The+Voter%27s+Self+Defense+System+-+Vote+Smart&rft_id=http%3A%2F%2Fvotesmart.org%2Fbill%2F10786%2F28834%2Fban-on-required-human-microchip-implantation%23.U49ngS_O63U&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rawstory.com\/rs\/2010\/02\/10\/virginia-passes-law-banning-chip-implants-mark-beast\/\" target=\"_blank\">Virginia delegates pass bill banning chip implants as \u2018mark of the beast\u2019<\/a>, <i>The Raw Story<\/i>, By Daniel Tencer, Wednesday, February 10, 2010 retrieved April 23, 2010<\/span>\n<\/li>\n<li id=\"cite_note-63\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-63\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/apps.leg.wa.gov\/billinfo\/summary.aspx?year=2009&bill=1142\" target=\"_blank\">HB 1142-2009-10<\/a> to study requiring the use of implanted RFID in certain felons.<\/span>\n<\/li>\n<li id=\"cite_note-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-64\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Dice\" title=\"Mark Dice\" rel=\"external_link\" target=\"_blank\">Dice, Mark<\/a> (July 26, 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/MarkDice\" target=\"_blank\"><i>The Resistance Manifesto<\/i><\/a>. The Resistance. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0967346649.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Resistance+Manifesto&rft.pub=The+Resistance&rft.date=2006-07-26&rft.isbn=0967346649&rft.aulast=Dice&rft.aufirst=Mark&rft_id=https%3A%2F%2Fwww.youtube.com%2FMarkDice&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-65\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-65\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Streitfield, David (9 May 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/pqasb.pqarchiver.com\/latimes\/access\/118857652.html?dids=118857652:118857652&FMT=ABS&FMTS=ABS:FT&type=current&date=May+09%2C+2002&author=DAVID+STREITFELD&pub=Los+Angeles+Times&desc=First+Humans+to+Receive+ID+Chips%3B+Technology%3A+Device+injected+under+the+skin+will+provide+identification+and+medical+information.&pqatl=google\" target=\"_blank\">\"First Humans to Receive ID Chips; Technology: Device injected under the skin will provide identification and medical information\"<\/a>. <i>Los Angeles Times<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 September<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Los+Angeles+Times&rft.atitle=First+Humans+to+Receive+ID+Chips%3B+Technology%3A+Device+injected+under+the+skin+will+provide+identification+and+medical+information.&rft.date=2002-05-09&rft.aulast=Streitfield&rft.aufirst=David&rft_id=https%3A%2F%2Fpqasb.pqarchiver.com%2Flatimes%2Faccess%2F118857652.html%3Fdids%3D118857652%3A118857652%26FMT%3DABS%26FMTS%3DABS%3AFT%26type%3Dcurrent%26date%3DMay%2B09%252C%2B2002%26author%3DDAVID%2BSTREITFELD%26pub%3DLos%2BAngeles%2BTimes%26desc%3DFirst%2BHumans%2Bto%2BReceive%2BID%2BChips%253B%2BTechnology%253A%2BDevice%2Binjected%2Bunder%2Bthe%2Bskin%2Bwill%2Bprovide%2Bidentification%2Band%2Bmedical%2Binformation.%26pqatl%3Dgoogle&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-66\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-66\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Gilbert, Alorie (16 February 2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.cnet.com\/8301-10784_3-5579795-7.html\" target=\"_blank\">\"Is RFID the mark of the beast?\"<\/a>. <i>CNET News<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 September<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CNET+News&rft.atitle=Is+RFID+the+mark+of+the+beast%3F&rft.date=2005-02-16&rft.aulast=Gilbert&rft.aufirst=Alorie&rft_id=http%3A%2F%2Fnews.cnet.com%2F8301-10784_3-5579795-7.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-67\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biblegateway.com\/passage\/?search=revelation%2013:16-18&version=NIV\" target=\"_blank\">\"Revelation 14:9-11\"<\/a>. Bible Gateway<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-07-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Revelation+14%3A9-11&rft.pub=Bible+Gateway&rft_id=http%3A%2F%2Fwww.biblegateway.com%2Fpassage%2F%3Fsearch%3Drevelation%252013%3A16-18%26version%3DNIV&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-68\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Katherine_Albrecht\" title=\"Katherine Albrecht\" rel=\"external_link\" target=\"_blank\">Albrecht, Katherine<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liz_McIntyre_(writer)\" title=\"Liz McIntyre (writer)\" rel=\"external_link\" target=\"_blank\">McIntyre, Liz<\/a> (2006-01-31). <i>The Spychips Threat: Why Christians Should Resist RFID and Electronic Surveillance<\/i>. Nelson Current. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-59555-021-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Spychips+Threat%3A+Why+Christians+Should+Resist+RFID+and+Electronic+Surveillance&rft.pub=Nelson+Current&rft.date=2006-01-31&rft.isbn=1-59555-021-6&rft.aulast=Albrecht&rft.aufirst=Katherine&rft.au=McIntyre%2C+Liz&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-69\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Baard, Mark (2006-06-06). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/science\/discoveries\/news\/2006\/06\/70308\" target=\"_blank\">\"RFID: Sign of the (End) Times?\"<\/a>. Wired.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-10-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=RFID%3A+Sign+of+the+%28End%29+Times%3F&rft.pub=Wired.com&rft.date=2006-06-06&rft.aulast=Baard&rft.aufirst=Mark&rft_id=https%3A%2F%2Fwww.wired.com%2Fscience%2Fdiscoveries%2Fnews%2F2006%2F06%2F70308&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-70\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Scheeres, Julia (6 February 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archive.wired.com\/politics\/security\/news\/2002\/02\/50187?currentPage=2\" target=\"_blank\">\"They Want Their ID Chips Now\"<\/a>. <i>Wired News<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 September<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Wired+News&rft.atitle=They+Want+Their+ID+Chips+Now&rft.date=2002-02-06&rft.aulast=Scheeres&rft.aufirst=Julia&rft_id=http%3A%2F%2Farchive.wired.com%2Fpolitics%2Fsecurity%2Fnews%2F2002%2F02%2F50187%3FcurrentPage%3D2&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Haag, Stephen; Cummings, Maeve,; McCubbrey, Donald (2004). <i>Management Information Systems for the Information Age<\/i> (4th ed.). New York City, New York: McGraw-Hill. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-07-281947-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Management+Information+Systems+for+the+Information+Age&rft.place=New+York+City%2C+New+York&rft.edition=4th&rft.pub=McGraw-Hill&rft.date=2004&rft.isbn=0-07-281947-2&rft.aulast=Haag&rft.aufirst=Stephen&rft.au=Cummings%2C+Maeve%2C&rft.au=McCubbrey%2C+Donald&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Graafstra, Amal (2004). <i>RFID Toys: 11 Cool Projects for Home, Office and Entertainment<\/i> (4th ed.). New York City, New York: (ExtremeTech) Ziff Davis Publishing Holdings Inc. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-471-77196-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=RFID+Toys%3A+11+Cool+Projects+for+Home%2C+Office+and+Entertainment&rft.place=New+York+City%2C+New+York&rft.edition=4th&rft.pub=%28ExtremeTech%29+Ziff+Davis+Publishing+Holdings+Inc.&rft.date=2004&rft.isbn=0-471-77196-1&rft.aulast=Graafstra&rft.aufirst=Amal&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181129160604\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.548 seconds\nReal time usage: 0.643 seconds\nPreprocessor visited node count: 2616\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 92950\/2097152 bytes\nTemplate argument size: 1088\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 143992\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.324\/10.000 seconds\nLua memory usage: 5.73 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 559.663 1 -total\n<\/p>\n<pre>71.43% 399.742 1 Template:Reflist\n21.21% 118.698 30 Template:Cite_web\n16.48% 92.220 7 Template:Cite_news\n11.11% 62.199 2 Template:Citation_needed\n 9.71% 54.336 2 Template:Fix\n 8.71% 48.749 5 Template:Cite_book\n 8.00% 44.771 5 Template:Cite_journal\n 5.83% 32.652 4 Template:Category_handler\n 5.25% 29.374 5 Template:Citation\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:25004968-1!canonical and timestamp 20181129160603 and revision id 871146215\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_%28human%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214641\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.154 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.390 1 - wikipedia:Microchip_implant_(human)\n100.00% 145.390 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8042-0!*!*!*!*!*!* and timestamp 20181217214640 and revision id 24152\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)\">https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6f82a58abdc5f62be708c1c05caa09c3_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg\/440px-Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/RFID_hand.jpg\/440px-RFID_hand.jpg"],"6f82a58abdc5f62be708c1c05caa09c3_timestamp":1545083200,"0c7f4a93fe9060b2b16eed45b8d2aa03_type":"article","0c7f4a93fe9060b2b16eed45b8d2aa03_title":"Intramedullary rod","0c7f4a93fe9060b2b16eed45b8d2aa03_url":"https:\/\/www.limswiki.org\/index.php\/Intramedullary_rod","0c7f4a93fe9060b2b16eed45b8d2aa03_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tIntramedullary rod\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t X-ray showing the proximal portion of a fractured tibia with an intramedullary nail.\n X-ray showing the distal portion of a fractured tibia and intramedular nail.\n Proximal femur nail with locking and stabilisation screws for treatment of femur fractures of left thigh.\nAn intramedullary rod, also known as an intramedullary nail (IM nail) or inter-locking nail or K\u00fcntscher nail (without proximal or distal fixation), is a metal rod forced into the medullary cavity of a bone. IM nails have long been used to treat fractures of long bones of the body. Gerhard K\u00fcntscher is credited with the first use of this device in 1939,[1][2] during World War II, for soldiers with fractures of the femur. Prior to that, treatment of such fractures was limited to traction or plaster, both of which required long periods of inactivity. IM nails resulted in earlier return to activity for the soldiers, sometimes even within a span of a few weeks, since they share the load with the bone, rather than entirely supporting the bone.[3]\n\nContents \n\n1 Design \n2 Complications \n3 See also \n4 References \n5 External links \n\n\nDesign \nThe earliest IM nails were triangular or 'V' shaped in cross-section. Later they were modified to their present and more rotationally stable clover-leaf shape.[2] Several modifications and shapes were introduced subsequently for various bones such as V-nails for tibia, radius and ulna nails, Rusch nails etc. \nAlthough stainless steel was used for older IM nails, titanium has several advantages, including lower mechanical failure rates and improved biocompatibility.[4] However the biggest problem with the earlier designs was the failure to prevent collapse or rotation in inherently unstable fractures. This was addressed by the introduction of the concept of 'locking' of the nails using bolts on each end of the nail (thus fixing the nail to the bony cortex and preventing rotation among the fragments), leading to emergence of locked IM nailing, which is the standard today.[3]\nThe extension mechanism of intramedullary can be of two types: ratcheting, such as in the Bliskunov, Albizzia, and the Internal Skeletal Kinetic Distractor (ISKD, removed from market in 2015) nails; and rotating spindle, as in the Fitbone, Phenix, PRECICE, and PRECICE 2 nails.[5]\n\nComplications \nAt a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant.[6]\n\nSee also \nDistraction osteogenesis\nReferences \n\n\n^ \"AO Dialogue 2206: The magazine of AO community\" (PDF) . AO Foundation. p. 42. Retrieved 2013-03-12 . \n\n^ a b Bong, Matthew R.; Koval, Kenneth J.; Egol, Kenneth A. (2006). \"The History of Intramedullary Nailing\" (PDF) . Bulletin of the NYU Hospital for Joint Diseases. NYU Hospital for Joint Diseases. 64 (3\/4): 94\u201397. PMID 17155917. Retrieved 2013-03-12 . \n\n^ a b \"Wheeless' Textbook of Orthopaedics - Intramedullary Nailing of Femoral Shaft Frx\". Duke Orthopaedics. Retrieved 2011-08-04 . \n\n^ Leung, Kwok-Sui; Kempf, Ivan; Alt, Volker; Taglang, Gilbert; Haarman, H. J. Th. M.; Seidel, Hartmut; Schnettler, Reinhard (15 February 2006). Practice of intramedullary locked nails: new developments in techniques and applications. Birkh\u00e4user. p. 100. ISBN 978-3-540-25349-5. Retrieved 20 December 2011 . \n\n^ Green, Stuart A.; Dahl, Mark T. (2017). Intramedullary Limb Lengthening: Principles and Practice. Springer. p. 180. ISBN 9783319602974. \n\n^ Lefaivre, K. A.; Guy, P.; Chan, H.; Blachut, P. A. (2008). \"Long-Term Follow-up of Tibial Shaft Fractures Treated with Intramedullary Nailing\". Journal of Orthopaedic Trauma. 22 (8): 525\u2013529. doi:10.1097\/BOT.0b013e318180e646. PMID 18758282. \n\n\nExternal links \nCluett, Jonathan (M.D.). \"Intramedullary Rod\". About.com. Retrieved 2008-12-19 . \nAuthority control \nGND: 4329197-1 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Intramedullary_rod\">https:\/\/www.limswiki.org\/index.php\/Intramedullary_rod<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:23.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,221 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0c7f4a93fe9060b2b16eed45b8d2aa03_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Intramedullary_rod skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Intramedullary rod<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:K-Knie-z2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/89\/K-Knie-z2.jpg\/220px-K-Knie-z2.jpg\" width=\"220\" height=\"207\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:K-Knie-z2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>X-ray showing the proximal portion of a fractured <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tibia\" title=\"Tibia\" rel=\"external_link\" target=\"_blank\">tibia<\/a> with an intramedullary nail.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:K-Fuss-z2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c7\/K-Fuss-z2.jpg\/220px-K-Fuss-z2.jpg\" width=\"220\" height=\"176\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:K-Fuss-z2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>X-ray showing the distal portion of a fractured tibia and intramedular nail.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Proximal_femur_nail.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3d\/Proximal_femur_nail.jpg\/220px-Proximal_femur_nail.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Proximal_femur_nail.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Proximal femur nail with locking and stabilisation screws for treatment of femur fractures of left thigh.<\/div><\/div><\/div>\n<p>An <b>intramedullary rod<\/b>, also known as an <b><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intramedullary\" class=\"mw-redirect\" title=\"Intramedullary\" rel=\"external_link\" target=\"_blank\">intramedullary<\/a> nail<\/b> (IM nail) or inter-locking nail or K\u00fcntscher nail (without proximal or distal fixation), is a metal rod forced into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medullary_cavity\" title=\"Medullary cavity\" rel=\"external_link\" target=\"_blank\">medullary cavity<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a>. IM nails have long been used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_fracture\" title=\"Bone fracture\" rel=\"external_link\" target=\"_blank\">fractures<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Long_bones\" class=\"mw-redirect\" title=\"Long bones\" rel=\"external_link\" target=\"_blank\">long bones<\/a> of the body. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gerhard_K%C3%BCntscher\" title=\"Gerhard K\u00fcntscher\" rel=\"external_link\" target=\"_blank\">Gerhard K\u00fcntscher<\/a> is credited with the first use of this device in 1939,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bong-etal-2006_2-0\" class=\"reference\"><a href=\"#cite_note-Bong-etal-2006-2\" rel=\"external_link\">[2]<\/a><\/sup> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_War_II\" title=\"World War II\" rel=\"external_link\" target=\"_blank\">World War II<\/a>, for soldiers with fractures of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a>. Prior to that, treatment of such fractures was limited to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Traction_(orthopedics)\" title=\"Traction (orthopedics)\" rel=\"external_link\" target=\"_blank\">traction<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plaster\" title=\"Plaster\" rel=\"external_link\" target=\"_blank\">plaster<\/a>, both of which required long periods of inactivity. IM nails resulted in earlier return to activity for the soldiers, sometimes even within a span of a few weeks, since they share the load with the bone, rather than entirely supporting the bone.<sup id=\"rdp-ebb-cite_ref-WHFEMFRX_3-0\" class=\"reference\"><a href=\"#cite_note-WHFEMFRX-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<p>The earliest IM nails were triangular or 'V' shaped in cross-section. Later they were modified to their present and more rotationally stable clover-leaf shape.<sup id=\"rdp-ebb-cite_ref-Bong-etal-2006_2-1\" class=\"reference\"><a href=\"#cite_note-Bong-etal-2006-2\" rel=\"external_link\">[2]<\/a><\/sup> Several modifications and shapes were introduced subsequently for various bones such as V-nails for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tibia\" title=\"Tibia\" rel=\"external_link\" target=\"_blank\">tibia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radius_(bone)\" title=\"Radius (bone)\" rel=\"external_link\" target=\"_blank\">radius<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ulna\" title=\"Ulna\" rel=\"external_link\" target=\"_blank\">ulna<\/a> nails, Rusch nails etc. \n<\/p><p>Although <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> was used for older IM nails, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> has several advantages, including lower mechanical failure rates and improved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>.<sup id=\"rdp-ebb-cite_ref-LeungTaglang2006_4-0\" class=\"reference\"><a href=\"#cite_note-LeungTaglang2006-4\" rel=\"external_link\">[4]<\/a><\/sup> However the biggest problem with the earlier designs was the failure to prevent collapse or rotation in inherently unstable fractures. This was addressed by the introduction of the concept of 'locking' of the nails using bolts on each end of the nail (thus fixing the nail to the bony cortex and preventing rotation among the fragments), leading to emergence of locked IM nailing, which is the standard today.<sup id=\"rdp-ebb-cite_ref-WHFEMFRX_3-1\" class=\"reference\"><a href=\"#cite_note-WHFEMFRX-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The extension mechanism of intramedullary can be of two types: ratcheting, such as in the Bliskunov, Albizzia, and the Internal Skeletal Kinetic Distractor (ISKD, removed from market in 2015) nails; and rotating spindle, as in the Fitbone, Phenix, PRECICE, and PRECICE 2 nails.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<p>At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Distraction_osteogenesis\" title=\"Distraction osteogenesis\" rel=\"external_link\" target=\"_blank\">Distraction osteogenesis<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.aofoundation.org\/Documents\/ao_dialogue_2006_01.pdf\" target=\"_blank\">\"AO Dialogue 2206: The magazine of AO community\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. AO Foundation. p. 42<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-03-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=AO+Dialogue+2206%3A+The+magazine+of+AO+community&rft.pages=42&rft.pub=AO+Foundation&rft_id=https%3A%2F%2Fwww.aofoundation.org%2FDocuments%2Fao_dialogue_2006_01.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntramedullary+rod\" class=\"Z3988\"><\/span> <\/span>\n<\/li>\n<li id=\"cite_note-Bong-etal-2006-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Bong-etal-2006_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bong-etal-2006_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bong, Matthew R.; Koval, Kenneth J.; Egol, Kenneth A. (2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nyuhjdbulletin.org\/Mod\/Bulletin\/V64N3-4\/Docs\/V64N3-4_2.pdf\" target=\"_blank\">\"The History of Intramedullary Nailing\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Bulletin of the NYU Hospital for Joint Diseases<\/i>. NYU Hospital for Joint Diseases. <b>64<\/b> (3\/4): 94\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17155917\" target=\"_blank\">17155917<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-03-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bulletin+of+the+NYU+Hospital+for+Joint+Diseases&rft.atitle=The+History+of+Intramedullary+Nailing&rft.volume=64&rft.issue=3%2F4&rft.pages=94-97&rft.date=2006&rft_id=info%3Apmid%2F17155917&rft.aulast=Bong&rft.aufirst=Matthew+R.&rft.au=Koval%2C+Kenneth+J.&rft.au=Egol%2C+Kenneth+A.&rft_id=http%3A%2F%2Fwww.nyuhjdbulletin.org%2FMod%2FBulletin%2FV64N3-4%2FDocs%2FV64N3-4_2.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntramedullary+rod\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <\/span>\n<\/li>\n<li id=\"cite_note-WHFEMFRX-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-WHFEMFRX_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WHFEMFRX_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wheelessonline.com\/ortho\/intramedullary_nailing_of_femoral_shaft_frx\" target=\"_blank\">\"Wheeless' Textbook of Orthopaedics - Intramedullary Nailing of Femoral Shaft Frx\"<\/a>. Duke Orthopaedics<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-08-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Wheeless%27+Textbook+of+Orthopaedics+-+Intramedullary+Nailing+of+Femoral+Shaft+Frx&rft.pub=Duke+Orthopaedics&rft_id=http%3A%2F%2Fwww.wheelessonline.com%2Fortho%2Fintramedullary_nailing_of_femoral_shaft_frx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntramedullary+rod\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-LeungTaglang2006-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-LeungTaglang2006_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Leung, Kwok-Sui; Kempf, Ivan; Alt, Volker; Taglang, Gilbert; Haarman, H. J. Th. M.; Seidel, Hartmut; Schnettler, Reinhard (15 February 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=uy8Q3cfF_cMC&pg=PA100\" target=\"_blank\"><i>Practice of intramedullary locked nails: new developments in techniques and applications<\/i><\/a>. Birkh\u00e4user. p. 100. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-25349-5<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 December<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Practice+of+intramedullary+locked+nails%3A+new+developments+in+techniques+and+applications&rft.pages=100&rft.pub=Birkh%C3%A4user&rft.date=2006-02-15&rft.isbn=978-3-540-25349-5&rft.aulast=Leung&rft.aufirst=Kwok-Sui&rft.au=Kempf%2C+Ivan&rft.au=Alt%2C+Volker&rft.au=Taglang%2C+Gilbert&rft.au=Haarman%2C+H.+J.+Th.+M.&rft.au=Seidel%2C+Hartmut&rft.au=Schnettler%2C+Reinhard&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Duy8Q3cfF_cMC%26pg%3DPA100&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntramedullary+rod\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Green, Stuart A.; Dahl, Mark T. (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=n6U2DwAAQBAJ\" target=\"_blank\"><i>Intramedullary Limb Lengthening: Principles and Practice<\/i><\/a>. Springer. p. 180. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783319602974.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Intramedullary+Limb+Lengthening%3A+Principles+and+Practice&rft.pages=180&rft.pub=Springer&rft.date=2017&rft.isbn=9783319602974&rft.aulast=Green&rft.aufirst=Stuart+A.&rft.au=Dahl%2C+Mark+T.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dn6U2DwAAQBAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntramedullary+rod\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lefaivre, K. A.; Guy, P.; Chan, H.; Blachut, P. A. (2008). \"Long-Term Follow-up of Tibial Shaft Fractures Treated with Intramedullary Nailing\". <i>Journal of Orthopaedic Trauma<\/i>. <b>22<\/b> (8): 525\u2013529. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FBOT.0b013e318180e646\" target=\"_blank\">10.1097\/BOT.0b013e318180e646<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18758282\" target=\"_blank\">18758282<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Orthopaedic+Trauma&rft.atitle=Long-Term+Follow-up+of+Tibial+Shaft+Fractures+Treated+with+Intramedullary+Nailing&rft.volume=22&rft.issue=8&rft.pages=525-529&rft.date=2008&rft_id=info%3Adoi%2F10.1097%2FBOT.0b013e318180e646&rft_id=info%3Apmid%2F18758282&rft.aulast=Lefaivre&rft.aufirst=K.+A.&rft.au=Guy%2C+P.&rft.au=Chan%2C+H.&rft.au=Blachut%2C+P.+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntramedullary+rod\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><cite class=\"citation web\">Cluett, Jonathan (M.D.). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthopedics.about.com\/cs\/brokenbones\/g\/imrod.htm\" target=\"_blank\">\"Intramedullary Rod\"<\/a>. About.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-12-19<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Intramedullary+Rod&rft.pub=About.com&rft.aulast=Cluett&rft.aufirst=Jonathan+%28M.D.%29&rft_id=http%3A%2F%2Forthopedics.about.com%2Fcs%2Fbrokenbones%2Fg%2Fimrod.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntramedullary+rod\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1253\nCached time: 20181215170303\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.204 seconds\nReal time usage: 0.253 seconds\nPreprocessor visited node count: 487\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 15606\/2097152 bytes\nTemplate argument size: 115\/2097152 bytes\nHighest expansion depth: 8\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 19221\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.124\/10.000 seconds\nLua memory usage: 2.7 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 212.717 1 -total\n<\/p>\n<pre>80.43% 171.086 1 Template:Reflist\n38.69% 82.309 3 Template:Cite_web\n20.32% 43.225 2 Template:Cite_journal\n16.14% 34.343 1 Template:Authority_control\n13.18% 28.029 2 Template:Cite_book\n 3.22% 6.856 1 Template:Google_books\n 1.48% 3.144 1 Template:Main_other\n 1.17% 2.481 1 Template:Trim\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:20768793-1!canonical and timestamp 20181215170303 and revision id 850521128\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intramedullary_rod\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214640\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.026 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 153.165 1 - wikipedia:Intramedullary_rod\n100.00% 153.165 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8254-0!*!*!*!*!*!* and timestamp 20181217214640 and revision id 24464\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Intramedullary_rod\">https:\/\/www.limswiki.org\/index.php\/Intramedullary_rod<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0c7f4a93fe9060b2b16eed45b8d2aa03_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/89\/K-Knie-z2.jpg\/440px-K-Knie-z2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c7\/K-Fuss-z2.jpg\/440px-K-Fuss-z2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3d\/Proximal_femur_nail.jpg\/440px-Proximal_femur_nail.jpg"],"0c7f4a93fe9060b2b16eed45b8d2aa03_timestamp":1545083200,"6027f3f932190fd7bf82e76d96a63319_type":"article","6027f3f932190fd7bf82e76d96a63319_title":"Cochlear implant","6027f3f932190fd7bf82e76d96a63319_url":"https:\/\/www.limswiki.org\/index.php\/Cochlear_implant","6027f3f932190fd7bf82e76d96a63319_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCochlear implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCochlear implantCochlear implantMedlinePlus007203 [edit on Wikidata]\nA cochlear implant (CI) is a surgically implanted neuroprosthetic device that provides a sense of sound to a person with severe to profound sensorineural hearing loss. Cochlear implants bypass the normal acoustic hearing process, instead replacing it with electric hearing. Namely, the sound sensation comes from the sound that is converted to electric signals which directly stimulate the auditory nerve. The brain adapts to the new mode of hearing, and eventually can interpret the electric signals as sound and speech.\nThe implant has two main components. The outside component is generally worn behind the ear, but could also be attached to clothing, for example, in young children. This component, the sound processor, contains microphones, electronics that include DSP chips, battery, and a coil which transmits a signal to the implant across the skin. The inside component, the actual implant, has a coil to receive signals, electronics, and an array of electrodes which is placed into the cochlea, which stimulate the cochlear nerve.\nThe surgical procedure is performed under general anesthesia. Surgical risks are minimal but can include tinnitus and dizziness.\nFrom the early days of implants in the 1970s and the 1980s, speech perception via an implant has steadily increased. Many users of modern implants gain reasonable to good hearing and speech perception skills post-implantation, especially when combined with lipreading.[1][2] One of the challenges that remain with these implants is that hearing and speech understanding skills after implantation show a wide range of variation across individual implant users. Factors such as duration and cause of hearing loss, how the implant is situated in the cochlea, the overall health of the cochlear nerve, but also individual capabilities of re-learning are considered to contribute to this variation, yet no certain predictive factors are known.[3][4][5] In children with severe to profound hearing loss, implants have shown to positively contribute to spoken language development.[6]\nDespite providing the ability for hearing and oral speech communication to children and adults with severe to profound hearing loss, there is also controversy around the devices. Much of the strongest objection to cochlear implants has come from the Deaf community. For some in the Deaf community, cochlear implants are an affront to their culture, which as some view it, is a minority threatened by the hearing majority.[7]\n\nContents \n\n1 History \n2 Parts \n3 Surgical procedure \n4 Efficacy \n5 Society and culture \n\n5.1 Usage \n5.2 Cost \n5.3 Manufacturers \n5.4 Criticism and controversy \n\n\n6 See also \n7 References \n8 External links \n\n\nHistory \n An infant with a cochlear implant.\nAndr\u00e9 Djourno and Charles Eyri\u00e8s invented the original cochlear implant in 1957. This original design distributed stimulation using a single channel. Two years later they went their separate ways due to personal and professional differences.[8]\nThe first cochlear implant was invented by William House, in 1961.[9] In 1964, Blair Simmons and Robert J. White implanted a six-channel electrode in a patient's cochlea at Stanford University.[10]\nThe modern multichannel cochlear implant was independently developed and commercialized by Graeme Clark from Australia and Ingeborg Hochmair and her future husband, Erwin Hochmair, with the Hochmairs' first implanted in a person in December 1977 and Clark's in August 1978.[11]\n\nParts \nCochlear implants bypass most of the peripheral auditory system which receives sound and converts that sound into movements of hair cells in the cochlea; the inside-portion of these hair cells release potassium ions in response to the movement of the hairs, and the potassium in turn stimulates other cells to release the neurotransmitter, glutamate, which makes the cochlear nerve send signals to the brain, which creates the experience of sound. Instead, the devices pick up sound and digitize it, convert that digitized sound into electrical signals, and transmit those signals to electrodes embedded in the cochlea. The electrodes electrically stimulate the cochlear nerve, causing it to send signals to the brain.[12][13][14]\nThere are several systems available, but generally they have the following components:[12][14]\n\nExternal\n An illustration of a cochlear implant.\none or more microphones that pick up sound from the environment\na speech processor which selectively filters sound to prioritize audible speech\na transmitter that sends power and the processed sound signals across the skin to the internal device by radio frequency transmission\nInternal:\n The internal part of a cochlear implant (model Cochlear Freedom 24 RE)\na receiver\/stimulator, which receives signals from the speech processor and converts them into electric impulses.\nan electrode array embedded in the cochlea\nSurgical procedure \nThe surgical procedure most often used to implant the device is called mastoidectomy with facial recess approach (MFRA).[14] If a person's individual anatomy prevents MFRA, other approaches, such as through the suprameatal triangle are used. A systematic literature review published in 2016 found that studies comparing the two approaches were generally small, not randomized, and retrospective so were not useful for making generalizations; it is not known which approach is safer or more effective.[15]\nThe procedure is usually done under general anesthesia. Risks of the procedures include mastoiditis, otitis media (acute or with effusion), shifting of the implanted device requiring a second procedure, damage to the facial nerve, damage to the chorda tympani, and wound infections.[15]\nThe rate of complications is about 12% for minor complications and 3% for major complications; major complications include infections, facial paralysis, and device failure. To avoid the risk of bacterial meningitis, which while low is about thirty times as high compared to people who don't undergo CI procedures, the FDA recommends vaccination prior to the procedure. The rate of transient facial nerve palsy is estimated to be approximately 1%. Device failure requiring reimplantation is estimated to occur in 2.5-6% of the time. Up to one-third of people experience disequilibrium, vertigo, or vestibular weakness lasting more than 1 week after the procedure; in people under 70 these symptoms generally resolve over weeks to months, but in people over 70 the problems tend to persist.[14]\nCochlear implants are only approved for people who are deaf in both ears; as of 2014[update] a cochlear implant had been used experimentally in some people who had acquired deafness in one ear after they had learned how to speak, and none who were deaf in one ear from birth; clinical studies as of 2014[update] had been too small to draw generalizations from.[16]\n\nEfficacy \nA 2011 AHRQ review of the evidence of the effectiveness of CI in people with bilateral hearing loss - the device's primary use - found low to moderate quality data that showed speech perception in noisy conditions was much better for people who had implants in both ears done at the same time compared to people who had only one. The data also showed that no conclusions could be drawn about changes in speech perception in quiet conditions and health-related quality-of-life. There was only one good study comparing implanting implants in both ears at the same time to implanting them sequentially; this study found that in the sequential approach, the second implantation made no change, or made things worse.[17]\nA 2012 review found that the ability to communicate in spoken language was better the earlier the implantation was done. This review also found that, overall, the efficacy of cochlear implants is highly variable, and that it was not possible to accurately predict which children will and will not acquire spoken language successfully.[18]\nA 2015 review examined whether CI implantation to treat people with bilateral hearing loss had any effect on tinnitus. This review found the quality of evidence to be poor and the results variable: overall total tinnitus suppression rates varied from 8% to 45% of people who received CI; decrease of tinnitus was seen in 25% to 72%, of people; for 0% to 36% of the people there was no change; increase of tinnitus occurred in between 0% to 25% of patients; and, in between 0 and 10% of cases, people who did not have tinnitus before the procedure, got it.[19]\nA 2015 literature review on the use of CI for people with auditory neuropathy spectrum disorder found that, as of that date, description and diagnosis of the condition was too heterogeneous to make clear claims about whether CI is a safe and effective way to manage it.[20]\nA 2016 systematic review of CI for people with unilateral hearing loss (UHL) found that of the studies conducted and published, none were randomized, only one evaluated a control group, and no study was blinded. After eliminating multiple uses of the same subjects, the authors found that 137 people with UHL had received a CI.[21] While acknowledging the weakness of the data, the authors found that CI in people with UHL improves sound localization compared with other treatments in people who lost hearing after they learned to speak; in the one study that examined this, CI did improve sound localization in people with UHL who lost hearing before learning to speak.[21] It appeared to improve speech perception and to reduce tinnitus.[21]\n\nSociety and culture \nUsage \nAs of October 2010[update], approximately 188,000 individuals had been fitted with cochlear implants.[22] As of December 2012[update], the same publication cited approximately 324,000 cochlear implant devices having been surgically implanted. In the U.S., roughly 58,000 devices were implanted in adults and 38,000 in children.[13] As of 2016[update], the Ear Foundation in the United Kingdom, estimates the number of cochlear implant recipients to be around 600,000.[23]\n\nCost \nIn the United States, the overall cost of getting cochlear implants was about $100,000 as of 2017[update].[24] Some or all of this may be covered by health insurance. In the United Kingdom, the NHS covers cochlear implants in full, as does Medicare in Australia, and the Department of Health[25] in Ireland, Seguridad Social in Spain and Israel, and the Ministry of Health or ACC (depending on the cause of deafness) in New Zealand. According to the US National Institute on Deafness and Other Communication Disorders, the estimated total cost is $60,000 per person implanted.[citation needed ]\nA study by Johns Hopkins University determined that for a three-year-old child who receives them, cochlear implants can save $30,000 to $50,000 in special-education costs for elementary and secondary schools as the child is more likely to be mainstreamed in school and thus use fewer support services than similarly deaf children.[26]\n\nManufacturers \nAs of 2013[update], the three cochlear implant devices approved for use in the US were manufactured by Cochlear Limited (Australia), Advanced Bionics (a division of Sonova) and MED-EL (Austria). In Europe, Africa, Asia, South America, and Canada, an additional device manufactured by Neurelec (France, a division of William Demant) was available. A device made by Nurotron (China) was also available in some parts of the world. Each manufacturer has adapted some of the successful innovations of the other companies to its own devices. There is no consensus that any one of these implants is superior to the others. Users of all devices report a wide range of performance after implantation.[citation needed ]\n\nCriticism and controversy \nMuch of the strongest objection to cochlear implants has come from within the Deaf community, some of whom are pre-lingually Deaf people whose first language is a sign language. For some in the Deaf community, cochlear implants are an affront to their culture, which, as they view it, is a minority threatened by the hearing majority.[7] This is an old problem for the Deaf community, going back as far as the 18th century with the argument of manualism vs. oralism. This is consistent with medicalisation and the standardisation of the \"normal\" body in the 19th century, when differences between normal and abnormal began to be debated.[27] It is important to consider the sociocultural context, particularly in regards to the Deaf community, which considers itself to possess its own unique language and culture.[28] This accounts for the cochlear implant being seen as an affront to their culture, as many do not believe that deafness is something that needs to be cured. However, it has also been argued that this does not necessarily have to be the case: the cochlear implant can act as a tool deaf people can use to access the \"hearing world\" without losing their Deaf identity.[28]\nCochlear implants for congenitally deaf children are considered to be most effective when implanted at a young age, during the critical period in which the brain is still learning to interpret sound.[29] Hence they are implanted before the recipients can decide for themselves, on the assumption that deafness is a disability. Deaf culture critics argue that the cochlear implant and the subsequent therapy often become the focus of the child's identity at the expense of a possible future deaf identity and ease of communication in sign language, and claim that measuring the child's success only by their mastery of hearing and speech will lead to a poor self-image as \"disabled\" (because the implants do not produce normal hearing) rather than having the healthy self-concept of a proudly deaf person.[30]\nChildren with cochlear implants are more likely to be educated orally, in the standard fashion, and without access to sign language and are often isolated from other deaf children and from sign language.[31] Cochlear implants have been one of the technological and social factors implicated in the decline of sign languages in the developed world.[32] Some of the more extreme responses from deaf activists have labeled the widespread implantation of children as \"cultural genocide\".[33]\nAs the trend for cochlear implants in children grows, Deaf-community advocates have tried to counter the \"either or\" formulation of oralism vs manualism with a \"both and\" approach; some schools are now successfully integrating cochlear implants with sign language in their educational programs.[34]\n\nSee also \nAuditory brainstem response\nAuditory brainstem implant\nBone-anchored hearing aid\nBone conduction\nBrain implant\nEar trumpet\nElectric Acoustic Stimulation\nElectrophonic hearing\nHearing Aid\nNeuroprosthetics\nNoise health effects\nVisual prosthesis\nLanguage deprivation \u00a7 Deaf and Hard of Hearing Children\nReferences \n\n\n^ Clark, Graeme M. (April 2015). \"The Multi-Channel Cochlear Implant: Multi-Disciplinary Development of Electrical Stimulation of the Cochlea and the Resulting Clinical Benefit\". Hearing Research. 322: 4\u201313. doi:10.1016\/j.heares.2014.08.002. PMID 25159273. \n\n^ Shannon, Robert V. (February 2012). \"Advances in Auditory Prostheses\". Current Opinion in Neurology. 25 (1): 61\u201366. doi:10.1097\/WCO.0b013e32834ef878. PMC 4123811 . PMID 22157109. \n\n^ Blamey, Peter; Artieres, Fran\u00e7oise; Ba\u015fkent, Deniz; Bergeron, Fran\u00e7ois; Beynon, Andy; Burke, Elaine; Dillier, Norbert; Dowell, Richard; Fraysse, Bernard; Gall\u00e9go, St\u00e9phane; Govaerts, Paul J.; Green, Kevin; Huber, Alexander M.; Kleine-Punte, Andrea; Maat, Bert; Marx, Mathieu; Mawman, Deborah; Mosnier, Isabelle; O'Connor, Alec Fitzgerald; O'Leary, Stephen; Rousset, Alexandra; Schauwers, Karen; Skarzynski, Henryk; Skarzynski, Piotr H.; Sterkers, Olivier; Terranti, Assia; Truy, Eric; Van de Heyning, Paul; Venail, Fr\u00e9deric; Vincent, Christophe; Lazard, Diane S. (2013). \"Factors Affecting Auditory Performance of Postlinguistically Deaf Adults Using Cochlear Implants: An Update with 2251 Patients\". Audiology and Neurotology. 18 (1): 36\u201347. doi:10.1159\/000343189. PMID 23095305. \n\n^ Ba\u015fkent, D.; Gaudrain, E.; Tamati, T.N.; Wagner, A. (2016). Perception and psychoacoustics of speech in cochlear implant users, in Scientific Foundations of Audiology: Perspectives from Physics, Biology, Modeling, and Medicine, Eds. A.T. Cacace, E. de Kleine, A.G. Holt, and P. van Dijk. San Diego, CA, USA: Plural Publishing, Inc. pp. 285\u2013319. \n\n^ Pisoni, David B.; Kronenberger, William G.; Harris, Michael S.; Moberly, Aaron C. (December 2017). \"Three challenges for future research on cochlear implants\". World Journal of Otorhinolaryngology - Head and Neck Surgery. 3 (4): 240\u2013254. doi:10.1016\/j.wjorl.2017.12.010. PMC 5956139 . PMID 29780970. \n\n^ Geers, Ann E.; Nicholas, Johanna G.; Sedey, Allison L. (February 2003). \"Language Skills of Children with Early Cochlear Implantation\". Ear and Hearing. 24 (Supplement): 46S\u201358S. doi:10.1097\/01.AUD.0000051689.57380.1B. PMID 12612480. \n\n^ a b \"The Cochlear Implant Controversy, Issues And Debates\". NEW YORK: CBS News. September 4, 2001. Retrieved 2008-11-09 . \n\n^ Svirsky, Mario (2017). \"Cochlear implants and electronic hearing\". Physics Today. 70 (8): 52\u201358. doi:10.1063\/PT.3.3661. ISSN 0031-9228. \n\n^ Martin, Douglas (December 15, 2012). \"Dr. William F. House, Inventor of Pioneering Ear-Implant Device, Dies at 89\". The New York Times. Retrieved 2012-12-16 . \n\n^ Mudry, A; Mills, M (May 2013). \"The early history of the cochlear implant: a retrospective\". JAMA Otolaryngology\u2013Head & Neck Surgery. 139 (5): 446\u201353. doi:10.1001\/jamaoto.2013.293. PMID 23681026. \n\n^ \"2013 Lasker~DeBakey Clinical Medical Research Award: Modern cochlear implant\". The Lasker Foundation. Retrieved 14 July 2017 . \n\n^ a b Roche JP, Hansen MR (2015). \"On the Horizon: Cochlear Implant Technology\". Otolaryngol. Clin. North Am. 48 (6): 1097\u2013116. doi:10.1016\/j.otc.2015.07.009. PMC 4641792 . PMID 26443490. \n\n^ a b NIH Publication No. 11-4798 (2013-11-01). \"Cochlear Implants\". National Institute on Deafness and Other Communication Disorders. Retrieved February 18, 2016 . \n\n^ a b c d Yawn R, Hunter JB, Sweeney AD, Bennett ML (2015). \"Cochlear implantation: a biomechanical prosthesis for hearing loss\". F1000Prime Rep. 7: 45. doi:10.12703\/P7-45. PMC 4447036 . PMID 26097718. \n\n^ a b Bruijnzeel H, et al. Systematic Review on Surgical Outcomes and Hearing Preservation for Cochlear Implantation in Children and Adults. Otolaryngol Head Neck Surg. 2016 Feb 16. Review. doi:10.1177\/0194599815627146 PMID 26884363 \n\n^ Tokita, J; Dunn, C; Hansen, MR (October 2014). \"Cochlear implantation and single-sided deafness\". Current Opinion in Otolaryngology & Head and Neck Surgery. 22 (5): 353\u20138. doi:10.1097\/moo.0000000000000080. PMC 4185341 . PMID 25050566. \n\n^ Raman G, et al. Effectiveness of Cochlear Implants in Adults with Sensorineural Hearing Loss [Internet]. Agency for Healthcare Research and Quality (US); 2011 Jun 17. PMID 25927131 Free full text \n\n^ Ganek, Hillary; Robbins, Amy McConkey; Niparko, John K. (2012). \"Language Outcomes After Cochlear Implantation\". Otolaryngologic Clinics of North America. 45 (1): 173\u2013185. doi:10.1016\/j.otc.2011.08.024. PMID 22115689. \n\n^ Ramakers GG, van Zon A, Stegeman I, Grolman W (2015). \"The effect of cochlear implantation on tinnitus in patients with bilateral hearing loss: A systematic review\". Laryngoscope. 125 (11): 2584\u201392. doi:10.1002\/lary.25370. PMID 26153087. \n\n^ Harrison RV, Gordon KA, Papsin BC, Negandhi J, James AL (2015). \"Auditory neuropathy spectrum disorder (ANSD) and cochlear implantation\". Int. J. Pediatr. Otorhinolaryngol. 79 (12): 1980\u20137. doi:10.1016\/j.ijporl.2015.10.006. PMID 26545793. \n\n^ a b c Cabral Junior F, Pinna MH, Alves RD, Malerbi AF, Bento RF (2016). \"Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature\". Int Arch Otorhinolaryngol. 20 (1): 69\u201375. doi:10.1055\/s-0035-1559586. PMC 4687988 . PMID 26722349. \n\n^ \"NIH Fact Sheets - Cochlear Implants\". report.nih.gov. Retrieved 2018-09-14 . \n\n^ \"The Ear Foundation | Cochlear Implant Information Sheet\". www.earfoundation.org.uk. Retrieved 2018-09-14 . \n\n^ \"Cochlear Implants\". American Academy of Otolaryngology\u2013Head and Neck Surgery. 21 April 2014. Retrieved 12 May 2017 . \n\n^ \"Beaumont Hospital - Cochlear Implant - How to Refer\". \n\n^ John M. Williams (2000-05-05). \"Do Health-Care Providers Have to Pay for Assistive Tech?\". Business Week. Retrieved 2009-10-25 . \n\n^ Lock, M. and Nguyen, V-K., An Anthropology of Biomedicine, Oxford, Wiley-Blackwell, 2010.[page needed ] \n\n^ a b Power D (2005). \"Models of deafness: cochlear implants in the Australian daily press\". Journal of Deaf Studies and Deaf Education. 10 (4): 451\u20139. doi:10.1093\/deafed\/eni042. PMID 16000690. \n\n^ Paul Oginni (2009-11-16). \"UCI Research with Cochlear Implants No Longer Falling on Deaf Ears\". New University. Retrieved 2009-11-18 . \n\n^ NAD Cochlear Implant Committee. \"Cochlear Implants\". Archived from the original on 2007-02-20. \n\n^ Ringo, Allegra (August 9, 2013). \"Understanding Deafness: Not Everyone Wants to Be 'Fixed' \". The Atlantic. \n\n^ Johnston, T (2004). \"W(h)ither the deaf community? Population, genetics, and the future of Australian sign language\". American Annals of the Deaf. 148 (5): 358\u201375. PMID 15132016. \n\n^ Christiansen, John B.; Leigh, Irene W.; Spencer, Patricia Elizabeth; Lucker, Jay R. (2001). Cochlear implants in children : ethics and choices ([Online-Ausg.] ed.). Washington, D.C.: Gallaudet University Press. pp. 304\u2013305. ISBN 9781563681165. \n\n^ Denworth, Lydia (April 25, 2014). \"Science Gave My Son the Gift of Sound\". Time. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Cochlear implants.\nCochlear Implants at Curlie\nWhat is it like to live with a cochlear implant? A short documentary video clip\nWhat do cochlear implants sound like? An audio example\nCochlear Implants Information from the National Institutes of Health (NIH).\nNASA Spinoff article on engineer Adam Kissiah's contribution to cochlear implants beginning in the 1970s.\nWilson, Blake S.; Finley, Charles C.; Lawson, Dewey T.; Wolford, Robert D.; Eddington, Donald K.; Rabinowitz, William M. (1991). \"Better speech recognition with cochlear implants\". Nature. 352 (6332): 236\u20138. Bibcode:1991Natur.352..236W. doi:10.1038\/352236a0. PMID 1857418. \nNPR Story about improvements to improve the processing of music. Includes simulations of what someone with implants might hear.\nMore recent NPR Story about improvements to improve the processing of music. Includes updated simulations of music, before and after these updates.\nTuning In PBS article about advances in cochlear implant technology with simulations of what someone with each type of implant would hear.\nMy Bionic Quest for Bol\u00e9ro (Wired, November 2005): Author Michael Chorost writes about his own implant and trying the latest software from researchers in a quest to hear music better.\nCharles Limb, \"Building the musical muscle\", TEDMED 2011, October 2011\nAuthority control \nNDL: 00577308 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cochlear_implant\">https:\/\/www.limswiki.org\/index.php\/Cochlear_implant<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:34.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,686 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6027f3f932190fd7bf82e76d96a63319_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Cochlear_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Cochlear implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>cochlear implant<\/b> (<b>CI<\/b>) is a surgically implanted neuroprosthetic device that provides a sense of sound to a person with severe to profound sensorineural hearing loss. Cochlear implants bypass the normal acoustic hearing process, instead replacing it with electric hearing. Namely, the sound sensation comes from the sound that is converted to electric signals which directly stimulate the auditory nerve. The brain adapts to the new mode of hearing, and eventually can interpret the electric signals as sound and speech.\n<\/p><p>The implant has two main components. The outside component is generally worn behind the ear, but could also be attached to clothing, for example, in young children. This component, the sound processor, contains microphones, electronics that include DSP chips, battery, and a coil which transmits a signal to the implant across the skin. The inside component, the actual implant, has a coil to receive signals, electronics, and an array of electrodes which is placed into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlea<\/a>, which stimulate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_nerve\" title=\"Cochlear nerve\" rel=\"external_link\" target=\"_blank\">cochlear nerve<\/a>.\n<\/p><p>The surgical procedure is performed under <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>. Surgical risks are minimal but can include tinnitus and dizziness.\n<\/p><p>From the early days of implants in the 1970s and the 1980s, speech perception via an implant has steadily increased. Many users of modern implants gain reasonable to good hearing and speech perception skills post-implantation, especially when combined with lipreading.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> One of the challenges that remain with these implants is that hearing and speech understanding skills after implantation show a wide range of variation across individual implant users. Factors such as duration and cause of hearing loss, how the implant is situated in the cochlea, the overall health of the cochlear nerve, but also individual capabilities of re-learning are considered to contribute to this variation, yet no certain predictive factors are known.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> In children with severe to profound hearing loss, implants have shown to positively contribute to spoken language development.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Despite providing the ability for hearing and oral speech communication to children and adults with severe to profound hearing loss, there is also controversy around the devices. Much of the strongest objection to cochlear implants has come from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deaf_culture\" title=\"Deaf culture\" rel=\"external_link\" target=\"_blank\">Deaf community<\/a>. For some in the Deaf community, cochlear implants are an affront to their culture, which as some view it, is a minority threatened by the hearing majority.<sup id=\"rdp-ebb-cite_ref-CBS_News_7-0\" class=\"reference\"><a href=\"#cite_note-CBS_News-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Infant_with_cochlear_implant.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/04\/Infant_with_cochlear_implant.jpg\/220px-Infant_with_cochlear_implant.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Infant_with_cochlear_implant.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An infant with a cochlear implant.<\/div><\/div><\/div>\n<p>Andr\u00e9 Djourno and Charles Eyri\u00e8s invented the original cochlear implant in 1957. This original design distributed stimulation using a single channel. Two years later they went their separate ways due to personal and professional differences.<sup id=\"rdp-ebb-cite_ref-Svirsky2017_8-0\" class=\"reference\"><a href=\"#cite_note-Svirsky2017-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>The first cochlear implant was invented by <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_F._House\" title=\"William F. House\" rel=\"external_link\" target=\"_blank\">William House<\/a>, in 1961.<sup id=\"rdp-ebb-cite_ref-nytimes_9-0\" class=\"reference\"><a href=\"#cite_note-nytimes-9\" rel=\"external_link\">[9]<\/a><\/sup> In 1964, Blair Simmons and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_J._White\" title=\"Robert J. White\" rel=\"external_link\" target=\"_blank\">Robert J. White<\/a> implanted a six-channel electrode in a patient's cochlea at Stanford University.<sup id=\"rdp-ebb-cite_ref-MudryHist_10-0\" class=\"reference\"><a href=\"#cite_note-MudryHist-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>The modern multichannel cochlear implant was independently developed and commercialized by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Graeme_Clark_(doctor)\" title=\"Graeme Clark (doctor)\" rel=\"external_link\" target=\"_blank\">Graeme Clark<\/a> from Australia and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ingeborg_Hochmair\" title=\"Ingeborg Hochmair\" rel=\"external_link\" target=\"_blank\">Ingeborg Hochmair<\/a> and her future husband, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erwin_Hochmair\" title=\"Erwin Hochmair\" rel=\"external_link\" target=\"_blank\">Erwin Hochmair<\/a>, with the Hochmairs' first implanted in a person in December 1977 and Clark's in August 1978.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Parts\">Parts<\/span><\/h2>\n<p>Cochlear implants bypass most of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_system#Peripheral_auditory_system\" title=\"Auditory system\" rel=\"external_link\" target=\"_blank\">peripheral auditory system<\/a> which receives sound and converts that sound into movements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hair_cells\" class=\"mw-redirect\" title=\"Hair cells\" rel=\"external_link\" target=\"_blank\">hair cells<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlea<\/a>; the inside-portion of these hair cells release <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium#Biochemical_function\" title=\"Potassium\" rel=\"external_link\" target=\"_blank\">potassium ions<\/a> in response to the movement of the hairs, and the potassium in turn stimulates other cells to release the neurotransmitter, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glutamate\" class=\"mw-redirect\" title=\"Glutamate\" rel=\"external_link\" target=\"_blank\">glutamate<\/a>, which makes the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_nerve\" title=\"Cochlear nerve\" rel=\"external_link\" target=\"_blank\">cochlear nerve<\/a> send signals to the brain, which creates the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Experience\" title=\"Experience\" rel=\"external_link\" target=\"_blank\">experience<\/a> of sound. Instead, the devices pick up sound and digitize it, convert that digitized sound into electrical signals, and transmit those signals to electrodes embedded in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlea<\/a>. The electrodes electrically stimulate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_nerve\" title=\"Cochlear nerve\" rel=\"external_link\" target=\"_blank\">cochlear nerve<\/a>, causing it to send signals to the brain.<sup id=\"rdp-ebb-cite_ref-2016Horizon_12-0\" class=\"reference\"><a href=\"#cite_note-2016Horizon-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-NIDCD2016_13-0\" class=\"reference\"><a href=\"#cite_note-NIDCD2016-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2015f1000_14-0\" class=\"reference\"><a href=\"#cite_note-2015f1000-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>There are several systems available, but generally they have the following components:<sup id=\"rdp-ebb-cite_ref-2016Horizon_12-1\" class=\"reference\"><a href=\"#cite_note-2016Horizon-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2015f1000_14-1\" class=\"reference\"><a href=\"#cite_note-2015f1000-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<dl><dd>External<\/dd><\/dl>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cochlear_Implant.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Cochlear_Implant.png\/220px-Cochlear_Implant.png\" width=\"220\" height=\"110\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cochlear_Implant.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An illustration of a cochlear implant.<\/div><\/div><\/div>\n<ul><li>one or more microphones that pick up sound from the environment<\/li>\n<li>a speech processor which selectively <a href=\"https:\/\/en.wikipedia.org\/wiki\/Filter_(signal_processing)\" title=\"Filter (signal processing)\" rel=\"external_link\" target=\"_blank\">filters<\/a> sound to prioritize <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_communication\" class=\"mw-redirect\" title=\"Speech communication\" rel=\"external_link\" target=\"_blank\">audible speech<\/a><\/li>\n<li>a transmitter that sends power and the processed sound signals across the skin to the internal device by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmitter\" title=\"Transmitter\" rel=\"external_link\" target=\"_blank\">radio frequency transmission<\/a><\/li><\/ul>\n<dl><dd>Internal:<\/dd><\/dl>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cochearimplants.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Cochearimplants.JPG\/220px-Cochearimplants.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cochearimplants.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The internal part of a cochlear implant (model Cochlear Freedom 24 RE)<\/div><\/div><\/div>\n<ul><li>a receiver\/stimulator, which receives signals from the speech processor and converts them into electric impulses.<\/li>\n<li>an electrode array embedded in the cochlea<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Surgical_procedure\">Surgical procedure<\/span><\/h2>\n<p>The surgical procedure most often used to implant the device is called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastoidectomy\" title=\"Mastoidectomy\" rel=\"external_link\" target=\"_blank\">mastoidectomy<\/a> with facial recess approach (MFRA).<sup id=\"rdp-ebb-cite_ref-2015f1000_14-2\" class=\"reference\"><a href=\"#cite_note-2015f1000-14\" rel=\"external_link\">[14]<\/a><\/sup> If a person's individual anatomy prevents MFRA, other approaches, such as through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suprameatal_triangle\" title=\"Suprameatal triangle\" rel=\"external_link\" target=\"_blank\">suprameatal triangle<\/a> are used. A systematic literature review published in 2016 found that studies comparing the two approaches were generally small, not randomized, and retrospective so were not useful for making generalizations; it is not known which approach is safer or more effective.<sup id=\"rdp-ebb-cite_ref-2016procRev_15-0\" class=\"reference\"><a href=\"#cite_note-2016procRev-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>The procedure is usually done under general anesthesia. Risks of the procedures include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastoiditis\" title=\"Mastoiditis\" rel=\"external_link\" target=\"_blank\">mastoiditis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otitis media<\/a> (acute or with effusion), shifting of the implanted device requiring a second procedure, damage to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Facial_nerve\" title=\"Facial nerve\" rel=\"external_link\" target=\"_blank\">facial nerve<\/a>, damage to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chorda_tympani\" title=\"Chorda tympani\" rel=\"external_link\" target=\"_blank\">chorda tympani<\/a>, and wound infections.<sup id=\"rdp-ebb-cite_ref-2016procRev_15-1\" class=\"reference\"><a href=\"#cite_note-2016procRev-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>The rate of complications is about 12% for minor complications and 3% for major complications; major complications include infections, facial paralysis, and device failure. To avoid the risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacterial_meningitis\" class=\"mw-redirect\" title=\"Bacterial meningitis\" rel=\"external_link\" target=\"_blank\">bacterial meningitis<\/a>, which while low is about thirty times as high compared to people who don't undergo CI procedures, the FDA recommends vaccination prior to the procedure. The rate of transient facial nerve palsy is estimated to be approximately 1%. Device failure requiring reimplantation is estimated to occur in 2.5-6% of the time. Up to one-third of people experience disequilibrium, vertigo, or vestibular weakness lasting more than 1 week after the procedure; in people under 70 these symptoms generally resolve over weeks to months, but in people over 70 the problems tend to persist.<sup id=\"rdp-ebb-cite_ref-2015f1000_14-3\" class=\"reference\"><a href=\"#cite_note-2015f1000-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Cochlear implants are only approved for people who are deaf in both ears; as of 2014<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup> a cochlear implant had been used experimentally in some people who had acquired deafness in one ear after they had learned how to speak, and none who were deaf in one ear from birth; clinical studies as of 2014<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup> had been too small to draw generalizations from.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Efficacy\">Efficacy<\/span><\/h2>\n<p>A 2011 AHRQ review of the evidence of the effectiveness of CI in people with bilateral hearing loss - the device's primary use - found low to moderate quality data that showed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_perception\" title=\"Speech perception\" rel=\"external_link\" target=\"_blank\">speech perception<\/a> in noisy conditions was much better for people who had implants in both ears done at the same time compared to people who had only one. The data also showed that no conclusions could be drawn about changes in speech perception in quiet conditions and health-related quality-of-life. There was only one good study comparing implanting implants in both ears at the same time to implanting them sequentially; this study found that in the sequential approach, the second implantation made no change, or made things worse.<sup id=\"rdp-ebb-cite_ref-AHRQ2011_17-0\" class=\"reference\"><a href=\"#cite_note-AHRQ2011-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>A 2012 review found that the ability to communicate in spoken language was better the earlier the implantation was done. This review also found that, overall, the efficacy of cochlear implants is highly variable, and that it was not possible to accurately predict which children will and will not acquire spoken language successfully.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>A 2015 review examined whether CI implantation to treat people with bilateral hearing loss had any effect on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tinnitus\" title=\"Tinnitus\" rel=\"external_link\" target=\"_blank\">tinnitus<\/a>. This review found the quality of evidence to be poor and the results variable: overall total tinnitus suppression rates varied from 8% to 45% of people who received CI; decrease of tinnitus was seen in 25% to 72%, of people; for 0% to 36% of the people there was no change; increase of tinnitus occurred in between 0% to 25% of patients; and, in between 0 and 10% of cases, people who did not have tinnitus before the procedure, got it.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>A 2015 literature review on the use of CI for people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_neuropathy_spectrum_disorder\" title=\"Auditory neuropathy spectrum disorder\" rel=\"external_link\" target=\"_blank\">auditory neuropathy spectrum disorder<\/a> found that, as of that date, description and diagnosis of the condition was too heterogeneous to make clear claims about whether CI is a safe and effective way to manage it.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>A 2016 systematic review of CI for people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unilateral_hearing_loss\" title=\"Unilateral hearing loss\" rel=\"external_link\" target=\"_blank\">unilateral hearing loss<\/a> (UHL) found that of the studies conducted and published, none were randomized, only one evaluated a control group, and no study was blinded. After eliminating multiple uses of the same subjects, the authors found that 137 people with UHL had received a CI.<sup id=\"rdp-ebb-cite_ref-2016cabral_21-0\" class=\"reference\"><a href=\"#cite_note-2016cabral-21\" rel=\"external_link\">[21]<\/a><\/sup> While acknowledging the weakness of the data, the authors found that CI in people with UHL improves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sound_localization\" title=\"Sound localization\" rel=\"external_link\" target=\"_blank\">sound localization<\/a> compared with other treatments in people who lost hearing after they learned to speak; in the one study that examined this, CI did improve sound localization in people with UHL who lost hearing before learning to speak.<sup id=\"rdp-ebb-cite_ref-2016cabral_21-1\" class=\"reference\"><a href=\"#cite_note-2016cabral-21\" rel=\"external_link\">[21]<\/a><\/sup> It appeared to improve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_perception\" title=\"Speech perception\" rel=\"external_link\" target=\"_blank\">speech perception<\/a> and to reduce <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tinnitus\" title=\"Tinnitus\" rel=\"external_link\" target=\"_blank\">tinnitus<\/a>.<sup id=\"rdp-ebb-cite_ref-2016cabral_21-2\" class=\"reference\"><a href=\"#cite_note-2016cabral-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Society_and_culture\">Society and culture<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Usage\">Usage<\/span><\/h3>\n<p>As of October 2010<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, approximately 188,000 individuals had been fitted with cochlear implants.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> As of December 2012<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, the same publication cited approximately 324,000 cochlear implant devices having been surgically implanted. In the U.S., roughly 58,000 devices were implanted in adults and 38,000 in children.<sup id=\"rdp-ebb-cite_ref-NIDCD2016_13-1\" class=\"reference\"><a href=\"#cite_note-NIDCD2016-13\" rel=\"external_link\">[13]<\/a><\/sup> As of 2016<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, the Ear Foundation in the United Kingdom, estimates the number of cochlear implant recipients to be around 600,000.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cost\">Cost<\/span><\/h3>\n<p>In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>, the overall cost of getting cochlear implants was about $100,000 as of 2017<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> Some or all of this may be covered by health insurance. In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">United Kingdom<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Health_Service\" title=\"National Health Service\" rel=\"external_link\" target=\"_blank\">NHS<\/a> covers cochlear implants in full, as does Medicare in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Australia\" title=\"Australia\" rel=\"external_link\" target=\"_blank\">Australia<\/a>, and the Department of Health<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ireland\" title=\"Ireland\" rel=\"external_link\" target=\"_blank\">Ireland<\/a>, Seguridad Social in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spain\" title=\"Spain\" rel=\"external_link\" target=\"_blank\">Spain<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Israel\" title=\"Israel\" rel=\"external_link\" target=\"_blank\">Israel<\/a>, and the Ministry of Health or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accident_Compensation_Corporation\" title=\"Accident Compensation Corporation\" rel=\"external_link\" target=\"_blank\">ACC<\/a> (depending on the cause of deafness) in <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_Zealand\" title=\"New Zealand\" rel=\"external_link\" target=\"_blank\">New Zealand<\/a>. According to the US <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_on_Deafness_and_Other_Communication_Disorders\" title=\"National Institute on Deafness and Other Communication Disorders\" rel=\"external_link\" target=\"_blank\">National Institute on Deafness and Other Communication Disorders<\/a>, the estimated total cost is $60,000 per person implanted.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>A study by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johns_Hopkins_University\" title=\"Johns Hopkins University\" rel=\"external_link\" target=\"_blank\">Johns Hopkins University<\/a> determined that for a three-year-old child who receives them, cochlear implants can save $30,000 to $50,000 in special-education costs for elementary and secondary schools as the child is more likely to be mainstreamed in school and thus use fewer support services than similarly deaf children.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Manufacturers\">Manufacturers<\/span><\/h3>\n<p>As of 2013<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, the three cochlear implant devices approved for use in the US were manufactured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_Limited\" title=\"Cochlear Limited\" rel=\"external_link\" target=\"_blank\">Cochlear Limited<\/a> (Australia), Advanced Bionics (a division of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sonova\" title=\"Sonova\" rel=\"external_link\" target=\"_blank\">Sonova<\/a>) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/MED-EL\" title=\"MED-EL\" rel=\"external_link\" target=\"_blank\">MED-EL<\/a> (Austria). In Europe, Africa, Asia, South America, and Canada, an additional device manufactured by (France, a division of <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Demant\" title=\"William Demant\" rel=\"external_link\" target=\"_blank\">William Demant<\/a>) was available. A device made by Nurotron (China) was also available in some parts of the world. Each manufacturer has adapted some of the successful innovations of the other companies to its own devices. There is no consensus that any one of these implants is superior to the others. Users of all devices report a wide range of performance after implantation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Criticism_and_controversy\">Criticism and controversy<\/span><\/h3>\n<p>Much of the strongest objection to cochlear implants has come from within the Deaf community, some of whom are people whose first language is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sign_language\" title=\"Sign language\" rel=\"external_link\" target=\"_blank\">sign language<\/a>. For some in the Deaf community, cochlear implants are an affront to their culture, which, as they view it, is a minority threatened by the hearing majority.<sup id=\"rdp-ebb-cite_ref-CBS_News_7-1\" class=\"reference\"><a href=\"#cite_note-CBS_News-7\" rel=\"external_link\">[7]<\/a><\/sup> This is an old problem for the Deaf community, going back as far as the 18th century with the argument of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manualism_and_oralism\" class=\"mw-redirect\" title=\"Manualism and oralism\" rel=\"external_link\" target=\"_blank\">manualism vs. oralism<\/a>. This is consistent with medicalisation and the standardisation of the \"normal\" body in the 19th century, when differences between normal and abnormal began to be debated.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> It is important to consider the sociocultural context, particularly in regards to the Deaf community, which considers itself to possess its own unique language and culture.<sup id=\"rdp-ebb-cite_ref-Power,_D._2005,_pp._451-459_28-0\" class=\"reference\"><a href=\"#cite_note-Power,_D._2005,_pp._451-459-28\" rel=\"external_link\">[28]<\/a><\/sup> This accounts for the cochlear implant being seen as an affront to their culture, as many do not believe that deafness is something that needs to be cured. However, it has also been argued that this does not necessarily have to be the case: the cochlear implant can act as a tool deaf people can use to access the \"hearing world\" without losing their Deaf identity.<sup id=\"rdp-ebb-cite_ref-Power,_D._2005,_pp._451-459_28-1\" class=\"reference\"><a href=\"#cite_note-Power,_D._2005,_pp._451-459-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p><p>Cochlear implants for congenitally deaf children are considered to be most effective when implanted at a young age, during the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Critical_period\" title=\"Critical period\" rel=\"external_link\" target=\"_blank\">critical period<\/a> in which the brain is still learning to interpret sound.<sup id=\"rdp-ebb-cite_ref-UCIResearch_29-0\" class=\"reference\"><a href=\"#cite_note-UCIResearch-29\" rel=\"external_link\">[29]<\/a><\/sup> Hence they are implanted before the recipients can decide for themselves, on the assumption that deafness is a disability. Deaf culture critics argue that the cochlear implant and the subsequent therapy often become the focus of the child's identity at the expense of a possible future deaf identity and ease of communication in sign language, and claim that measuring the child's success only by their mastery of hearing and speech will lead to a poor self-image as \"disabled\" (because the implants do not produce normal hearing) rather than having the healthy self-concept of a proudly deaf person.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>Children with cochlear implants are more likely to be educated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oralism\" title=\"Oralism\" rel=\"external_link\" target=\"_blank\">orally<\/a>, in the standard fashion, and without access to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sign_language\" title=\"Sign language\" rel=\"external_link\" target=\"_blank\">sign language<\/a> and are often isolated from other deaf children and from sign language.<sup id=\"rdp-ebb-cite_ref-Atlantic_31-0\" class=\"reference\"><a href=\"#cite_note-Atlantic-31\" rel=\"external_link\">[31]<\/a><\/sup> Cochlear implants have been one of the technological and social factors implicated in the decline of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sign_language\" title=\"Sign language\" rel=\"external_link\" target=\"_blank\">sign languages<\/a> in the developed world.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> Some of the more extreme responses from deaf activists have labeled the widespread implantation of children as \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cultural_genocide\" title=\"Cultural genocide\" rel=\"external_link\" target=\"_blank\">cultural genocide<\/a>\".<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p><p>As the trend for cochlear implants in children grows, Deaf-community advocates have tried to counter the \"either or\" formulation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manualism_and_oralism\" class=\"mw-redirect\" title=\"Manualism and oralism\" rel=\"external_link\" target=\"_blank\">oralism vs manualism<\/a> with a \"both and\" approach; some schools are now successfully integrating cochlear implants with sign language in their educational programs.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_brainstem_response\" title=\"Auditory brainstem response\" rel=\"external_link\" target=\"_blank\">Auditory brainstem response<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_brainstem_implant\" title=\"Auditory brainstem implant\" rel=\"external_link\" target=\"_blank\">Auditory brainstem implant<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone-anchored_hearing_aid\" title=\"Bone-anchored hearing aid\" rel=\"external_link\" target=\"_blank\">Bone-anchored hearing aid<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_conduction\" title=\"Bone conduction\" rel=\"external_link\" target=\"_blank\">Bone conduction<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_implant\" title=\"Brain implant\" rel=\"external_link\" target=\"_blank\">Brain implant<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear_trumpet\" title=\"Ear trumpet\" rel=\"external_link\" target=\"_blank\">Ear trumpet<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_Acoustic_Stimulation\" class=\"mw-redirect\" title=\"Electric Acoustic Stimulation\" rel=\"external_link\" target=\"_blank\">Electric Acoustic Stimulation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrophonic_hearing\" class=\"mw-redirect\" title=\"Electrophonic hearing\" rel=\"external_link\" target=\"_blank\">Electrophonic hearing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_Aid\" class=\"mw-redirect\" title=\"Hearing Aid\" rel=\"external_link\" target=\"_blank\">Hearing Aid<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">Neuroprosthetics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Noise_health_effects\" class=\"mw-redirect\" title=\"Noise health effects\" rel=\"external_link\" target=\"_blank\">Noise health effects<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">Visual prosthesis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Language_deprivation#Deaf_and_Hard_of_Hearing_Children\" title=\"Language deprivation\" rel=\"external_link\" target=\"_blank\">Language deprivation \u00a7 Deaf and Hard of Hearing Children<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Clark, Graeme M. (April 2015). \"The Multi-Channel Cochlear Implant: Multi-Disciplinary Development of Electrical Stimulation of the Cochlea and the Resulting Clinical Benefit\". <i>Hearing Research<\/i>. <b>322<\/b>: 4\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.heares.2014.08.002\" target=\"_blank\">10.1016\/j.heares.2014.08.002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25159273\" target=\"_blank\">25159273<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hearing+Research&rft.atitle=The+Multi-Channel+Cochlear+Implant%3A+Multi-Disciplinary+Development+of+Electrical+Stimulation+of+the+Cochlea+and+the+Resulting+Clinical+Benefit&rft.volume=322&rft.pages=4-13&rft.date=2015-04&rft_id=info%3Adoi%2F10.1016%2Fj.heares.2014.08.002&rft_id=info%3Apmid%2F25159273&rft.aulast=Clark&rft.aufirst=Graeme+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shannon, Robert V. (February 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4123811\" target=\"_blank\">\"Advances in Auditory Prostheses\"<\/a>. <i>Current Opinion in Neurology<\/i>. <b>25<\/b> (1): 61\u201366. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FWCO.0b013e32834ef878\" target=\"_blank\">10.1097\/WCO.0b013e32834ef878<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4123811\" target=\"_blank\">4123811<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22157109\" target=\"_blank\">22157109<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Neurology&rft.atitle=Advances+in+Auditory+Prostheses&rft.volume=25&rft.issue=1&rft.pages=61-66&rft.date=2012-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4123811&rft_id=info%3Apmid%2F22157109&rft_id=info%3Adoi%2F10.1097%2FWCO.0b013e32834ef878&rft.aulast=Shannon&rft.aufirst=Robert+V.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4123811&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blamey, Peter; Artieres, Fran\u00e7oise; Ba\u015fkent, Deniz; Bergeron, Fran\u00e7ois; Beynon, Andy; Burke, Elaine; Dillier, Norbert; Dowell, Richard; Fraysse, Bernard; Gall\u00e9go, St\u00e9phane; Govaerts, Paul J.; Green, Kevin; Huber, Alexander M.; Kleine-Punte, Andrea; Maat, Bert; Marx, Mathieu; Mawman, Deborah; Mosnier, Isabelle; O'Connor, Alec Fitzgerald; O'Leary, Stephen; Rousset, Alexandra; Schauwers, Karen; Skarzynski, Henryk; Skarzynski, Piotr H.; Sterkers, Olivier; Terranti, Assia; Truy, Eric; Van de Heyning, Paul; Venail, Fr\u00e9deric; Vincent, Christophe; Lazard, Diane S. (2013). \"Factors Affecting Auditory Performance of Postlinguistically Deaf Adults Using Cochlear Implants: An Update with 2251 Patients\". <i>Audiology and Neurotology<\/i>. <b>18<\/b> (1): 36\u201347. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000343189\" target=\"_blank\">10.1159\/000343189<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23095305\" target=\"_blank\">23095305<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Audiology+and+Neurotology&rft.atitle=Factors+Affecting+Auditory+Performance+of+Postlinguistically+Deaf+Adults+Using+Cochlear+Implants%3A+An+Update+with+2251+Patients&rft.volume=18&rft.issue=1&rft.pages=36-47&rft.date=2013&rft_id=info%3Adoi%2F10.1159%2F000343189&rft_id=info%3Apmid%2F23095305&rft.aulast=Blamey&rft.aufirst=Peter&rft.au=Artieres%2C+Fran%C3%A7oise&rft.au=Ba%C5%9Fkent%2C+Deniz&rft.au=Bergeron%2C+Fran%C3%A7ois&rft.au=Beynon%2C+Andy&rft.au=Burke%2C+Elaine&rft.au=Dillier%2C+Norbert&rft.au=Dowell%2C+Richard&rft.au=Fraysse%2C+Bernard&rft.au=Gall%C3%A9go%2C+St%C3%A9phane&rft.au=Govaerts%2C+Paul+J.&rft.au=Green%2C+Kevin&rft.au=Huber%2C+Alexander+M.&rft.au=Kleine-Punte%2C+Andrea&rft.au=Maat%2C+Bert&rft.au=Marx%2C+Mathieu&rft.au=Mawman%2C+Deborah&rft.au=Mosnier%2C+Isabelle&rft.au=O%27Connor%2C+Alec+Fitzgerald&rft.au=O%27Leary%2C+Stephen&rft.au=Rousset%2C+Alexandra&rft.au=Schauwers%2C+Karen&rft.au=Skarzynski%2C+Henryk&rft.au=Skarzynski%2C+Piotr+H.&rft.au=Sterkers%2C+Olivier&rft.au=Terranti%2C+Assia&rft.au=Truy%2C+Eric&rft.au=Van+de+Heyning%2C+Paul&rft.au=Venail%2C+Fr%C3%A9deric&rft.au=Vincent%2C+Christophe&rft.au=Lazard%2C+Diane+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Ba\u015fkent, D.; Gaudrain, E.; Tamati, T.N.; Wagner, A. (2016). <i>Perception and psychoacoustics of speech in cochlear implant users, in Scientific Foundations of Audiology: Perspectives from Physics, Biology, Modeling, and Medicine, Eds. A.T. Cacace, E. de Kleine, A.G. Holt, and P. van Dijk<\/i>. San Diego, CA, USA: Plural Publishing, Inc. pp. 285\u2013319.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Perception+and+psychoacoustics+of+speech+in+cochlear+implant+users%2C+in+Scientific+Foundations+of+Audiology%3A+Perspectives+from+Physics%2C+Biology%2C+Modeling%2C+and+Medicine%2C+Eds.+A.T.+Cacace%2C+E.+de+Kleine%2C+A.G.+Holt%2C+and+P.+van+Dijk&rft.place=San+Diego%2C+CA%2C+USA&rft.pages=285-319&rft.pub=Plural+Publishing%2C+Inc&rft.date=2016&rft.aulast=Ba%C5%9Fkent&rft.aufirst=D.&rft.au=Gaudrain%2C+E.&rft.au=Tamati%2C+T.N.&rft.au=Wagner%2C+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pisoni, David B.; Kronenberger, William G.; Harris, Michael S.; Moberly, Aaron C. (December 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5956139\" target=\"_blank\">\"Three challenges for future research on cochlear implants\"<\/a>. <i>World Journal of Otorhinolaryngology - Head and Neck Surgery<\/i>. <b>3<\/b> (4): 240\u2013254. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.wjorl.2017.12.010\" target=\"_blank\">10.1016\/j.wjorl.2017.12.010<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5956139\" target=\"_blank\">5956139<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29780970\" target=\"_blank\">29780970<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Journal+of+Otorhinolaryngology+-+Head+and+Neck+Surgery&rft.atitle=Three+challenges+for+future+research+on+cochlear+implants&rft.volume=3&rft.issue=4&rft.pages=240-254&rft.date=2017-12&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5956139&rft_id=info%3Apmid%2F29780970&rft_id=info%3Adoi%2F10.1016%2Fj.wjorl.2017.12.010&rft.aulast=Pisoni&rft.aufirst=David+B.&rft.au=Kronenberger%2C+William+G.&rft.au=Harris%2C+Michael+S.&rft.au=Moberly%2C+Aaron+C.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5956139&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Geers, Ann E.; Nicholas, Johanna G.; Sedey, Allison L. (February 2003). \"Language Skills of Children with Early Cochlear Implantation\". <i>Ear and Hearing<\/i>. <b>24<\/b> (Supplement): 46S\u201358S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.AUD.0000051689.57380.1B\" target=\"_blank\">10.1097\/01.AUD.0000051689.57380.1B<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12612480\" target=\"_blank\">12612480<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ear+and+Hearing&rft.atitle=Language+Skills+of+Children+with+Early+Cochlear+Implantation&rft.volume=24&rft.issue=Supplement&rft.pages=46S-58S&rft.date=2003-02&rft_id=info%3Adoi%2F10.1097%2F01.AUD.0000051689.57380.1B&rft_id=info%3Apmid%2F12612480&rft.aulast=Geers&rft.aufirst=Ann+E.&rft.au=Nicholas%2C+Johanna+G.&rft.au=Sedey%2C+Allison+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CBS_News-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CBS_News_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CBS_News_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cbsnews.com\/stories\/1998\/06\/02\/sunday\/main10794.shtml\" target=\"_blank\">\"The Cochlear Implant Controversy, Issues And Debates\"<\/a>. NEW YORK: CBS News. September 4, 2001<span class=\"reference-accessdate\">. 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Agency for Healthcare Research and Quality (US); 2011 Jun 17. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25927131\" target=\"_blank\">25927131<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmedhealth\/PMH0073442\/pdf\/PubMedHealth_PMH0073442.pdf\" target=\"_blank\">Free full text<\/a><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ganek, Hillary; Robbins, Amy McConkey; <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Niparko\" title=\"John Niparko\" rel=\"external_link\" target=\"_blank\">Niparko, John K.<\/a> (2012). \"Language Outcomes After Cochlear Implantation\". <i>Otolaryngologic Clinics of North America<\/i>. <b>45<\/b> (1): 173\u2013185. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.otc.2011.08.024\" target=\"_blank\">10.1016\/j.otc.2011.08.024<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22115689\" target=\"_blank\">22115689<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Otolaryngologic+Clinics+of+North+America&rft.atitle=Language+Outcomes+After+Cochlear+Implantation&rft.volume=45&rft.issue=1&rft.pages=173-185&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.otc.2011.08.024&rft_id=info%3Apmid%2F22115689&rft.aulast=Ganek&rft.aufirst=Hillary&rft.au=Robbins%2C+Amy+McConkey&rft.au=Niparko%2C+John+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ramakers GG, van Zon A, Stegeman I, Grolman W (2015). \"The effect of cochlear implantation on tinnitus in patients with bilateral hearing loss: A systematic review\". <i>Laryngoscope<\/i>. <b>125<\/b> (11): 2584\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Flary.25370\" target=\"_blank\">10.1002\/lary.25370<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26153087\" target=\"_blank\">26153087<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Laryngoscope&rft.atitle=The+effect+of+cochlear+implantation+on+tinnitus+in+patients+with+bilateral+hearing+loss%3A+A+systematic+review&rft.volume=125&rft.issue=11&rft.pages=2584-92&rft.date=2015&rft_id=info%3Adoi%2F10.1002%2Flary.25370&rft_id=info%3Apmid%2F26153087&rft.aulast=Ramakers&rft.aufirst=GG&rft.au=van+Zon%2C+A&rft.au=Stegeman%2C+I&rft.au=Grolman%2C+W&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Harrison RV, Gordon KA, Papsin BC, Negandhi J, James AL (2015). \"Auditory neuropathy spectrum disorder (ANSD) and cochlear implantation\". <i>Int. 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(May 2014)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-Power,_D._2005,_pp._451-459-28\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Power,_D._2005,_pp._451-459_28-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Power,_D._2005,_pp._451-459_28-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Power D (2005). \"Models of deafness: cochlear implants in the Australian daily press\". <i>Journal of Deaf Studies and Deaf Education<\/i>. <b>10<\/b> (4): 451\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fdeafed%2Feni042\" target=\"_blank\">10.1093\/deafed\/eni042<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16000690\" target=\"_blank\">16000690<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Deaf+Studies+and+Deaf+Education&rft.atitle=Models+of+deafness%3A+cochlear+implants+in+the+Australian+daily+press&rft.volume=10&rft.issue=4&rft.pages=451-9&rft.date=2005&rft_id=info%3Adoi%2F10.1093%2Fdeafed%2Feni042&rft_id=info%3Apmid%2F16000690&rft.au=Power+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-UCIResearch-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-UCIResearch_29-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Paul Oginni (2009-11-16). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.newuniversity.org\/2009\/11\/news\/uci-research-with-cochlear-implants-no-longer-falling-on-deaf-ears\/\" target=\"_blank\">\"UCI Research with Cochlear Implants No Longer Falling on Deaf Ears\"<\/a>. New University<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-11-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=UCI+Research+with+Cochlear+Implants+No+Longer+Falling+on+Deaf+Ears&rft.pub=New+University&rft.date=2009-11-16&rft.au=Paul+Oginni&rft_id=http%3A%2F%2Fwww.newuniversity.org%2F2009%2F11%2Fnews%2Fuci-research-with-cochlear-implants-no-longer-falling-on-deaf-ears%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">NAD Cochlear Implant Committee. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070220131900\/http:\/\/www.nad.org\/site\/pp.asp?c=foINKQMBF&b=138140\" target=\"_blank\">\"Cochlear Implants\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nad.org\/site\/pp.asp?c=foINKQMBF&b=138140\" target=\"_blank\">the original<\/a> on 2007-02-20.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Cochlear+Implants&rft.au=NAD+Cochlear+Implant+Committee&rft_id=http%3A%2F%2Fwww.nad.org%2Fsite%2Fpp.asp%3Fc%3DfoINKQMBF%26b%3D138140&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Atlantic-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Atlantic_31-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Ringo, Allegra (August 9, 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theatlantic.com\/health\/archive\/2013\/08\/understanding-deafness-not-everyone-wants-to-be-fixed\/278527\/\" target=\"_blank\">\"Understanding Deafness: Not Everyone Wants to Be 'Fixed<span class=\"cs1-kern-right\">'<\/span>\"<\/a>. <i>The Atlantic<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Atlantic&rft.atitle=Understanding+Deafness%3A+Not+Everyone+Wants+to+Be+%27Fixed%27&rft.date=2013-08-09&rft.aulast=Ringo&rft.aufirst=Allegra&rft_id=https%3A%2F%2Fwww.theatlantic.com%2Fhealth%2Farchive%2F2013%2F08%2Funderstanding-deafness-not-everyone-wants-to-be-fixed%2F278527%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Johnston, T (2004). \"W(h)ither the deaf community? Population, genetics, and the future of Australian sign language\". <i>American Annals of the Deaf<\/i>. <b>148<\/b> (5): 358\u201375. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15132016\" target=\"_blank\">15132016<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Annals+of+the+Deaf&rft.atitle=W%28h%29ither+the+deaf+community%3F+Population%2C+genetics%2C+and+the+future+of+Australian+sign+language&rft.volume=148&rft.issue=5&rft.pages=358-75&rft.date=2004&rft_id=info%3Apmid%2F15132016&rft.aulast=Johnston&rft.aufirst=T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Christiansen, John B.; Leigh, Irene W.; Spencer, Patricia Elizabeth; Lucker, Jay R. (2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=GBAmGL_te7UC&pg=PA305\" target=\"_blank\"><i>Cochlear implants in children : ethics and choices<\/i><\/a> ([Online-Ausg.] ed.). Washington, D.C.: Gallaudet University Press. pp. 304\u2013305. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781563681165.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Cochlear+implants+in+children+%3A+ethics+and+choices&rft.place=Washington%2C+D.C.&rft.pages=304-305&rft.edition=%5BOnline-Ausg.%5D&rft.pub=Gallaudet+University+Press&rft.date=2001&rft.isbn=9781563681165&rft.aulast=Christiansen&rft.aufirst=John+B.&rft.au=Leigh%2C+Irene+W.&rft.au=Spencer%2C+Patricia+Elizabeth&rft.au=Lucker%2C+Jay+R.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DGBAmGL_te7UC%26pg%3DPA305&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Denworth, Lydia (April 25, 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/time.com\/76154\/deaf-culture-cochlear-implants\/\" target=\"_blank\">\"Science Gave My Son the Gift of Sound\"<\/a>. <i>Time<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Time&rft.atitle=Science+Gave+My+Son+the+Gift+of+Sound&rft.date=2014-04-25&rft.aulast=Denworth&rft.aufirst=Lydia&rft_id=http%3A%2F%2Ftime.com%2F76154%2Fdeaf-culture-cochlear-implants%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/curlie.org\/Business\/Healthcare\/Products_and_Services\/Disability\/Hearing_and_Listening_Aids\/Cochlear_Implants\/\" target=\"_blank\">Cochlear Implants<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Curlie\" class=\"mw-redirect\" title=\"Curlie\" rel=\"external_link\" target=\"_blank\">Curlie<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/auditoryneuroscience.com\/CI_success_story\" target=\"_blank\">What is it like to live with a cochlear implant? A short documentary video clip<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/auditoryneuroscience.com\/prosthetics\/noise_vocoded_speech\" target=\"_blank\">What do cochlear implants sound like? An audio example<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nidcd.nih.gov\/health\/hearing\/pages\/coch.aspx\" target=\"_blank\">Cochlear Implants<\/a> Information from the National Institutes of Health (NIH).<\/li>\n<li>NASA <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/ntrs.nasa.gov\/archive\/nasa\/casi.ntrs.nasa.gov\/20030099659_2003114614.pdf\" target=\"_blank\">Spinoff article<\/a> on engineer Adam Kissiah's contribution to cochlear implants beginning in the 1970s.<\/li>\n<li><cite class=\"citation journal\">Wilson, Blake S.; Finley, Charles C.; Lawson, Dewey T.; Wolford, Robert D.; Eddington, Donald K.; Rabinowitz, William M. (1991). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nature.com\/nature\/journal\/v352\/n6332\/abs\/352236a0.html\" target=\"_blank\">\"Better speech recognition with cochlear implants\"<\/a>. <i>Nature<\/i>. <b>352<\/b> (6332): 236\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1991Natur.352..236W\" target=\"_blank\">1991Natur.352..236W<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F352236a0\" target=\"_blank\">10.1038\/352236a0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1857418\" target=\"_blank\">1857418<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Better+speech+recognition+with+cochlear+implants&rft.volume=352&rft.issue=6332&rft.pages=236-8&rft.date=1991&rft_id=info%3Apmid%2F1857418&rft_id=info%3Adoi%2F10.1038%2F352236a0&rft_id=info%3Abibcode%2F1991Natur.352..236W&rft.aulast=Wilson&rft.aufirst=Blake+S.&rft.au=Finley%2C+Charles+C.&rft.au=Lawson%2C+Dewey+T.&rft.au=Wolford%2C+Robert+D.&rft.au=Eddington%2C+Donald+K.&rft.au=Rabinowitz%2C+William+M.&rft_id=http%3A%2F%2Fwww.nature.com%2Fnature%2Fjournal%2Fv352%2Fn6332%2Fabs%2F352236a0.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACochlear+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.npr.org\/templates\/story\/story.php?storyId=4961269\" target=\"_blank\">NPR Story about improvements to improve the processing of music.<\/a> Includes simulations of what someone with implants might hear.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2015\/05\/18\/406838781\/deaf-jam-experiencing-music-through-a-cochlear-implant\" target=\"_blank\">More recent NPR Story about improvements to improve the processing of music.<\/a> Includes updated simulations of music, before and after these updates.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.pbs.org\/saf\/1205\/features\/Interactive\/intro1.htm\" target=\"_blank\">Tuning In<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_Broadcasting_Service\" class=\"mw-redirect\" title=\"Public Broadcasting Service\" rel=\"external_link\" target=\"_blank\">PBS<\/a> article about advances in cochlear implant technology with simulations of what someone with each type of implant would hear.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/wired\/archive\/13.11\/bolero.html?tw=wn_tophead_4\" target=\"_blank\">My Bionic Quest for Bol\u00e9ro<\/a> (Wired, November 2005): Author <a href=\"https:\/\/en.wikipedia.org\/wiki\/Michael_Chorost\" title=\"Michael Chorost\" rel=\"external_link\" target=\"_blank\">Michael Chorost<\/a> writes about his own implant and trying the latest software from researchers in a quest to hear music better.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Limb\" title=\"Charles Limb\" rel=\"external_link\" target=\"_blank\">Charles Limb<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ted.com\/talks\/charles_limb_building_the_musical_muscle.html\" target=\"_blank\">\"Building the musical muscle\"<\/a>, TEDMED 2011, October 2011<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1320\nCached time: 20181211235448\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.700 seconds\nReal time usage: 0.881 seconds\nPreprocessor visited node count: 3678\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 88431\/2097152 bytes\nTemplate argument size: 4980\/2097152 bytes\nHighest expansion depth: 19\/40\nExpensive parser function count: 14\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 98307\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.401\/10.000 seconds\nLua memory usage: 5.73 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 793.342 1 -total\n<\/p>\n<pre>52.25% 414.508 1 Template:Reflist\n32.08% 254.504 17 Template:Cite_journal\n11.94% 94.715 1 Template:Infobox_medical_intervention\n11.25% 89.283 1 Template:Infobox\n10.01% 79.440 3 Template:Fix\n 9.83% 77.960 2 Template:Citation_needed\n 7.57% 60.080 1 Template:Commons_category\n 6.71% 53.242 7 Template:As_of\n 6.15% 48.767 6 Template:Category_handler\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:241649-1!canonical and timestamp 20181211235447 and revision id 871254622\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214640\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.019 seconds\nReal time usage: 0.142 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 131.310 1 - wikipedia:Cochlear_implant\n100.00% 131.310 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8004-0!*!*!*!*!*!* and timestamp 20181217214640 and revision id 24115\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cochlear_implant\">https:\/\/www.limswiki.org\/index.php\/Cochlear_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6027f3f932190fd7bf82e76d96a63319_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/50\/Blausen_0244_CochlearImplant_01.png\/560px-Blausen_0244_CochlearImplant_01.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/04\/Infant_with_cochlear_implant.jpg\/440px-Infant_with_cochlear_implant.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Cochlear_Implant.png\/440px-Cochlear_Implant.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Cochearimplants.JPG\/440px-Cochearimplants.JPG"],"6027f3f932190fd7bf82e76d96a63319_timestamp":1545083200,"d3ae356ae2cf35486b5f95caa1bf80f0_type":"article","d3ae356ae2cf35486b5f95caa1bf80f0_title":"Cerebral shunt","d3ae356ae2cf35486b5f95caa1bf80f0_url":"https:\/\/www.limswiki.org\/index.php\/Cerebral_shunt","d3ae356ae2cf35486b5f95caa1bf80f0_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCerebral shunt\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCerebral shuntA diagram of a typical brain shuntMeSHD002557 [edit on Wikidata]\nCerebral shunts are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid (CSF). If left unchecked, the cerebrospinal fluid can build up leading to an increase in intracranial pressure (ICP) which can lead to intracranial hematoma, cerebral edema, crushed brain tissue or herniation.[1] The cerebral shunt can be used to alleviate or prevent these problems in patients who suffer from hydrocephalus or other related diseases. \nShunts can come in a variety of forms but most of them consist of a valve housing connected to a catheter, the end of which is usually placed in the peritoneal cavity. The main differences between shunts are usually in the materials used to construct them, the types of valve (if any) used, and whether the valve is programmable or not.[2]\n\nContents \n\n1 Types of valves \n2 Shunt location \n\n2.1 Shunt routing \n\n\n3 Surgical wound healing for a ventriculo-peritoneal shunt (VP shunt) \n4 Complications \n\n4.1 Infection \n\n4.1.1 Treatment of shunt infections \n4.1.2 Medical treatment of shunt infection \n4.1.3 Surgical treatment of shunt infection \n\n\n4.2 Obstruction \n4.3 Over drainage \n\n4.3.1 Chiari I malformation \n4.3.2 Slit ventricle syndrome \n\n\n4.4 Intraventricular hemorrhage \n\n\n5 Conditions requiring shunting \n6 Removing shunts \n7 See also \n8 References \n9 External links \n\n\nTypes of valves \n A ventriculoperitoneal shunt running from a brain ventricle to the abdominal cavity. CT scan of the head, 2016.\n\n\n\nValve type\n\nDescription\n\n\nDelta\n\nDesigned to prevent overdrainage. Remains closed until ICP reaches a predetermined level. Leaves shunted ventricle larger than the non-shunted ventricles.[3][4]\n\n\nMedium pressure cylindrical\n\nCan lead to uneven drainage of ventricles.[3]\n\n\nNulsen and Spitz\n\nContains two ball-valve units connected with a spring. Does not have an adjustable pressure setting. First mass-produced valve used to treat hydrocephalus in 1956.[5]\n\n\nSpitz-Holter\n\nUses slits in silicone to avoid mechanical failure.[6][7]\n\n\nAnti-siphon\n\nPrevents over drainage by preventing the siphon effect. The device closes when the pressure within the valve becomes negative relative to the ambient pressure. Prevents overdrainage that might occur when a patient sits, stands or rapidly changes posture.[8]\n\n\nSigma\n\nThe Sigma valve operates on a flow-control mechanism as opposed to the pressure-control system of other valves. The device can regulate CSF flow changes without being programmed or surgically changed. The first iteration was introduced in 1987. Valve operated in three stages to prevent over and under drainage.[9]\n\nShunt location \n X-ray of a ventriculoperitoneal shunt.\nThe location of the shunt is determined by the neurosurgeon based on the type and location of the blockage causing hydrocephalus. All brain ventricles are candidates for shunting. The catheter is most commonly placed in the abdomen but other locations include the heart and lungs.[10] Shunts can often be named after the route used by the neurosurgeon. The distal end of the catheter can be located in just about any tissue with enough epithelial cells to absorb the incoming CSF. Below are some common routing plans for cerebral shunts.\n\nShunt routing \n\n\n\nRoute\n\nLocation of Fluid Drain\n\n\nVentriculo-peritoneal shunt (VP shunt)\n\nPeritoneal cavity\n\n\nVentriculo-atrial shunt (VA shunt)\n\nRight atrium of the heart\n\n\nVentriculo-pleural shunt (VPL shunt)\n\nPleural cavity\n\n\nVentriculo-cisternal shunt (VC shunt)\n\nCisterna magna\n\n\nVentriculo-subgaleal shunt (SG shunt)\n\nSubgaleal space\n\n\nLumbar-peritoneal shunt (LP shunt)\n\nPeritoneal cavity\n\nA subgaleal shunt is usually a temporary measure used in infants who are too small or premature to tolerate other shunt types. The surgeon forms a pocket beneath the epicranial aponeurosis (the subgaleal space) and allows CSF to drain from the ventricles, creating a fluid-filled swelling on the baby's scalp. These shunts are normally converted to VP or other shunt types once the infant is big enough.[11]\n\n Surgical wound healing for a ventriculo-peritoneal shunt (VP shunt) \n\n\t\t\n\t\t\t\n\t\t\t\nHead wound at day 6\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBelly wound at day 12\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nHead wound at day 15, stitches removed\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBelly wound at day 15, stitches removed\n\n\t\t\t\n\t\t\n\nComplications \nThere are a number of complications associated with shunt placement. Many of these complications occur during childhood and cease once the patient has reached adulthood. Many of the complications seen in patients require immediate shunt revision (the replacement or reprogramming of the already existing shunt). The common symptoms often resemble the new onset of hydrocephalus such as headaches, nausea, vomiting, double-vision, and an alteration of consciousness.[10] Furthermore, in the pediatric population, the shunt failure rate 2 years after implantation has been estimated to be as high as 50%.[12]\n\nInfection \nInfection is a common complication that normally affects pediatric patients because they have not yet built up immunities to a number of different diseases. Normally, the incidence of infection decreases as the patient grows older and the body gains immunity to various infectious agents.[10] \nShunt infection is a common problem and can occur in up to 27% of patients with a shunt. Infection can lead to long term cognitive defects, neurological problems, and in some cases death. Common microbial agents for shunt infection include Staphylococcus epidermidis, Staphylococcus aureus, and Candida albicans. Further factors leading to shunt infection include shunt insertion at a young age (<6 months old) and the type of hydrocephalus being treated. There is no strong correlation between infection and shunt type.[13]\nThe symptoms of a shunt infection are very similar to the symptoms seen in hydrocephalus but can also include fever and elevated white blood cell counts.[14]\n\nTreatment of shunt infections \nTreatment of a CSF shunt infection generally includes removal of the shunt and placement of a temporary ventricular reservoir until the infection is resolved.[15][16] There are four main methods of treating ventriculoperitoneal (VP) shunt infections: (1) antibiotics; (2) removal of infected shunt with immediate replacement; (3) externalization of shunt with eventual replacement; (4) removal of infected shunt with external ventricular drain (EVD) placement and eventual shunt re-insertion. The last method is best with over 95% success rate.[17]\n\nMedical treatment of shunt infection \nInitial empiric therapy for CSF shunt infection should include broad coverage that includes gram-negative aerobic bacilli including pseudomonas and gram-positive organisms including Staph aureus and coagulase negative staphylococcus, such as a combination of ceftazidime and vancomycin. Some clinicians add either parenteral or intrathecal aminoglycosides to provide enhanced pseudomonas coverage, although the efficacy of this is not clear at this time. Meropenem and aztreonam are additional options that are effective against gram-negative bacterial infections.[18]\n\nSurgical treatment of shunt infection \nTo evaluate the benefit of surgical shunt removal or externalization followed by removal, Wong et al. compared two groups: one with medical treatment alone and another with medical and surgical treatment simultaneously. 28 patients suffering from infection after ventriculoperitoneal shunt implantation over an 8-year period in their neurosurgical center were studied. 17 of these patients were treated with shunt removal or externalization followed by removal in addition to IV antibiotics while the other 11 were treated with IV antibiotics only. The group receiving both surgical shunt removal and antibiotics showed lower mortality \u2013 19% versus 42% (p = 0.231). Despite the fact that these results are not statistically significant, Wong et al. suggest managing VP shunt infections via both surgical and medical treatment.[19]\nAn analysis of 17 studies published over the past 30 years regarding children with CSF shunt infections revealed that treating with both shunt removal and antibiotics successfully treated 88% of 244 infections, while antibiotic therapy alone successfully treated the CSF shunt infection in only 33% of 230 infections.[16][20]\nWhile typical surgical methods of handling VP shunt infections involve removal and reimplantation of the shunt, different types of operations have used with success in select patients. \nSteinbok et al. treated a case of recurrent VP shunt infections in an eczematous patient with a ventriculosubgaleal shunt for two months till the eczema healed completely. This type of shunt allowed them to avoid the area of diseased skin that acted as the source of infection.[17]\nJones et al. have treated 4 patients with non-communicating hydrocephalus that suffered VP shunt infections with shunt removal and third ventriculostomy. These patients were cured of the infection and have not required shunt re-insertion, thus showing the effectiveness of this procedure in these types of patients.[21]\n\n<\/p>\nObstruction \nAnother leading cause of shunt failure is the blockage of the shunt at either the proximal or distal end. At the proximal end the shunt valve can become blocked due to the buildup of excess protein in the CSF. The extra protein will collect at the point of drainage and slowly clog the valve. The shunt can also become blocked at the distal end if the shunt is pulled out of the abdominal cavity (in the case of VP shunts), or from similar protein buildup. Other causes of blockage are overdrainage and slit ventricle syndrome.[10]\n\nOver drainage \nOver drainage occurs when a shunt has not been adequately designed for the particular patient. Overdrainage can lead to a number of different complications some of which are highlighted below.\nUsually one of two types of overdrainage can occur. First when the CSF drains too rapidly, a condition known as extra-axial fluid collection can occur. In this condition the brain collapses on itself resulting in the collection of CSF or blood around the brain. This can cause severe brain damage by compressing the brain. Furthermore, a subdural hematoma may develop. Extra-axial fluid collection can be treated in three different ways depending on the severity of the condition. Usually the shunt will be replaced or reprogrammed to release less CSF and the fluid collected around the brain will be drained. The second condition known as slit ventricle syndrome occurs when CSF slowly overdrains, over several years. More information on slit ventricle syndrome appears below.[10][22]\n\nChiari I malformation \nRecent studies have shown that over drainage of CSF due to shunting can lead to acquired Chiari I Malformation.[23] It was previously thought that Chiari I Malformation was a result of a congenital defect but new studies have shown that overdrainage of Cysto-peritoneal shunts used to treat arachnoid cysts can lead to the development of posterior fossa overcrowding and tonsillar herniation, the latter of which is the classic definition of Chiari Malformation I. Common symptoms include major headaches, hearing loss, fatigue, muscle weakness and loss of cerebellum function.[citation needed ]\n\nSlit ventricle syndrome \nSlit ventricle syndrome is an uncommon disorder associated with shunted patients, but results in a large number of shunt revisions. The condition usually occurs several years after shunt implantation. The most common symptoms are similar to normal shunt malfunction, but there are several key differences. First the symptoms are often cyclical and will appear and then subside several times over a lifetime. Second, the symptoms can be alleviated by lying prone. In the case of shunt malfunction neither time nor postural position will affect the symptoms.[24]\nThe condition is often thought to occur during a period where overdrainage and brain growth occur simultaneously. In this case the brain fills the intraventricular space, leaving the ventricles collapsed. Furthermore, the compliance of the brain will decrease, which prevents the ventricles from enlarging, thus reducing the chance for curing the syndrome. The collapsed ventricles can also block the shunt valve, leading to obstruction. Since the effects of slit ventricle syndrome are irreversible, constant care in managing the condition is needed.[22][23]\n\nIntraventricular hemorrhage \nAn intraventricular hemorrhage can occur at any time during or after a shunt insertion or revision. Intraparenchymal hemorrhages that are multi-focal in nature have also been described in the pediatric population following ventriculoperitoneal shunting.[25] Studies in the pediatric population have described The hemorrhage can cause an impairment in shunt function which can lead to severe neurological deficiencies.[23] Studies have shown that intraventricular hemorrhage can occur in nearly 31% of shunt revisions.[26]\n\nConditions requiring shunting \nBelow is a short list of known complications that can lead to hydrocephalus requiring shunting.\n\n\n\n\nDiagnoses\n\nDescription\n\nIncidence\n\n\nCongenital hydrocephalus\n\nA wide range of genetic abnormalities that could lead to hydrocephalus at birth.\n\n0.04-0.08%[27]\n\n\nTumor\n\nA number of different tumors can lead to CSF blockage if they are located in certain areas. Some of these areas include the lateral or third ventricles, the posterior fossa, and intraspinal tumors. The tumors may be malignant or benign.[28]\n\nUnknown\n\n\nPost-haemorrhagic hydrocephalus\n\nBleeding into the ventricles of the brain, especially in infancy, can lead to blockage of CSF drainage and cause hydrocephalus.\n\n\nSpina bifida\n\nSpecifically spina bifida myelomeningocele can cause the development of hydrocephalus because the cerebellum will block the flow of CSF in a development of Chiari Malformation II.\n\n.125%[29]\n\n\nCongenital aqueductal stenosis\n\nA genetic disorder which can cause deformations of the nervous system. The defect is commonly associated with mental retardation, abducted thumbs and spastic paraplegia.[27]\n\n.003%[27]\n\n\nCraniosynostosis\n\nCraniosynostosis occurs when the sutures of the skull close too early. The result of multiple sutures fusing before the brain stops growing is an increase in ICP leading to hydrocephalus.[30]\n\n0.05%[30]\n\n\nPost-meningitic hydrocephalus\n\nThe inflammation and scarring caused by meningitis can inhibit CSF absorption.\n\n\nDandy-Walker syndrome\n\nPatients usually present with a cystic deformity of the fourth ventricle, hypoplasia of the cerebellar vermis, and an enlarged posterior fossa. The condition is a genetically heritable disease.[31]\n\n0.003%[32]\n\n\nArachnoid cyst\n\nA defect caused when CSF forms a collection that is trapped in the arachnoid membranes. The resulting cyst can then block the normal flow of CSF from the brain resulting in hydrocephalus as well as other defects. The most common locations for an arachnoid cyst are the middle fossa and the posterior fossa. The most common symptoms are nausea and vertigo.[33]\n\n0.05%[34]\n\n\nIdiopathic intracranial hypertension\n\nA rare neurological disorder affecting approximately 1 in 100,000 people, most of whom are women of child bearing age. IIH results in a raised intracranial pressure and can lead to permanent loss of vision.\n\n\n\nRemoving shunts \nThough there have been many cases of patients reaching \"shunt independence\", there is no common accord in which doctors can agree in which a patient might survive without a shunt. Another problem with shunt removal is that it is very difficult to discern when a patient might be shunt independent without very specific conditions. Overall shunt removal is a rare but not unheard of procedure.[35]\n\nSee also \nExternal ventricular drain\nReferences \n\n\n^ Hlatky, Roman; Valadka, Alex B.; Robertson, Claudia S. (2003). \"Intracranial hypertension and cerebral ischemia after severe traumatic brain injury\". Neurosurgical Focus. 14 (4): e2. doi:10.3171\/foc.2003.14.4.2. PMID 15679301. \n\n^ Bradley, William G.; Bahl, Gautam; Alksne, John F. (2006). \"Idiopathic normal pressure hydrocephalus may be a 'Two Hit' disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood\". Journal of Magnetic Resonance Imaging. 24 (4): 747\u201355. doi:10.1002\/jmri.20684. PMID 16958056. \n\n^ a b Jain, Harsh; Natarajan, Kal; Sgouros, Spyros (2005). \"Influence of the shunt type in the difference in reduction of volume between the two lateral ventricles in shunted hydrocephalic children\". Child's Nervous System. 21 (7): 552\u20138. doi:10.1007\/s00381-004-1096-y. PMID 15682319. \n\n^ (2008). http:\/\/www.medtronic.com\/neurosurgery\/valves.html, Retrieved November 30, 2009 \n\n^ Boockvar, John A.; Loudon, William; Sutton, Leslie N. (2001). \"Development of the Spitz\u2014Holter valve in Philadelphia\". Journal of Neurosurgery. 95 (1): 145\u20137. doi:10.3171\/jns.2001.95.1.0145. PMID 11453388. \n\n^ http:\/\/www.uh.edu\/engines\/epi2582.htm[full citation needed ] \n\n^ http:\/\/www.medterms.com\/script\/main\/art.asp?articlekey=26245[full citation needed ] \n\n^ Anti-Siphon Device; Integra Neurosciences; Label 2002[full citation needed ] \n\n^ http:\/\/www.integra-ls.com\/products\/?product=47, Retrieved November 30, 2009[full citation needed ] \n\n^ a b c d e Interview with Dr. Gary R. Gropper; Piedmont Neurosurgery; October 15, 2009[verification needed ] \n\n^ Rizvi, Syed Ali A.; Wood, Martin (2010). \"Ventriculosubgaleal Shunting for Post-Haemorrhagic Hydrocephalus in Premature Neonates\". Pediatric Neurosurgery. 46 (5): 335\u20139. doi:10.1159\/000320135. PMID 21346395. \n\n^ Drake, J. M.; Kestle, J. R. W.; Tuli, S. (2000). \"CSF shunts 50 years on - past, present and future\". Child's Nervous System. 16 (10\u201311): 800\u20134. doi:10.1007\/s003810000351. PMID 11151733. \n\n^ Enger, P. \u00d8.; Svendsen, F.; Wester, K. (2003). \"CSF shunt infections in children: experiences from a population-based study\". Acta Neurochirurgica. 145 (4): 243\u20138, discussion 248. doi:10.1007\/s00701-002-1068-5. PMID 12748883. \n\n^ Brook, Itzhak (2002). \"Meningitis and shunt infection caused by anaerobic bacteria in children\". Pediatric Neurology. 26 (2): 99\u2013105. doi:10.1016\/S0887-8994(01)00330-7. PMID 11897473. \n\n^ Shah, Samir S.; Smith, Michael J.; Zaoutis, Theoklis E. (2005). \"Device-related Infections in Children\". Pediatric Clinics of North America. 52 (4): 1189\u2013208, x. doi:10.1016\/j.pcl.2005.05.003. PMID 16009263. \n\n^ a b James, H E; Walsh, J W; Wilson, H D; Connor, J D; Bean, J R; Tibbs, P A (1980). \"Prospective randomized study of therapy in cerebrospinal fluid shunt infection\". Neurosurgery. 7 (5): 459\u201363. doi:10.1097\/00006123-198011000-00006. PMID 7003434. \n\n^ a b Steinbok, Paul; Cochrane, D. Douglas (1994). \"Ventriculosubgaleal shunt in the management of recurrent ventriculoperitoneal shunt infection\". Child's Nervous System. 10 (8): 536\u20139. doi:10.1007\/BF00335079. PMID 7882378. \n\n^ Morris, Andrew; Low, Donald E. (1999). \"Nosocomial bacterial meningitis, including central nervous system shunt infections\". Infectious Disease Clinics of North America. 13 (3): 735\u201350. doi:10.1016\/s0891-5520(05)70103-3. PMID 10470564. \n\n^ Wong, George Kwok Chu; Wong, Sin Man; Poon, Wai Sang (2011). \"Ventriculoperitoneal shunt infection: intravenous antibiotics, shunt removal and more aggressive treatment?\". ANZ Journal of Surgery. 81 (4): 307. doi:10.1111\/j.1445-2197.2011.05690.x. PMID 21418491. \n\n^ Schreffler, Rachel T.; Schreffler, Andrew J.; Wittler, Robert R. (2002). \"Treatment of cerebrospinal fluid shunt infections: a decision analysis\". The Pediatric Infectious Disease Journal. 21 (7): 632\u20136. doi:10.1097\/00006454-200207000-00006. PMID 12237594. \n\n^ Jones, R. F.C.; Stening, W. A.; Kwok, B. C.T.; Sands, T. M. (1993). \"Third Ventriculostomy for Shunt Infections in Children\". Neurosurgery. 32 (5): 855\u20139, discussion 860. doi:10.1227\/00006123-199305000-00024. PMID 8492866. \n\n^ a b Browd, Samuel R.; Gottfried, Oren N.; Ragel, Brian T.; Kestle, John R.W. (2006). \"Failure of Cerebrospinal Fluid Shunts: Part II: Overdrainage, Loculation, and Abdominal Complications\". Pediatric Neurology. 34 (3): 171\u20136. doi:10.1016\/j.pediatrneurol.2005.05.021. PMID 16504785. \n\n^ a b c Mart\u00ednez-Lage, Juan F.; Ru\u00edz-Espejo, Antonio M.; Almagro, Mar\u00eda-Jos\u00e9; Alfaro, Ra\u00fal; Felipe-Murcia, Mat\u00edas; L\u00f3pez L\u00f3pez-Guerrero, A. (2009). \"CSF overdrainage in shunted intracranial arachnoid cysts: a series and review\". Child's Nervous System. 25 (9): 1061\u20139. doi:10.1007\/s00381-009-0910-y. PMID 19452154. \n\n^ Gkolemis, C; Zogopoulos, P; Kokkalis, P; Stamatopoulos, G; Syrmos, N; and Paleologos, T.S. (2014) \"Management of multiple, late onset complications in a 33-year-old female, with a ventriculoperitoneal shunt and crohn's disease,\" Pakistan Journal of Neurological Sciences (PJNS): Vol. 9: Iss. 3, Article 10. \n\n^ Oushy, Soliman; Parker, Jonathon J.; Campbell, Kristen; Palmer, Claire; Wilkinson, Corbett; Stence, Nicholas V.; Handler, Michael H.; Mirsky, David M. (November 2017). \"Frontal and occipital horn ratio is associated with multifocal intraparenchymal hemorrhages in neonatal shunted hydrocephalus\". Journal of Neurosurgery. Pediatrics. 20 (5): 432\u2013438. doi:10.3171\/2017.6.PEDS16481. ISSN 1933-0715. PMID 28885094. \n\n^ Brownlee, Richard D.; Dold, Oliver N.R.; Myles, Terence (1995). \"Intraventricular Hemorrhage Complicating Ventricular Catheter Revision: Incidence and Effect on Shunt Survival\". Pediatric Neurosurgery. 22 (6): 315\u201320. doi:10.1159\/000120922. PMID 7577666. \n\n^ a b c Schrander-Stumpel, C.; Fryns, J. -P. (1998). \"Congenital hydrocephalus: Nosology and guidelines for clinical approach and genetic counselling\". European Journal of Pediatrics. 157 (5): 355\u201362. doi:10.1007\/s004310050830. PMID 9625330. \n\n^ Zuccaro, Graciela; Sosa, Fidel; Cuccia, Vicente; Lubieniecky, Fabiana; Monges, Jorge (1999). \"Lateral ventricle tumors in children: a series of 54 cases\". Child's Nervous System. 15 (11\u201312): 774\u201385. doi:10.1007\/s003810050470. PMID 10603022. \n\n^ MedlinePlus Encyclopedia Myelomeningocele \n\n^ a b http:\/\/www.chw.org\/display\/PPF\/DocID\/21810\/router.asp[full citation needed ] \n\n^ Tal, Y.; Freigang, B.; Dunn, H. G.; Durity, F. A.; Moyes, P. D. (1980). \"Dandy-Walker Syndrome: Analysis of 21 Cases\". Developmental Medicine & Child Neurology. 22 (2): 189\u2013201. doi:10.1111\/j.1469-8749.1980.tb04327.x. PMID 7380119. \n\n^ Imaging in Dandy-Walker Malformation at eMedicine \n\n^ Samii, Madjid; Carvalho, Gustavo A; Schuhmann, Martin U; Matthies, Cordula (1999). \"Arachnoid cysts of the posterior fossa\". Surgical Neurology. 51 (4): 376\u201382. doi:10.1016\/S0090-3019(98)00095-0. PMID 10199290. \n\n^ http:\/\/www.wrongdiagnosis.com\/a\/arachnoid_cysts\/prevalence.htm[full citation needed ] \n\n^ Iannelli, A.; Rea, G.; Di Rocco, C. (2005). \"CSF shunt removal in children with hydrocephalus\". Acta Neurochirurgica. 147 (5): 503\u20137, discussion 507. doi:10.1007\/s00701-005-0494-6. PMID 15838593. \n\n\n\n\n\nWikimedia Commons has media related to Cerebral shunt.\nExternal links \nInteractive explainer: shunt and hydrocephalus treatments | Stanford Children's Health\nvteNeurosurgical and other procedures (ICD-9-CM V3 01\u201305+89.1, ICD-10-PCS 00\u201301)Skull\nCraniotomy\nDecompressive craniectomy\nCranioplasty\nCNSBrainthalamus and globus pallidus: \nThalamotomy\nThalamic stimulator\nPallidotomy\nventricular system: \nVentriculostomy\nSuboccipital puncture\nIntracranial pressure monitoring\ncerebrum: \nPsychosurgery\nLobotomy\nBilateral cingulotomy\nHemispherectomy\nAnterior temporal lobectomy\npituitary gland: \nHypophysectomy\nhippocampus: \nAmygdalohippocampectomy\n\nBrain biopsy\nCerebral meninges\nMeningeal biopsy\nSpinal cord and spinal canal\nSpinal cord and roots\nCordotomy\nRhizotomy\nVertebrae and intervertebral discs: see Template:Bone, cartilage, and joint procedures\nMedical imaging\nComputed tomography of the head\nCerebral angiography\nPneumoencephalography\nEchoencephalography\/Transcranial Doppler\nMagnetic resonance imaging of the brain\nBrain PET\nMyelography\nDiagnostic\nElectroencephalography\nLumbar puncture\nPolysomnography\nCPRs\nGlasgow Coma Scale\nMini\u2013mental state examination\nNational Institutes of Health Stroke Scale\nCHADS2 score\nPNSCranial and peripheral nerves\nNerve block\nVagotomy\nSympathetic nerves or ganglia\nGanglionectomy\nSympathectomy\nEndoscopic thoracic sympathectomy\nNerves (general)\nAxotomy\nNeurectomy\nNerve biopsy\nDiagnostic\nNerve conduction study\nElectromyography\nMedical imaging\nMagnetic resonance neurography\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cerebral_shunt\">https:\/\/www.limswiki.org\/index.php\/Cerebral_shunt<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:31.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,020 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d3ae356ae2cf35486b5f95caa1bf80f0_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Cerebral_shunt skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Cerebral shunt<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Cerebral shunts<\/b> are commonly used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocephalus\" title=\"Hydrocephalus\" rel=\"external_link\" target=\"_blank\">hydrocephalus<\/a>, the swelling of the brain due to excess buildup of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">cerebrospinal fluid (CSF)<\/a>. If left unchecked, the cerebrospinal fluid can build up leading to an increase in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure\" title=\"Intracranial pressure\" rel=\"external_link\" target=\"_blank\">intracranial pressure (ICP)<\/a> which can lead to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intracranial_hematoma\" class=\"mw-redirect\" title=\"Intracranial hematoma\" rel=\"external_link\" target=\"_blank\">intracranial hematoma<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_edema\" title=\"Cerebral edema\" rel=\"external_link\" target=\"_blank\">cerebral edema<\/a>, crushed brain tissue or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herniation\" class=\"mw-redirect\" title=\"Herniation\" rel=\"external_link\" target=\"_blank\">herniation<\/a>.<sup id=\"rdp-ebb-cite_ref-Braindamage_1-0\" class=\"reference\"><a href=\"#cite_note-Braindamage-1\" rel=\"external_link\">[1]<\/a><\/sup> The cerebral shunt can be used to alleviate or prevent these problems in patients who suffer from hydrocephalus or other related diseases. \nShunts can come in a variety of forms but most of them consist of a valve housing connected to a catheter, the end of which is usually placed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_cavity\" title=\"Peritoneal cavity\" rel=\"external_link\" target=\"_blank\">peritoneal cavity<\/a>. The main differences between shunts are usually in the materials used to construct them, the types of valve (if any) used, and whether the valve is programmable or not.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_valves\">Types of valves<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ShuntCT.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/ShuntCT.png\/220px-ShuntCT.png\" width=\"220\" height=\"291\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ShuntCT.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A ventriculoperitoneal shunt running from a brain ventricle to the abdominal cavity. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a> of the head, 2016.<\/div><\/div><\/div>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Valve type\n<\/th>\n<th>Description\n<\/th><\/tr>\n<tr>\n<td>Delta\n<\/td>\n<td>Designed to prevent overdrainage. Remains closed until ICP reaches a predetermined level. Leaves shunted ventricle larger than the non-shunted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_system\" title=\"Ventricular system\" rel=\"external_link\" target=\"_blank\">ventricles<\/a>.<sup id=\"rdp-ebb-cite_ref-valves_3-0\" class=\"reference\"><a href=\"#cite_note-valves-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Medtronic_4-0\" class=\"reference\"><a href=\"#cite_note-Medtronic-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Medium pressure cylindrical\n<\/td>\n<td>Can lead to uneven drainage of ventricles.<sup id=\"rdp-ebb-cite_ref-valves_3-1\" class=\"reference\"><a href=\"#cite_note-valves-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Nulsen and Spitz\n<\/td>\n<td>Contains two ball-valve units connected with a spring. Does not have an adjustable pressure setting. First mass-produced valve used to treat hydrocephalus in 1956.<sup id=\"rdp-ebb-cite_ref-spitz_5-0\" class=\"reference\"><a href=\"#cite_note-spitz-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Spitz-Holter\n<\/td>\n<td>Uses slits in silicone to avoid mechanical failure.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Anti-siphon\n<\/td>\n<td>Prevents over drainage by preventing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Siphon\" title=\"Siphon\" rel=\"external_link\" target=\"_blank\">siphon effect<\/a>. The device closes when the pressure within the valve becomes negative relative to the ambient pressure. Prevents overdrainage that might occur when a patient sits, stands or rapidly changes posture.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Sigma\n<\/td>\n<td>The Sigma valve operates on a flow-control mechanism as opposed to the pressure-control system of other valves. The device can regulate CSF flow changes without being programmed or surgically changed. The first iteration was introduced in 1987. Valve operated in three stages to prevent over and under drainage.<sup id=\"rdp-ebb-cite_ref-integra_9-0\" class=\"reference\"><a href=\"#cite_note-integra-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Shunt_location\">Shunt location<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Radiograph_of_a_ventriculoperitoneal_shunt.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/53\/Radiograph_of_a_ventriculoperitoneal_shunt.jpg\/220px-Radiograph_of_a_ventriculoperitoneal_shunt.jpg\" width=\"220\" height=\"369\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Radiograph_of_a_ventriculoperitoneal_shunt.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> of a ventriculoperitoneal shunt.<\/div><\/div><\/div>\n<p>The location of the shunt is determined by the neurosurgeon based on the type and location of the blockage causing hydrocephalus. All brain ventricles are candidates for shunting. The catheter is most commonly placed in the abdomen but other locations include the heart and lungs.<sup id=\"rdp-ebb-cite_ref-gropper_10-0\" class=\"reference\"><a href=\"#cite_note-gropper-10\" rel=\"external_link\">[10]<\/a><\/sup> Shunts can often be named after the route used by the neurosurgeon. The distal end of the catheter can be located in just about any tissue with enough epithelial cells to absorb the incoming CSF. Below are some common routing plans for cerebral shunts.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Shunt_routing\">Shunt routing<\/span><\/h3>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Route\n<\/th>\n<th>Location of Fluid Drain\n<\/th><\/tr>\n<tr>\n<td>Ventriculo-peritoneal shunt (VP shunt)\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_cavity\" title=\"Peritoneal cavity\" rel=\"external_link\" target=\"_blank\">Peritoneal cavity<\/a>\n<\/td><\/tr>\n<tr>\n<td>Ventriculo-atrial shunt (VA shunt)\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_atrium\" class=\"mw-redirect\" title=\"Right atrium\" rel=\"external_link\" target=\"_blank\">Right atrium<\/a> of the heart\n<\/td><\/tr>\n<tr>\n<td>Ventriculo-pleural shunt (VPL shunt)\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pleural_cavity\" title=\"Pleural cavity\" rel=\"external_link\" target=\"_blank\">Pleural cavity<\/a>\n<\/td><\/tr>\n<tr>\n<td>Ventriculo-cisternal shunt (VC shunt)\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cisterna_magna\" title=\"Cisterna magna\" rel=\"external_link\" target=\"_blank\">Cisterna magna<\/a>\n<\/td><\/tr>\n<tr>\n<td>Ventriculo-subgaleal shunt (SG shunt)\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>Lumbar-peritoneal shunt (LP shunt)\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_cavity\" title=\"Peritoneal cavity\" rel=\"external_link\" target=\"_blank\">Peritoneal cavity<\/a>\n<\/td><\/tr><\/tbody><\/table>\n<p>A subgaleal shunt is usually a temporary measure used in infants who are too small or premature to tolerate other shunt types. The surgeon forms a pocket beneath the epicranial aponeurosis (the subgaleal space) and allows CSF to drain from the ventricles, creating a fluid-filled swelling on the baby's scalp. These shunts are normally converted to VP or other shunt types once the infant is big enough.<sup id=\"rdp-ebb-cite_ref-rizvi_and_wood_11-0\" class=\"reference\"><a href=\"#cite_note-rizvi_and_wood-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-Surgical_wound_healing_for_a_ventriculo-peritoneal_shunt_.28VP_shunt.29\"><\/span><span class=\"mw-headline\" id=\"Surgical_wound_healing_for_a_ventriculo-peritoneal_shunt_(VP_shunt)\">Surgical wound healing for a ventriculo-peritoneal shunt (VP shunt)<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_6_-_2018.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_6_-_2018.jpg\/90px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_6_-_2018.jpg\" width=\"90\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Head wound at day 6\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_12.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_12.jpg\/120px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_12.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Belly wound at day 12\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_15_-_stitches_removed_-_2018.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/88\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_15_-_stitches_removed_-_2018.jpg\/67px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_15_-_stitches_removed_-_2018.jpg\" width=\"67\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Head wound at day 15, stitches removed\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_15_-_stitches_removed.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_15_-_stitches_removed.jpg\/120px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_15_-_stitches_removed.jpg\" width=\"120\" height=\"67\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Belly wound at day 15, stitches removed\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<p>There are a number of complications associated with shunt placement. Many of these complications occur during childhood and cease once the patient has reached adulthood. Many of the complications seen in patients require immediate shunt revision (the replacement or reprogramming of the already existing shunt). The common symptoms often resemble the new onset of hydrocephalus such as headaches, nausea, vomiting, double-vision, and an alteration of consciousness.<sup id=\"rdp-ebb-cite_ref-gropper_10-1\" class=\"reference\"><a href=\"#cite_note-gropper-10\" rel=\"external_link\">[10]<\/a><\/sup> Furthermore, in the pediatric population, the shunt failure rate 2 years after implantation has been estimated to be as high as 50%.<sup id=\"rdp-ebb-cite_ref-drake_12-0\" class=\"reference\"><a href=\"#cite_note-drake-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Infection\">Infection<\/span><\/h3>\n<p>Infection is a common complication that normally affects pediatric patients because they have not yet built up immunities to a number of different diseases. Normally, the incidence of infection decreases as the patient grows older and the body gains immunity to various infectious agents.<sup id=\"rdp-ebb-cite_ref-gropper_10-2\" class=\"reference\"><a href=\"#cite_note-gropper-10\" rel=\"external_link\">[10]<\/a><\/sup> \nShunt infection is a common problem and can occur in up to 27% of patients with a shunt. Infection can lead to long term cognitive defects, neurological problems, and in some cases death. Common microbial agents for shunt infection include <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_epidermidis\" title=\"Staphylococcus epidermidis\" rel=\"external_link\" target=\"_blank\">Staphylococcus epidermidis<\/a><\/i>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_aureus\" title=\"Staphylococcus aureus\" rel=\"external_link\" target=\"_blank\">Staphylococcus aureus<\/a><\/i>, and <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Candida_albicans\" title=\"Candida albicans\" rel=\"external_link\" target=\"_blank\">Candida albicans<\/a><\/i>. Further factors leading to shunt infection include shunt insertion at a young age (<6 months old) and the type of hydrocephalus being treated. There is no strong correlation between infection and shunt type.<sup id=\"rdp-ebb-cite_ref-enger_13-0\" class=\"reference\"><a href=\"#cite_note-enger-13\" rel=\"external_link\">[13]<\/a><\/sup>\nThe symptoms of a shunt infection are very similar to the symptoms seen in hydrocephalus but can also include fever and elevated white blood cell counts.<sup id=\"rdp-ebb-cite_ref-meningitis_14-0\" class=\"reference\"><a href=\"#cite_note-meningitis-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Treatment_of_shunt_infections\">Treatment of shunt infections<\/span><\/h4>\n<p>Treatment of a CSF shunt infection generally includes removal of the shunt and placement of a temporary ventricular reservoir until the infection is resolved.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Device_16-0\" class=\"reference\"><a href=\"#cite_note-Device-16\" rel=\"external_link\">[16]<\/a><\/sup> There are four main methods of treating ventriculoperitoneal (VP) shunt infections: (1) antibiotics; (2) removal of infected shunt with immediate replacement; (3) externalization of shunt with eventual replacement; (4) removal of infected shunt with external ventricular drain (EVD) placement and eventual shunt re-insertion. The last method is best with over 95% success rate.<sup id=\"rdp-ebb-cite_ref-V-subgaleal_17-0\" class=\"reference\"><a href=\"#cite_note-V-subgaleal-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Medical_treatment_of_shunt_infection\">Medical treatment of shunt infection<\/span><\/h4>\n<p>Initial empiric therapy for CSF shunt infection should include broad coverage that includes gram-negative aerobic bacilli including pseudomonas and gram-positive organisms including Staph aureus and coagulase negative staphylococcus, such as a combination of ceftazidime and vancomycin. Some clinicians add either parenteral or intrathecal aminoglycosides to provide enhanced pseudomonas coverage, although the efficacy of this is not clear at this time. Meropenem and aztreonam are additional options that are effective against gram-negative bacterial infections.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Surgical_treatment_of_shunt_infection\">Surgical treatment of shunt infection<\/span><\/h4>\n<p>To evaluate the benefit of surgical shunt removal or externalization followed by removal, Wong et al. compared two groups: one with medical treatment alone and another with medical and surgical treatment simultaneously. 28 patients suffering from infection after ventriculoperitoneal shunt implantation over an 8-year period in their neurosurgical center were studied. 17 of these patients were treated with shunt removal or externalization followed by removal in addition to IV antibiotics while the other 11 were treated with IV antibiotics only. The group receiving both surgical shunt removal and antibiotics showed lower mortality \u2013 19% versus 42% (p = 0.231). Despite the fact that these results are not statistically significant, Wong et al. suggest managing VP shunt infections via both surgical and medical treatment.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>An analysis of 17 studies published over the past 30 years regarding children with CSF shunt infections revealed that treating with both shunt removal and antibiotics successfully treated 88% of 244 infections, while antibiotic therapy alone successfully treated the CSF shunt infection in only 33% of 230 infections.<sup id=\"rdp-ebb-cite_ref-Device_16-1\" class=\"reference\"><a href=\"#cite_note-Device-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>While typical surgical methods of handling VP shunt infections involve removal and reimplantation of the shunt, different types of operations have used with success in select patients. \n<p>Steinbok et al. treated a case of recurrent VP shunt infections in an eczematous patient with a ventriculosubgaleal shunt for two months till the eczema healed completely. This type of shunt allowed them to avoid the area of diseased skin that acted as the source of infection.<sup id=\"rdp-ebb-cite_ref-V-subgaleal_17-1\" class=\"reference\"><a href=\"#cite_note-V-subgaleal-17\" rel=\"external_link\">[17]<\/a><\/sup>\nJones et al. have treated 4 patients with non-communicating hydrocephalus that suffered VP shunt infections with shunt removal and third ventriculostomy. These patients were cured of the infection and have not required shunt re-insertion, thus showing the effectiveness of this procedure in these types of patients.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Obstruction\">Obstruction<\/span><\/h3>\n<p>Another leading cause of shunt failure is the blockage of the shunt at either the proximal or distal end. At the proximal end the shunt valve can become blocked due to the buildup of excess protein in the CSF. The extra protein will collect at the point of drainage and slowly clog the valve. The shunt can also become blocked at the distal end if the shunt is pulled out of the abdominal cavity (in the case of VP shunts), or from similar protein buildup. Other causes of blockage are overdrainage and slit ventricle syndrome.<sup id=\"rdp-ebb-cite_ref-gropper_10-3\" class=\"reference\"><a href=\"#cite_note-gropper-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Over_drainage\">Over drainage<\/span><\/h3>\n<p>Over drainage occurs when a shunt has not been adequately designed for the particular patient. Overdrainage can lead to a number of different complications some of which are highlighted below.\n<\/p><p>Usually one of two types of overdrainage can occur. First when the CSF drains too rapidly, a condition known as extra-axial fluid collection can occur. In this condition the brain collapses on itself resulting in the collection of CSF or blood around the brain. This can cause severe brain damage by compressing the brain. Furthermore, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subdural_hematoma\" title=\"Subdural hematoma\" rel=\"external_link\" target=\"_blank\">subdural hematoma<\/a> may develop. Extra-axial fluid collection can be treated in three different ways depending on the severity of the condition. Usually the shunt will be replaced or reprogrammed to release less CSF and the fluid collected around the brain will be drained. The second condition known as slit ventricle syndrome occurs when CSF slowly overdrains, over several years. More information on slit ventricle syndrome appears below.<sup id=\"rdp-ebb-cite_ref-gropper_10-4\" class=\"reference\"><a href=\"#cite_note-gropper-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-failure_22-0\" class=\"reference\"><a href=\"#cite_note-failure-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Chiari_I_malformation\">Chiari I malformation<\/span><\/h4>\n<p>Recent studies have shown that over drainage of CSF due to shunting can lead to acquired <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arnold-Chiari_malformation\" class=\"mw-redirect\" title=\"Arnold-Chiari malformation\" rel=\"external_link\" target=\"_blank\">Chiari I Malformation<\/a>.<sup id=\"rdp-ebb-cite_ref-Lage_23-0\" class=\"reference\"><a href=\"#cite_note-Lage-23\" rel=\"external_link\">[23]<\/a><\/sup> It was previously thought that Chiari I Malformation was a result of a congenital defect but new studies have shown that overdrainage of Cysto-peritoneal shunts used to treat arachnoid cysts can lead to the development of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_cranial_fossa\" title=\"Posterior cranial fossa\" rel=\"external_link\" target=\"_blank\">posterior fossa<\/a> overcrowding and tonsillar <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herniation\" class=\"mw-redirect\" title=\"Herniation\" rel=\"external_link\" target=\"_blank\">herniation<\/a>, the latter of which is the classic definition of Chiari Malformation I. Common symptoms include major headaches, hearing loss, fatigue, muscle weakness and loss of cerebellum function.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Slit_ventricle_syndrome\">Slit ventricle syndrome<\/span><\/h4>\n<p> is an uncommon disorder associated with shunted patients, but results in a large number of shunt revisions. The condition usually occurs several years after shunt implantation. The most common symptoms are similar to normal shunt malfunction, but there are several key differences. First the symptoms are often cyclical and will appear and then subside several times over a lifetime. Second, the symptoms can be alleviated by lying prone. In the case of shunt malfunction neither time nor postural position will affect the symptoms.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>The condition is often thought to occur during a period where overdrainage and brain growth occur simultaneously. In this case the brain fills the intraventricular space, leaving the ventricles collapsed. Furthermore, the compliance of the brain will decrease, which prevents the ventricles from enlarging, thus reducing the chance for curing the syndrome. The collapsed ventricles can also block the shunt valve, leading to obstruction. Since the effects of slit ventricle syndrome are irreversible, constant care in managing the condition is needed.<sup id=\"rdp-ebb-cite_ref-failure_22-1\" class=\"reference\"><a href=\"#cite_note-failure-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Lage_23-1\" class=\"reference\"><a href=\"#cite_note-Lage-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Intraventricular_hemorrhage\">Intraventricular hemorrhage<\/span><\/h3>\n<p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraventricular_hemorrhage\" title=\"Intraventricular hemorrhage\" rel=\"external_link\" target=\"_blank\">intraventricular hemorrhage<\/a> can occur at any time during or after a shunt insertion or revision. Intraparenchymal hemorrhages that are multi-focal in nature have also been described in the pediatric population following ventriculoperitoneal shunting.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Studies in the pediatric population have described The hemorrhage can cause an impairment in shunt function which can lead to severe neurological deficiencies.<sup id=\"rdp-ebb-cite_ref-Lage_23-2\" class=\"reference\"><a href=\"#cite_note-Lage-23\" rel=\"external_link\">[23]<\/a><\/sup> Studies have shown that intraventricular hemorrhage can occur in nearly 31% of shunt revisions.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Conditions_requiring_shunting\">Conditions requiring shunting<\/span><\/h2>\n<p>Below is a short list of known complications that can lead to hydrocephalus requiring shunting.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Diagnoses\n<\/th>\n<th>Description\n<\/th>\n<th>Incidence\n<\/th><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocephalus\" title=\"Hydrocephalus\" rel=\"external_link\" target=\"_blank\">Congenital hydrocephalus<\/a>\n<\/td>\n<td>A wide range of genetic abnormalities that could lead to hydrocephalus at birth.\n<\/td>\n<td>0.04-0.08%<sup id=\"rdp-ebb-cite_ref-nosology_27-0\" class=\"reference\"><a href=\"#cite_note-nosology-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Tumor\n<\/td>\n<td>A number of different tumors can lead to CSF blockage if they are located in certain areas. Some of these areas include the lateral or third ventricles, the posterior fossa, and intraspinal tumors. The tumors may be malignant or benign.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/td>\n<td>Unknown\n<\/td><\/tr>\n<tr>\n<td>Post-haemorrhagic hydrocephalus\n<\/td>\n<td>Bleeding into the ventricles of the brain, especially in infancy, can lead to blockage of CSF drainage and cause hydrocephalus.\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Spina_bifida\" title=\"Spina bifida\" rel=\"external_link\" target=\"_blank\">Spina bifida<\/a>\n<\/td>\n<td>Specifically spina bifida myelomeningocele can cause the development of hydrocephalus because the cerebellum will block the flow of CSF in a development of Chiari Malformation II.\n<\/td>\n<td>.125%<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Congenital aqueductal stenosis\n<\/td>\n<td>A genetic disorder which can cause deformations of the nervous system. The defect is commonly associated with mental retardation, abducted thumbs and spastic paraplegia.<sup id=\"rdp-ebb-cite_ref-nosology_27-1\" class=\"reference\"><a href=\"#cite_note-nosology-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/td>\n<td>.003%<sup id=\"rdp-ebb-cite_ref-nosology_27-2\" class=\"reference\"><a href=\"#cite_note-nosology-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniosynostosis\" title=\"Craniosynostosis\" rel=\"external_link\" target=\"_blank\">Craniosynostosis<\/a>\n<\/td>\n<td>Craniosynostosis occurs when the sutures of the skull close too early. The result of multiple sutures fusing before the brain stops growing is an increase in ICP leading to hydrocephalus.<sup id=\"rdp-ebb-cite_ref-suture_30-0\" class=\"reference\"><a href=\"#cite_note-suture-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/td>\n<td>0.05%<sup id=\"rdp-ebb-cite_ref-suture_30-1\" class=\"reference\"><a href=\"#cite_note-suture-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Post-meningitic hydrocephalus\n<\/td>\n<td>The inflammation and scarring caused by meningitis can inhibit CSF absorption.\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dandy-Walker_syndrome\" class=\"mw-redirect\" title=\"Dandy-Walker syndrome\" rel=\"external_link\" target=\"_blank\">Dandy-Walker syndrome<\/a>\n<\/td>\n<td>Patients usually present with a cystic deformity of the fourth ventricle, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoplasia\" title=\"Hypoplasia\" rel=\"external_link\" target=\"_blank\">hypoplasia<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebellar_vermis\" title=\"Cerebellar vermis\" rel=\"external_link\" target=\"_blank\">cerebellar vermis<\/a>, and an enlarged posterior fossa. The condition is a genetically heritable disease.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/td>\n<td>0.003%<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arachnoid_cyst\" title=\"Arachnoid cyst\" rel=\"external_link\" target=\"_blank\">Arachnoid cyst<\/a>\n<\/td>\n<td>A defect caused when CSF forms a collection that is trapped in the arachnoid membranes. The resulting cyst can then block the normal flow of CSF from the brain resulting in hydrocephalus as well as other defects. The most common locations for an arachnoid cyst are the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_cranial_fossa\" title=\"Middle cranial fossa\" rel=\"external_link\" target=\"_blank\">middle fossa<\/a> and the posterior fossa. The most common symptoms are nausea and vertigo.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/td>\n<td>0.05%<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure\" title=\"Intracranial pressure\" rel=\"external_link\" target=\"_blank\">Idiopathic intracranial hypertension<\/a>\n<\/td>\n<td>A rare neurological disorder affecting approximately 1 in 100,000 people, most of whom are women of child bearing age. IIH results in a raised intracranial pressure and can lead to permanent loss of vision.\n<\/td>\n<td>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Removing_shunts\">Removing shunts<\/span><\/h2>\n<p>Though there have been many cases of patients reaching \"shunt independence\", there is no common accord in which doctors can agree in which a patient might survive without a shunt. Another problem with shunt removal is that it is very difficult to discern when a patient might be shunt independent without very specific conditions. Overall shunt removal is a rare but not unheard of procedure.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain\" title=\"External ventricular drain\" rel=\"external_link\" target=\"_blank\">External ventricular drain<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Braindamage-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Braindamage_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hlatky, Roman; Valadka, Alex B.; Robertson, Claudia S. (2003). \"Intracranial hypertension and cerebral ischemia after severe traumatic brain injury\". <i>Neurosurgical Focus<\/i>. <b>14<\/b> (4): e2. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3171%2Ffoc.2003.14.4.2\" target=\"_blank\">10.3171\/foc.2003.14.4.2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15679301\" target=\"_blank\">15679301<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgical+Focus&rft.atitle=Intracranial+hypertension+and+cerebral+ischemia+after+severe+traumatic+brain+injury&rft.volume=14&rft.issue=4&rft.pages=e2&rft.date=2003&rft_id=info%3Adoi%2F10.3171%2Ffoc.2003.14.4.2&rft_id=info%3Apmid%2F15679301&rft.aulast=Hlatky&rft.aufirst=Roman&rft.au=Valadka%2C+Alex+B.&rft.au=Robertson%2C+Claudia+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bradley, William G.; Bahl, Gautam; Alksne, John F. (2006). \"Idiopathic normal pressure hydrocephalus may be a 'Two Hit' disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood\". <i>Journal of Magnetic Resonance Imaging<\/i>. <b>24<\/b> (4): 747\u201355. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjmri.20684\" target=\"_blank\">10.1002\/jmri.20684<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16958056\" target=\"_blank\">16958056<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Magnetic+Resonance+Imaging&rft.atitle=Idiopathic+normal+pressure+hydrocephalus+may+be+a+%27Two+Hit%27+disease%3A+Benign+external+hydrocephalus+in+infancy+followed+by+deep+white+matter+ischemia+in+late+adulthood&rft.volume=24&rft.issue=4&rft.pages=747-55&rft.date=2006&rft_id=info%3Adoi%2F10.1002%2Fjmri.20684&rft_id=info%3Apmid%2F16958056&rft.aulast=Bradley&rft.aufirst=William+G.&rft.au=Bahl%2C+Gautam&rft.au=Alksne%2C+John+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-valves-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-valves_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-valves_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jain, Harsh; Natarajan, Kal; Sgouros, Spyros (2005). \"Influence of the shunt type in the difference in reduction of volume between the two lateral ventricles in shunted hydrocephalic children\". <i>Child's Nervous System<\/i>. <b>21<\/b> (7): 552\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00381-004-1096-y\" target=\"_blank\">10.1007\/s00381-004-1096-y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15682319\" target=\"_blank\">15682319<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Child%27s+Nervous+System&rft.atitle=Influence+of+the+shunt+type+in+the+difference+in+reduction+of+volume+between+the+two+lateral+ventricles+in+shunted+hydrocephalic+children&rft.volume=21&rft.issue=7&rft.pages=552-8&rft.date=2005&rft_id=info%3Adoi%2F10.1007%2Fs00381-004-1096-y&rft_id=info%3Apmid%2F15682319&rft.aulast=Jain&rft.aufirst=Harsh&rft.au=Natarajan%2C+Kal&rft.au=Sgouros%2C+Spyros&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Medtronic-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Medtronic_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">(2008). <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.medtronic.com\/neurosurgery\/valves.html\" target=\"_blank\">http:\/\/www.medtronic.com\/neurosurgery\/valves.html<\/a>, Retrieved November 30, 2009<\/span>\n<\/li>\n<li id=\"cite_note-spitz-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-spitz_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Boockvar, John A.; Loudon, William; Sutton, Leslie N. (2001). \"Development of the Spitz\u2014Holter valve in Philadelphia\". <i>Journal of Neurosurgery<\/i>. <b>95<\/b> (1): 145\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3171%2Fjns.2001.95.1.0145\" target=\"_blank\">10.3171\/jns.2001.95.1.0145<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11453388\" target=\"_blank\">11453388<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurosurgery&rft.atitle=Development+of+the+Spitz%E2%80%94Holter+valve+in+Philadelphia&rft.volume=95&rft.issue=1&rft.pages=145-7&rft.date=2001&rft_id=info%3Adoi%2F10.3171%2Fjns.2001.95.1.0145&rft_id=info%3Apmid%2F11453388&rft.aulast=Boockvar&rft.aufirst=John+A.&rft.au=Loudon%2C+William&rft.au=Sutton%2C+Leslie+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.uh.edu\/engines\/epi2582.htm\" target=\"_blank\">http:\/\/www.uh.edu\/engines\/epi2582.htm<\/a><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (August 2015)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.medterms.com\/script\/main\/art.asp?articlekey=26245\" target=\"_blank\">http:\/\/www.medterms.com\/script\/main\/art.asp?articlekey=26245<\/a><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (August 2015)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Anti-Siphon Device; Integra Neurosciences; Label 2002<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (August 2015)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-integra-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-integra_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.integra-ls.com\/products\/?product=47\" target=\"_blank\">http:\/\/www.integra-ls.com\/products\/?product=47<\/a>, Retrieved November 30, 2009<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (August 2015)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-gropper-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-gropper_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-gropper_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-gropper_10-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-gropper_10-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-gropper_10-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Interview with Dr. Gary R. Gropper; Piedmont Neurosurgery; October 15, 2009<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Verifiability\" title=\"Wikipedia:Verifiability\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag needs to be fact-checked with the cited source(s). (August 2015)\">verification needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-rizvi_and_wood-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-rizvi_and_wood_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rizvi, Syed Ali A.; Wood, Martin (2010). \"Ventriculosubgaleal Shunting for Post-Haemorrhagic Hydrocephalus in Premature Neonates\". <i>Pediatric Neurosurgery<\/i>. <b>46<\/b> (5): 335\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000320135\" target=\"_blank\">10.1159\/000320135<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21346395\" target=\"_blank\">21346395<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatric+Neurosurgery&rft.atitle=Ventriculosubgaleal+Shunting+for+Post-Haemorrhagic+Hydrocephalus+in+Premature+Neonates&rft.volume=46&rft.issue=5&rft.pages=335-9&rft.date=2010&rft_id=info%3Adoi%2F10.1159%2F000320135&rft_id=info%3Apmid%2F21346395&rft.aulast=Rizvi&rft.aufirst=Syed+Ali+A.&rft.au=Wood%2C+Martin&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-drake-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-drake_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Drake, J. M.; Kestle, J. R. W.; Tuli, S. (2000). \"CSF shunts 50 years on - past, present and future\". <i>Child's Nervous System<\/i>. <b>16<\/b> (10\u201311): 800\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs003810000351\" target=\"_blank\">10.1007\/s003810000351<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11151733\" target=\"_blank\">11151733<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Child%27s+Nervous+System&rft.atitle=CSF+shunts+50+years+on+-+past%2C+present+and+future&rft.volume=16&rft.issue=10%E2%80%9311&rft.pages=800-4&rft.date=2000&rft_id=info%3Adoi%2F10.1007%2Fs003810000351&rft_id=info%3Apmid%2F11151733&rft.aulast=Drake&rft.aufirst=J.+M.&rft.au=Kestle%2C+J.+R.+W.&rft.au=Tuli%2C+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-enger-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-enger_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Enger, P. \u00d8.; Svendsen, F.; Wester, K. (2003). \"CSF shunt infections in children: experiences from a population-based study\". <i>Acta Neurochirurgica<\/i>. <b>145<\/b> (4): 243\u20138, discussion 248. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00701-002-1068-5\" target=\"_blank\">10.1007\/s00701-002-1068-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12748883\" target=\"_blank\">12748883<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Neurochirurgica&rft.atitle=CSF+shunt+infections+in+children%3A+experiences+from+a+population-based+study&rft.volume=145&rft.issue=4&rft.pages=243-8%2C+discussion+248&rft.date=2003&rft_id=info%3Adoi%2F10.1007%2Fs00701-002-1068-5&rft_id=info%3Apmid%2F12748883&rft.aulast=Enger&rft.aufirst=P.+%C3%98.&rft.au=Svendsen%2C+F.&rft.au=Wester%2C+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-meningitis-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-meningitis_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brook, Itzhak (2002). \"Meningitis and shunt infection caused by anaerobic bacteria in children\". <i>Pediatric Neurology<\/i>. <b>26<\/b> (2): 99\u2013105. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0887-8994%2801%2900330-7\" target=\"_blank\">10.1016\/S0887-8994(01)00330-7<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11897473\" target=\"_blank\">11897473<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatric+Neurology&rft.atitle=Meningitis+and+shunt+infection+caused+by+anaerobic+bacteria+in+children&rft.volume=26&rft.issue=2&rft.pages=99-105&rft.date=2002&rft_id=info%3Adoi%2F10.1016%2FS0887-8994%2801%2900330-7&rft_id=info%3Apmid%2F11897473&rft.aulast=Brook&rft.aufirst=Itzhak&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shah, Samir S.; Smith, Michael J.; Zaoutis, Theoklis E. 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G.; Durity, F. A.; Moyes, P. D. (1980). \"Dandy-Walker Syndrome: Analysis of 21 Cases\". <i>Developmental Medicine & Child Neurology<\/i>. <b>22<\/b> (2): 189\u2013201. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1469-8749.1980.tb04327.x\" target=\"_blank\">10.1111\/j.1469-8749.1980.tb04327.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7380119\" target=\"_blank\">7380119<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Developmental+Medicine+%26+Child+Neurology&rft.atitle=Dandy-Walker+Syndrome%3A+Analysis+of+21+Cases&rft.volume=22&rft.issue=2&rft.pages=189-201&rft.date=1980&rft_id=info%3Adoi%2F10.1111%2Fj.1469-8749.1980.tb04327.x&rft_id=info%3Apmid%2F7380119&rft.aulast=Tal&rft.aufirst=Y.&rft.au=Freigang%2C+B.&rft.au=Dunn%2C+H.+G.&rft.au=Durity%2C+F.+A.&rft.au=Moyes%2C+P.+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/emedicine.medscape.com\/article\/408059-overview\" target=\"_blank\">Imaging in Dandy-Walker Malformation<\/a><\/i> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/EMedicine\" title=\"EMedicine\" rel=\"external_link\" target=\"_blank\">eMedicine<\/a><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Samii, Madjid; Carvalho, Gustavo A; Schuhmann, Martin U; Matthies, Cordula (1999). \"Arachnoid cysts of the posterior fossa\". <i>Surgical Neurology<\/i>. <b>51<\/b> (4): 376\u201382. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0090-3019%2898%2900095-0\" target=\"_blank\">10.1016\/S0090-3019(98)00095-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10199290\" target=\"_blank\">10199290<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+Neurology&rft.atitle=Arachnoid+cysts+of+the+posterior+fossa&rft.volume=51&rft.issue=4&rft.pages=376-82&rft.date=1999&rft_id=info%3Adoi%2F10.1016%2FS0090-3019%2898%2900095-0&rft_id=info%3Apmid%2F10199290&rft.aulast=Samii&rft.aufirst=Madjid&rft.au=Carvalho%2C+Gustavo+A&rft.au=Schuhmann%2C+Martin+U&rft.au=Matthies%2C+Cordula&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.wrongdiagnosis.com\/a\/arachnoid_cysts\/prevalence.htm\" target=\"_blank\">http:\/\/www.wrongdiagnosis.com\/a\/arachnoid_cysts\/prevalence.htm<\/a><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (August 2015)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Iannelli, A.; Rea, G.; Di Rocco, C. (2005). \"CSF shunt removal in children with hydrocephalus\". <i>Acta Neurochirurgica<\/i>. <b>147<\/b> (5): 503\u20137, discussion 507. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00701-005-0494-6\" target=\"_blank\">10.1007\/s00701-005-0494-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15838593\" target=\"_blank\">15838593<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Neurochirurgica&rft.atitle=CSF+shunt+removal+in+children+with+hydrocephalus&rft.volume=147&rft.issue=5&rft.pages=503-7%2C+discussion+507&rft.date=2005&rft_id=info%3Adoi%2F10.1007%2Fs00701-005-0494-6&rft_id=info%3Apmid%2F15838593&rft.aulast=Iannelli&rft.aufirst=A.&rft.au=Rea%2C+G.&rft.au=Di+Rocco%2C+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACerebral+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.stanfordchildrens.org\/en\/service\/neurosurgery\/hydrocephalus-treatment\" target=\"_blank\">Interactive explainer: shunt and hydrocephalus treatments | Stanford Children's Health<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181205005146\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.568 seconds\nReal time usage: 0.699 seconds\nPreprocessor visited node count: 3053\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 114695\/2097152 bytes\nTemplate argument size: 4989\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 84104\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.307\/10.000 seconds\nLua memory usage: 5.29 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 591.678 1 -total\n<\/p>\n<pre>54.50% 322.480 1 Template:Reflist\n36.55% 216.239 24 Template:Cite_journal\n14.92% 88.297 8 Template:Fix\n12.98% 76.783 1 Template:Infobox_medical_intervention\n12.12% 71.737 1 Template:Infobox\n10.70% 63.327 1 Template:Commonscat\n 9.76% 57.752 4 Template:Navbox\n 8.92% 52.803 1 Template:Citation_needed\n 7.14% 42.221 10 Template:Category_handler\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:9089927-1!canonical and timestamp 20181205005145 and revision id 861140600\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_shunt\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214639\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.028 seconds\nReal time usage: 0.175 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 166.828 1 - wikipedia:Cerebral_shunt\n100.00% 166.828 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8002-0!*!*!*!*!*!* and timestamp 20181217214639 and revision id 24112\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cerebral_shunt\">https:\/\/www.limswiki.org\/index.php\/Cerebral_shunt<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d3ae356ae2cf35486b5f95caa1bf80f0_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c7\/Diagram_showing_a_brain_shunt_CRUK_052.svg\/560px-Diagram_showing_a_brain_shunt_CRUK_052.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/ShuntCT.png\/440px-ShuntCT.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/53\/Radiograph_of_a_ventriculoperitoneal_shunt.jpg\/440px-Radiograph_of_a_ventriculoperitoneal_shunt.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_6_-_2018.jpg\/180px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_6_-_2018.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_12.jpg\/240px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_12.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/88\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_15_-_stitches_removed_-_2018.jpg\/135px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_head_-_day_15_-_stitches_removed_-_2018.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_15_-_stitches_removed.jpg\/240px-Ventriculoperitoneal_shunt_-_surgical_wound_healing_-_belly_-_day_15_-_stitches_removed.jpg"],"d3ae356ae2cf35486b5f95caa1bf80f0_timestamp":1545083199,"080c85ceaf86caa08168d9673750ed5c_type":"article","080c85ceaf86caa08168d9673750ed5c_title":"Breast implant","080c85ceaf86caa08168d9673750ed5c_url":"https:\/\/www.limswiki.org\/index.php\/Breast_implant","080c85ceaf86caa08168d9673750ed5c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBreast implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA breast implant is a prosthesis used to change the size, shape, and contour of a woman's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast mound for post\u2013mastectomy breast reconstruction patients or to correct congenital defects and deformities of the chest wall. They are also used cosmetically to enhance or enlarge the appearance of the breast through breast augmentation surgery.\n\nPlay media (video) A doctor marking the chest for implants.\nThere are three general types of breast implant devices, defined by their filler material: saline solution, silicone gel, and composite filler. The saline implant has an elastomer silicone shell filled with sterile saline solution during surgery; the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel; and the alternative composition implants featured miscellaneous fillers, such as soy oil, polypropylene string, etc. Composite implants are typically not recommended for use anymore and, in fact, their use is banned in the United States and Europe due to associated health risks and complications.\nIn surgical practice, for the reconstruction of a breast, the tissue expander device is a temporary breast prosthesis used to form and establish an implant pocket for the future permanent breast implant. For the correction of male breast defects and deformities, the pectoral implant is the breast prosthesis used for the reconstruction and the aesthetic repair of a man's chest wall (see: gynecomastia and mastopexy).\n\nContents \n\n1 History \n\n1.1 19th century \n1.2 The 20th century \n\n\n2 Types \n\n2.1 Saline implants \n2.2 Silicone gel implants \n\n2.2.1 First generation \n2.2.2 Second generation \n2.2.3 Third and Fourth generations \n2.2.4 Fifth generation \n\n\n\n\n3 Psychology \n4 Surgical procedures \n\n4.1 Indications \n4.2 Incision types \n4.3 Implant pocket placement \n4.4 Post-surgical recovery \n\n\n5 Complications \n\n5.1 Implant rupture \n5.2 Capsular contracture \n5.3 Repair and revision surgeries \n\n\n6 Systemic Illness and ALCL Cancer \n\n6.1 Claims of Systemic disease and sickness \n6.2 Platinum toxicity \n6.3 Anaplastic large cell lymphoma \n\n\n7 Implants and breast-feeding \n8 Implants and mammography \n9 U.S. FDA approval \n10 Safety of Breast Implants \n11 See also \n12 References \n13 External links \n\n\n\nHistory \n Vincenz Czerny (1842\u20131916), a surgical pioneer in breast reconstruction.\n19th century \nSince the late nineteenth century, breast implants have been used to surgically augment the size (volume), modify the shape (contour), and enhance the feel (tact) of a woman's breasts. In 1895, surgeon Vincenz Czerny effected the earliest breast implant emplacement when he used the patient's autologous adipose tissue, harvested from a benign lumbar lipoma, to repair the asymmetry of the breast from which he had removed a tumor.[1] In 1889, surgeon Robert Gersuny experimented with paraffin injections, with disastrous results.[further explanation needed ]\n\nThe 20th century \nFrom the first half of the twentieth century, physicians used other substances as breast implant fillers\u2014ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, Ivalon (polyvinyl alcohol\u2014formaldehyde polymer sponge), a polyethylene sac with Ivalon, polyether foam sponge (Etheron), polyethylene tape (Polystan) strips wound into a ball, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses.[2]\nIn the mid-twentieth century, Morton I. Berson, in 1945, and Jacques Maliniac, in 1950, each performed flap-based breast augmentations by rotating the patient's chest wall tissue into the breast to increase its volume. Furthermore, throughout the 1950s and the 1960s, plastic surgeons used synthetic fillers\u2014including silicone injections received by some 50,000 women, from which developed silicone granulomas and breast hardening that required treatment by mastectomy.[3] In 1961, the American plastic surgeons Thomas Cronin and Frank Gerow, and the Dow Corning Corporation, developed the first silicone breast prosthesis, filled with silicone gel; in due course, the first augmentation mammoplasty was performed in 1962 using the Cronin\u2013Gerow Implant, prosthesis model 1963. In 1964, the French company Laboratoires Arion developed and manufactured the saline breast implant, filled with saline solution, and then introduced for use as a medical device in 1964.[4]\n\nTypes \n Saline-solution-filled breast implant device models.\n The original breast implant: the Cronin\u2013Gerow Implant, prosthesis model 1963, was an anatomic tear-shaped design that featured a posterior fastener made of Dacron, to affix it in the implant pocket.\n Late-generation models of silicone gel-filled prostheses.\nToday, there are two types of breast implants commonly used for mammaplasty, breast reconstruction, and breast augmentation procedures:[5]\n\nsaline implant filled with sterile saline solution.\nsilicone implant filled with viscous silicone gel.\nSaline implants \nThe saline breast implant\u2014filled with saline solution (biological-concentration salt water 0.90% w\/v of NaCl, ca. 300 mOsm\/L.)\u2014was first manufactured by the Laboratoires Arion company, in France, and was introduced for use as a prosthetic medical device in 1964. The contemporary models of saline breast implant are manufactured with thicker, room-temperature vulcanized (RTV) shells made of a silicone elastomer. The study In vitro Deflation of Pre-filled Saline Breast Implants (2006) reported that the rates of deflation (filler leakage) of the pre-filled saline breast implant made it a second-choice prosthesis for corrective breast surgery.[4] Nonetheless, in the 1990s, the saline breast implant was the prosthesis most common device used for breast augmentation surgery in the United States, because of the U.S. FDA's restriction against the implantation of silicone-filled breast implants outside of clinical studies. Saline breast implants have enjoyed little popularity in the rest of the world, possessing negligible market share.\nThe technical goal of saline-implant technology was a physically less invasive surgical technique for emplacing an empty breast implant device through a smaller surgical incision.[6] In surgical praxis, after having emplaced the empty breast implants to the implant pockets, the plastic surgeon then filled each device with saline solution, and, because the required insertion-incisions are short and small, the resultant incision-scars will be smaller and shorter than the surgical scars usual to the long incisions required for inserting pre-filled, silicone-gel implants.\nWhen compared to the results achieved with a silicone-gel breast implant, the saline implant can yield acceptable results, of increased breast-size, smoother hemisphere-contour, and realistic texture; yet, it is likelier to cause cosmetic problems, such as the rippling and the wrinkling of the breast-envelope skin, accelerated lower breast pole stretch, and technical problems, such as the presence of the implant being noticeable to the eye and to the touch. The occurrence of such cosmetic problems is likelier in the case of the woman with very little breast tissue, and in the case of the woman who requires post-mastectomy breast reconstruction; thus, the silicone-gel implant is the technically superior prosthetic device for breast augmentation, and for breast reconstruction. In the case of the woman with much breast tissue, for whom sub-muscular emplacement is the recommended surgical approach, saline breast implants can produce an aesthetic result much like that afforded by silicone breast implants, albeit with greater implant palpability.[7]\n\nSilicone gel implants \nAs a medical device technology, there are five generations of silicone breast implant, each defined by common model-manufacturing techniques.[citation needed ]\nThe modern prosthetic breast was invented in 1961 by the American plastic surgeons Thomas Cronin and Frank Gerow, and manufactured by the Dow Corning Corporation; in due course, the first augmentation mammoplasty was performed in 1962.\n\nFirst generation \nThe Cronin\u2013Gerow Implant, prosthesis model 1963, was a silicone rubber envelope-sac, shaped like a teardrop, which was filled with viscous silicone-gel. To reduce the rotation of the emplaced breast implant upon the chest wall, the model 1963 prosthesis was affixed to the implant pocket with a fastener-patch, made of Dacron material (Polyethylene terephthalate), which was attached to the rear of the breast implant shell.[8]\n\nSecond generation \nIn the 1970s, manufacturers presented the second generation of breast implant prostheses that featured functional developments and aesthetic improvements to the technology:\n\nthe first technological developments were a thinner-gauge device-shell, and a filler gel of low-cohesion silicone, which improved the functionality and the verisimilitude (size, appearance, and texture) of the silicone-gel breast implant. Yet, in clinical practice, second-generation breast implants proved fragile, and suffered greater incidences of shell rupture, and of filler leakage (\"silicone-gel bleed\") through the intact device shell. The consequent, increased incidence-rates of medical complications (e.g. capsular contracture) precipitated faulty-product, class action-lawsuits, by the U.S. government, against the Dow Corning Corporation, and other manufacturers of breast prostheses.\nthe second technological development was a polyurethane foam coating for the shell of the breast implant; the coating reduced the incidence of capsular contracture, by causing an inflammatory reaction that impeded the formation of a capsule of fibrous collagen tissue around the breast implant. Nevertheless, despite that prophylactic measure, the medical use of polyurethane-coated breast implants was briefly discontinued, because of the potential health-risk posed by 2,4-toluenediamine (TDA), a carcinogenic by-product of the chemical breakdown of the polyurethane foam coating of the breast implant.[9]\nAfter reviewing the medical data, the U.S. Food and Drug Administration concluded that TDA-induced breast cancer was an infinitesimal health-risk to women with breast implants, and did not justify legally requiring physicians to explain the matter to their patients. In the event, polyurethane-coated breast implants remain in plastic surgery practice in Europe and in South America; and no manufacturer has sought FDA approval for medical sales of such breast implants in the U.S.[10]\nthe third technological development was the double lumen breast implant device, a double-cavity prosthesis composed of a silicone breast implant contained within a saline breast implant. The two-fold, technical goal was: (i) the cosmetic benefits of silicone-gel (the inner lumen) enclosed in saline solution (the outer lumen); (ii) a breast implant device the volume of which is post-operatively adjustable. Nevertheless, the more complex design of the double-lumen breast implant suffered a device-failure rate greater than that of single-lumen breast implants. The contemporary versions of second-generation breast implant devices (presented in 1984) are the \"Becker Expandable\" models of breast implant, which are primarily used for breast reconstruction.\nThird and Fourth generations \nIn the 1980s, the models of the Third and of the Fourth generations of breast implant devices were sequential advances in manufacturing technology, such as elastomer-coated shells that decreased gel-bleed (filler leakage), and a thicker (increased-cohesion) filler gel. Sociologically, the manufacturers of prosthetic breasts then designed and made anatomic models (natural breast) and shaped models (round, tapered) that realistically corresponded with the breast- and body- types of women. The tapered models of breast implant have a uniformly textured surface, which reduces the rotation of the prosthesis within the implant pocket; the round models of breast implant are available in smooth-surface- and textured-surface- types.\n\nFifth generation \nSince the mid-1990s, the fifth generation of silicone-gel breast implant is made of a high-strength, highly cohesive silicone gel that mostly eliminates the occurrences of filler leakage (\u201csilicone gel bleed\u201d) and of the migration of the silicone filler from the implant pocket to elsewhere in the woman's body. These implants are commonly referred to as \"gummy bear breast implants\" for their firm, pliant consistency, which is similar to gummy candies. The studies Experience with Anatomical Soft Cohesive Silicone gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery (2004) and Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported low incidence-rates of capsular contracture and of device-shell rupture; and greater rates of improved medical-safety and technical-efficacy than that of early generation breast implant devices.[11][12][13]\n\nPsychology \nFurther information: Body dysmorphic disorder, Body image, and Beauty\nThe breast augmentation patient usually is a young woman whose personality profile indicates psychological distress about her personal appearance and her bodily self image, and a history of having endured criticism (teasing) about the aesthetics of her person.[14] The studies Body Image Concerns of Breast Augmentation Patients (2003) and Body Dysmorphic Disorder and Cosmetic Surgery (2006) reported that the woman who underwent breast augmentation surgery also had undergone psychotherapy, suffered low self-esteem, presented frequent occurrences of psychological depression, had attempted suicide, and suffered body dysmorphia, a type of mental illness.\nPost-operative patient surveys about mental health and quality-of-life, reported improved physical health, physical appearance, social life, self-confidence, self-esteem, and satisfactory sexual functioning. Furthermore, the women reported long-term satisfaction with their breast implant outcomes; some despite having suffered medical complications that required surgical revision, either corrective or aesthetic. Likewise, in Denmark, 8 per cent of breast augmentation patients had a pre-operative history of psychiatric hospitalization.[15][16][17][18][19][20][21][22][23]\nIn 2008, the longitudinal study Excess Mortality from Suicide and other External Causes of Death Among Women with Cosmetic Breast Implants (2007), reported that women who sought breast implants are almost 3 times as likely to commit suicide as are women who have not sought breast implants. Compared to the standard suicide-rate for women of the general populace, the suicide-rate for women with augmented breasts remained constant until 10-years post-implantation, yet, it increased to 4.5 times greater at the 11-year mark, and so remained until the 19-year mark, when it increased to 6 times greater at 20-years post-implantation. Moreover, additional to the suicide-risk, women with breast implants also faced a trebled death-risk from alcoholism and the abuse of prescription and recreational drugs.[24][25] Although seven studies have statistically connected a woman's breast augmentation to a greater suicide-rate, the research indicates that breast augmentation surgery does not increase the death rate; and that, in the first instance, it is the psychopathologically-inclined woman who is more likely to undergo a breast augmentation procedure.[26][27][28][29][30][31]\nThe study Effect of Breast Augmentation Mammoplasty on Self-Esteem and Sexuality: A Quantitative Analysis (2007), reported that the women attributed their improved self image, self-esteem, and increased, satisfactory sexual functioning to having undergone breast augmentation; the cohort, aged 21\u201357 years, averaged post-operative self-esteem increases that ranged from 20.7 to 24.9 points on the 30-point Rosenberg self-esteem scale, which data supported the 78.6 per cent increase in the woman's libido, relative to her pre-operative level of libido.[32] Therefore, before agreeing to any surgery, the plastic surgeon evaluates and considers the woman's mental health to determine if breast implants can positively affect her self-esteem and sexual functioning.\n\nSurgical procedures \nIndications \nA mammoplasty procedure for the placement of breast implant devices has three (3) purposes:\n\nprimary reconstruction: the replacement of breast tissues damaged by trauma (blunt, penetrating, blast), disease (breast cancer), and failed anatomic development (tuberous breast deformity).\nrevision and reconstruction: to revise (correct) the outcome of a previous breast reconstruction surgery.\nprimary augmentation: to aesthetically augment the size, form, and feel of the breasts.\nThe operating room (OR) time of post\u2013mastectomy breast reconstruction, and of breast augmentation surgery is determined by the procedure employed, the type of incisions, the breast implant (type and materials), and the pectoral locale of the implant pocket.\nRecent research has indicated that mammograms should not be done with any increased frequency than used in normal procedure in patients undergoing breast surgery, including breast implant, augmentation, mastopexy, and breast reducation.[33]\n\nIncision types \nBreast implant emplacement is performed with five (5) types of surgical incisions:\n\nInframammary: an incision made to the inframammary fold (natural crease under your breast), which affords maximal access for precise dissection of the tissues and emplacement of the breast implants. It is the preferred surgical technique for emplacing silicone-gel implants, because it better exposes the breast tissue\u2013pectoralis muscle interface; yet, IMF implantation can produce thicker, slightly more visible surgical scars.\nPeriareolar: a border-line incision along the periphery of the areola, which provides an optimal approach when adjustments to the IMF position are required, or when a mastopexy (breast lift) is included to the primary mammoplasty procedure. In periareolar emplacement, the incision is around the medial-half (inferior half) of the areola's circumference. Silicone gel implants can be difficult to emplace via periareolar incision, because of the short, five-centimetre length (~ 5.0 cm) of the required access-incision. Aesthetically, because the scars are at the areola's border (periphery), they usually are less visible than the IMF-incision scars of women with light-pigment areolae; when compared to cutaneous-incision scars, the modified epithelia of the areolae are less prone to (raised) hypertrophic scars.\nTransaxillary: an incision made to the axilla (armpit), from which the dissection tunnels medially, to emplace the implants, either bluntly or with an endoscope (illuminated video microcamera), without producing visible scars on the breast proper; yet, it is likelier to produce inferior asymmetry of the implant-device position. Therefore, surgical revision of transaxillary emplaced breast implants usually requires either an IMF incision or a periareolar incision.\nTransumbilical: a trans-umbilical breast augmentation (TUBA) is a less common implant-device emplacement technique wherein the incision is at the umbilicus (navel), and the dissection tunnels superiorly, up towards the bust. The TUBA approach allows emplacing the breast implants without producing visible scars upon the breast proper; but makes appropriate dissection and device-emplacement more technically difficult. A TUBA procedure is performed bluntly\u2014without the endoscope's visual assistance\u2014and is not appropriate for emplacing (pre-filled) silicone-gel implants, because of the great potential for damaging the elastomer silicone shell of the breast implant during its manual insertion through the short (~2.0 cm) incision at the navel, and because pre-filled silicone gel implants are incompressible, and cannot be inserted through so small an incision.[34]\nTransabdominal: as in the TUBA procedure, in the transabdominoplasty breast augmentation (TABA), the breast implants are tunneled superiorly from the abdominal incision into bluntly dissected implant pockets, whilst the patient simultaneously undergoes an abdominoplasty.[35]\nImplant pocket placement \nImplant placement comparisonSubglandular implantSubpectoral implantSubmuscular implant\nThe four surgical approaches to emplacing a breast implant to the implant pocket are described in anatomical relation to the pectoralis major muscle.\n\nSubglandular: the breast implant is emplaced to the retromammary space, between the breast tissue (the mammary gland) and the pectoralis major muscle (major muscle of the chest), which most approximates the plane of normal breast tissue, and affords the most aesthetic results. Yet, in women with thin pectoral soft-tissue, the subglandular position is likelier to show the ripples and wrinkles of the underlying implant. Moreover, the capsular contracture incidence rate is slightly greater with subglandular implantation.\nSubfascial: the breast implant is emplaced beneath the fascia of the pectoralis major muscle; the subfascial position is a variant of the subglandular position for the breast implant.[36] The technical advantages of the subfascial implant-pocket technique are debated; proponent surgeons report that the layer of fascial tissue provides greater implant coverage and better sustains its position.[37]\nSubpectoral (dual plane): the breast implant is emplaced beneath the pectoralis major muscle, after the surgeon releases the inferior muscular attachments, with or without partial dissection of the subglandular plane. Resultantly, the upper pole of the implant is partially beneath the pectoralis major muscle, while the lower pole of the implant is in the subglandular plane. This implantation technique achieves maximal coverage of the upper pole of the implant, whilst allowing the expansion of the implant's lower pole; however, \u201canimation deformity\u201d, the movement of the implants in the subpectoral plane can be excessive for some patients.[38]\nSubmuscular: the breast implant is emplaced beneath the pectoralis major muscle, without releasing the inferior origin of the muscle proper. Total muscular coverage of the implant can be achieved by releasing the lateral muscles of the chest wall\u2014either the serratus muscle or the pectoralis minor muscle, or both\u2014and suturing it, or them, to the pectoralis major muscle. In breast reconstruction surgery, the submuscular implantation approach effects maximal coverage of the breast implants. This technique is rarely used in cosmetic surgery due to high risk of animation deformities.\nPost-surgical recovery \nThe surgical scars of a breast augmentation mammoplasty develop approximately at 6-weeks post-operative, and fade within months. Depending upon the daily-life physical activities required of the woman, the breast augmentation patient usually resumes her normal life at 1-week post-operative. Moreover, women whose breast implants were emplaced beneath the chest muscles (submuscular placement) usually have a longer, slightly more painful convalescence, because of the healing of the incisions to the chest muscles. Usually, she does not exercise or engage in strenuous physical activities for approximately 6 weeks. During the initial post-operative recovery, the woman is encouraged to regularly exercise (flex and move) her arm to alleviate pain and discomfort; if required, analgesic indwelling medication catheters can alleviate pain[39][40] Moreover, significantly improved patient recovery has resulted from refined breast-device implantation techniques (submuscular, subglandular) that allow 95 per cent of women to resume their normal lives at 24-hours post-procedure, without bandages, fluid drains, pain pumps, catheters, medical support brassi\u00e8res, or narcotic pain medication.[41][42][43][44]\n\nComplications \nThe plastic surgical emplacement of breast implant devices, either for breast reconstruction or for aesthetic purpose, presents the same health risks common to surgery, such as adverse reaction to anesthesia, hematoma (post-operative bleeding), late hematoma (post-operative bleeding after 6 months or more),[45] seroma (fluid accumulation), incision-site breakdown (wound infection). Complications specific to breast augmentation include breast pain, altered sensation, impeded breast-feeding function, visible wrinkling, asymmetry, thinning of the breast tissue, and symmastia, the \u201cbread loafing\u201d of the bust that interrupts the natural plane between the breasts. Specific treatments for the complications of indwelling breast implants\u2014capsular contracture and capsular rupture\u2014are periodic MRI monitoring and physical examinations. Furthermore, complications and re-operations related to the implantation surgery, and to tissue expanders (implant place-holders during surgery) can cause unfavorable scarring in approximately 6\u20137 per cent of the patients.\n[46][47][48] Statistically, 20 per cent of women who underwent cosmetic implantation, and 50 per cent of women who underwent breast reconstruction implantation, required their explantation at the 10-year mark.[49]\n\nImplant rupture \nBecause a breast implant is a Class III medical device of limited product-life, the principal rupture-rate factors are its age and design; Nonetheless, a breast implant device can retain its mechanical integrity for decades in a woman's body.[50] When a saline breast implant ruptures, leaks, and empties, it quickly deflates, and thus can be readily explanted (surgically removed). The follow-up report, Natrelle Saline-filled Breast Implants: a Prospective 10-year Study (2009) indicated rupture-deflation rates of 3\u20135 per cent at 3-years post-implantation, and 7\u201310 per cent rupture-deflation rates at 10-years post-implantation.[51]\n\n A breast implant failure: the parts of a surgically explanted breast implant are the red, fibrous capsule (left), the ruptured silicone implant (center), and the transparent filler-gel that leaked with the capsule (right).\nWhen a silicone breast implant ruptures it usually does not deflate, yet the filler gel does leak from it, which can migrate to the implant pocket; therefore, an intracapsular rupture (in-capsule leak) can become an extracapsular rupture (out-of-capsule leak), and each occurrence is resolved by explantation. Although the leaked silicone filler-gel can migrate from the chest tissues to elsewhere in the woman's body, most clinical complications are limited to the breast and armpit areas, usually manifested as granulomas (inflammatory nodules) and axillary lymphadenopathy (enlarged lymph glands in the armpit area).[52][53][54]\nThe suspected mechanisms of breast implant rupture are:\n\ndamage during implantation\ndamage during (other) surgical procedures\nchemical degradation of the breast implant shell\ntrauma (blunt trauma, penetrating trauma, blast trauma)\nmechanical pressure of traditional mammographic breast examination [55]\nSilicone implant rupture can be evaluated using magnetic resonance imaging; from the long-term MRI data for single-lumen breast implants, the European literature about second generation silicone-gel breast implants (1970s design), reported silent device-rupture rates of 8\u201315 per cent at 10-years post-implantation (15\u201330% of the patients).[56][57][58][59]\nThe study Safety and Effectiveness of Mentor\u2019s MemoryGel Implants at 6 Years (2009), which was a branch study of the U.S. FDA's core clinical trials for primary breast augmentation surgery patients, reported low device-rupture rates of 1.1 per cent at 6-years post-implantation.[60] The first series of MRI evaluations of the silicone breast implants with thick filler-gel reported a device-rupture rate of 1 percent, or less, at the median 6-year device-age.[61] Statistically, the manual examination (palpation) of the woman is inadequate for accurately evaluating if a breast implant has ruptured. The study, The Diagnosis of Silicone Breast implant Rupture: Clinical Findings Compared with Findings at Magnetic Resonance Imaging (2005), reported that, in asymptomatic patients, only 30 per cent of the ruptured breast implants are accurately palpated and detected by an experienced plastic surgeon, whereas MRI examinations accurately detected 86 per cent of breast implant ruptures.[62] Therefore, the U.S. FDA recommended scheduled MRI examinations, as silent-rupture screenings, beginning at the 3-year-mark post-implantation, and then every two years, thereafter.[46] Nonetheless, beyond the U.S., the medical establishments of other nations have not endorsed routine MRI screening, and, in its stead, proposed that such a radiologic examination be reserved for two purposes: (i) for the woman with a suspected breast implant rupture; and (ii) for the confirmation of mammographic and ultrasonic studies that indicate the presence of a ruptured breast implant.[63]\nFurthermore, The Effect of Study design Biases on the Diagnostic Accuracy of Magnetic Resonance Imaging for Detecting Silicone Breast Implant Ruptures: a Meta-analysis (2011) reported that the breast-screening MRIs of asymptomatic women might overestimate the incidence of breast implant rupture.[64] In the event, the U.S. Food and Drug Administration emphasised that \u201cbreast implants are not lifetime devices. The longer a woman has silicone gel-filled breast implants, the more likely she is to experience complications.\u201d[65]\n\nCapsular contracture \nMain article: Capsular contracture\nThe human body's immune response to a surgically installed foreign object\u2014breast implant, cardiac pacemaker, orthopedic prosthesis\u2014is to encapsulate it with scar tissue capsules of tightly woven collagen fibers, in order to maintain the integrity of the body by isolating the foreign object, and so tolerate its presence. Capsular contracture\u2014which should be distinguished from normal capsular tissue\u2014occurs when the collagen-fiber capsule thickens and compresses the breast implant; it is a painful complication that might distort either the breast implant, or the breast, or both.\n\n A breast implant failure: capsular contracture is a medical complication, in this case, a Baker scale Grade IV contraction, of a subglandular silicone implant in the right breast.\nThe cause of capsular contracture is unknown, but the common incidence factors include bacterial contamination, device-shell rupture, filler leakage, and hematoma. The surgical implantation procedures that have reduced the incidence of capsular contracture include submuscular emplacement, the use of breast implants with a textured surface (polyurethane-coated);[66][67][68] limited pre-operative handling of the implants, limited contact with the chest skin of the implant pocket before the emplacement of the breast implant, and irrigation of the recipient site with triple-antibiotic solutions.[69][70]\nThe correction of capsular contracture might require an open capsulotomy (surgical release) of the collagen-fiber capsule, or the removal, and possible replacement, of the breast implant. Furthermore, in treating capsular contracture, the closed capsulotomy (disruption via external manipulation) once was a common maneuver for treating hard capsules, but now is a discouraged technique, because it can rupture the breast implant. Non-surgical treatments for collagen-fiber capsules include massage, external ultrasonic therapy, leukotriene pathway inhibitors such as zafirlukast (Accolate) or montelukast (Singulair), and pulsed electromagnetic field therapy (PEMFT).[71][72][73][74]\n\nRepair and revision surgeries \nWhen the patient is unsatisfied with the outcome of the augmentation mammoplasty; or when technical or medical complications occur; or because of the breast implants\u2019 limited product life, it is likely she might require replacing the breast implants. Common revision surgery indications include major and minor medical complications, capsular contracture, shell rupture, and device deflation.[55] Revision incidence rates were greater for breast reconstruction patients, because of the post-mastectomy changes to the soft-tissues and to the skin envelope of the breast, and to the anatomical borders of the breast, especially in women who received adjuvant external radiation therapy.[55] Moreover, besides breast reconstruction, breast cancer patients usually undergo revision surgery of the nipple-areola complex (NAC), and symmetry procedures upon the opposite breast, to create a bust of natural appearance, size, form, and feel. Carefully matching the type and size of the breast implants to the patient's pectoral soft-tissue characteristics reduces the incidence of revision surgery. Appropriate tissue matching, implant selection, and proper implantation technique, the re-operation rate was 3 percent at the 7-year-mark, compared with the re-operation rate of 20 per cent at the 3-year-mark, as reported by the U.S. Food and Drug Administration.[75][76]\n\nSystemic Illness and ALCL Cancer \n Chest X-ray showing breast implants\nClaims of Systemic disease and sickness \nSince the early 1990s, a number of independent systemic comprehensive reviews have examined studies concerning links between silicone gel breast implants and claims of systemic diseases. The consensus of these reviews (outlined below under Safety of Breast Implants heading) is that there has been no evidence of a causal link between the implantation of saline or silicone breast implants and systemic disease After investigating this issue, the U.S. FDA has concurred and since reaffirmed that \u201cthe weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants.\u201d. A comprehensive systemic review by Lipworth (2011) [77] concludes that \"any claims that remain regarding an association between cosmetic breast implants and CTDs are not supported by the scientific literature\".\n\nPlatinum toxicity \nPlatinum is a catalyst used in the making of silicone implant polymer shells and other silicone devices used in medicine. The literature indicates that small amounts of platinum leaches (leaks) from these implants and is present in the surrounding tissue. The FDA reviewed the available studies from the medical literature on platinum and breast implants in 2002 and concluded there was little evidence suggesting toxicity from platinum in implant patients.[78] The FDA revisited this study and additional literature several years later, reaffirming prior conclusions that platinum catalysts used in implants is likely not ionized and therefore would not represent a risk to women.[79]\n\nAnaplastic large cell lymphoma \nThe FDA has identified that breast implants may be associated with a rare form of cancer called anaplastic large-cell lymphoma, believed to be associated with chronic bacterial inflammation.[80] Similar ALCL phenomena have been seen with other types of medical implants including vascular access ports, orthopedic hip implants, and jaw (TMJ) implants. As of February 1, 2017, the FDA has received a total of 359 medical device reports of breast-implant-associated ALCL (BIALCL), including 9 deaths.[81] Most cases of breast implant-associated ALCL had implants in for many years prior to the condition, and are usually treated successfully by simple removal of the implant and the capsule surrounding the implant without the need for chemotherapy if no evidence of systemic disease exists. If women with implants present with delayed swelling or fluid collection, cytologic studies and test for a marker \"CD30\" are suggested. The American Society of Plastic Surgery (ASPS) states, \"CD30 is the main diagnostic test that must be performed on the seroma fluid as routine pathology or H&E staining can frequently miss the diagnosis.\" [82] Diagnosis and treatment of breast implant associated ALCL now follows standardized guidelines established by the National Comprehensive Cancer Network.[83]\nThe current lifetime risk of BIA-ALCL in the U.S. is unknown, but estimates have ranged between estimated to be between 1 in 70,000 to 1 in 500,000 women with breast implants according to MD Anderson.[84] Certain geographic locations have demonstrated variable risks. For instance, a December 2016 update from the Therapeutic Goods Administration of Australia and New Zealand reported a risk of 1:1,000 to 1:10,000 for textured implants.\".[82] To date (2017), there has not been a case of BIAL reported where the patient had only implantation of smooth shell breast implants or a textured tissue expander that was exchanged for a smooth implant. The paucity of cases reported in Asian populations has raised the possibility that there may be a range of genetic susceptibility to the phenomena, or alternatively merely reflect differences in how cases are identified and reported.\nThe ASPS and the Plastic Surgery Foundation (PSF) have partnered with the FDA to study this condition and in doing so created the Patient Registry and Outcomes For breast Implants and anaplastic large cell Lymphoma Etiology and epidemiology (PROFILE). The United States FDA strongly encourages all physicians to report cases to PROFILE in an effort to better understand the role of breast implants in ALCL and the management of this disease.[85]\n\nImplants and breast-feeding \n Cross-section scheme of the mammary gland. Chest wallPectoralis musclesLobulesNippleAreolaMilk ductFatty tissueSkin envelope\nThe presence of breast implants currently presents no contraindication to breast feeding, and no evidence to support that the practice may present health issues to a breast feeding infant is recognized by the USFDA.\nWomen with breast implants may have functional breast-feeding difficulties; mammoplasty procedures that feature periareolar incisions are especially likely to cause breast-feeding difficulties. Surgery may also damage the lactiferous ducts and the nerves in the nipple-areola area.[86][87][88]\nFunctional breast-feeding difficulties arise if the surgeon cut the milk ducts or the major nerves innervating the breast, or if the milk glands were otherwise damaged. Milk duct and nerve damage are more common if the incisions cut tissue near the nipple. The milk glands are most likely to be affected by subglandular implants (under the gland), and by large-sized breast implants, which pinch the lactiferous ducts and impede milk flow. Small-sized breast implants, and submuscular implantation, cause fewer breast-function problems; however, it is impossible to predict whether a woman who undergoes breast augmentation will be able to successfully breast feed since some women are able to breast-feed after periareolar incisions and subglandular placement and some are not able to after augmentation using submuscular and other types of surgical incisions.[88]\n\nImplants and mammography \nThe presence of radiologically opaque breast implants (either saline or silicone) might interfere with the radiographic sensitivity of the mammograph, that is, the image might not show any tumor(s) present. In this case, an Eklund view mammogram is required to ascertain either the presence or the absence of a cancerous tumor, wherein the breast implant is manually displaced against the chest wall and the breast is pulled forward, so that the mammograph can visualize a greater volume of the internal tissues; nonetheless, approximately one-third of the breast tissue remains inadequately visualized, resulting in an increased incidence of mammograms with false-negative results.[89]\n\n A mammograph of a normal breast (left);a mammograph of a cancerous breast (right).\nThe breast cancer studies Cancer in the Augmented Breast: Diagnosis and Prognosis (1993) and Breast Cancer after Augmentation Mammoplasty (2001) of women with breast implant prostheses reported no significant differences in disease-stage at the time of the diagnosis of cancer; prognoses are similar in both groups of women, with augmented patients at a lower risk for subsequent cancer recurrence or death.[90][91] Conversely, the use of implants for breast reconstruction after breast cancer mastectomy appears to have no negative effect upon the incidence of cancer-related death.[92] That patients with breast implants are more often diagnosed with palpable\u2014but not larger\u2014tumors indicates that equal-sized tumors might be more readily palpated in augmented patients, which might compensate for the impaired mammogram images.[93] The ready palpability of the breast-cancer tumor(s) is consequent to breast tissue thinning by compression, innately in smaller breasts a priori (because they have lesser tissue volumes), and that the implant serves as a radio-opaque base against which a cancerous tumor can be differentiated.[94]\n\n Breast MRI of a patient with implant (Blue)\nThe breast implant has no clinical bearing upon lumpectomy breast-conservation surgery for women who developed breast cancer after the implantation procedure, nor does the breast implant interfere with external beam radiation treatments (XRT); moreover, the post-treatment incidence of breast-tissue fibrosis is common, and thus a consequent increased rate of capsular contracture.[95] The study Breast Cancer Detection and Survival among Women with Cosmetic Breast Implants: Systematic Review and Meta-analysis of Observational Studies, reported an average later stage in the diagnoses of women who developed breast cancer after undergoing breast augmentation, when compared to breast cancer patients who had not undergone breast augmentation, although this did not ultimately affect the patients prognosis. The use of implants for breast reconstruction after breast cancer mastectomy appears to have no negative effect upon the incidence of cancer-related death.[92][96]\n\nU.S. FDA approval \nIn 1988, twenty-six years after the 1962 introduction of breast implants filled with silicone gel, the U.S. Food and Drug Administration (FDA) investigated breast implant failures and the subsequent complications, and re-classified breast implant devices as Class III medical devices, and required from manufacturers the documentary data substantiating the safety and efficacy of their breast implant devices.[97] In 1992, the FDA placed silicone-gel breast implants in moratorium in the U.S., because there was \u201cinadequate information to demonstrate that breast implants were safe and effective\u201d. Nonetheless, medical access to silicone-gel breast implant devices continued for clinical studies of post-mastectomy breast reconstruction, the correction of congenital deformities, and the replacement of ruptured silicone-gel implants. The FDA required from the manufacturers the clinical trial data, and permitted their providing breast implants to the breast augmentation patients for the statistical studies required by the U.S. Food and Drug Administration.[97] In mid\u20131992, the FDA approved an adjunct study protocol for silicone-gel filled implants for breast reconstruction patients, and for revision-surgery patients. Also in 1992, the Dow Corning Corporation, a silicone products and breast implant manufacturer, announced the discontinuation of five implant-grade silicones, but would continue producing 45 other, medical-grade, silicone materials\u2014three years later, in 1995, the Dow Corning Corporation went bankrupt when it faced large class action lawsuits claiming a variety of illnesses.[97]\n\nIn 1997, the U.S. Department of Health and Human Services (HHS) appointed the Institute of Medicine (IOM) of the U.S. National Academy of Sciences (NAS) to investigate the potential risks of operative and post-operative complications from the emplacement of silicone breast implants. The IOM's review of the safety and efficacy of silicone gel-filled breast implants, reported that the \"evidence suggests diseases or conditions, such as connective tissue diseases, cancer, neurological diseases, or other systemic complaints or conditions are no more common in women with breast implants, than in women without implants\" subsequent studies and systemic review found no causal link between silicone breast implants and disease.[97]\n The U.S. Department of Health and Human Services verifies the scientific, medical, and clinical data of medical devices.\nIn 1998, the U.S. FDA approved adjunct study protocols for silicone-gel filled implants only for breast reconstruction patients and for revision-surgery patients; and also approved the Dow Corning Corporation's Investigational Device Exemption (IDE) study for silicone-gel breast implants for a limited number of breast augmentation-, reconstruction-, and revision-surgery patients.[97]\nIn 1999, the Institute of Medicine published the Safety of Silicone Breast Implants (1999) study that reported no evidence that saline-filled and silicone-gel filled breast implant devices caused systemic health problems; that their use posed no new health or safety risks; and that local complications are \u201cthe primary safety issue with silicone breast implants\u201d, in distinguishing among routine and local medical complications and systemic health concerns.\u201d[97][98][99]\nIn 2000, the FDA approved saline breast implant Premarket Approval Applications (PMA) containing the type and rate data of the local medical complications experienced by the breast surgery patients.[100] \"Despite complications experienced by some women, the majority of those women still in the Inamed Corporation and Mentor Corporation studies, after three years, reported being satisfied with their implants.\"[97] The premarket approvals were granted for breast augmentation, for women at least 18 years old, and for women requiring breast reconstruction.[101][102]\nIn 2006, for the Inamed Corporation and for the Mentor Corporation, the U.S. Food and Drug Administration lifted its restrictions against using silicone-gel breast implants for breast reconstruction and for augmentation mammoplasty. Yet, the approval was conditional upon accepting FDA monitoring, the completion of 10-year-mark studies of the women who already had the breast implants, and the completion of a second, 10-year-mark study of the safety of the breast implants in 40,000 other women.[103] The FDA warned the public that breast implants do carry medical risks, and recommended that women who undergo breast augmentation should periodically undergo MRI examinations to screen for signs of either shell rupture or of filler leakage, or both conditions; and ordered that breast surgery patients be provided with detailed, informational brochures explaining the medical risks of using silicone-gel breast implants.[97]\nThe U.S. Food and Drug Administration established the age ranges for women seeking breast implants; for breast reconstruction, silicone-gel filled implants and saline-filled implants were approved for women of all ages; for breast augmentation, saline implants were approved for women 18 years of age and older; silicone implants were approved for women 22 years of age and older.[104] Because each breast implant device entails different medical risks, the minimum age of the patient for saline breast implants is different from the minimum age of the patient for silicone breast implants\u2014because of the filler leakage and silent shell-rupture risks; thus, periodic MRI screening examinations are the recommended post-operative, follow-up therapy for the patient.[105] In other countries, in Europe and Oceania, the national health ministries' breast implant policies do not endorse periodic MRI screening of asymptomatic patients, but suggest palpation proper\u2014with or without an ultrasonic screening\u2014to be sufficient post-operative therapy for most patients.\n\nSafety of Breast Implants \nIn the early 1990s, the national health ministries of the listed countries reviewed the pertinent studies for causal links among silicone-gel breast implants and systemic and auto-immune diseases. The collective conclusion is that there is no evidence establishing a causal connection between the implantation of silicone breast implants and either type of disease. The Danish study Long-term Health Status of Danish Women with Silicone Breast Implants (2004) reported that women who had breast implants for an average of 19 years were no more likely to report an excessive number of rheumatic disease symptoms than would the women of the control group.[106] The follow-up study Mortality Rates Among Augmentation Mammoplasty Patients: An Update (2006) reported a decreased standardized mortality ratio and an increased risk of lung cancer death among breast implant patients, than among patients for other types of plastic surgery; the mortality rate differences were attributed to tobacco smoking.[107] The study Mortality Among Canadian Women with Cosmetic Breast Implants (2006), about some 25,000 women with breast implants, reported a 43 per cent lower rate of breast cancer among them than among the general populace, and a lower-than-average risk of cancer.[108]\n\n\n\nYear\n\nCountry\n\nSystemic Review Group\n\nConclusions\n\n\n1991\u201393\n\nUnited Kingdom\n\nIndependent Expert Advisory Group (IEAG)\n\nThere was no evidence of an increased risk of connective-tissue disease in patients who had undergone silicone-gel breast implant emplacement, and no cause for changing either breast implant practice or policy in the U.K.\n\n\n1996\n\nUnited States\n\nU.S. Institute of Medicine (IOM)[109]\n\nThere was \"insufficient evidence for an association of silicone gel- or saline-filled breast implants with defined connective tissue disease.\"\n\n\n1996\n\nFrance\n\nAgence Nationale pour le Developpement de l\u2019Evaluation Medicale (ANDEM) [National Agency for Medical Development and Evaluation][110]\n\nFrench original: \"Nous n'avons pas observ\u00e9 de connectivit\u00e9 ni d'autre pathologie auto-immune susceptible d'\u00eatre directement ou indirectement induite par la pr\u00e9sence d'un implant mammaire en particulier en gel de silicone....\"\nEnglish translation: \"We did not observe connective tissue diseases to be directly or indirectly associated by the presence of a breast implant, in particular one of silicone gel....\"\n\n\n\n1997\n\nAustralia\n\nTherapeutic Devices Evaluation Committee (TDEC)\n\nThe \"current, high-quality literature suggest that there is no association between breast implants and connective tissue disease-like syndromes (atypical connective tissue diseases).\"[111]\n\n\n1998\n\nGermany\n\nFederal Institute for Medicine and Medical Products\n\nReported that \"silicone breast implants neither cause auto-immune diseases nor rheumatic diseases and have no disadvantageous effects on pregnancy, breast-feeding capability, or the health of children who are breast-fed. There is no scientific evidence for the existence of silicone allergy, silicone poisoning, atypical silicone diseases or a new silicone disease.\"[112]\n\n\n2000\n\nUnited States\n\nFederal court-ordered review[113]\n\n\"No evidence of an association between... silicone-gel-filled breast implants specifically, and any of the individual CTDs, all definite CTDs combined, or other auto-immune or rheumatic conditions.\"\n\n\n2000\n\nEuropean Union\n\nEuropean Committee on Quality Assurance & Medical Devices in Plastic Surgery (EQUAM)\n\n\"Additional medical studies have not demonstrated any association between silicone-gel filled breast implants and traditional auto-immune or connective tissue diseases, cancer, nor any other malignant disease. . . . EQUAM continues to believe that there is no scientific evidence that silicone allergy, silicone intoxication, atypical disease or a 'new silicone disease' exists.\"[114]\n\n\n2001\n\nUnited Kingdom\n\nUK Independent Review Group (UK-IRG)\n\n\"There is no evidence of an association with an abnormal immune response or typical or atypical connective tissue diseases or syndromes.\"[115]\n\n\n2001\n\nUnited States\n\nCourt-appointed National Science Panel review[116]\n\nThe panel evaluated established and undifferentiated connective tissue diseases (CTD), and concluded there was no causal evidence between breast implants and these CTDs.\n\n\n2003\n\nSpain\n\nScience and Technology Options Assessment (STOA)\n\nThe STOA report to the European Parliament Petitions Committee reported that the current scientific evidence demonstrates no solid, causal evidence linking SBI [silicone breast implants] to severe diseases, e.g. breast cancer, connective tissue diseases.[117]\n\n\n2009\n\nEuropean Union\n\nInternational Committee for Quality Assurance, Medical Technologies & Devices in Plastic Surgery panel (IQUAM)\n\nThe consensus statement of the Transatlantic Innovations conference (April 2009) indicated that additional medical studies demonstrated no association between silicone gel-filled breast implants and carcinoma, or any metabolic, immune, or allergic disorder.[118]\n\n\n\nSee also \n\nBreast\nBreast augmentation (Augmentation mammoplasty)\nBreast enlargement supplements\nBreast reconstruction\nBreast reduction plasty\nMammoplasty\nMastopexy (breast lift)\nPoly Implant Proth\u00e8se\nPolypropylene breast implants\nTrans-umbilical breast augmentation (TUBA)\n\nReferences \n\n\n^ Czerny V (1895). \"Plastischer Ersatz der Brusthus durch ein Lipoma\". Zentralblatt f\u00fcr Chirurgie. 27: 72. \n\n^ Bondurant S, Ernster V, Herdman R (eds); Committee on the Safety of Silicone Breast Implants (1999). Safety of Silicone Breast Implants. Institute of Medicine. p. 21. ISBN 0-309-06532-1. Archived from the original on 2007-03-13. CS1 maint: Uses authors parameter (link) \n\n^ Anderson N (1997). \"Lawsuit Science: Lessons from the Silicone Breast Implant Controversy\". New York Law School Law Review. 41 (2): 401\u201307. \n\n^ a b Stevens WG, Hirsch EM, Stoker DA, Cohen R (2006). \"In vitro Deflation of Pre-filled Saline Breast Implants\". Plastic and Reconstructive Surgery. 118 (2): 347\u2013349. doi:10.1097\/01.prs.0000227674.65284.80. PMID 16874200. \n\n^ \"Choosing Your Breast Implants\" (Web) . Minneapolis Plastic Surgery, LTD. Archived from the original on 24 November 2016. Retrieved 23 November 2016 . \n\n^ Arion HG (1965). \"Retromammary Prosthesis\". 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PMID 12627791 \n\n^ [2] \n\n^ Commissioner, Office of the. \"Safety Alerts for Human Medical Products - Breast Implants: Update - Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)\". www.fda.gov. Archived from the original on 28 April 2018. Retrieved 28 April 2018 . \n\n^ Health, Center for Devices and Radiological. \"Breast Implants - Medical Device Reports of Breast Implant-Associated Anaplastic Large Cell Lymphoma\". www.fda.gov. Archived from the original on 28 April 2018. Retrieved 28 April 2018 . \n\n^ a b Clemens, Mark. \"Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Archived 2017-03-26 at the Wayback Machine.\" (2017). \n\n^ Clemens, Mark W.; Horwitz, Steven M. (2017-03-01). \"NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma\". Aesthetic Surgery Journal. 37 (3): 285\u2013289. doi:10.1093\/asj\/sjw259. ISSN 1527-330X. PMID 28184418. \n\n^ \"Implant-associated ALCL Facts | The MD Anderson Foundation\". www.mdanderson.org. Archived from the original on 2017-12-09. Retrieved 2017-12-08 . \n\n^ \"Breast Implant Associated ALCL: PROFILE Project | The Plastic Surgery Foundation\". www.thepsf.org. Archived from the original on 2017-05-07. Retrieved 2017-04-25 . \n\n^ Breastfeeding after Breast Surgery Archived 2010-12-30 at the Wayback Machine., La Leche League, contains references. \n\n^ Breastfeeding and Breast Implants Archived 2010-12-31 at the Wayback Machine., Selected Bibliography April 2003, LLLI Center for Breastfeeding Information \n\n^ a b Inorganic Milk: Can Kendra Wilkinson breast-feed her baby even though she has implants? Archived 2010-01-25 at the Wayback Machine., Christopher Beam, Slate.com, 11 December 2009 \n\n^ Handel N, Silverstein MJ, Gamagami P, Jensen JA, Collins A (1992). \"Factors Affecting Mammographic Visualization of the Breast after Augmentation Mammaplasty\". JAMA. 268 (14): 1913\u20131917. doi:10.1001\/jama.268.14.1913. PMID 1404718. \n\n^ Clark CP, Peters GN, O'Brien KM (1993). \"Cancer in the Augmented Breast: Diagnosis and Prognosis\". Cancer. 72 (7): 2170&ndash, 4. doi:10.1002\/1097-0142(19931001)72:7<2170::AID-CNCR2820720717>3.0.CO;2-1. PMID 8374874. \n\n^ Skinner KA, Silberman H, Dougherty W, Gamagami P, Waisman J, Sposto R, Silverstein MJ (2001). \"Breast cancer after augmentation mammoplasty\". Ann Surg Oncol. 8 (2): 138&ndash, 44. doi:10.1007\/s10434-001-0138-x. PMID 11258778. \n\n^ a b Le GM, O'Malley CD, Glaser SL, Lynch CF, Stanford JL, Keegan TH, West DW (2005). \"Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival\". Breast Cancer Res. 7 (2): R184\u201393. doi:10.1186\/bcr974. PMC 1064128 . PMID 15743498. \n\n^ Handel N, Silverstein MJ (2006). \"Breast cancer diagnosis and prognosis in augmented women\". Plastic and Reconstructive Surgery. 118 (3): 587&ndash, 93. doi:10.1097\/01.prs.0000233038.47009.04. PMID 16932162. \n\n^ Cunningham B (2006). \"Breast cancer diagnosis and prognosis in augmented women- Discussion\". Plastic and Reconstructive Surgery. 118 (3): 594\u2013595. doi:10.1097\/01.prs.0000233047.87102.8e. \n\n^ Schwartz GF, Veronesi U, Clough KB, Dixon JM, Fentiman IS, Heywang-K\u00f6brunner SH, Holland R, Hughes KS, Mansel RE, Margolese R, Mendelson EB, Olivotto IA, Palazzo JP, Solin LJ (2006). \"Consensus Conference on Breast Conservation\". JACAS. 203 (2): 198\u2013207. doi:10.1016\/j.jamcollsurg.2006.04.009. PMID 16864033. \n\n^ Hwang ES; et al. (April 2013). \"Survival after Lumpectomy and Mastectomy for Early stage Invasive Breast Cancer: The Effect of Age and Hormone receptor Status\". Cancer. 119: 1402\u20131411. doi:10.1002\/cncr.27795. PMC 3604076 . \n\n^ a b c d e f g h FDA Breast Implant Consumer Handbook - 2004 Archived 2008-09-17 at the Wayback Machine. \n\n^ \"Safety of Silicone Breast Implants - The National Academies Press\". nap.edu. Archived from the original on 2008-11-19. \n\n^ Martha Grigg, Stuart Bondurant, Virginia L. Ernster, and Roger Herdman, Editors. \"Information for Women about the Safety of Silicone Breast Implants - The National Academies Press\". nap.edu. Archived from the original on 2008-08-21. CS1 maint: Uses authors parameter (link) \n\n^ FDA study Archived January 13, 2008, at the Wayback Machine. \n\n^ \"FDA approval\". fda.gov. Archived from the original on 30 March 2009. Retrieved 28 April 2018 . \n\n^ \"FDA approval\". fda.gov. Archived from the original on 26 May 2009. Retrieved 28 April 2018 . \n\n^ \"FDA Approves Silicone Gel-Filled Breast Implants\". FDA. Archived from the original on 2008-07-26. Retrieved 2008-07-01 . \n\n^ [3] Archived 2010-11-12 at the Wayback Machine. \n\n^ [4] Archived 2010-11-12 at the Wayback Machine. \n\n^ Breiting VB, H\u00f6lmich LR, Brandt B, Fryzek JP, Wolthers MS, Kj\u00f8ller K, McLaughlin JK, Wiik A, Friis S (2004). \"Long-term Health Status of Danish Women with Silicone Breast Implants\". Plastic and Reconstructive Surgery. 114 (1): 217\u2013226. doi:10.1097\/01.PRS.0000128823.77637.8A. PMID 15220596. \n\n^ Brinton LA, Lubin JH, Murray MC, Colton T, Hoover RN (2006). \"Mortality Rates Among Augmentation Mammoplasty Patients: An Update\". Epidemiology. 17 (2): 162&ndash, 9. doi:10.1097\/01.ede.0000197056.84629.19. PMID 16477256. \n\n^ Villeneuve PJ, Holowaty EJ, Brisson J, Xie L, Ugnat AM, Latulippe L, Mao Y (June 2006). \"Mortality Among Canadian Women with Cosmetic Breast Implants\". American Journal of Epidemiology. 164 (4): 334\u2013341. doi:10.1093\/aje\/kwj214. PMID 16777929. \n\n^ Brinton LA, Malone KE, Coates RJ, Schoenberg JB, Swanson CA, Daling JR, Stanford JL (1996). \"Breast Enlargement and Reduction: Results from a Breast Cancer Case-control Study\". Plastic and Reconstructive Surgery. 97 (2): 269\u2013275. doi:10.1097\/00006534-199602000-00001. PMID 8559808. \n\n^ Benadiba, Laurent (2004). \"Histoire des protheses mammaires\" (in French). Archived from the original on 29 January 2015. Retrieved 12 October 2015 . \n\n^ \"Archived copy\" (PDF) . Archived from the original (PDF) on 2007-01-01. Retrieved 2006-12-29 . CS1 maint: Archived copy as title (link) \n\n^ \"German Society for Senology, Declaration of Consensus for the Security of Silicone Breast Implants-24 September 1998\". 1998. \n\n^ Janowsky EC, Kupper LL, Hulka BS (2000). \"Meta-analyses of the Relation between Silicone Breast Implants and the Risk of Connective-tissue Diseases\". New England Journal of Medicine. 342 (11): 781\u2013790. doi:10.1056\/NEJM200003163421105. PMID 10717013. \n\n^ [5] Archived December 27, 2005, at the Wayback Machine. \n\n^ [6] Archived June 23, 2006, at the Wayback Machine. \n\n^ Tugwell P, Wells G, Peterson J, Welch V, Page J, Davison C, McGowan J, Ramroth D, Shea B (2001). \"Do silicone Breast Implants Cause Rheumatologic Disorders? A Systematic Review for a Court-appointed National Science Panel\". Arthritis Rheum. 44 (11): 2477&ndash, 84. doi:10.1002\/1529-0131(200111)44:11<2477::AID-ART427>3.0.CO;2-Q. PMID 11710703. \n\n^ https:\/\/web.archive.org\/web\/20030829114951\/http:\/\/www.eucomed.be\/docs\/STOA-SILICONE%20BREAST%20IMPLANT%20Study%20update-30May03.pdf \n\n^ Neuhann-Lorenz C, Fedeles J, Eisenman-Klein M, Kinney B, Cunningham BL (2001). \"Eighth IQUAM Consensus Position Statement: Transatlantic Innovations, April 2009\". Plastic and Reconstructive Surgery. 127 (3): 1368&ndash, 75. doi:10.1097\/PRS.0b013e318206312e. PMID 21364439. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Breast implants.\nArticle \"Expander-Implant Breast Reconstruction\" at Medscape\nvteOperations\/surgeries and other procedures of the breast (ICD-9-CM V3 85, ICD-10-PCS 0H)Breast surgery\nBreast-conserving surgery\nLumpectomy\nMastectomy\nRadical mastectomy\nMammoplasty\nBreast implant\nBreast reduction plasty\nSPAIR\nMastopexy\nBreast reconstruction\nBreast biopsy\nFine-needle aspiration \nInterventions on the Lactiferous ducts\nDuctal lavage\nDuctoscopy\nMicrodochectomy\nCentral duct excision\nBreast imaging\nMammography\nPositron emission mammography\nTomosynthesis\nXeromammography\nGalactography\nBreast MRI\nBreast ultrasound\nAutomated whole-breast ultrasound\nScintimammography\nTactile imaging\nOther\nBreast cancer screening\nBreast self-examination\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Breast_implant\">https:\/\/www.limswiki.org\/index.php\/Breast_implant<\/a>\n\t\t\t\t\tCategories: Body modificationImplants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:53.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 2,085 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","080c85ceaf86caa08168d9673750ed5c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Breast_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Breast implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>breast implant<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a> used to change the size, shape, and contour of a woman's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast\" title=\"Breast\" rel=\"external_link\" target=\"_blank\">breast<\/a>. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast mound for post\u2013<a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastectomy\" title=\"Mastectomy\" rel=\"external_link\" target=\"_blank\">mastectomy<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a> patients or to correct <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_defect\" class=\"mw-redirect\" title=\"Congenital defect\" rel=\"external_link\" target=\"_blank\">congenital defects<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_abnormality\" class=\"mw-redirect\" title=\"Congenital abnormality\" rel=\"external_link\" target=\"_blank\">deformities<\/a> of the chest wall. They are also used cosmetically to enhance or enlarge the appearance of the breast through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation surgery<\/a>.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_0\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:854px"><video id="mwe_player_1" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/Breast_Implant_Markings.ogv\/854px--Breast_Implant_Markings.ogv.jpg" controls="" preload="none" autoplay="" style="width:854px;height:480px" class="kskin" data-durationhint="16.066666666667" data-startoffset="0" data-mwtitle="Breast_Implant_Markings.ogv" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.480p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="SD WebM (480P)" data-shorttitle="WebM 480P" data-transcodekey="480p.webm" data-width="854" data-height="480" data-bandwidth="1001304" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.480p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="SD VP9 (480P)" data-shorttitle="VP9 480P" data-transcodekey="480p.vp9.webm" data-width="854" data-height="480" data-bandwidth="1191064" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.720p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="HD WebM (720P)" data-shorttitle="WebM 720P" data-transcodekey="720p.webm" data-width="1280" data-height="720" data-bandwidth="2184432" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.720p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="HD VP9 (720P)" data-shorttitle="VP9 720P" data-transcodekey="720p.vp9.webm" data-width="1280" data-height="720" data-bandwidth="2288416" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.1080p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Full HD WebM (1080P)" data-shorttitle="WebM 1080P" data-transcodekey="1080p.webm" data-width="1920" data-height="1080" data-bandwidth="4338648" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.1080p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Full HD VP9 (1080P)" data-shorttitle="VP9 1080P" data-transcodekey="1080p.vp9.webm" data-width="1920" data-height="1080" data-bandwidth="4944624" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/5\/57\/Breast_Implant_Markings.ogv" type="video\/ogg; codecs=&quot;theora&quot;" data-title="Original Ogg file, 1,920 \u00d7 1,080 (14.94 Mbps)" data-shorttitle="Ogg source" data-width="1920" data-height="1080" data-bandwidth="14936463" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="214" data-height="120" data-bandwidth="121448" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="284" data-height="160" data-bandwidth="128336" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="320" data-height="180" data-bandwidth="202536" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="426" data-height="240" data-bandwidth="252304" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="426" data-height="240" data-bandwidth="318544" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="640" data-height="360" data-bandwidth="503400" data-framerate="30"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/5\/57\/Breast_Implant_Markings.ogv\/Breast_Implant_Markings.ogv.360p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="640" data-height="360" data-bandwidth="616272" data-framerate="30"\/><\/video><\/div>\"><img alt=\"File:Breast Implant Markings.ogv\" style=\"width:220px;height:124px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/Breast_Implant_Markings.ogv\/220px--Breast_Implant_Markings.ogv.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/5\/57\/Breast_Implant_Markings.ogv\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Breast_Implant_Markings.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>(video) A doctor marking the chest for implants.<\/div><\/div><\/div>\n<p>There are three general types of <b>breast implant devices<\/b>, defined by their filler material: saline solution, silicone gel, and composite filler. The saline implant has an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomer<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> shell filled with sterile <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline solution<\/a> during surgery; the silicone implant has an elastomer silicone shell pre-filled with viscous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> gel; and the alternative composition implants featured miscellaneous fillers, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soy\" class=\"mw-redirect\" title=\"Soy\" rel=\"external_link\" target=\"_blank\">soy oil<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/String_breast_implant\" class=\"mw-redirect\" title=\"String breast implant\" rel=\"external_link\" target=\"_blank\">polypropylene string<\/a>, etc. Composite implants are typically not recommended for use anymore and, in fact, their use is banned in the United States and Europe due to associated health risks and complications.\n<\/p><p>In surgical practice, for the reconstruction of a breast, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_expansion\" title=\"Tissue expansion\" rel=\"external_link\" target=\"_blank\">tissue expander<\/a> device is a temporary breast prosthesis used to form and establish an implant pocket for the future permanent breast implant. For the correction of male breast defects and deformities, the pectoral implant is the breast prosthesis used for the reconstruction and the aesthetic repair of a man's chest wall (see: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gynecomastia\" title=\"Gynecomastia\" rel=\"external_link\" target=\"_blank\">gynecomastia<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastopexy\" title=\"Mastopexy\" rel=\"external_link\" target=\"_blank\">mastopexy<\/a>).\n<\/p>\n<div class=\"toclimit-3\">\n<\/div>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:187px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vincenz_Czerny.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Vincenz_Czerny.jpg\/185px-Vincenz_Czerny.jpg\" width=\"185\" height=\"285\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vincenz_Czerny.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Vincenz Czerny (1842\u20131916), a surgical pioneer in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a>.<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"19th_century\">19th century<\/span><\/h3>\n<p>Since the late nineteenth century, breast implants have been used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">surgically<\/a> augment the size (volume), modify the shape (contour), and enhance the feel (tact) of a woman's breasts. In 1895, surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vincenz_Czerny\" title=\"Vincenz Czerny\" rel=\"external_link\" target=\"_blank\">Vincenz Czerny<\/a> effected the earliest breast implant emplacement when he used the patient's autologous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_tissue\" title=\"Adipose tissue\" rel=\"external_link\" target=\"_blank\">adipose tissue<\/a>, harvested from a benign <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbar\" title=\"Lumbar\" rel=\"external_link\" target=\"_blank\">lumbar<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lipoma\" title=\"Lipoma\" rel=\"external_link\" target=\"_blank\">lipoma<\/a>, to repair the asymmetry of the breast from which he had removed a tumor.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> In 1889, surgeon Robert Gersuny experimented with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alkane\" title=\"Alkane\" rel=\"external_link\" target=\"_blank\">paraffin<\/a> injections, with disastrous results.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag needs further explanation. (October 2018)\">further explanation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"The_20th_century\">The 20th century<\/span><\/h3>\n<p>From the first half of the twentieth century, physicians used other substances as breast implant fillers\u2014<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ivory\" title=\"Ivory\" rel=\"external_link\" target=\"_blank\">ivory<\/a>, glass balls, ground <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rubber\" class=\"mw-redirect\" title=\"Rubber\" rel=\"external_link\" target=\"_blank\">rubber<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ox\" title=\"Ox\" rel=\"external_link\" target=\"_blank\">ox<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">cartilage<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Terylene\" class=\"mw-redirect\" title=\"Terylene\" rel=\"external_link\" target=\"_blank\">Terylene<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wool\" title=\"Wool\" rel=\"external_link\" target=\"_blank\">wool<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gutta-percha\" title=\"Gutta-percha\" rel=\"external_link\" target=\"_blank\">gutta-percha<\/a>, Dicora, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> chips, Ivalon (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_alcohol\" title=\"Polyvinyl alcohol\" rel=\"external_link\" target=\"_blank\">polyvinyl alcohol<\/a>\u2014formaldehyde polymer sponge), a polyethylene sac with Ivalon, polyether foam sponge (Etheron), polyethylene tape (Polystan) strips wound into a ball, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a> (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In the mid-twentieth century, Morton I. Berson, in 1945, and Jacques Maliniac, in 1950, each performed flap-based breast augmentations by rotating the patient's chest wall tissue into the breast to increase its volume. Furthermore, throughout the 1950s and the 1960s, plastic surgeons used synthetic fillers\u2014including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> injections received by some 50,000 women, from which developed silicone <a href=\"https:\/\/en.wikipedia.org\/wiki\/Granuloma\" title=\"Granuloma\" rel=\"external_link\" target=\"_blank\">granulomas<\/a> and breast hardening that required treatment by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastectomy\" title=\"Mastectomy\" rel=\"external_link\" target=\"_blank\">mastectomy<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> In 1961, the American plastic surgeons Thomas Cronin and Frank Gerow, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dow_Corning_Corporation\" class=\"mw-redirect\" title=\"Dow Corning Corporation\" rel=\"external_link\" target=\"_blank\">Dow Corning Corporation<\/a>, developed the first silicone breast prosthesis, filled with silicone gel; in due course, the first augmentation mammoplasty was performed in 1962 using the Cronin\u2013Gerow Implant, prosthesis model 1963. In 1964, the French company Laboratoires Arion developed and manufactured the saline breast implant, filled with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline solution<\/a>, and then introduced for use as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> in 1964.<sup id=\"rdp-ebb-cite_ref-Stevens_4-0\" class=\"reference\"><a href=\"#cite_note-Stevens-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Saline-filled_breast_implants.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Saline-filled_breast_implants.jpeg\/220px-Saline-filled_breast_implants.jpeg\" width=\"220\" height=\"157\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Saline-filled_breast_implants.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">Saline<\/a>-solution-filled breast implant device models.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Original_implant.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/7\/78\/Original_implant.jpg\/220px-Original_implant.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Original_implant.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The original breast implant: the Cronin\u2013Gerow Implant, prosthesis model 1963, was an anatomic tear-shaped design that featured a posterior fastener made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">Dacron<\/a>, to affix it in the implant pocket.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Silicone_gel-filled_breast_implants.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/32\/Silicone_gel-filled_breast_implants.jpeg\/220px-Silicone_gel-filled_breast_implants.jpeg\" width=\"220\" height=\"157\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Silicone_gel-filled_breast_implants.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Late-generation models of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> gel-filled prostheses.<\/div><\/div><\/div>\n<p>Today, there are two types of breast implants commonly used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammaplasty\" title=\"Mammaplasty\" rel=\"external_link\" target=\"_blank\">mammaplasty<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> procedures:<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<ol><li>saline implant filled with sterile <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline solution<\/a>.<\/li>\n<li>silicone implant filled with viscous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> gel.<\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Saline_implants\">Saline implants<\/span><\/h3>\n<p>The saline breast implant\u2014filled with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline solution<\/a> (biological-concentration salt water 0.90% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_concentration_(chemistry)\" title=\"Mass concentration (chemistry)\" rel=\"external_link\" target=\"_blank\">w\/v<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_chloride\" title=\"Sodium chloride\" rel=\"external_link\" target=\"_blank\">NaCl<\/a>, ca. 300 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osmolality\" class=\"mw-redirect\" title=\"Osmolality\" rel=\"external_link\" target=\"_blank\">mOsm<\/a>\/L.)\u2014was first manufactured by the Laboratoires Arion company, in France, and was introduced for use as a prosthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> in 1964. The contemporary models of saline breast implant are manufactured with thicker, room-temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vulcanization\" title=\"Vulcanization\" rel=\"external_link\" target=\"_blank\">vulcanized<\/a> (RTV) shells made of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomer<\/a>. The study <i>In vitro Deflation of Pre-filled Saline Breast Implants<\/i> (2006) reported that the rates of deflation (filler leakage) of the pre-filled saline breast implant made it a second-choice prosthesis for corrective breast surgery.<sup id=\"rdp-ebb-cite_ref-Stevens_4-1\" class=\"reference\"><a href=\"#cite_note-Stevens-4\" rel=\"external_link\">[4]<\/a><\/sup> Nonetheless, in the 1990s, the saline breast implant was the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a> most common device used for breast augmentation surgery in the United States, because of the U.S. FDA's restriction against the implantation of silicone-filled breast implants outside of clinical studies. Saline breast implants have enjoyed little popularity in the rest of the world, possessing negligible market share.\n<\/p><p>The technical goal of saline-implant technology was a physically less invasive surgical technique for emplacing an empty breast implant device through a smaller surgical incision.<sup id=\"rdp-ebb-cite_ref-Arion1965_6-0\" class=\"reference\"><a href=\"#cite_note-Arion1965-6\" rel=\"external_link\">[6]<\/a><\/sup> In surgical praxis, after having emplaced the empty breast implants to the implant pockets, the plastic surgeon then filled each device with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline solution<\/a>, and, because the required insertion-incisions are short and small, the resultant incision-scars will be smaller and shorter than the surgical scars usual to the long incisions required for inserting pre-filled, silicone-gel implants.\n<\/p><p>When compared to the results achieved with a silicone-gel breast implant, the saline implant can yield acceptable results, of increased breast-size, smoother hemisphere-contour, and realistic texture; yet, it is likelier to cause cosmetic problems, such as the rippling and the wrinkling of the breast-envelope skin, accelerated lower breast pole stretch, and technical problems, such as the presence of the implant being noticeable to the eye and to the touch. The occurrence of such cosmetic problems is likelier in the case of the woman with very little <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast\" title=\"Breast\" rel=\"external_link\" target=\"_blank\">breast<\/a> tissue, and in the case of the woman who requires <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastectomy\" title=\"Mastectomy\" rel=\"external_link\" target=\"_blank\">post-mastectomy<\/a> breast reconstruction; thus, the silicone-gel implant is the technically superior <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthetic<\/a> device for breast augmentation, and for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a>. In the case of the woman with much breast tissue, for whom sub-muscular emplacement is the recommended surgical approach, saline breast implants can produce an aesthetic result much like that afforded by silicone breast implants, albeit with greater implant palpability.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Silicone_gel_implants\">Silicone gel implants<\/span><\/h3>\n<p>As a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technology\" title=\"Technology\" rel=\"external_link\" target=\"_blank\">technology<\/a>, there are five generations of silicone breast implant, each defined by common model-manufacturing techniques.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The modern prosthetic breast was invented in 1961 by the American <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">plastic surgeons<\/a> Thomas Cronin and Frank Gerow, and manufactured by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dow_Corning_Corporation\" class=\"mw-redirect\" title=\"Dow Corning Corporation\" rel=\"external_link\" target=\"_blank\">Dow Corning Corporation<\/a>; in due course, the first augmentation mammoplasty was performed in 1962.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"First_generation\">First generation<\/span><\/h4>\n<p>The Cronin\u2013Gerow Implant, prosthesis model 1963, was a silicone rubber envelope-sac, shaped like a teardrop, which was filled with viscous silicone-gel. To reduce the rotation of the emplaced breast implant upon the chest wall, the model 1963 prosthesis was affixed to the implant pocket with a fastener-patch, made of Dacron material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">Polyethylene terephthalate<\/a>), which was attached to the rear of the breast implant shell.<sup id=\"rdp-ebb-cite_ref-Cronin_1963_8-0\" class=\"reference\"><a href=\"#cite_note-Cronin_1963-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Second_generation\">Second generation<\/span><\/h4>\n<p>In the 1970s, manufacturers presented the second generation of breast implant prostheses that featured functional developments and aesthetic improvements to the technology:\n<\/p>\n<ul><li>the first technological developments were a thinner-gauge device-shell, and a filler gel of low-cohesion silicone, which improved the functionality and the verisimilitude (size, appearance, and texture) of the silicone-gel breast implant. Yet, in clinical practice, second-generation breast implants proved fragile, and suffered greater incidences of shell rupture, and of filler leakage (\"silicone-gel bleed\") through the intact device shell. The consequent, increased incidence-rates of medical complications (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a>) precipitated faulty-product, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Class_action\" title=\"Class action\" rel=\"external_link\" target=\"_blank\">class action-lawsuits<\/a>, by the U.S. government, against the Dow Corning Corporation, and other manufacturers of breast prostheses.<\/li>\n<li>the second technological development was a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane foam coating<\/a> for the shell of the breast implant; the coating reduced the incidence of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a>, by causing an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammatory reaction<\/a> that impeded the formation of a capsule of fibrous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> tissue around the breast implant. Nevertheless, despite that prophylactic measure, the medical use of polyurethane-coated breast implants was briefly discontinued, because of the potential health-risk posed by 2,4-toluenediamine (TDA), a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carcinogen\" title=\"Carcinogen\" rel=\"external_link\" target=\"_blank\">carcinogenic<\/a> by-product of the chemical breakdown of the polyurethane foam coating of the breast implant.<sup id=\"rdp-ebb-cite_ref-Luu11998_9-0\" class=\"reference\"><a href=\"#cite_note-Luu11998-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li><\/ul>\n<dl><dd>After reviewing the medical data, the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> concluded that TDA-induced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a> was an infinitesimal health-risk to women with breast implants, and did not justify legally requiring physicians to explain the matter to their patients. In the event, polyurethane-coated breast implants remain in plastic surgery practice in Europe and in South America; and no manufacturer has sought FDA approval for medical sales of such breast implants in the U.S.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><\/dd><\/dl>\n<ul><li>the third technological development was the double lumen breast implant device, a double-cavity prosthesis composed of a silicone breast implant contained within a saline breast implant. The two-fold, technical goal was: (i) the cosmetic benefits of silicone-gel (the inner lumen) enclosed in saline solution (the outer lumen); (ii) a breast implant device the volume of which is post-operatively adjustable. Nevertheless, the more complex design of the double-lumen breast implant suffered a device-failure rate greater than that of single-lumen breast implants. The contemporary versions of second-generation breast implant devices (presented in 1984) are the \"Becker Expandable\" models of breast implant, which are primarily used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reconstructive_surgery\" title=\"Reconstructive surgery\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a>.<\/li><\/ul>\n<h4><span class=\"mw-headline\" id=\"Third_and_Fourth_generations\">Third and Fourth generations<\/span><\/h4>\n<p>In the 1980s, the models of the Third and of the Fourth generations of breast implant devices were sequential advances in manufacturing technology, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomer<\/a>-coated shells that decreased gel-bleed (filler leakage), and a thicker (increased-cohesion) filler gel. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sociology_of_health_and_illness\" title=\"Sociology of health and illness\" rel=\"external_link\" target=\"_blank\">Sociologically<\/a>, the manufacturers of prosthetic breasts then designed and made anatomic models (natural breast) and shaped models (round, tapered) that realistically corresponded with the breast- and body- types of women. The tapered models of breast implant have a uniformly textured surface, which reduces the rotation of the prosthesis within the implant pocket; the round models of breast implant are available in smooth-surface- and textured-surface- types.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Fifth_generation\">Fifth generation<\/span><\/h4>\n<p>Since the mid-1990s, the fifth generation of silicone-gel breast implant is made of a high-strength, highly cohesive silicone gel that mostly eliminates the occurrences of filler leakage (\u201csilicone gel bleed\u201d) and of the migration of the silicone filler from the implant pocket to elsewhere in the woman's body. These implants are commonly referred to as \"gummy bear breast implants\" for their firm, pliant consistency, which is similar to gummy candies. The studies <i>Experience with Anatomical Soft Cohesive Silicone gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery<\/i> (2004) and <i>Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery<\/i> (2005) reported low incidence-rates of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a> and of device-shell rupture; and greater rates of improved medical-safety and technical-efficacy than that of early generation breast implant devices.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Psychology\">Psychology<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_dysmorphic_disorder\" title=\"Body dysmorphic disorder\" rel=\"external_link\" target=\"_blank\">Body dysmorphic disorder<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_image\" title=\"Body image\" rel=\"external_link\" target=\"_blank\">Body image<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beauty\" title=\"Beauty\" rel=\"external_link\" target=\"_blank\">Beauty<\/a><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> patient usually is a young woman whose personality profile indicates psychological distress about her personal appearance and her bodily <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self_image\" class=\"mw-redirect\" title=\"Self image\" rel=\"external_link\" target=\"_blank\">self image<\/a>, and a history of having endured criticism (teasing) about the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aesthetics\" title=\"Aesthetics\" rel=\"external_link\" target=\"_blank\">aesthetics<\/a> of her person.<sup id=\"rdp-ebb-cite_ref-Brinton2000_14-0\" class=\"reference\"><a href=\"#cite_note-Brinton2000-14\" rel=\"external_link\">[14]<\/a><\/sup> The studies <i>Body Image Concerns of Breast Augmentation Patients<\/i> (2003) and <i>Body Dysmorphic Disorder and Cosmetic Surgery<\/i> (2006) reported that the woman who underwent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> surgery also had undergone <a href=\"https:\/\/en.wikipedia.org\/wiki\/Psychotherapy\" title=\"Psychotherapy\" rel=\"external_link\" target=\"_blank\">psychotherapy<\/a>, suffered low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-esteem\" title=\"Self-esteem\" rel=\"external_link\" target=\"_blank\">self-esteem<\/a>, presented frequent occurrences of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Depression_(mood)\" title=\"Depression (mood)\" rel=\"external_link\" target=\"_blank\">psychological depression<\/a>, had attempted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suicide\" title=\"Suicide\" rel=\"external_link\" target=\"_blank\">suicide<\/a>, and suffered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_dysmorphia\" class=\"mw-redirect\" title=\"Body dysmorphia\" rel=\"external_link\" target=\"_blank\">body dysmorphia<\/a>, a type of mental illness.\n<\/p><p>Post-operative patient surveys about mental health and quality-of-life, reported improved physical health, physical appearance, social life, self-confidence, self-esteem, and satisfactory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_attraction\" title=\"Sexual attraction\" rel=\"external_link\" target=\"_blank\">sexual functioning<\/a>. Furthermore, the women reported long-term satisfaction with their breast implant outcomes; some despite having suffered medical complications that required surgical revision, either corrective or aesthetic. Likewise, in Denmark, 8 per cent of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> patients had a pre-operative history of psychiatric hospitalization.<sup id=\"rdp-ebb-cite_ref-Jacobsen_PH_2004_15-0\" class=\"reference\"><a href=\"#cite_note-Jacobsen_PH_2004-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Young1994_16-0\" class=\"reference\"><a href=\"#cite_note-Young1994-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Crerand_2006_17-0\" class=\"reference\"><a href=\"#cite_note-Crerand_2006-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Sarwer2003_18-0\" class=\"reference\"><a href=\"#cite_note-Sarwer2003-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-chahraoui2006_19-0\" class=\"reference\"><a href=\"#cite_note-chahraoui2006-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Cash2002_20-0\" class=\"reference\"><a href=\"#cite_note-Cash2002-20\" rel=\"external_link\">[20]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Haas2007_21-0\" class=\"reference\"><a href=\"#cite_note-Haas2007-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Inamed2006_22-0\" class=\"reference\"><a href=\"#cite_note-Inamed2006-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HandelN_23-0\" class=\"reference\"><a href=\"#cite_note-HandelN-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>In 2008, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Longitudinal_study\" title=\"Longitudinal study\" rel=\"external_link\" target=\"_blank\">longitudinal study<\/a> <i>Excess Mortality from Suicide and other External Causes of Death Among Women with Cosmetic Breast Implants<\/i> (2007), reported that women who sought breast implants are almost 3 times as likely to commit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suicide\" title=\"Suicide\" rel=\"external_link\" target=\"_blank\">suicide<\/a> as are women who have not sought breast implants. Compared to the standard suicide-rate for women of the general populace, the suicide-rate for women with augmented breasts remained constant until 10-years post-implantation, yet, it increased to 4.5 times greater at the 11-year mark, and so remained until the 19-year mark, when it increased to 6 times greater at 20-years post-implantation. Moreover, additional to the suicide-risk, women with breast implants also faced a trebled death-risk from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcoholism\" title=\"Alcoholism\" rel=\"external_link\" target=\"_blank\">alcoholism<\/a> and the abuse of prescription and recreational drugs.<sup id=\"rdp-ebb-cite_ref-reuters.com_24-0\" class=\"reference\"><a href=\"#cite_note-reuters.com-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-usatoday.com_25-0\" class=\"reference\"><a href=\"#cite_note-usatoday.com-25\" rel=\"external_link\">[25]<\/a><\/sup> Although seven studies have statistically connected a woman's breast augmentation to a greater suicide-rate, the research indicates that breast augmentation surgery does not increase the death rate; and that, in the first instance, it is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Psychopathology\" title=\"Psychopathology\" rel=\"external_link\" target=\"_blank\">psychopathologically<\/a>-inclined woman who is more likely to undergo a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> procedure.<sup id=\"rdp-ebb-cite_ref-pmid11306343_26-0\" class=\"reference\"><a href=\"#cite_note-pmid11306343-26\" rel=\"external_link\">[26]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid12623911_27-0\" class=\"reference\"><a href=\"#cite_note-pmid12623911-27\" rel=\"external_link\">[27]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid14520056_28-0\" class=\"reference\"><a href=\"#cite_note-pmid14520056-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid16777929_29-0\" class=\"reference\"><a href=\"#cite_note-pmid16777929-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid16477256_30-0\" class=\"reference\"><a href=\"#cite_note-pmid16477256-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>The study <i>Effect of Breast Augmentation Mammoplasty on Self-Esteem and Sexuality: A Quantitative Analysis<\/i> (2007), reported that the women attributed their improved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self_image\" class=\"mw-redirect\" title=\"Self image\" rel=\"external_link\" target=\"_blank\">self image<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-esteem\" title=\"Self-esteem\" rel=\"external_link\" target=\"_blank\">self-esteem<\/a>, and increased, satisfactory sexual functioning to having undergone breast augmentation; the cohort, aged 21\u201357 years, averaged post-operative self-esteem increases that ranged from 20.7 to 24.9 points on the 30-point <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rosenberg_self-esteem_scale\" title=\"Rosenberg self-esteem scale\" rel=\"external_link\" target=\"_blank\">Rosenberg self-esteem scale<\/a>, which data supported the 78.6 per cent increase in the woman's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Libido\" title=\"Libido\" rel=\"external_link\" target=\"_blank\">libido<\/a>, relative to her pre-operative level of libido.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> Therefore, before agreeing to any surgery, the plastic surgeon evaluates and considers the woman's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mental_health\" title=\"Mental health\" rel=\"external_link\" target=\"_blank\">mental health<\/a> to determine if breast implants can positively affect her self-esteem and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_attraction\" title=\"Sexual attraction\" rel=\"external_link\" target=\"_blank\">sexual functioning<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_procedures\">Surgical procedures<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h3>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammoplasty\" class=\"mw-redirect\" title=\"Mammoplasty\" rel=\"external_link\" target=\"_blank\">mammoplasty<\/a> procedure for the placement of breast implant devices has three (3) purposes:\n<\/p>\n<ol><li>primary reconstruction: the replacement of breast tissues damaged by trauma (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Blunt_trauma\" title=\"Blunt trauma\" rel=\"external_link\" target=\"_blank\">blunt<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penetrating_trauma\" title=\"Penetrating trauma\" rel=\"external_link\" target=\"_blank\">penetrating<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blast_injury\" title=\"Blast injury\" rel=\"external_link\" target=\"_blank\">blast<\/a>), disease (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a>), and failed anatomic development (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuberous_breast_deformity\" class=\"mw-redirect\" title=\"Tuberous breast deformity\" rel=\"external_link\" target=\"_blank\">tuberous breast deformity<\/a>).<\/li>\n<li>revision and reconstruction: to revise (correct) the outcome of a previous breast reconstruction surgery.<\/li>\n<li>primary augmentation: to aesthetically <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">augment<\/a> the size, form, and feel of the breasts.<\/li><\/ol>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_room\" class=\"mw-redirect\" title=\"Operating room\" rel=\"external_link\" target=\"_blank\">operating room<\/a> (OR) time of post\u2013<a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastectomy\" title=\"Mastectomy\" rel=\"external_link\" target=\"_blank\">mastectomy<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a>, and of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> surgery is determined by the procedure employed, the type of incisions, the breast implant (type and materials), and the pectoral locale of the implant pocket.\n<\/p><p>Recent research has indicated that mammograms should not be done with any increased frequency than used in normal procedure in patients undergoing breast surgery, including breast implant, augmentation, mastopexy, and breast reducation.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Incision_types\">Incision types<\/span><\/h3>\n<p>Breast implant emplacement is performed with five (5) types of surgical incisions:\n<\/p>\n<ol><li>Inframammary: an incision made to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infra-mammary_fold\" class=\"mw-redirect\" title=\"Infra-mammary fold\" rel=\"external_link\" target=\"_blank\">inframammary fold<\/a> (natural crease under your breast), which affords maximal access for precise dissection of the tissues and emplacement of the breast implants. It is the preferred surgical technique for emplacing silicone-gel implants, because it better exposes the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast\" title=\"Breast\" rel=\"external_link\" target=\"_blank\">breast tissue<\/a>\u2013<a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_major_muscle\" class=\"mw-redirect\" title=\"Pectoralis major muscle\" rel=\"external_link\" target=\"_blank\">pectoralis muscle<\/a> interface; yet, IMF implantation can produce thicker, slightly more visible surgical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scars<\/a>.<\/li>\n<li>Periareolar: a border-line incision along the periphery of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Areola\" title=\"Areola\" rel=\"external_link\" target=\"_blank\">areola<\/a>, which provides an optimal approach when adjustments to the IMF position are required, or when a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastopexy\" title=\"Mastopexy\" rel=\"external_link\" target=\"_blank\">mastopexy<\/a> (breast lift) is included to the primary mammoplasty procedure. In periareolar emplacement, the incision is around the medial-half (inferior half) of the areola's circumference. Silicone gel implants can be difficult to emplace via periareolar incision, because of the short, five-centimetre length (~ 5.0 cm) of the required access-incision. Aesthetically, because the scars are at the areola's border (periphery), they usually are less visible than the IMF-incision scars of women with light-pigment areolae; when compared to cutaneous-incision scars, the modified <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epithelium\" title=\"Epithelium\" rel=\"external_link\" target=\"_blank\">epithelia<\/a> of the areolae are less prone to (raised) hypertrophic scars.<\/li>\n<li>Transaxillary: an incision made to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axilla\" title=\"Axilla\" rel=\"external_link\" target=\"_blank\">axilla<\/a> (armpit), from which the dissection tunnels medially, to emplace the implants, either bluntly or with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a> (illuminated video microcamera), without producing visible scars on the breast proper; yet, it is likelier to produce inferior asymmetry of the implant-device position. Therefore, surgical revision of transaxillary emplaced breast implants usually requires either an IMF incision or a periareolar incision.<\/li>\n<li>Transumbilical: a trans-umbilical breast augmentation (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Trans-umbilical_breast_augmentation\" title=\"Trans-umbilical breast augmentation\" rel=\"external_link\" target=\"_blank\">TUBA<\/a>) is a less common implant-device emplacement technique wherein the incision is at the umbilicus (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Navel\" title=\"Navel\" rel=\"external_link\" target=\"_blank\">navel<\/a>), and the dissection tunnels superiorly, up towards the bust. The TUBA approach allows emplacing the breast implants without producing visible scars upon the breast proper; but makes appropriate dissection and device-emplacement more technically difficult. A TUBA procedure is performed bluntly\u2014without the endoscope's visual assistance\u2014and is not appropriate for emplacing (pre-filled) silicone-gel implants, because of the great potential for damaging the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomer<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> shell of the breast implant during its manual insertion through the short (~2.0 cm) incision at the navel, and because pre-filled silicone gel implants are incompressible, and cannot be inserted through so small an incision.<sup id=\"rdp-ebb-cite_ref-johnson_34-0\" class=\"reference\"><a href=\"#cite_note-johnson-34\" rel=\"external_link\">[34]<\/a><\/sup><\/li>\n<li>Transabdominal: as in the TUBA procedure, in the transabdominoplasty breast augmentation (TABA), the breast implants are tunneled superiorly from the abdominal incision into bluntly dissected implant pockets, whilst the patient simultaneously undergoes an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominoplasty\" title=\"Abdominoplasty\" rel=\"external_link\" target=\"_blank\">abdominoplasty<\/a>.<sup id=\"rdp-ebb-cite_ref-TABA_35-0\" class=\"reference\"><a href=\"#cite_note-TABA-35\" rel=\"external_link\">[35]<\/a><\/sup><\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Implant_pocket_placement\">Implant pocket placement<\/span><\/h3>\n<div class=\"thumb tmulti tright\"><div class=\"thumbinner\" style=\"width:442px;max-width:442px\"><div style=\"clear:both;font-weight:bold;text-align:center;background-color:transparent\">Implant placement comparison<\/div><div class=\"tsingle\" style=\"float:left;margin:1px;width:152px;max-width:152px\"><div class=\"thumbimage\" style=\"height:186px;overflow:hidden\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Subglandular_breast_implants.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Subglandular breast implant diagram\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Subglandular_breast_implants.png\/150px-Subglandular_breast_implants.png\" width=\"150\" height=\"186\" \/><\/a><\/div><div class=\"thumbcaption\" style=\"clear:left;text-align:center\">Subglandular implant<\/div><\/div><div class=\"tsingle\" style=\"float:left;margin:1px;width:142px;max-width:142px\"><div class=\"thumbimage\" style=\"height:186px;overflow:hidden\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Subpectoral_breast_implants.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Subpectoral breast implant diagram\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/Subpectoral_breast_implants.png\/140px-Subpectoral_breast_implants.png\" width=\"140\" height=\"187\" \/><\/a><\/div><div class=\"thumbcaption\" style=\"clear:left;text-align:center\">Subpectoral implant<\/div><\/div><div class=\"tsingle\" style=\"float:left;margin:1px;width:142px;max-width:142px\"><div class=\"thumbimage\" style=\"height:186px;overflow:hidden\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Submuscular_breast_implants.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Submuscular breast implant diagram\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/ff\/Submuscular_breast_implants.png\/140px-Submuscular_breast_implants.png\" width=\"140\" height=\"187\" \/><\/a><\/div><div class=\"thumbcaption\" style=\"clear:left;text-align:center\">Submuscular implant<\/div><\/div><div style=\"clear:left\"><\/div><\/div><\/div>\n<p>The four <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> approaches to emplacing a breast implant to the implant pocket are described in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_anatomy\" class=\"mw-redirect\" title=\"Human anatomy\" rel=\"external_link\" target=\"_blank\">anatomical<\/a> relation to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_major_muscle\" class=\"mw-redirect\" title=\"Pectoralis major muscle\" rel=\"external_link\" target=\"_blank\">pectoralis major muscle<\/a>.\n<\/p>\n<ol><li>Subglandular: the breast implant is emplaced to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retromammary_space\" title=\"Retromammary space\" rel=\"external_link\" target=\"_blank\">retromammary space<\/a>, between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammary_gland\" title=\"Mammary gland\" rel=\"external_link\" target=\"_blank\">breast tissue<\/a> (the mammary gland) and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_major_muscle\" class=\"mw-redirect\" title=\"Pectoralis major muscle\" rel=\"external_link\" target=\"_blank\">pectoralis major muscle<\/a> (major muscle of the chest), which most approximates the plane of normal breast tissue, and affords the most aesthetic results. Yet, in women with thin pectoral soft-tissue, the subglandular position is likelier to show the ripples and wrinkles of the underlying implant. Moreover, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a> incidence rate is slightly greater with subglandular implantation.<\/li>\n<li>Subfascial: the breast implant is emplaced beneath the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fascia\" title=\"Fascia\" rel=\"external_link\" target=\"_blank\">fascia<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_major_muscle\" class=\"mw-redirect\" title=\"Pectoralis major muscle\" rel=\"external_link\" target=\"_blank\">pectoralis major muscle<\/a>; the subfascial position is a variant of the subglandular position for the breast implant.<sup id=\"rdp-ebb-cite_ref-Graf_36-0\" class=\"reference\"><a href=\"#cite_note-Graf-36\" rel=\"external_link\">[36]<\/a><\/sup> The technical advantages of the subfascial implant-pocket technique are debated; proponent surgeons report that the layer of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fascia\" title=\"Fascia\" rel=\"external_link\" target=\"_blank\">fascial tissue<\/a> provides greater implant coverage and better sustains its position.<sup id=\"rdp-ebb-cite_ref-subfascial_37-0\" class=\"reference\"><a href=\"#cite_note-subfascial-37\" rel=\"external_link\">[37]<\/a><\/sup><\/li>\n<li>Subpectoral (dual plane): the breast implant is emplaced beneath the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_major_muscle\" class=\"mw-redirect\" title=\"Pectoralis major muscle\" rel=\"external_link\" target=\"_blank\">pectoralis major muscle<\/a>, after the surgeon releases the inferior muscular attachments, with or without partial dissection of the subglandular plane. Resultantly, the upper pole of the implant is partially beneath the pectoralis major muscle, while the lower pole of the implant is in the subglandular plane. This implantation technique achieves maximal coverage of the upper pole of the implant, whilst allowing the expansion of the implant's lower pole; however, \u201canimation deformity\u201d, the movement of the implants in the subpectoral plane can be excessive for some patients.<sup id=\"rdp-ebb-cite_ref-Tebbettsdual_38-0\" class=\"reference\"><a href=\"#cite_note-Tebbettsdual-38\" rel=\"external_link\">[38]<\/a><\/sup><\/li>\n<li>Submuscular: the breast implant is emplaced beneath the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_major_muscle\" class=\"mw-redirect\" title=\"Pectoralis major muscle\" rel=\"external_link\" target=\"_blank\">pectoralis major muscle<\/a>, without releasing the inferior origin of the muscle proper. Total muscular coverage of the implant can be achieved by releasing the lateral muscles of the chest wall\u2014either the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Serratus_muscle\" class=\"mw-redirect\" title=\"Serratus muscle\" rel=\"external_link\" target=\"_blank\">serratus muscle<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_minor_muscle\" class=\"mw-redirect\" title=\"Pectoralis minor muscle\" rel=\"external_link\" target=\"_blank\">pectoralis minor muscle<\/a>, or both\u2014and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">suturing<\/a> it, or them, to the pectoralis major muscle. In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a> surgery, the submuscular implantation approach effects maximal coverage of the breast implants. This technique is rarely used in cosmetic surgery due to high risk of animation deformities.<\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Post-surgical_recovery\">Post-surgical recovery<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scars<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammoplasty\" class=\"mw-redirect\" title=\"Mammoplasty\" rel=\"external_link\" target=\"_blank\">mammoplasty<\/a> develop approximately at 6-weeks post-operative, and fade within months. Depending upon the daily-life physical activities required of the woman, the breast augmentation patient usually resumes her normal life at 1-week post-operative. Moreover, women whose breast implants were emplaced beneath the chest muscles (submuscular placement) usually have a longer, slightly more painful convalescence, because of the healing of the incisions to the chest muscles. Usually, she does not exercise or engage in strenuous physical activities for approximately 6 weeks. During the initial post-operative recovery, the woman is encouraged to regularly exercise (flex and move) her arm to alleviate pain and discomfort; if required, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic\" title=\"Analgesic\" rel=\"external_link\" target=\"_blank\">analgesic<\/a> indwelling medication catheters can alleviate pain<sup id=\"rdp-ebb-cite_ref-pmid19083538_39-0\" class=\"reference\"><a href=\"#cite_note-pmid19083538-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid19083591_40-0\" class=\"reference\"><a href=\"#cite_note-pmid19083591-40\" rel=\"external_link\">[40]<\/a><\/sup> Moreover, significantly improved patient recovery has resulted from refined breast-device implantation techniques (submuscular, subglandular) that allow 95 per cent of women to resume their normal lives at 24-hours post-procedure, without bandages, fluid drains, pain pumps, catheters, medical support brassi\u00e8res, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Narcotic\" title=\"Narcotic\" rel=\"external_link\" target=\"_blank\">narcotic<\/a> pain medication.<sup id=\"rdp-ebb-cite_ref-pmid11964998_41-0\" class=\"reference\"><a href=\"#cite_note-pmid11964998-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid16327616_42-0\" class=\"reference\"><a href=\"#cite_note-pmid16327616-42\" rel=\"external_link\">[42]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid11786826_43-0\" class=\"reference\"><a href=\"#cite_note-pmid11786826-43\" rel=\"external_link\">[43]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid11786828_44-0\" class=\"reference\"><a href=\"#cite_note-pmid11786828-44\" rel=\"external_link\">[44]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">plastic surgical<\/a> emplacement of breast implant devices, either for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a> or for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">aesthetic purpose<\/a>, presents the same health risks common to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>, such as adverse reaction to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia\" title=\"Anesthesia\" rel=\"external_link\" target=\"_blank\">anesthesia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_hematoma\" title=\"Breast hematoma\" rel=\"external_link\" target=\"_blank\">hematoma<\/a> (post-operative bleeding), late hematoma (post-operative bleeding after 6 months or more),<sup id=\"rdp-ebb-cite_ref-Grippaudo2013_45-0\" class=\"reference\"><a href=\"#cite_note-Grippaudo2013-45\" rel=\"external_link\">[45]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seroma\" title=\"Seroma\" rel=\"external_link\" target=\"_blank\">seroma<\/a> (fluid accumulation), incision-site breakdown (wound infection). Complications specific to breast augmentation include breast pain, altered sensation, impeded breast-feeding function, visible wrinkling, asymmetry, thinning of the breast tissue, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Symmastia\" title=\"Symmastia\" rel=\"external_link\" target=\"_blank\">symmastia<\/a>, the \u201cbread loafing\u201d of the bust that interrupts the natural plane between the breasts. Specific treatments for the complications of indwelling breast implants\u2014<a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a> and capsular rupture\u2014are periodic <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> monitoring and physical examinations. Furthermore, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complications_(medical)\" class=\"mw-redirect\" title=\"Complications (medical)\" rel=\"external_link\" target=\"_blank\">complications<\/a> and re-operations related to the implantation surgery, and to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_expansion\" title=\"Tissue expansion\" rel=\"external_link\" target=\"_blank\">tissue expanders<\/a> (implant place-holders during surgery) can cause unfavorable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scarring<\/a> in approximately 6\u20137 per cent of the patients.\n<sup id=\"rdp-ebb-cite_ref-AUG_2006_46-0\" class=\"reference\"><a href=\"#cite_note-AUG_2006-46\" rel=\"external_link\">[46]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MMG_2006_47-0\" class=\"reference\"><a href=\"#cite_note-MMG_2006-47\" rel=\"external_link\">[47]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDA_2004d_48-0\" class=\"reference\"><a href=\"#cite_note-FDA_2004d-48\" rel=\"external_link\">[48]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Statistics\" title=\"Statistics\" rel=\"external_link\" target=\"_blank\">Statistically<\/a>, 20 per cent of women who underwent cosmetic implantation, and 50 per cent of women who underwent breast reconstruction implantation, required their explantation at the 10-year mark.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Implant_rupture\">Implant rupture<\/span><\/h3>\n<p>Because a breast implant is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Class III medical device<\/a> of limited product-life, the principal rupture-rate factors are its age and design; Nonetheless, a breast implant device can retain its mechanical integrity for decades in a woman's body.<sup id=\"rdp-ebb-cite_ref-Brown2000_50-0\" class=\"reference\"><a href=\"#cite_note-Brown2000-50\" rel=\"external_link\">[50]<\/a><\/sup> When a saline breast implant ruptures, leaks, and empties, it quickly deflates, and thus can be readily explanted (surgically removed). The follow-up report, <i>Natrelle Saline-filled Breast Implants: a Prospective 10-year Study<\/i> (2009) indicated rupture-deflation rates of 3\u20135 per cent at 3-years post-implantation, and 7\u201310 per cent rupture-deflation rates at 10-years post-implantation.<sup id=\"rdp-ebb-cite_ref-Walker2009_51-0\" class=\"reference\"><a href=\"#cite_note-Walker2009-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ruptured_implant.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/52\/Ruptured_implant.JPG\/250px-Ruptured_implant.JPG\" width=\"250\" height=\"188\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ruptured_implant.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A breast implant failure: the parts of a surgically explanted breast implant are the red, fibrous capsule (left), the ruptured silicone implant (center), and the transparent filler-gel that leaked with the capsule (right).<\/div><\/div><\/div>\n<p>When a silicone breast implant ruptures it usually does not deflate, yet the filler gel does leak from it, which can migrate to the implant pocket; therefore, an intracapsular rupture (in-capsule leak) can become an extracapsular rupture (out-of-capsule leak), and each occurrence is resolved by explantation. Although the leaked silicone filler-gel can migrate from the chest tissues to elsewhere in the woman's body, most clinical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complication_(medicine)\" title=\"Complication (medicine)\" rel=\"external_link\" target=\"_blank\">complications<\/a> are limited to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast\" title=\"Breast\" rel=\"external_link\" target=\"_blank\">breast<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axilla\" title=\"Axilla\" rel=\"external_link\" target=\"_blank\">armpit<\/a> areas, usually manifested as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Granuloma\" title=\"Granuloma\" rel=\"external_link\" target=\"_blank\">granulomas<\/a> (inflammatory nodules) and axillary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lymphadenopathy\" title=\"Lymphadenopathy\" rel=\"external_link\" target=\"_blank\">lymphadenopathy<\/a> (enlarged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lymph_node\" title=\"Lymph node\" rel=\"external_link\" target=\"_blank\">lymph glands<\/a> in the armpit area).<sup id=\"rdp-ebb-cite_ref-Holmich2004_52-0\" class=\"reference\"><a href=\"#cite_note-Holmich2004-52\" rel=\"external_link\">[52]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Katzin_2005_53-0\" class=\"reference\"><a href=\"#cite_note-Katzin_2005-53\" rel=\"external_link\">[53]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDA_2004c_54-0\" class=\"reference\"><a href=\"#cite_note-FDA_2004c-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/p><p>The suspected mechanisms of breast implant rupture are:\n<\/p>\n<ul><li>damage during implantation<\/li>\n<li>damage during (other) surgical procedures<\/li>\n<li>chemical degradation of the breast implant shell<\/li>\n<li>trauma (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Blunt_trauma\" title=\"Blunt trauma\" rel=\"external_link\" target=\"_blank\">blunt trauma<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penetrating_trauma\" title=\"Penetrating trauma\" rel=\"external_link\" target=\"_blank\">penetrating trauma<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blast_injury\" title=\"Blast injury\" rel=\"external_link\" target=\"_blank\">blast trauma<\/a>)<\/li>\n<li>mechanical pressure of traditional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammography\" title=\"Mammography\" rel=\"external_link\" target=\"_blank\">mammographic<\/a> breast examination <sup id=\"rdp-ebb-cite_ref-FDA_2004b_55-0\" class=\"reference\"><a href=\"#cite_note-FDA_2004b-55\" rel=\"external_link\">[55]<\/a><\/sup><\/li><\/ul>\n<p>Silicone implant rupture can be evaluated using magnetic resonance imaging; from the long-term <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> data for single-lumen breast implants, the European literature about second generation silicone-gel breast implants (1970s design), reported silent device-rupture rates of 8\u201315 per cent at 10-years post-implantation (15\u201330% of the patients).<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Holmich2003_57-0\" class=\"reference\"><a href=\"#cite_note-Holmich2003-57\" rel=\"external_link\">[57]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Heden2006_58-0\" class=\"reference\"><a href=\"#cite_note-Heden2006-58\" rel=\"external_link\">[58]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Collis2005_59-0\" class=\"reference\"><a href=\"#cite_note-Collis2005-59\" rel=\"external_link\">[59]<\/a><\/sup>\n<\/p><p>The study <i>Safety and Effectiveness of Mentor\u2019s MemoryGel Implants at 6 Years<\/i> (2009), which was a branch study of the U.S. FDA's core <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trial\" title=\"Clinical trial\" rel=\"external_link\" target=\"_blank\">clinical trials<\/a> for primary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> surgery patients, reported low device-rupture rates of 1.1 per cent at 6-years post-implantation.<sup id=\"rdp-ebb-cite_ref-cunningham2009_60-0\" class=\"reference\"><a href=\"#cite_note-cunningham2009-60\" rel=\"external_link\">[60]<\/a><\/sup> The first series of <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> evaluations of the silicone breast implants with thick filler-gel reported a device-rupture rate of 1 percent, or less, at the median 6-year device-age.<sup id=\"rdp-ebb-cite_ref-Heden_61-0\" class=\"reference\"><a href=\"#cite_note-Heden-61\" rel=\"external_link\">[61]<\/a><\/sup> Statistically, the manual examination (palpation) of the woman is inadequate for accurately evaluating if a breast implant has ruptured. The study, <i>The Diagnosis of Silicone Breast implant Rupture: Clinical Findings Compared with Findings at Magnetic Resonance Imaging<\/i> (2005), reported that, in asymptomatic patients, only 30 per cent of the ruptured breast implants are accurately palpated and detected by an experienced plastic surgeon, whereas MRI examinations accurately detected 86 per cent of breast implant ruptures.<sup id=\"rdp-ebb-cite_ref-Holmich2005_62-0\" class=\"reference\"><a href=\"#cite_note-Holmich2005-62\" rel=\"external_link\">[62]<\/a><\/sup> Therefore, the U.S. FDA recommended scheduled MRI examinations, as silent-rupture screenings, beginning at the 3-year-mark post-implantation, and then every two years, thereafter.<sup id=\"rdp-ebb-cite_ref-AUG_2006_46-1\" class=\"reference\"><a href=\"#cite_note-AUG_2006-46\" rel=\"external_link\">[46]<\/a><\/sup> Nonetheless, beyond the U.S., the medical establishments of other nations have not endorsed routine MRI screening, and, in its stead, proposed that such a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiology\" title=\"Radiology\" rel=\"external_link\" target=\"_blank\">radiologic<\/a> examination be reserved for two purposes: (i) for the woman with a suspected breast implant rupture; and (ii) for the confirmation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammography\" title=\"Mammography\" rel=\"external_link\" target=\"_blank\">mammographic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasonic<\/a> studies that indicate the presence of a ruptured breast implant.<sup id=\"rdp-ebb-cite_ref-Canada_2005_63-0\" class=\"reference\"><a href=\"#cite_note-Canada_2005-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p><p>Furthermore, <i>The Effect of Study design Biases on the Diagnostic Accuracy of Magnetic Resonance Imaging for Detecting Silicone Breast Implant Ruptures: a Meta-analysis<\/i> (2011) reported that the breast-screening MRIs of asymptomatic women might overestimate the incidence of breast implant rupture.<sup id=\"rdp-ebb-cite_ref-song2011_64-0\" class=\"reference\"><a href=\"#cite_note-song2011-64\" rel=\"external_link\">[64]<\/a><\/sup> In the event, the U.S. Food and Drug Administration emphasised that \u201cbreast implants are not lifetime devices. The longer a woman has silicone gel-filled breast implants, the more likely she is to experience complications.\u201d<sup id=\"rdp-ebb-cite_ref-65\" class=\"reference\"><a href=\"#cite_note-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Capsular_contracture\">Capsular contracture<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">Capsular contracture<\/a><\/div>\n<p>The human body's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a> to a surgically installed foreign object\u2014breast implant, cardiac <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">pacemaker<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic\" class=\"mw-redirect\" title=\"Orthopedic\" rel=\"external_link\" target=\"_blank\">orthopedic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a>\u2014is to encapsulate it with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar tissue<\/a> capsules of tightly woven <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> fibers, in order to maintain the integrity of the body by isolating the foreign object, and so tolerate its presence. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">Capsular contracture<\/a>\u2014which should be distinguished from normal capsular tissue\u2014occurs when the collagen-fiber capsule thickens and compresses the breast implant; it is a painful <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complication_(medical)\" class=\"mw-redirect\" title=\"Complication (medical)\" rel=\"external_link\" target=\"_blank\">complication<\/a> that might distort either the breast implant, or the breast, or both.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Capsular_fibrosis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a6\/Capsular_fibrosis.jpg\/220px-Capsular_fibrosis.jpg\" width=\"220\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Capsular_fibrosis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A breast implant failure: capsular contracture is a medical complication, in this case, a Baker scale Grade IV contraction, of a subglandular silicone implant in the right breast.<\/div><\/div><\/div>\n<p>The cause of capsular contracture is unknown, but the common incidence factors include bacterial contamination, device-shell rupture, filler leakage, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hematoma\" title=\"Hematoma\" rel=\"external_link\" target=\"_blank\">hematoma<\/a>. The surgical implantation procedures that have reduced the incidence of capsular contracture include submuscular emplacement, the use of breast implants with a textured surface (polyurethane-coated);<sup id=\"rdp-ebb-cite_ref-Barnsley2006_66-0\" class=\"reference\"><a href=\"#cite_note-Barnsley2006-66\" rel=\"external_link\">[66]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Wong2006_67-0\" class=\"reference\"><a href=\"#cite_note-Wong2006-67\" rel=\"external_link\">[67]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HandelGut2006_68-0\" class=\"reference\"><a href=\"#cite_note-HandelGut2006-68\" rel=\"external_link\">[68]<\/a><\/sup> limited pre-operative handling of the implants, limited contact with the chest skin of the implant pocket before the emplacement of the breast implant, and irrigation of the recipient site with triple-antibiotic solutions.<sup id=\"rdp-ebb-cite_ref-Mladick1993_69-0\" class=\"reference\"><a href=\"#cite_note-Mladick1993-69\" rel=\"external_link\">[69]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Adams2006_70-0\" class=\"reference\"><a href=\"#cite_note-Adams2006-70\" rel=\"external_link\">[70]<\/a><\/sup>\n<\/p><p>The correction of capsular contracture might require an open capsulotomy (surgical release) of the collagen-fiber capsule, or the removal, and possible replacement, of the breast implant. Furthermore, in treating capsular contracture, the closed capsulotomy (disruption via external manipulation) once was a common maneuver for treating hard capsules, but now is a discouraged technique, because it can rupture the breast implant. Non-surgical treatments for collagen-fiber capsules include massage, external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasound\" title=\"Medical ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasonic<\/a> therapy, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Leukotriene_antagonist\" class=\"mw-redirect\" title=\"Leukotriene antagonist\" rel=\"external_link\" target=\"_blank\">leukotriene pathway inhibitors<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zafirlukast\" title=\"Zafirlukast\" rel=\"external_link\" target=\"_blank\">zafirlukast<\/a> (Accolate) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Montelukast\" title=\"Montelukast\" rel=\"external_link\" target=\"_blank\">montelukast<\/a> (Singulair), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsed_Electromagnetic_Field_Therapy\" class=\"mw-redirect\" title=\"Pulsed Electromagnetic Field Therapy\" rel=\"external_link\" target=\"_blank\">pulsed electromagnetic field therapy<\/a> (PEMFT).<sup id=\"rdp-ebb-cite_ref-Planas2001_71-0\" class=\"reference\"><a href=\"#cite_note-Planas2001-71\" rel=\"external_link\">[71]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Schlesinger2002_72-0\" class=\"reference\"><a href=\"#cite_note-Schlesinger2002-72\" rel=\"external_link\">[72]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Scuderi_73-0\" class=\"reference\"><a href=\"#cite_note-Scuderi-73\" rel=\"external_link\">[73]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Silver1982_74-0\" class=\"reference\"><a href=\"#cite_note-Silver1982-74\" rel=\"external_link\">[74]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Repair_and_revision_surgeries\">Repair and revision surgeries<\/span><\/h3>\n<p>When the patient is unsatisfied with the outcome of the augmentation mammoplasty; or when technical or medical complications occur; or because of the breast implants\u2019 limited product life, it is likely she might require replacing the breast implants. Common revision surgery indications include major and minor medical complications, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a>, shell rupture, and device deflation.<sup id=\"rdp-ebb-cite_ref-FDA_2004b_55-1\" class=\"reference\"><a href=\"#cite_note-FDA_2004b-55\" rel=\"external_link\">[55]<\/a><\/sup> Revision incidence rates were greater for breast reconstruction patients, because of the post-mastectomy changes to the soft-tissues and to the skin envelope of the breast, and to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_anatomy\" class=\"mw-redirect\" title=\"Human anatomy\" rel=\"external_link\" target=\"_blank\">anatomical<\/a> borders of the breast, especially in women who received adjuvant external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiation_therapy\" title=\"Radiation therapy\" rel=\"external_link\" target=\"_blank\">radiation therapy<\/a>.<sup id=\"rdp-ebb-cite_ref-FDA_2004b_55-2\" class=\"reference\"><a href=\"#cite_note-FDA_2004b-55\" rel=\"external_link\">[55]<\/a><\/sup> Moreover, besides breast reconstruction, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a> patients usually undergo revision surgery of the nipple-areola complex (NAC), and symmetry procedures upon the opposite breast, to create a bust of natural appearance, size, form, and feel. Carefully matching the type and size of the breast implants to the patient's pectoral soft-tissue characteristics reduces the incidence of revision surgery. Appropriate tissue matching, implant selection, and proper implantation technique, the re-operation rate was 3 percent at the 7-year-mark, compared with the re-operation rate of 20 per cent at the 3-year-mark, as reported by the U.S. Food and Drug Administration.<sup id=\"rdp-ebb-cite_ref-Tebbets2006_75-0\" class=\"reference\"><a href=\"#cite_note-Tebbets2006-75\" rel=\"external_link\">[75]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Tebbets2_76-0\" class=\"reference\"><a href=\"#cite_note-Tebbets2-76\" rel=\"external_link\">[76]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Systemic_Illness_and_ALCL_Cancer\">Systemic Illness and ALCL Cancer<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BreastImplant09.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fe\/BreastImplant09.JPG\/220px-BreastImplant09.JPG\" width=\"220\" height=\"260\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BreastImplant09.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Chest X-ray showing breast implants<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Claims_of_Systemic_disease_and_sickness\">Claims of Systemic disease and sickness<\/span><\/h3>\n<p>Since the early 1990s, a number of independent systemic comprehensive reviews have examined studies concerning links between silicone gel breast implants and claims of systemic diseases. The consensus of these reviews (outlined below under Safety of Breast Implants heading) is that there has been no evidence of a causal link between the implantation of saline or silicone breast implants and systemic disease After investigating this issue, the U.S. FDA has concurred and since reaffirmed that \u201cthe weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants.\u201d. A comprehensive systemic review by Lipworth (2011) <sup id=\"rdp-ebb-cite_ref-77\" class=\"reference\"><a href=\"#cite_note-77\" rel=\"external_link\">[77]<\/a><\/sup> concludes that \"any claims that remain regarding an association between cosmetic breast implants and CTDs are not supported by the scientific literature\".\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Platinum_toxicity\">Platinum toxicity<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum\" title=\"Platinum\" rel=\"external_link\" target=\"_blank\">Platinum<\/a> is a catalyst used in the making of silicone implant polymer shells and other silicone devices used in medicine. The literature indicates that small amounts of platinum leaches (leaks) from these implants and is present in the surrounding tissue. The FDA reviewed the available studies from the medical literature on platinum and breast implants in 2002 and concluded there was little evidence suggesting toxicity from platinum in implant patients.<sup id=\"rdp-ebb-cite_ref-78\" class=\"reference\"><a href=\"#cite_note-78\" rel=\"external_link\">[78]<\/a><\/sup> The FDA revisited this study and additional literature several years later, reaffirming prior conclusions that platinum catalysts used in implants is likely not ionized and therefore would not represent a risk to women.<sup id=\"rdp-ebb-cite_ref-FDA_Backgrounder_on_Platinum_in_breast_implants_79-0\" class=\"reference\"><a href=\"#cite_note-FDA_Backgrounder_on_Platinum_in_breast_implants-79\" rel=\"external_link\">[79]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Anaplastic_large_cell_lymphoma\">Anaplastic large cell lymphoma<\/span><\/h3>\n<p>The FDA has identified that breast implants may be associated with a rare form of cancer called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaplastic_large-cell_lymphoma\" title=\"Anaplastic large-cell lymphoma\" rel=\"external_link\" target=\"_blank\">anaplastic large-cell lymphoma<\/a>, believed to be associated with chronic bacterial inflammation.<sup id=\"rdp-ebb-cite_ref-80\" class=\"reference\"><a href=\"#cite_note-80\" rel=\"external_link\">[80]<\/a><\/sup> Similar ALCL phenomena have been seen with other types of medical implants including vascular access ports, orthopedic hip implants, and jaw (TMJ) implants. As of February 1, 2017, the FDA has received a total of 359 medical device reports of breast-implant-associated ALCL (BIALCL), including 9 deaths.<sup id=\"rdp-ebb-cite_ref-81\" class=\"reference\"><a href=\"#cite_note-81\" rel=\"external_link\">[81]<\/a><\/sup> Most cases of breast implant-associated ALCL had implants in for many years prior to the condition, and are usually treated successfully by simple removal of the implant and the capsule surrounding the implant without the need for chemotherapy if no evidence of systemic disease exists. If women with implants present with delayed swelling or fluid collection, cytologic studies and test for a marker \"CD30\" are suggested. The American Society of Plastic Surgery (ASPS) states, \"CD30 is the main diagnostic test that must be performed on the seroma fluid as routine pathology or H&E staining can frequently miss the diagnosis.\" <sup id=\"rdp-ebb-cite_ref-plasticsurgery.org_82-0\" class=\"reference\"><a href=\"#cite_note-plasticsurgery.org-82\" rel=\"external_link\">[82]<\/a><\/sup> Diagnosis and treatment of breast implant associated ALCL now follows standardized guidelines established by the National Comprehensive Cancer Network.<sup id=\"rdp-ebb-cite_ref-83\" class=\"reference\"><a href=\"#cite_note-83\" rel=\"external_link\">[83]<\/a><\/sup>\n<\/p><p>The current lifetime risk of BIA-ALCL in the U.S. is unknown, but estimates have ranged between estimated to be between 1 in 70,000 to 1 in 500,000 women with breast implants according to MD Anderson.<sup id=\"rdp-ebb-cite_ref-84\" class=\"reference\"><a href=\"#cite_note-84\" rel=\"external_link\">[84]<\/a><\/sup> Certain geographic locations have demonstrated variable risks. For instance, a December 2016 update from the Therapeutic Goods Administration of Australia and New Zealand reported a risk of <b>1:1,000 to 1:10,000 for textured implants.\"<\/b>.<sup id=\"rdp-ebb-cite_ref-plasticsurgery.org_82-1\" class=\"reference\"><a href=\"#cite_note-plasticsurgery.org-82\" rel=\"external_link\">[82]<\/a><\/sup> To date (2017), there has not been a case of BIAL reported where the patient had only implantation of smooth shell breast implants or a textured tissue expander that was exchanged for a smooth implant. The paucity of cases reported in Asian populations has raised the possibility that there may be a range of genetic susceptibility to the phenomena, or alternatively merely reflect differences in how cases are identified and reported.\n<\/p><p>The ASPS and the Plastic Surgery Foundation (PSF) have partnered with the FDA to study this condition and in doing so created the Patient Registry and Outcomes For breast Implants and anaplastic large cell Lymphoma Etiology and epidemiology (PROFILE). The United States FDA strongly encourages all physicians to report cases to PROFILE in an effort to better understand the role of breast implants in ALCL and the management of this disease.<sup id=\"rdp-ebb-cite_ref-85\" class=\"reference\"><a href=\"#cite_note-85\" rel=\"external_link\">[85]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implants_and_breast-feeding\">Implants and breast-feeding<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Breast_anatomy_normal_scheme.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Breast_anatomy_normal_scheme.png\/220px-Breast_anatomy_normal_scheme.png\" width=\"220\" height=\"254\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Breast_anatomy_normal_scheme.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cross-section scheme of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammary_gland\" title=\"Mammary gland\" rel=\"external_link\" target=\"_blank\">mammary gland<\/a>. <div><ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_wall\" class=\"mw-redirect\" title=\"Chest wall\" rel=\"external_link\" target=\"_blank\">Chest wall<\/a><\/li><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_muscle\" class=\"mw-redirect\" title=\"Pectoralis muscle\" rel=\"external_link\" target=\"_blank\">Pectoralis muscles<\/a><\/li><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lobules\" class=\"mw-redirect\" title=\"Lobules\" rel=\"external_link\" target=\"_blank\">Lobules<\/a><\/li><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nipple\" title=\"Nipple\" rel=\"external_link\" target=\"_blank\">Nipple<\/a><\/li><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Areola\" title=\"Areola\" rel=\"external_link\" target=\"_blank\">Areola<\/a><\/li><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lactiferous_duct\" title=\"Lactiferous duct\" rel=\"external_link\" target=\"_blank\">Milk duct<\/a><\/li><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_tissue\" title=\"Adipose tissue\" rel=\"external_link\" target=\"_blank\">Fatty tissue<\/a><\/li><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_skin\" title=\"Human skin\" rel=\"external_link\" target=\"_blank\">Skin envelope<\/a><\/li><\/ol><\/div><\/div><\/div><\/div>\n<p>The presence of breast implants currently presents no contraindication to breast feeding, and no evidence to support that the practice may present health issues to a breast feeding infant is recognized by the USFDA.\n<\/p><p>Women with breast implants may have functional breast-feeding difficulties; mammoplasty procedures that feature periareolar incisions are especially likely to cause breast-feeding difficulties. Surgery may also damage the lactiferous ducts and the nerves in the nipple-areola area.<sup id=\"rdp-ebb-cite_ref-86\" class=\"reference\"><a href=\"#cite_note-86\" rel=\"external_link\">[86]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-87\" class=\"reference\"><a href=\"#cite_note-87\" rel=\"external_link\">[87]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-slate_88-0\" class=\"reference\"><a href=\"#cite_note-slate-88\" rel=\"external_link\">[88]<\/a><\/sup>\n<\/p><p>Functional breast-feeding difficulties arise if the surgeon cut the milk ducts or the major nerves innervating the breast, or if the milk glands were otherwise damaged. Milk duct and nerve damage are more common if the incisions cut tissue near the nipple. The milk glands are most likely to be affected by subglandular implants (under the gland), and by large-sized breast implants, which pinch the lactiferous ducts and impede milk flow. Small-sized breast implants, and submuscular implantation, cause fewer breast-function problems; however, it is impossible to predict whether a woman who undergoes breast augmentation will be able to successfully breast feed since some women are able to breast-feed after periareolar incisions and subglandular placement and some are not able to after augmentation using submuscular and other types of surgical incisions.<sup id=\"rdp-ebb-cite_ref-slate_88-1\" class=\"reference\"><a href=\"#cite_note-slate-88\" rel=\"external_link\">[88]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implants_and_mammography\">Implants and mammography<\/span><\/h2>\n<p>The presence of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiology\" title=\"Radiology\" rel=\"external_link\" target=\"_blank\">radiologically<\/a> opaque breast implants (either saline or silicone) might interfere with the radiographic sensitivity of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammograph\" class=\"mw-redirect\" title=\"Mammograph\" rel=\"external_link\" target=\"_blank\">mammograph<\/a>, that is, the image might not show any tumor(s) present. In this case, an Eklund view mammogram is required to ascertain either the presence or the absence of a cancerous tumor, wherein the breast implant is manually displaced against the chest wall and the breast is pulled forward, so that the mammograph can visualize a greater volume of the internal tissues; nonetheless, approximately one-third of the breast tissue remains inadequately visualized, resulting in an increased incidence of mammograms with false-negative results.<sup id=\"rdp-ebb-cite_ref-Handel1992_89-0\" class=\"reference\"><a href=\"#cite_note-Handel1992-89\" rel=\"external_link\">[89]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mammo_breast_cancer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Mammo_breast_cancer.jpg\/220px-Mammo_breast_cancer.jpg\" width=\"220\" height=\"161\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mammo_breast_cancer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A mammograph of a normal breast (left);a mammograph of a cancerous breast (right).<\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a> studies <i> Cancer in the Augmented Breast: Diagnosis and Prognosis<\/i> (1993) and <i>Breast Cancer after Augmentation Mammoplasty<\/i> (2001) of women with breast implant prostheses reported no significant differences in disease-stage at the time of the diagnosis of cancer; prognoses are similar in both groups of women, with augmented patients at a lower risk for subsequent cancer recurrence or death.<sup id=\"rdp-ebb-cite_ref-Clark1993_90-0\" class=\"reference\"><a href=\"#cite_note-Clark1993-90\" rel=\"external_link\">[90]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Skinner2001_91-0\" class=\"reference\"><a href=\"#cite_note-Skinner2001-91\" rel=\"external_link\">[91]<\/a><\/sup> Conversely, the use of implants for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a> <i>after<\/i> breast cancer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastectomy\" title=\"Mastectomy\" rel=\"external_link\" target=\"_blank\">mastectomy<\/a> appears to have no negative effect upon the incidence of cancer-related death.<sup id=\"rdp-ebb-cite_ref-Lee2005_92-0\" class=\"reference\"><a href=\"#cite_note-Lee2005-92\" rel=\"external_link\">[92]<\/a><\/sup> That patients with breast implants are more often diagnosed with palpable\u2014but not larger\u2014tumors indicates that equal-sized tumors might be more readily palpated in augmented patients, which might compensate for the impaired mammogram images.<sup id=\"rdp-ebb-cite_ref-HandelSilver2006_93-0\" class=\"reference\"><a href=\"#cite_note-HandelSilver2006-93\" rel=\"external_link\">[93]<\/a><\/sup> The ready palpability of the breast-cancer tumor(s) is consequent to breast tissue thinning by compression, innately in smaller breasts <i>a priori<\/i> (because they have lesser tissue volumes), and that the implant serves as a radio-opaque base against which a cancerous tumor can be differentiated.<sup id=\"rdp-ebb-cite_ref-Cunningham2006_94-0\" class=\"reference\"><a href=\"#cite_note-Cunningham2006-94\" rel=\"external_link\">[94]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Breast_MRI_Implant_T1FSE_T2FSE_InPhase_STIR_Silicon_23.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Breast_MRI_Implant_T1FSE_T2FSE_InPhase_STIR_Silicon_23.jpg\/220px-Breast_MRI_Implant_T1FSE_T2FSE_InPhase_STIR_Silicon_23.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Breast_MRI_Implant_T1FSE_T2FSE_InPhase_STIR_Silicon_23.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Breast MRI of a patient with implant (Blue)<\/div><\/div><\/div>\n<p>The breast implant has no clinical bearing upon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumpectomy\" title=\"Lumpectomy\" rel=\"external_link\" target=\"_blank\">lumpectomy<\/a> breast-conservation surgery for women who developed breast cancer after the implantation procedure, nor does the breast implant interfere with external beam radiation treatments (XRT); moreover, the post-treatment incidence of breast-tissue fibrosis is common, and thus a consequent increased rate of capsular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contracture\" title=\"Contracture\" rel=\"external_link\" target=\"_blank\">contracture<\/a>.<sup id=\"rdp-ebb-cite_ref-Scwartz2006_95-0\" class=\"reference\"><a href=\"#cite_note-Scwartz2006-95\" rel=\"external_link\">[95]<\/a><\/sup> The study <i>Breast Cancer Detection and Survival among Women with Cosmetic Breast Implants: Systematic Review and Meta-analysis of Observational Studies<\/i>, reported an average later stage in the diagnoses of women who developed breast cancer after undergoing breast augmentation, when compared to breast cancer patients who had not undergone breast augmentation, although this did not ultimately affect the patients prognosis. The use of implants for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a> <i>after<\/i> breast cancer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastectomy\" title=\"Mastectomy\" rel=\"external_link\" target=\"_blank\">mastectomy<\/a> appears to have no negative effect upon the incidence of cancer-related death.<sup id=\"rdp-ebb-cite_ref-Lee2005_92-1\" class=\"reference\"><a href=\"#cite_note-Lee2005-92\" rel=\"external_link\">[92]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-96\" class=\"reference\"><a href=\"#cite_note-96\" rel=\"external_link\">[96]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"U.S._FDA_approval\">U.S. FDA approval<\/span><\/h2>\n<p>In 1988, twenty-six years after the 1962 introduction of breast implants filled with silicone gel, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Food_and_Drug_Administration\" class=\"mw-redirect\" title=\"U.S. Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a> (FDA) investigated breast implant failures and the subsequent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complications_(medical)\" class=\"mw-redirect\" title=\"Complications (medical)\" rel=\"external_link\" target=\"_blank\">complications<\/a>, and re-classified breast implant devices as Class III medical devices, and required from manufacturers the documentary data substantiating the safety and efficacy of their breast implant devices.<sup id=\"rdp-ebb-cite_ref-FDABICH_97-0\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup> In 1992, the FDA placed silicone-gel breast implants in moratorium in the U.S., because there was \u201cinadequate information to demonstrate that breast implants were safe and effective\u201d. Nonetheless, medical access to silicone-gel breast implant devices continued for clinical studies of post-mastectomy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a>, the correction of congenital deformities, and the replacement of ruptured silicone-gel implants. The FDA required from the manufacturers the clinical trial data, and permitted their providing breast implants to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> patients for the statistical studies required by the U.S. Food and Drug Administration.<sup id=\"rdp-ebb-cite_ref-FDABICH_97-1\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup> In mid\u20131992, the FDA approved an adjunct study protocol for silicone-gel filled implants for breast reconstruction patients, and for revision-surgery patients. Also in 1992, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dow_Corning_Corporation\" class=\"mw-redirect\" title=\"Dow Corning Corporation\" rel=\"external_link\" target=\"_blank\">Dow Corning Corporation<\/a>, a silicone products and breast implant manufacturer, announced the discontinuation of five implant-grade <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicones<\/a>, but would continue producing 45 other, medical-grade, silicone materials\u2014three years later, in 1995, the Dow Corning Corporation went <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bankruptcy\" title=\"Bankruptcy\" rel=\"external_link\" target=\"_blank\">bankrupt<\/a> when it faced large class action lawsuits claiming a variety of illnesses.<sup id=\"rdp-ebb-cite_ref-FDABICH_97-2\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup>\n<\/p>\n<ul><li>In 1997, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Department_of_Health_and_Human_Services\" class=\"mw-redirect\" title=\"U.S. Department of Health and Human Services\" rel=\"external_link\" target=\"_blank\">U.S. Department of Health and Human Services<\/a> (HHS) appointed the Institute of Medicine (IOM) of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_National_Academy_of_Sciences\" class=\"mw-redirect\" title=\"United States National Academy of Sciences\" rel=\"external_link\" target=\"_blank\">U.S. National Academy of Sciences<\/a> (NAS) to investigate the potential risks of operative and post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complication_(medical)\" class=\"mw-redirect\" title=\"Complication (medical)\" rel=\"external_link\" target=\"_blank\">complications<\/a> from the emplacement of silicone breast implants. The IOM's review of the safety and efficacy of silicone gel-filled breast implants, reported that the \"evidence suggests diseases or conditions, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">connective tissue<\/a> diseases, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancer<\/a>, neurological diseases, or other systemic complaints or conditions are no more common in women with breast implants, than in women without implants\" subsequent studies and systemic review found no causal link between silicone breast implants and disease.<sup id=\"rdp-ebb-cite_ref-FDABICH_97-3\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup><\/li><\/ul>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Seal_of_the_United_States_Department_of_Health_and_Human_Services.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/79\/Seal_of_the_United_States_Department_of_Health_and_Human_Services.svg\/220px-Seal_of_the_United_States_Department_of_Health_and_Human_Services.svg.png\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Seal_of_the_United_States_Department_of_Health_and_Human_Services.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The U.S. Department of Health and Human Services verifies the scientific, medical, and clinical data of medical devices.<\/div><\/div><\/div>\n<ul><li>In 1998, the U.S. FDA approved adjunct study protocols for silicone-gel filled implants only for breast reconstruction patients and for revision-surgery patients; and also approved the Dow Corning Corporation's Investigational Device Exemption (IDE) study for silicone-gel breast implants for a limited number of breast augmentation-, reconstruction-, and revision-surgery patients.<sup id=\"rdp-ebb-cite_ref-FDABICH_97-4\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup><\/li>\n<li>In 1999, the Institute of Medicine published the <i>Safety of Silicone Breast Implants<\/i> (1999) study that reported no evidence that saline-filled and silicone-gel filled breast implant devices caused systemic health problems; that their use posed no new health or safety risks; and that local complications are \u201cthe primary safety issue with silicone breast implants\u201d, in distinguishing among routine and local medical complications and systemic health concerns.\u201d<sup id=\"rdp-ebb-cite_ref-FDABICH_97-5\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-98\" class=\"reference\"><a href=\"#cite_note-98\" rel=\"external_link\">[98]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-99\" class=\"reference\"><a href=\"#cite_note-99\" rel=\"external_link\">[99]<\/a><\/sup><\/li>\n<li>In 2000, the FDA approved saline breast implant Premarket Approval Applications (PMA) containing the type and rate data of the local medical complications experienced by the breast surgery patients.<sup id=\"rdp-ebb-cite_ref-100\" class=\"reference\"><a href=\"#cite_note-100\" rel=\"external_link\">[100]<\/a><\/sup> \"Despite complications experienced by some women, the majority of those women still in the and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mentor_(company)\" title=\"Mentor (company)\" rel=\"external_link\" target=\"_blank\">Mentor Corporation<\/a> studies, after three years, reported being satisfied with their implants.\"<sup id=\"rdp-ebb-cite_ref-FDABICH_97-6\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup> The premarket approvals were granted for breast augmentation, for women at least 18 years old, and for women requiring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">breast reconstruction<\/a>.<sup id=\"rdp-ebb-cite_ref-101\" class=\"reference\"><a href=\"#cite_note-101\" rel=\"external_link\">[101]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-102\" class=\"reference\"><a href=\"#cite_note-102\" rel=\"external_link\">[102]<\/a><\/sup><\/li>\n<li>In 2006, for the Inamed Corporation and for the Mentor Corporation, the U.S. Food and Drug Administration lifted its restrictions against using silicone-gel breast implants for breast reconstruction and for augmentation mammoplasty. Yet, the approval was conditional upon accepting FDA monitoring, the completion of 10-year-mark studies of the women who already had the breast implants, and the completion of a second, 10-year-mark study of the safety of the breast implants in 40,000 other women.<sup id=\"rdp-ebb-cite_ref-103\" class=\"reference\"><a href=\"#cite_note-103\" rel=\"external_link\">[103]<\/a><\/sup> The FDA warned the public that breast implants do carry medical risks, and recommended that women who undergo <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">breast augmentation<\/a> should periodically undergo <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI<\/a> examinations to screen for signs of either shell rupture or of filler leakage, or both conditions; and ordered that breast surgery patients be provided with detailed, informational brochures explaining the medical risks of using silicone-gel breast implants.<sup id=\"rdp-ebb-cite_ref-FDABICH_97-7\" class=\"reference\"><a href=\"#cite_note-FDABICH-97\" rel=\"external_link\">[97]<\/a><\/sup><\/li><\/ul>\n<p>The U.S. Food and Drug Administration established the age ranges for women seeking breast implants; for breast reconstruction, silicone-gel filled implants and saline-filled implants were approved for women of all ages; for breast augmentation, saline implants were approved for women 18 years of age and older; silicone implants were approved for women 22 years of age and older.<sup id=\"rdp-ebb-cite_ref-104\" class=\"reference\"><a href=\"#cite_note-104\" rel=\"external_link\">[104]<\/a><\/sup> Because each breast implant device entails different medical risks, the minimum age of the patient for saline breast implants is different from the minimum age of the patient for silicone breast implants\u2014because of the filler leakage and silent shell-rupture risks; thus, periodic <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> screening examinations are the recommended post-operative, follow-up therapy for the patient.<sup id=\"rdp-ebb-cite_ref-105\" class=\"reference\"><a href=\"#cite_note-105\" rel=\"external_link\">[105]<\/a><\/sup> In other countries, in Europe and Oceania, the national health ministries' breast implant policies do not endorse periodic MRI screening of asymptomatic patients, but suggest palpation proper\u2014with or without an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasonic<\/a> screening\u2014to be sufficient post-operative therapy for most patients.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Safety_of_Breast_Implants\">Safety of Breast Implants<\/span><\/h2>\n<p>In the early 1990s, the national health ministries of the listed countries reviewed the pertinent studies for causal links among silicone-gel breast implants and systemic and auto-immune diseases. The collective conclusion is that there is no evidence establishing a causal connection between the implantation of silicone breast implants and either type of disease. The Danish study <i>Long-term Health Status of Danish Women with Silicone Breast Implants<\/i> (2004) reported that women who had breast implants for an average of 19 years were no more likely to report an excessive number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatic_disease\" class=\"mw-redirect\" title=\"Rheumatic disease\" rel=\"external_link\" target=\"_blank\">rheumatic disease<\/a> symptoms than would the women of the control group.<sup id=\"rdp-ebb-cite_ref-Breiting2004_106-0\" class=\"reference\"><a href=\"#cite_note-Breiting2004-106\" rel=\"external_link\">[106]<\/a><\/sup> The follow-up study <i>Mortality Rates Among Augmentation Mammoplasty Patients: An Update<\/i> (2006) reported a decreased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Standardized_mortality_ratio\" title=\"Standardized mortality ratio\" rel=\"external_link\" target=\"_blank\">standardized mortality ratio<\/a> and an increased risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung_cancer\" title=\"Lung cancer\" rel=\"external_link\" target=\"_blank\">lung cancer<\/a> death among breast implant patients, than among patients for other types of plastic surgery; the mortality rate differences were attributed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tobacco_smoking\" title=\"Tobacco smoking\" rel=\"external_link\" target=\"_blank\">tobacco smoking<\/a>.<sup id=\"rdp-ebb-cite_ref-Brinton2006_107-0\" class=\"reference\"><a href=\"#cite_note-Brinton2006-107\" rel=\"external_link\">[107]<\/a><\/sup> The study <i>Mortality Among Canadian Women with Cosmetic Breast Implants<\/i> (2006), about some 25,000 women with breast implants, reported a 43 per cent lower rate of breast cancer among them than among the general populace, and a lower-than-average risk of cancer.<sup id=\"rdp-ebb-cite_ref-Villenueve2006_108-0\" class=\"reference\"><a href=\"#cite_note-Villenueve2006-108\" rel=\"external_link\">[108]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable sortable\" style=\"\">\n<tbody><tr>\n<th>Year\n<\/th>\n<th>Country\n<\/th>\n<th>Systemic Review Group\n<\/th>\n<th>Conclusions\n<\/th><\/tr>\n<tr>\n<td>1991\u201393\n<\/td>\n<td>United Kingdom\n<\/td>\n<td>Independent Expert Advisory Group (IEAG)\n<\/td>\n<td>There was no evidence of an increased risk of connective-tissue disease in patients who had undergone silicone-gel breast implant emplacement, and no cause for changing either breast implant practice or policy in the U.K.\n<\/td><\/tr>\n<tr>\n<td>1996\n<\/td>\n<td>United States\n<\/td>\n<td>U.S. Institute of Medicine (IOM)<sup id=\"rdp-ebb-cite_ref-Brinton1996_109-0\" class=\"reference\"><a href=\"#cite_note-Brinton1996-109\" rel=\"external_link\">[109]<\/a><\/sup>\n<\/td>\n<td>There was \"insufficient evidence for an association of silicone gel- or saline-filled breast implants with defined connective tissue disease.\"\n<\/td><\/tr>\n<tr>\n<td>1996\n<\/td>\n<td>France\n<\/td>\n<td>Agence Nationale pour le Developpement de l\u2019Evaluation Medicale (ANDEM) [National Agency for Medical Development and Evaluation]<sup id=\"rdp-ebb-cite_ref-110\" class=\"reference\"><a href=\"#cite_note-110\" rel=\"external_link\">[110]<\/a><\/sup>\n<\/td>\n<td>French original: \"Nous n'avons pas observ\u00e9 de connectivit\u00e9 ni d'autre pathologie auto-immune susceptible d'\u00eatre directement ou indirectement induite par la pr\u00e9sence d'un implant mammaire en particulier en gel de silicone....\"\n<p>English translation: \"We did not observe connective tissue diseases to be directly or indirectly associated by the presence of a breast implant, in particular one of silicone gel....\"\n<\/p>\n<\/td><\/tr>\n<tr>\n<td>1997\n<\/td>\n<td>Australia\n<\/td>\n<td>Therapeutic Devices Evaluation Committee (TDEC)\n<\/td>\n<td>The \"current, high-quality literature suggest that there is no association between breast implants and connective tissue disease-like syndromes (atypical connective tissue diseases).\"<sup id=\"rdp-ebb-cite_ref-111\" class=\"reference\"><a href=\"#cite_note-111\" rel=\"external_link\">[111]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>1998\n<\/td>\n<td>Germany\n<\/td>\n<td>Federal Institute for Medicine and Medical Products\n<\/td>\n<td>Reported that \"silicone breast implants neither cause auto-immune diseases nor rheumatic diseases and have no disadvantageous effects on pregnancy, breast-feeding capability, or the health of children who are breast-fed. There is no scientific evidence for the existence of silicone allergy, silicone poisoning, atypical silicone diseases or a new silicone disease.\"<sup id=\"rdp-ebb-cite_ref-Germany1998_112-0\" class=\"reference\"><a href=\"#cite_note-Germany1998-112\" rel=\"external_link\">[112]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>2000\n<\/td>\n<td>United States\n<\/td>\n<td>Federal court-ordered review<sup id=\"rdp-ebb-cite_ref-NEJM2000-Janowsky_113-0\" class=\"reference\"><a href=\"#cite_note-NEJM2000-Janowsky-113\" rel=\"external_link\">[113]<\/a><\/sup>\n<\/td>\n<td>\"No evidence of an association between... silicone-gel-filled breast implants specifically, and any of the individual CTDs, all definite CTDs combined, or other auto-immune or rheumatic conditions.\"\n<\/td><\/tr>\n<tr>\n<td>2000\n<\/td>\n<td>European Union\n<\/td>\n<td>European Committee on Quality Assurance & Medical Devices in Plastic Surgery (EQUAM)\n<\/td>\n<td>\"Additional medical studies have not demonstrated any association between silicone-gel filled breast implants and traditional auto-immune or connective tissue diseases, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancer<\/a>, nor any other malignant disease. . . . EQUAM continues to believe that there is no scientific evidence that silicone allergy, silicone intoxication, atypical disease or a 'new silicone disease' exists.\"<sup id=\"rdp-ebb-cite_ref-114\" class=\"reference\"><a href=\"#cite_note-114\" rel=\"external_link\">[114]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>2001\n<\/td>\n<td>United Kingdom\n<\/td>\n<td>UK Independent Review Group (UK-IRG)\n<\/td>\n<td>\"There is no evidence of an association with an abnormal immune response or typical or atypical connective tissue diseases or syndromes.\"<sup id=\"rdp-ebb-cite_ref-115\" class=\"reference\"><a href=\"#cite_note-115\" rel=\"external_link\">[115]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>2001\n<\/td>\n<td>United States\n<\/td>\n<td>Court-appointed National Science Panel review<sup id=\"rdp-ebb-cite_ref-ArthritisRheum2001-Tugwell_116-0\" class=\"reference\"><a href=\"#cite_note-ArthritisRheum2001-Tugwell-116\" rel=\"external_link\">[116]<\/a><\/sup>\n<\/td>\n<td>The panel evaluated established and undifferentiated connective tissue diseases (CTD), and concluded there was no causal evidence between breast implants and these CTDs.\n<\/td><\/tr>\n<tr>\n<td>2003\n<\/td>\n<td>Spain\n<\/td>\n<td>Science and Technology Options Assessment (STOA)\n<\/td>\n<td>The STOA report to the European Parliament Petitions Committee reported that the current scientific evidence demonstrates no solid, causal evidence linking SBI [silicone breast implants] to severe diseases, e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a>, connective tissue diseases.<sup id=\"rdp-ebb-cite_ref-117\" class=\"reference\"><a href=\"#cite_note-117\" rel=\"external_link\">[117]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>2009\n<\/td>\n<td>European Union\n<\/td>\n<td>International Committee for Quality Assurance, Medical Technologies & Devices in Plastic Surgery panel (IQUAM)\n<\/td>\n<td>The consensus statement of the Transatlantic Innovations conference (April 2009) indicated that additional medical studies demonstrated no association between silicone gel-filled breast implants and carcinoma, or any metabolic, immune, or allergic disorder.<sup id=\"rdp-ebb-cite_ref-iquam2009_118-0\" class=\"reference\"><a href=\"#cite_note-iquam2009-118\" rel=\"external_link\">[118]<\/a><\/sup>\n<\/td><\/tr>\n\n<\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast\" title=\"Breast\" rel=\"external_link\" target=\"_blank\">Breast<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">Breast augmentation<\/a> (Augmentation mammoplasty)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_enlargement_supplements\" class=\"mw-redirect\" title=\"Breast enlargement supplements\" rel=\"external_link\" target=\"_blank\">Breast enlargement supplements<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reconstruction\" title=\"Breast reconstruction\" rel=\"external_link\" target=\"_blank\">Breast reconstruction<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_reduction_plasty\" class=\"mw-redirect\" title=\"Breast reduction plasty\" rel=\"external_link\" target=\"_blank\">Breast reduction plasty<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mammoplasty\" class=\"mw-redirect\" title=\"Mammoplasty\" rel=\"external_link\" target=\"_blank\">Mammoplasty<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastopexy\" title=\"Mastopexy\" rel=\"external_link\" target=\"_blank\">Mastopexy<\/a> (breast lift)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly_Implant_Proth%C3%A8se\" title=\"Poly Implant Proth\u00e8se\" rel=\"external_link\" target=\"_blank\">Poly Implant Proth\u00e8se<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene_breast_implants\" class=\"mw-redirect\" title=\"Polypropylene breast implants\" rel=\"external_link\" target=\"_blank\">Polypropylene breast implants<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trans-umbilical_breast_augmentation\" title=\"Trans-umbilical breast augmentation\" rel=\"external_link\" target=\"_blank\">Trans-umbilical breast augmentation<\/a> (TUBA)<\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Czerny V (1895). \"Plastischer Ersatz der Brusthus durch ein Lipoma\". <i>Zentralblatt f\u00fcr Chirurgie<\/i>. <b>27<\/b>: 72.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Zentralblatt+f%C3%BCr+Chirurgie&rft.atitle=Plastischer+Ersatz+der+Brusthus+durch+ein+Lipoma&rft.volume=27&rft.pages=72&rft.date=1895&rft.au=Czerny+V&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bondurant S, Ernster V, Herdman R (eds); Committee on the Safety of Silicone Breast Implants (1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nap.edu\/books\/0309065321\/html\/21.html\" target=\"_blank\"><i>Safety of Silicone Breast Implants<\/i><\/a>. Institute of Medicine. p. 21. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-309-06532-1. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070313091328\/http:\/\/www.nap.edu\/books\/0309065321\/html\/21.html\" target=\"_blank\">Archived<\/a> from the original on 2007-03-13.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Safety+of+Silicone+Breast+Implants&rft.pages=21&rft.pub=Institute+of+Medicine&rft.date=1999&rft.isbn=0-309-06532-1&rft_id=http%3A%2F%2Fwww.nap.edu%2Fbooks%2F0309065321%2Fhtml%2F21.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anderson N (1997). \"Lawsuit Science: Lessons from the Silicone Breast Implant Controversy\". <i>New York Law School Law Review<\/i>. <b>41<\/b> (2): 401\u201307.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+York+Law+School+Law+Review&rft.atitle=Lawsuit+Science%3A+Lessons+from+the+Silicone+Breast+Implant+Controversy&rft.volume=41&rft.issue=2&rft.pages=401-07&rft.date=1997&rft.au=Anderson+N&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Stevens-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Stevens_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stevens_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stevens WG, Hirsch EM, Stoker DA, Cohen R (2006). \"In vitro Deflation of Pre-filled Saline Breast Implants\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (2): 347\u2013349. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000227674.65284.80\" target=\"_blank\">10.1097\/01.prs.0000227674.65284.80<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16874200\" target=\"_blank\">16874200<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=In+vitro+Deflation+of+Pre-filled+Saline+Breast+Implants&rft.volume=118&rft.issue=2&rft.pages=347-349&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000227674.65284.80&rft_id=info%3Apmid%2F16874200&rft.aulast=Stevens&rft.aufirst=WG&rft.au=Hirsch%2C+EM&rft.au=Stoker%2C+DA&rft.au=Cohen%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/mpsmn.com\/breast-procedures\/choosing-breast-implants\/\" target=\"_blank\">\"Choosing Your Breast Implants\"<\/a> <span class=\"cs1-format\">(Web)<\/span>. Minneapolis Plastic Surgery, LTD. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20161124092228\/http:\/\/mpsmn.com\/breast-procedures\/choosing-breast-implants\/\" target=\"_blank\">Archived<\/a> from the original on 24 November 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Choosing+Your+Breast+Implants&rft.pub=Minneapolis+Plastic+Surgery%2C+LTD&rft_id=http%3A%2F%2Fmpsmn.com%2Fbreast-procedures%2Fchoosing-breast-implants%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Arion1965-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Arion1965_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Arion HG (1965). \"Retromammary Prosthesis\". <i>C R Societ\u00e9 Fran\u00e7aise de Gyn\u00e9cologie<\/i>. <b>5<\/b>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=C+R+Societ%C3%A9+Fran%C3%A7aise+de+Gyn%C3%A9cologie&rft.atitle=Retromammary+Prosthesis&rft.volume=5&rft.date=1965&rft.au=Arion+HG&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eisenberg TS (2009). \"Silicone Gel Implants Are Back \u2014 So What?\". <i>American Journal of Cosmetic Surgery<\/i>. <b>26<\/b>: 5\u20137.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Cosmetic+Surgery&rft.atitle=Silicone+Gel+Implants+Are+Back+%E2%80%94+So+What%3F&rft.volume=26&rft.pages=5-7&rft.date=2009&rft.au=Eisenberg+TS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Cronin_1963-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Cronin_1963_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cronin TD, Gerow FJ (1963). \"Augmentation Mammaplasty: A New \"natural feel\" Prosthesis\". <i>Excerpta Medica International Congress Series<\/i>. <b>66<\/b>: 41.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Excerpta+Medica+International+Congress+Series&rft.atitle=Augmentation+Mammaplasty%3A+A+New+%22natural+feel%22+Prosthesis&rft.volume=66&rft.pages=41&rft.date=1963&rft.aulast=Cronin&rft.aufirst=TD&rft.au=Gerow%2C+FJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Luu11998-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Luu11998_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Luu HM, Hutter JC, Bushar HF (1998). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1533137\" target=\"_blank\">\"A Physiologically based Pharmacokinetic Model for 2,4-toluenediamine Leached from Polyurethane foam-covered Breast Implants\"<\/a>. <i>Environ Health Perspect<\/i>. <b>106<\/b> (7): 393\u2013400. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2307%2F3434066\" target=\"_blank\">10.2307\/3434066<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/3434066\" target=\"_blank\">3434066<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1533137\" target=\"_blank\">1533137<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9637796\" target=\"_blank\">9637796<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Environ+Health+Perspect&rft.atitle=A+Physiologically+based+Pharmacokinetic+Model+for+2%2C4-toluenediamine+Leached+from+Polyurethane+foam-covered+Breast+Implants&rft.volume=106&rft.issue=7&rft.pages=393-400&rft.date=1998&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1533137&rft_id=info%3Apmid%2F9637796&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F3434066&rft_id=info%3Adoi%2F10.2307%2F3434066&rft.aulast=Luu&rft.aufirst=HM&rft.au=Hutter%2C+JC&rft.au=Bushar%2C+HF&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1533137&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hester TR, Tebbetts JB, Maxwell GP (2001). \"The Polyurethane-covered Mammary Prosthesis: Facts and Fiction (II): A Look Back and a \"peek\" Ahead\". <i>Clinical Plastic Surgery<\/i>. <b>28<\/b> (3): 579\u201386. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11471963\" target=\"_blank\">11471963<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Plastic+Surgery&rft.atitle=The+Polyurethane-covered+Mammary+Prosthesis%3A+Facts+and+Fiction+%28II%29%3A+A+Look+Back+and+a+%22peek%22+Ahead&rft.volume=28&rft.issue=3&rft.pages=579-86&rft.date=2001&rft_id=info%3Apmid%2F11471963&rft.aulast=Hester&rft.aufirst=TR&rft.au=Tebbetts%2C+JB&rft.au=Maxwell%2C+GP&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brown MH, Shenker R, Silver SA (2005). \"Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery\". <i>Plastic and Reconstructive Surgery<\/i>. <b>116<\/b> (3): 768\u2013779, discussion 779\u20131. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000176259.66948.e7\" target=\"_blank\">10.1097\/01.prs.0000176259.66948.e7<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16141814\" target=\"_blank\">16141814<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Cohesive+silicone+gel+breast+implants+in+aesthetic+and+reconstructive+breast+surgery&rft.volume=116&rft.issue=3&rft.pages=768-779%2C+discussion+779-1&rft.date=2005&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000176259.66948.e7&rft_id=info%3Apmid%2F16141814&rft.aulast=Brown&rft.aufirst=MH&rft.au=Shenker%2C+R&rft.au=Silver%2C+SA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fruhstorfer BH, Hodgson EL, Malata CM (2004). \"Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery\". <i>Annals of Plastic Surgery<\/i>. <b>53<\/b> (6): 536\u2013542. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.sap.0000134508.43550.6f\" target=\"_blank\">10.1097\/01.sap.0000134508.43550.6f<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15602249\" target=\"_blank\">15602249<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Plastic+Surgery&rft.atitle=Early+experience+with+an+anatomical+soft+cohesive+silicone+gel+prosthesis+in+cosmetic+and+reconstructive+breast+implant+surgery&rft.volume=53&rft.issue=6&rft.pages=536-542&rft.date=2004&rft_id=info%3Adoi%2F10.1097%2F01.sap.0000134508.43550.6f&rft_id=info%3Apmid%2F15602249&rft.aulast=Fruhstorfer&rft.aufirst=BH&rft.au=Hodgson%2C+EL&rft.au=Malata%2C+CM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hed\u00e9n P, Jernbeck J, Hober M (2001). \"Breast augmentation with anatomical cohesive gel implants: The world's largest current experience\". <i>Clinics in plastic surgery<\/i>. <b>28<\/b> (3): 531\u2013552. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11471959\" target=\"_blank\">11471959<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinics+in+plastic+surgery&rft.atitle=Breast+augmentation+with+anatomical+cohesive+gel+implants%3A+The+world%27s+largest+current+experience&rft.volume=28&rft.issue=3&rft.pages=531-552&rft.date=2001&rft_id=info%3Apmid%2F11471959&rft.aulast=Hed%C3%A9n&rft.aufirst=P&rft.au=Jernbeck%2C+J&rft.au=Hober%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Brinton2000-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Brinton2000_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brinton LA, Brown SL, Colton T, Burich MC, Lubin J (2000). \"Characteristics of a Population of Women with Breast Implants Compared with Women Seeking other Types of Plastic Surgery\". <i>Plastic and Reconstructive Surgery<\/i>. <b>105<\/b> (3): 919\u2013927. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-200003000-00014\" target=\"_blank\">10.1097\/00006534-200003000-00014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10724251\" target=\"_blank\">10724251<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Characteristics+of+a+Population+of+Women+with+Breast+Implants+Compared+with+Women+Seeking+other+Types+of+Plastic+Surgery&rft.volume=105&rft.issue=3&rft.pages=919-927&rft.date=2000&rft_id=info%3Adoi%2F10.1097%2F00006534-200003000-00014&rft_id=info%3Apmid%2F10724251&rft.aulast=Brinton&rft.aufirst=LA&rft.au=Brown%2C+SL&rft.au=Colton%2C+T&rft.au=Burich%2C+MC&rft.au=Lubin%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Jacobsen_PH_2004-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Jacobsen_PH_2004_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jacobsen PH, H\u00f6lmich LR, McLaughlin JK, Johansen C, Olsen JH, Kj\u00f8ller K, Friis S (2004). \"Mortality and suicide among Danish women with cosmetic breast implants\". <i>Arch. Intern. Med<\/i>. <b>164<\/b> (22): 2450\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchinte.164.22.2450\" target=\"_blank\">10.1001\/archinte.164.22.2450<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15596635\" target=\"_blank\">15596635<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arch.+Intern.+Med.&rft.atitle=Mortality+and+suicide+among+Danish+women+with+cosmetic+breast+implants&rft.volume=164&rft.issue=22&rft.pages=2450-5&rft.date=2004&rft_id=info%3Adoi%2F10.1001%2Farchinte.164.22.2450&rft_id=info%3Apmid%2F15596635&rft.aulast=Jacobsen&rft.aufirst=PH&rft.au=H%C3%B6lmich%2C+LR&rft.au=McLaughlin%2C+JK&rft.au=Johansen%2C+C&rft.au=Olsen%2C+JH&rft.au=Kj%C3%B8ller%2C+K&rft.au=Friis%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Young1994-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Young1994_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Young VL, Nemecek JR, Nemecek DA (1994). \"The Efficacy of Breast Augmentation: Breast Size Increase, Patient Satisfaction, and Psychological Effects\". <i>Plastic and Reconstructive Surgery<\/i>. <b>94<\/b> (Dec): 958\u2013969. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-199412000-00009\" target=\"_blank\">10.1097\/00006534-199412000-00009<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7972484\" target=\"_blank\">7972484<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=The+Efficacy+of+Breast+Augmentation%3A+Breast+Size+Increase%2C+Patient+Satisfaction%2C+and+Psychological+Effects&rft.volume=94&rft.issue=Dec&rft.pages=958-969&rft.date=1994&rft_id=info%3Adoi%2F10.1097%2F00006534-199412000-00009&rft_id=info%3Apmid%2F7972484&rft.aulast=Young&rft.aufirst=VL&rft.au=Nemecek%2C+JR&rft.au=Nemecek%2C+DA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Crerand_2006-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Crerand_2006_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Crerand CE, Franklin ME, Sarwer DB (2006). \"Body Dysmorphic Disorder and Cosmetic Surgery\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (July): 167e\u2013180e. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000242500.28431.24\" target=\"_blank\">10.1097\/01.prs.0000242500.28431.24<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17102719\" target=\"_blank\">17102719<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Body+Dysmorphic+Disorder+and+Cosmetic+Surgery&rft.volume=118&rft.issue=July&rft.pages=167e-180e&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000242500.28431.24&rft_id=info%3Apmid%2F17102719&rft.aulast=Crerand&rft.aufirst=CE&rft.au=Franklin%2C+ME&rft.au=Sarwer%2C+DB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Sarwer2003-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Sarwer2003_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sarwer DB, LaRossa D, Bartlett SP, Low DW, Bucky LP, Whitaker LA (2003). \"Body Image Concerns of Breast Augmentation Patients\". <i>Plastic and Reconstructive Surgery<\/i>. <b>112<\/b> (July): 83\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PRS.0000066005.07796.51\" target=\"_blank\">10.1097\/01.PRS.0000066005.07796.51<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12832880\" target=\"_blank\">12832880<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Body+Image+Concerns+of+Breast+Augmentation+Patients&rft.volume=112&rft.issue=July&rft.pages=83-90&rft.date=2003&rft_id=info%3Adoi%2F10.1097%2F01.PRS.0000066005.07796.51&rft_id=info%3Apmid%2F12832880&rft.aulast=Sarwer&rft.aufirst=DB&rft.au=LaRossa%2C+D&rft.au=Bartlett%2C+SP&rft.au=Low%2C+DW&rft.au=Bucky%2C+LP&rft.au=Whitaker%2C+LA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-chahraoui2006-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-chahraoui2006_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chahraoui K, Danino A, Frachebois C, Clerc AS, Malka G (2006). \"Aesthetic Surgery and Quality of Life Before and Four Months Postoperatively\". <i>Journal of the Long-Term Effects of Medical Implants<\/i>. <b>51<\/b> (3): 207\u2013210. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.anplas.2005.07.010\" target=\"_blank\">10.1016\/j.anplas.2005.07.010<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16181718\" target=\"_blank\">16181718<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Long-Term+Effects+of+Medical+Implants&rft.atitle=Aesthetic+Surgery+and+Quality+of+Life+Before+and+Four+Months+Postoperatively&rft.volume=51&rft.issue=3&rft.pages=207-210&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.anplas.2005.07.010&rft_id=info%3Apmid%2F16181718&rft.aulast=Chahraoui&rft.aufirst=K&rft.au=Danino%2C+A&rft.au=Frachebois%2C+C&rft.au=Clerc%2C+AS&rft.au=Malka%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Cash2002-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Cash2002_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cash TF, Duel LA, Perkins LL (2002). \"Women's Psychosocial Outcomes of Breast Augmentation with Silicone gel-filled implants: a 2-year Prospective Study\". <i>Plastic and Reconstructive Surgery<\/i>. <b>109<\/b> (May): 2112\u20132121. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-200205000-00049\" target=\"_blank\">10.1097\/00006534-200205000-00049<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11994621\" target=\"_blank\">11994621<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Women%27s+Psychosocial+Outcomes+of+Breast+Augmentation+with+Silicone+gel-filled+implants%3A+a+2-year+Prospective+Study&rft.volume=109&rft.issue=May&rft.pages=2112-2121&rft.date=2002&rft_id=info%3Adoi%2F10.1097%2F00006534-200205000-00049&rft_id=info%3Apmid%2F11994621&rft.aulast=Cash&rft.aufirst=TF&rft.au=Duel%2C+LA&rft.au=Perkins%2C+LL&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Haas2007-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Haas2007_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Figueroa-Haas CL (2007). \"Effect of Breast Augmentation Mammoplasty on Self-esteem and Sexuality: A Quantitative Analysis\". <i>Plastic Surgery Nursing<\/i>. <b>27<\/b> (Mar): 16\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PSN.0000264159.30505.c9\" target=\"_blank\">10.1097\/01.PSN.0000264159.30505.c9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17356451\" target=\"_blank\">17356451<\/a>.<\/cite><span 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/pdf2\/P020056d.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2007-01-03.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Important+Information+for+Women+About+Breast+Augmentation+with+Inamed+Silicone+Gel-Filled+Implants&rft.date=2006&rft_id=http%3A%2F%2Fwww.fda.gov%2Fcdrh%2Fpdf2%2FP020056d.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HandelN-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HandelN_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Handel N, Cordray T, Gutierrez J, Jensen JA (2006). \"A Long-term Study of Outcomes, Complications, and Patient Satisfaction with Breast Implants\". <i>Plastic and Reconstructive Surgery<\/i>. <b>117<\/b> (Mar): 757\u2013767. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000201457.00772.1d\" target=\"_blank\">10.1097\/01.prs.0000201457.00772.1d<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16525261\" target=\"_blank\">16525261<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=A+Long-term+Study+of+Outcomes%2C+Complications%2C+and+Patient+Satisfaction+with+Breast+Implants&rft.volume=117&rft.issue=Mar&rft.pages=757-767&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000201457.00772.1d&rft_id=info%3Apmid%2F16525261&rft.aulast=Handel&rft.aufirst=N&rft.au=Cordray%2C+T&rft.au=Gutierrez%2C+J&rft.au=Jensen%2C+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-reuters.com-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-reuters.com_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.reuters.com\/article\/healthNews\/idUSN0836919020070808?feedType=RSS&rpc=22&sp=true\" target=\"_blank\">\"Breast Implants Linked with Suicide in Study\"<\/a>. <i>Reuters<\/i>. 2007-08-08. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081221140806\/http:\/\/www.reuters.com\/article\/healthNews\/idUSN0836919020070808?feedType=RSS&rpc=22&sp=true\" target=\"_blank\">Archived<\/a> from the original on 2008-12-21.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Reuters&rft.atitle=Breast+Implants+Linked+with+Suicide+in+Study&rft.date=2007-08-08&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2FhealthNews%2FidUSN0836919020070808%3FfeedType%3DRSS%26rpc%3D22%26sp%3Dtrue&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-usatoday.com-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-usatoday.com_25-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Manning, Anita (2007-08-06). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.usatoday.com\/news\/health\/2007-08-06-breast-implants_N.htm\" target=\"_blank\">\"Breast Implants Linked to Higher Suicide Rates\"<\/a>. <i>USA Today<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110318150357\/http:\/\/www.usatoday.com\/news\/health\/2007-08-06-breast-implants_N.htm\" target=\"_blank\">Archived<\/a> from the original on 2011-03-18<span class=\"reference-accessdate\">. 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href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC150462\" target=\"_blank\">\"Total and cause specific mortality among Swedish women with cosmetic breast implants: prospective study\"<\/a>. <i>BMJ<\/i>. <b>326<\/b> (7388): 527\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.326.7388.527\" target=\"_blank\">10.1136\/bmj.326.7388.527<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC150462\" target=\"_blank\">150462<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12623911\" target=\"_blank\">12623911<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ&rft.atitle=Total+and+cause+specific+mortality+among+Swedish+women+with+cosmetic+breast+implants%3A+prospective+study&rft.volume=326&rft.issue=7388&rft.pages=527-8&rft.date=2003&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC150462&rft_id=info%3Apmid%2F12623911&rft_id=info%3Adoi%2F10.1136%2Fbmj.326.7388.527&rft.aulast=Koot&rft.aufirst=VC&rft.au=Peeters%2C+PH&rft.au=Granath%2C+F&rft.au=Grobbee%2C+DE&rft.au=Nyren%2C+O&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC150462&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" 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href=\"https:\/\/web.archive.org\/web\/20140719103909\/http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-society-of-plastic-surgeons\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, American Society of Plastic Surgeons, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-society-of-plastic-surgeons\/\" target=\"_blank\">the original<\/a> on 19 July 2014<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">25 July<\/span> 2014<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.date=2014-04-24&rft.au=American+Society+of+Plastic+Surgeons&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-society-of-plastic-surgeons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-johnson-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-johnson_34-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Johnson GW, Christ JE (1993). \"The Endoscopic Breast augmentation: The Transumbilical Insertion of Saline-filled Breast Implants\". <i>Plastic and Reconstructive Surgery<\/i>. <b>92<\/b> (5): 801\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-199392050-00004\" target=\"_blank\">10.1097\/00006534-199392050-00004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8415961\" target=\"_blank\">8415961<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=The+Endoscopic+Breast+augmentation%3A+The+Transumbilical+Insertion+of+Saline-filled+Breast+Implants&rft.volume=92&rft.issue=5&rft.pages=801-8&rft.date=1993&rft_id=info%3Adoi%2F10.1097%2F00006534-199392050-00004&rft_id=info%3Apmid%2F8415961&rft.aulast=Johnson&rft.aufirst=GW&rft.au=Christ%2C+JE&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-TABA-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-TABA_35-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wallach SG (2004). \"Maximizing the Use of the Abdominoplasty Incision\". <i>Plastic and Reconstructive Surgery<\/i>. <b>113<\/b> (1): 411\u2013417. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PRS.0000091422.11191.1A\" target=\"_blank\">10.1097\/01.PRS.0000091422.11191.1A<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14707667\" target=\"_blank\">14707667<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Maximizing+the+Use+of+the+Abdominoplasty+Incision&rft.volume=113&rft.issue=1&rft.pages=411-417&rft.date=2004&rft_id=info%3Adoi%2F10.1097%2F01.PRS.0000091422.11191.1A&rft_id=info%3Apmid%2F14707667&rft.au=Wallach+SG&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Graf-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Graf_36-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Graf RM, Bernardes A, Rippel R, Araujo LR, Damasio RC, Auersvald A (2003). \"Subfascial Breast Implant: A New Procedure\". <i>Plastic and Reconstructive Surgery<\/i>. <b>111<\/b> (2): 904\u2013908. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PRS.0000041601.59651.15\" target=\"_blank\">10.1097\/01.PRS.0000041601.59651.15<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12560720\" target=\"_blank\">12560720<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Subfascial+Breast+Implant%3A+A+New+Procedure&rft.volume=111&rft.issue=2&rft.pages=904-908&rft.date=2003&rft_id=info%3Adoi%2F10.1097%2F01.PRS.0000041601.59651.15&rft_id=info%3Apmid%2F12560720&rft.aulast=Graf&rft.aufirst=RM&rft.au=Bernardes%2C+A&rft.au=Rippel%2C+R&rft.au=Araujo%2C+LR&rft.au=Damasio%2C+RC&rft.au=Auersvald%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-subfascial-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-subfascial_37-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB (2004). \"Does Fascia Provide Additional, Meaningful Coverage over a Breast Implant?\". <i>Plastic and Reconstructive Surgery<\/i>. <b>113<\/b> (2): 777\u2013779. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PRS.0000104516.13465.96\" target=\"_blank\">10.1097\/01.PRS.0000104516.13465.96<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14758271\" target=\"_blank\">14758271<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Does+Fascia+Provide+Additional%2C+Meaningful+Coverage+over+a+Breast+Implant%3F&rft.volume=113&rft.issue=2&rft.pages=777-779&rft.date=2004&rft_id=info%3Adoi%2F10.1097%2F01.PRS.0000104516.13465.96&rft_id=info%3Apmid%2F14758271&rft.au=Tebbetts+JB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Tebbettsdual-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Tebbettsdual_38-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB (2002). \"A System for Breast Implant Selection Based on Patient Tissue Characteristics and Implant-soft tissue Dynamics\". <i>Plastic and Reconstructive Surgery<\/i>. <b>109<\/b> (4): 1396\u20131409. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-200204010-00030\" target=\"_blank\">10.1097\/00006534-200204010-00030<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11964998\" target=\"_blank\">11964998<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=A+System+for+Breast+Implant+Selection+Based+on+Patient+Tissue+Characteristics+and+Implant-soft+tissue+Dynamics&rft.volume=109&rft.issue=4&rft.pages=1396-1409&rft.date=2002&rft_id=info%3Adoi%2F10.1097%2F00006534-200204010-00030&rft_id=info%3Apmid%2F11964998&rft.au=Tebbetts+JB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid19083538-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid19083538_39-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pacik PT, Nelson CE, Werner C (2008). \"Pain control in augmentation mammaplasty: safety and efficacy of indwelling catheters in 644 consecutive patients\". <i>Aesthet Surg J<\/i>. <b>28<\/b> (3): 279\u201384. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.asj.2008.02.001\" target=\"_blank\">10.1016\/j.asj.2008.02.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19083538\" target=\"_blank\">19083538<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthet+Surg+J&rft.atitle=Pain+control+in+augmentation+mammaplasty%3A+safety+and+efficacy+of+indwelling+catheters+in+644+consecutive+patients&rft.volume=28&rft.issue=3&rft.pages=279-84&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.asj.2008.02.001&rft_id=info%3Apmid%2F19083538&rft.aulast=Pacik&rft.aufirst=PT&rft.au=Nelson%2C+CE&rft.au=Werner%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid19083591-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid19083591_40-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pacik PT, Nelson CE, Werner C (2008). \"Pain control in augmentation mammaplasty using indwelling catheters in 687 consecutive patients: data analysis\". <i>Aesthet Surg J<\/i>. <b>28<\/b> (6): 631\u201341. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.asj.2008.09.001\" target=\"_blank\">10.1016\/j.asj.2008.09.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19083591\" target=\"_blank\">19083591<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthet+Surg+J&rft.atitle=Pain+control+in+augmentation+mammaplasty+using+indwelling+catheters+in+687+consecutive+patients%3A+data+analysis&rft.volume=28&rft.issue=6&rft.pages=631-41&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.asj.2008.09.001&rft_id=info%3Apmid%2F19083591&rft.aulast=Pacik&rft.aufirst=PT&rft.au=Nelson%2C+CE&rft.au=Werner%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid11964998-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid11964998_41-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB (2002). \"A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics\". <i>Plast. Reconstr. Surg<\/i>. <b>109<\/b> (4): 1396\u2013409, discussion 1410\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-200204010-00030\" target=\"_blank\">10.1097\/00006534-200204010-00030<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11964998\" target=\"_blank\">11964998<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plast.+Reconstr.+Surg.&rft.atitle=A+system+for+breast+implant+selection+based+on+patient+tissue+characteristics+and+implant-soft+tissue+dynamics&rft.volume=109&rft.issue=4&rft.pages=1396-409%2C+discussion+1410-5&rft.date=2002&rft_id=info%3Adoi%2F10.1097%2F00006534-200204010-00030&rft_id=info%3Apmid%2F11964998&rft.au=Tebbetts+JB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid16327616-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid16327616_42-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB, Adams WP (2005). \"Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process\". <i>Plast. 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Surg<\/i>. <b>116<\/b> (7): 2005\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000191163.19379.63\" target=\"_blank\">10.1097\/01.prs.0000191163.19379.63<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16327616\" target=\"_blank\">16327616<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plast.+Reconstr.+Surg.&rft.atitle=Five+critical+decisions+in+breast+augmentation+using+five+measurements+in+5+minutes%3A+the+high+five+decision+support+process&rft.volume=116&rft.issue=7&rft.pages=2005-16&rft.date=2005&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000191163.19379.63&rft_id=info%3Apmid%2F16327616&rft.aulast=Tebbetts&rft.aufirst=JB&rft.au=Adams%2C+WP&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid11786826-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid11786826_43-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB (2002). \"Achieving a predictable 24-hour return to normal activities after breast augmentation: part I. 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Surg<\/i>. <b>109<\/b> (1): 273\u201390, discussion 291\u20132. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-200201000-00044\" target=\"_blank\">10.1097\/00006534-200201000-00044<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11786826\" target=\"_blank\">11786826<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plast.+Reconstr.+Surg.&rft.atitle=Achieving+a+predictable+24-hour+return+to+normal+activities+after+breast+augmentation%3A+part+I.+Refining+practices+by+using+motion+and+time+study+principles&rft.volume=109&rft.issue=1&rft.pages=273-90%2C+discussion+291-2&rft.date=2002&rft_id=info%3Adoi%2F10.1097%2F00006534-200201000-00044&rft_id=info%3Apmid%2F11786826&rft.au=Tebbetts+JB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid11786828-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid11786828_44-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB (2002). \"Achieving a predictable 24-hour return to normal activities after breast augmentation: Part II. Patient preparation, refined surgical techniques, and instrumentation\". <i>Plast. Reconstr. Surg<\/i>. <b>109<\/b> (1): 293\u2013305, discussion 306\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-200201000-00046\" target=\"_blank\">10.1097\/00006534-200201000-00046<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11786828\" target=\"_blank\">11786828<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plast.+Reconstr.+Surg.&rft.atitle=Achieving+a+predictable+24-hour+return+to+normal+activities+after+breast+augmentation%3A+Part+II.+Patient+preparation%2C+refined+surgical+techniques%2C+and+instrumentation&rft.volume=109&rft.issue=1&rft.pages=293-305%2C+discussion+306-7&rft.date=2002&rft_id=info%3Adoi%2F10.1097%2F00006534-200201000-00046&rft_id=info%3Apmid%2F11786828&rft.au=Tebbetts+JB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Grippaudo2013-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Grippaudo2013_45-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Grippaudo FR, Renzi L, Costantino B, Longo B, Santanelli F (2013). \"Late unilateral hematoma after breast reconstruction with implants: case report and literature review\". <i>Aesthetic Surgical Journal<\/i>. <b>33<\/b> (6): 830\u2013834. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1090820X13496249\" target=\"_blank\">10.1177\/1090820X13496249<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23864111\" target=\"_blank\">23864111<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Surgical+Journal&rft.atitle=Late+unilateral+hematoma+after+breast+reconstruction+with+implants%3A+case+report+and+literature+review&rft.volume=33&rft.issue=6&rft.pages=830-834&rft.date=2013&rft_id=info%3Adoi%2F10.1177%2F1090820X13496249&rft_id=info%3Apmid%2F23864111&rft.aulast=Grippaudo&rft.aufirst=FR&rft.au=Renzi%2C+L&rft.au=Costantino%2C+B&rft.au=Longo%2C+B&rft.au=Santanelli%2C+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AUG_2006-46\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AUG_2006_46-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AUG_2006_46-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070103050703\/http:\/\/www.fda.gov\/cdrh\/pdf2\/P020056d.pdf\" target=\"_blank\">\"Important Information for Women About Breast Augmentation with INAMED Silicone-Filled Breast Implants\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2006-11-03. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/pdf2\/P020056d.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2007-01-03<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Important+Information+for+Women+About+Breast+Augmentation+with+INAMED+Silicone-Filled+Breast+Implants&rft.date=2006-11-03&rft_id=http%3A%2F%2Fwww.fda.gov%2Fcdrh%2Fpdf2%2FP020056d.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MMG_2006-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MMG_2006_47-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20141016082842\/http:\/\/theplasticsurgeon.org\/p030053d.pdf\" target=\"_blank\">\"Important Information for Augmentation Patients About Mentor MemoryGel Silicone Gel-Filled Breast Implants\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2006-11-03. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/theplasticsurgeon.org\/p030053d.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 16 October 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 October<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Important+Information+for+Augmentation+Patients+About+Mentor+MemoryGel+Silicone+Gel-Filled+Breast+Implants&rft.date=2006-11-03&rft_id=http%3A%2F%2Ftheplasticsurgeon.org%2Fp030053d.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDA_2004d-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDA_2004d_48-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061126155432\/http:\/\/www.fda.gov\/cdrh\/breastimplants\/labeling\/mentor_patient_labeling_5900.html\" target=\"_blank\">\"Saline-Filled Breast Implant Surgery: Making An Informed Decision (Mentor Corporation)\"<\/a>. <i>FDA Breast Implant Consumer Handbook - 2004<\/i>. 2004-01-13. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/breastimplants\/labeling\/mentor_patient_labeling_5900.html\" target=\"_blank\">the original<\/a> on 2006-11-26<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA+Breast+Implant+Consumer+Handbook+-+2004&rft.atitle=Saline-Filled+Breast+Implant+Surgery%3A+Making+An+Informed+Decision+%28Mentor+Corporation%29&rft.date=2004-01-13&rft_id=http%3A%2F%2Fwww.fda.gov%2Fcdrh%2Fbreastimplants%2Flabeling%2Fmentor_patient_labeling_5900.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm260235.htm\" target=\"_blank\">\"Archived copy\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20111103032451\/http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm260235.htm\" target=\"_blank\">Archived<\/a> from the original on 2011-11-03<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-11-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.fda.gov%2FNewsEvents%2FNewsroom%2FPressAnnouncements%2Fucm260235.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Brown2000-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Brown2000_50-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brown SL, Middleton MS, Berg WA, Soo MS, Pennello G (2000). \"Prevalence of Rupture of Silicone gel Breast Implants Revealed on MR Imaging in a Population of Women in Birmingham, Alabama\". <i>American Journal of Roentgenology<\/i>. <b>175<\/b> (4): 1057\u20131064. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2Fajr.175.4.1751057\" target=\"_blank\">10.2214\/ajr.175.4.1751057<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11000165\" target=\"_blank\">11000165<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Roentgenology&rft.atitle=Prevalence+of+Rupture+of+Silicone+gel+Breast+Implants+Revealed+on+MR+Imaging+in+a+Population+of+Women+in+Birmingham%2C+Alabama&rft.volume=175&rft.issue=4&rft.pages=1057-1064&rft.date=2000&rft_id=info%3Adoi%2F10.2214%2Fajr.175.4.1751057&rft_id=info%3Apmid%2F11000165&rft.aulast=Brown&rft.aufirst=SL&rft.au=Middleton%2C+MS&rft.au=Berg%2C+WA&rft.au=Soo%2C+MS&rft.au=Pennello%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Walker2009-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Walker2009_51-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Walker PS, Walls B, Murphy DK (2009). \"Natrelle Saline-filled Breast Implants: a Prospective 10-year Study\". <i>Aesthetic Surgery Journal<\/i>. <b>29<\/b> (1): 19\u201325. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.asj.2008.10.001\" target=\"_blank\">10.1016\/j.asj.2008.10.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19233001\" target=\"_blank\">19233001<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Surgery+Journal&rft.atitle=Natrelle+Saline-filled+Breast+Implants%3A+a+Prospective+10-year+Study&rft.volume=29&rft.issue=1&rft.pages=19-25&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fj.asj.2008.10.001&rft_id=info%3Apmid%2F19233001&rft.aulast=Walker&rft.aufirst=PS&rft.au=Walls%2C+B&rft.au=Murphy%2C+DK&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Holmich2004-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Holmich2004_52-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">H\u00f6lmich LR, Vejborg IM, Conrad C, Sletting S, H\u00f8ier-Madsen M, Fryzek JP, McLaughlin JK, Kj\u00f8ller K, Wiik A, Friis S (2004). \"Untreated Silicone Breast Implant Rupture\". <i>Plastic and Reconstructive Surgery<\/i>. <b>114<\/b> (1): 204\u2013214. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PRS.0000128821.87939.B5\" target=\"_blank\">10.1097\/01.PRS.0000128821.87939.B5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15220594\" target=\"_blank\">15220594<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Untreated+Silicone+Breast+Implant+Rupture&rft.volume=114&rft.issue=1&rft.pages=204-214&rft.date=2004&rft_id=info%3Adoi%2F10.1097%2F01.PRS.0000128821.87939.B5&rft_id=info%3Apmid%2F15220594&rft.aulast=H%C3%B6lmich&rft.aufirst=LR&rft.au=Vejborg%2C+IM&rft.au=Conrad%2C+C&rft.au=Sletting%2C+S&rft.au=H%C3%B8ier-Madsen%2C+M&rft.au=Fryzek%2C+JP&rft.au=McLaughlin%2C+JK&rft.au=Kj%C3%B8ller%2C+K&rft.au=Wiik%2C+A&rft.au=Friis%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Katzin_2005-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Katzin_2005_53-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Katzin WE, Centeno JA, Feng LJ, Kiley M, Mullick FG (2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090524051708\/http:\/\/www.ajsp.com\/pt\/re\/ajsp\/abstract.00000478-200504000-00013.htm%3Bjsessionid%3DG3QMCQKJ6hM5VsXLk60GQByjJfkSq7rzMMVZwKbyvpwxmmZXrQpK%21-1734750035%21-949856144%218091%21-1\" target=\"_blank\">\"Pathology of Lymph Nodes From Patients With Breast Implants: A Histologic and Spectroscopic Evaluation\"<\/a>. <i>American Journal of Surgical Pathology<\/i>. <b>29<\/b> (4): 506\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.pas.0000155145.60670.e4\" target=\"_blank\">10.1097\/01.pas.0000155145.60670.e4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15767806\" target=\"_blank\">15767806<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ajsp.com\/pt\/re\/ajsp\/abstract.00000478-200504000-00013.htm;jsessionid=G3QMCQKJ6hM5VsXLk60GQByjJfkSq7rzMMVZwKbyvpwxmmZXrQpK!-1734750035!-949856144!8091!-1\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(\u2014<sup><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/scholar.google.co.uk\/scholar?hl=en&lr=&q=intitle%3APathology+of+Lymph+Nodes+From+Patients+With+Breast+Implants%3A+A+Histologic+and+Spectroscopic+Evaluation&as_publication=American+Journal+of+Surgical+Pathology&as_ylo=2001&as_yhi=2001&btnG=Search\" target=\"_blank\">Scholar search<\/a><\/sup>)<\/span> on May 24, 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Surgical+Pathology&rft.atitle=Pathology+of+Lymph+Nodes+From+Patients+With+Breast+Implants%3A+A+Histologic+and+Spectroscopic+Evaluation&rft.volume=29&rft.issue=4&rft.pages=506-11&rft.date=2001&rft_id=info%3Adoi%2F10.1097%2F01.pas.0000155145.60670.e4&rft_id=info%3Apmid%2F15767806&rft.aulast=Katzin&rft.aufirst=WE&rft.au=Centeno%2C+JA&rft.au=Feng%2C+LJ&rft.au=Kiley%2C+M&rft.au=Mullick%2C+FG&rft_id=http%3A%2F%2Fwww.ajsp.com%2Fpt%2Fre%2Fajsp%2Fabstract.00000478-200504000-00013.htm%3Bjsessionid%3DG3QMCQKJ6hM5VsXLk60GQByjJfkSq7rzMMVZwKbyvpwxmmZXrQpK%21-1734750035%21-949856144%218091%21-1&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDA_2004c-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDA_2004c_54-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/breastimplants\/handbook2004\/diseases.html\" target=\"_blank\">\"Study of Rupture of Silicone Gel-filled Breast Implants (MRI Component)\"<\/a>. <i>FDA Breast Implant Consumer Handbook - 2004<\/i>. 2000-05-22. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070609134559\/http:\/\/www.fda.gov\/cdrh\/breastimplants\/handbook2004\/diseases.html\" target=\"_blank\">Archived<\/a> from the original on 2007-06-09<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA+Breast+Implant+Consumer+Handbook+-+2004&rft.atitle=Study+of+Rupture+of+Silicone+Gel-filled+Breast+Implants+%28MRI+Component%29&rft.date=2000-05-22&rft_id=http%3A%2F%2Fwww.fda.gov%2Fcdrh%2Fbreastimplants%2Fhandbook2004%2Fdiseases.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDA_2004b-55\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDA_2004b_55-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_2004b_55-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_2004b_55-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070513003957\/http:\/\/www.fda.gov\/cdrh\/breastimplants\/handbook2004\/localcomplications.html\" target=\"_blank\">\"Local Complications\"<\/a>. <i>FDA Breast Implant Consumer Handbook - 2004<\/i>. 2004-06-08. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/breastimplants\/handbook2004\/localcomplications.html\" target=\"_blank\">the original<\/a> on 2007-05-13<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA+Breast+Implant+Consumer+Handbook+-+2004&rft.atitle=Local+Complications&rft.date=2004-06-08&rft_id=http%3A%2F%2Fwww.fda.gov%2Fcdrh%2Fbreastimplants%2Fhandbook2004%2Flocalcomplications.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-56\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-56\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.claripacs.com\/case\/CL0335\" target=\"_blank\">MRI of a ruptured silicone breast implant<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130926005715\/http:\/\/www.claripacs.com\/case\/CL0335\" target=\"_blank\">Archived<\/a> 2013-09-26 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. 2013-04-05<\/span>\n<\/li>\n<li id=\"cite_note-Holmich2003-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Holmich2003_57-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">H\u00f6lmich LR, Friis S, Fryzek JP, Vejborg IM, Conrad C, Sletting S, Kj\u00f8ller K, McLaughlin JK, Olsen JH (2003). \"Incidence of Silicone Breast Implant Rupture\". <i>Arch. Surg<\/i>. <b>138<\/b> (7): 801\u2013806. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchsurg.138.7.801\" target=\"_blank\">10.1001\/archsurg.138.7.801<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12860765\" target=\"_blank\">12860765<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arch.+Surg.&rft.atitle=Incidence+of+Silicone+Breast+Implant+Rupture&rft.volume=138&rft.issue=7&rft.pages=801-806&rft.date=2003&rft_id=info%3Adoi%2F10.1001%2Farchsurg.138.7.801&rft_id=info%3Apmid%2F12860765&rft.aulast=H%C3%B6lmich&rft.aufirst=LR&rft.au=Friis%2C+S&rft.au=Fryzek%2C+JP&rft.au=Vejborg%2C+IM&rft.au=Conrad%2C+C&rft.au=Sletting%2C+S&rft.au=Kj%C3%B8ller%2C+K&rft.au=McLaughlin%2C+JK&rft.au=Olsen%2C+JH&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Heden2006-58\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Heden2006_58-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hed\u00e9n P, Nava MB, van Tetering JP, Magalon G, Fourie le R, Brenner RJ, Lindsey LE, Murphy DK, Walker PS (2006). \"Prevalence of Rupture in Inamed Silicone Breast Implants\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (2): 303\u2013308. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000233471.58039.30\" target=\"_blank\">10.1097\/01.prs.0000233471.58039.30<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16874191\" target=\"_blank\">16874191<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Prevalence+of+Rupture+in+Inamed+Silicone+Breast+Implants&rft.volume=118&rft.issue=2&rft.pages=303-308&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000233471.58039.30&rft_id=info%3Apmid%2F16874191&rft.aulast=Hed%C3%A9n&rft.aufirst=P&rft.au=Nava%2C+MB&rft.au=van+Tetering%2C+JP&rft.au=Magalon%2C+G&rft.au=Fourie+le%2C+R&rft.au=Brenner%2C+RJ&rft.au=Lindsey%2C+LE&rft.au=Murphy%2C+DK&rft.au=Walker%2C+PS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Collis2005-59\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Collis2005_59-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/ohrms\/dockets\/ac\/05\/briefing\/2005-4101b1_Mentor-Briefing%20doc-supplement.DOC\" target=\"_blank\">\"FDA summary of clinical issues (MS Word document)\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080308085809\/http:\/\/www.fda.gov\/ohrms\/dockets\/ac\/05\/briefing\/2005-4101b1_Mentor-Briefing%20doc-supplement.DOC\" target=\"_blank\">Archived<\/a> from the original on 2008-03-08.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=FDA+summary+of+clinical+issues+%28MS+Word+document%29&rft_id=http%3A%2F%2Fwww.fda.gov%2Fohrms%2Fdockets%2Fac%2F05%2Fbriefing%2F2005-4101b1_Mentor-Briefing%2520doc-supplement.DOC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-cunningham2009-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-cunningham2009_60-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cunningham B, McCue J (2009). \"Safety and effectiveness of Mentor's MemoryGel implants at 6 years\". <i>Plastic and Reconstructive Surgery<\/i>. <b>33<\/b> (3): 440\u2013444. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00266-009-9364-6\" target=\"_blank\">10.1007\/s00266-009-9364-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19437068\" target=\"_blank\">19437068<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Safety+and+effectiveness+of+Mentor%27s+MemoryGel+implants+at+6+years&rft.volume=33&rft.issue=3&rft.pages=440-444&rft.date=2009&rft_id=info%3Adoi%2F10.1007%2Fs00266-009-9364-6&rft_id=info%3Apmid%2F19437068&rft.aulast=Cunningham&rft.aufirst=B&rft.au=McCue%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Heden-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Heden_61-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hed\u00e9n P, Bon\u00e9 B, Murphy DK, Slicton A, Walker PS (2006). \"Style 410 Cohesive Silicone Breast Implants: Safety and Effectiveness at 5 to 9 years after Implantation\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (6): 1281\u20131287. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000239457.17721.5d\" target=\"_blank\">10.1097\/01.prs.0000239457.17721.5d<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17051096\" target=\"_blank\">17051096<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Style+410+Cohesive+Silicone+Breast+Implants%3A+Safety+and+Effectiveness+at+5+to+9+years+after+Implantation&rft.volume=118&rft.issue=6&rft.pages=1281-1287&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000239457.17721.5d&rft_id=info%3Apmid%2F17051096&rft.aulast=Hed%C3%A9n&rft.aufirst=P&rft.au=Bon%C3%A9%2C+B&rft.au=Murphy%2C+DK&rft.au=Slicton%2C+A&rft.au=Walker%2C+PS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Holmich2005-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Holmich2005_62-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">H\u00f6lmich LR, Fryzek JP, Kj\u00f8ller K, Breiting VB, J\u00f8rgensen A, Krag C, McLaughlin JK (2005). \"The Diagnosis of Silicone Breast implant Rupture: Clinical Findings Compared with Findings at Magnetic Resonance Imaging\". <i>Annals of Plastic Surgery<\/i>. <b>54<\/b> (6): 583\u2013589. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.sap.0000164470.76432.4f\" target=\"_blank\">10.1097\/01.sap.0000164470.76432.4f<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15900139\" target=\"_blank\">15900139<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Plastic+Surgery&rft.atitle=The+Diagnosis+of+Silicone+Breast+implant+Rupture%3A+Clinical+Findings+Compared+with+Findings+at+Magnetic+Resonance+Imaging&rft.volume=54&rft.issue=6&rft.pages=583-589&rft.date=2005&rft_id=info%3Adoi%2F10.1097%2F01.sap.0000164470.76432.4f&rft_id=info%3Apmid%2F15900139&rft.aulast=H%C3%B6lmich&rft.aufirst=LR&rft.au=Fryzek%2C+JP&rft.au=Kj%C3%B8ller%2C+K&rft.au=Breiting%2C+VB&rft.au=J%C3%B8rgensen%2C+A&rft.au=Krag%2C+C&rft.au=McLaughlin%2C+JK&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Canada_2005-63\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Canada_2005_63-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071107040623\/http:\/\/www.hc-sc.gc.ca\/dhp-mps\/md-im\/activit\/sci-consult\/implant-breast-mammaire\/eapbi_rop_gceim_crd_2005-09-29_e.html\" target=\"_blank\">\"Expert Advisory Panel on Breast Implants: Record of Proceedings\"<\/a>. HealthCanada. 2005-09-29. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hc-sc.gc.ca\/dhp-mps\/md-im\/activit\/sci-consult\/implant-breast-mammaire\/eapbi_rop_gceim_crd_2005-09-29_e.html\" target=\"_blank\">the original<\/a> on 2007-11-07<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-05-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Expert+Advisory+Panel+on+Breast+Implants%3A+Record+of+Proceedings&rft.pub=HealthCanada&rft.date=2005-09-29&rft_id=http%3A%2F%2Fwww.hc-sc.gc.ca%2Fdhp-mps%2Fmd-im%2Factivit%2Fsci-consult%2Fimplant-breast-mammaire%2Feapbi_rop_gceim_crd_2005-09-29_e.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-song2011-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-song2011_64-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Song JW, Kim HM, Bellfi LT, Chung KC (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3080104\" target=\"_blank\">\"The Effect of Study design Biases on the Diagnostic Accuracy of Magnetic Resonance Imaging for Detecting Silicone Breast Implant Ruptures: a Meta-analysis\"<\/a>. <i>Plastic and Reconstructive Surgery<\/i>. <b>127<\/b> (3): 1029\u20131044. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FPRS.0b013e3182043630\" target=\"_blank\">10.1097\/PRS.0b013e3182043630<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3080104\" target=\"_blank\">3080104<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21364405\" target=\"_blank\">21364405<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=The+Effect+of+Study+design+Biases+on+the+Diagnostic+Accuracy+of+Magnetic+Resonance+Imaging+for+Detecting+Silicone+Breast+Implant+Ruptures%3A+a+Meta-analysis&rft.volume=127&rft.issue=3&rft.pages=1029-1044&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3080104&rft_id=info%3Apmid%2F21364405&rft_id=info%3Adoi%2F10.1097%2FPRS.0b013e3182043630&rft.aulast=Song&rft.aufirst=JW&rft.au=Kim%2C+HM&rft.au=Bellfi%2C+LT&rft.au=Chung%2C+KC&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3080104&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-65\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-65\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">AFP (18 September 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.independent.co.uk\/life-style\/health-and-families\/breast-implants-safe-but-not-for-life-us-experts-2303085.html\" target=\"_blank\">\"Breast implants safe, but not for life: US experts\"<\/a>. <i>The Independent<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160803074016\/http:\/\/www.independent.co.uk\/life-style\/health-and-families\/breast-implants-safe-but-not-for-life-us-experts-2303085.html\" target=\"_blank\">Archived<\/a> from the original on 3 August 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+Independent&rft.atitle=Breast+implants+safe%2C+but+not+for+life%3A+US+experts&rft.date=2011-09-18&rft.au=AFP&rft_id=https%3A%2F%2Fwww.independent.co.uk%2Flife-style%2Fhealth-and-families%2Fbreast-implants-safe-but-not-for-life-us-experts-2303085.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Barnsley2006-66\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Barnsley2006_66-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Barnsley GP, Sigurdson LJ, Barnsley SE (2006). \"Textured surface Breast Implants in the Prevention of Capsular Contracture among Breast Augmentation Patients: a Meta-analysis of Randomized Controlled Trials\". <i>Plastic and Reconstructive Surgery<\/i>. <b>117<\/b> (7): 2182\u20132190. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000218184.47372.d5\" target=\"_blank\">10.1097\/01.prs.0000218184.47372.d5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16772915\" target=\"_blank\">16772915<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Textured+surface+Breast+Implants+in+the+Prevention+of+Capsular+Contracture+among+Breast+Augmentation+Patients%3A+a+Meta-analysis+of+Randomized+Controlled+Trials&rft.volume=117&rft.issue=7&rft.pages=2182-2190&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000218184.47372.d5&rft_id=info%3Apmid%2F16772915&rft.aulast=Barnsley&rft.aufirst=GP&rft.au=Sigurdson%2C+LJ&rft.au=Barnsley%2C+SE&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Wong2006-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Wong2006_67-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wong CH, Samuel M, Tan BK, Song C (2006). \"Capsular Contracture in Subglandular Breast Augmentation with Textured versus Smooth Breast Implants: a Systematic Review\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (5): 1224\u20131236. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000237013.50283.d2\" target=\"_blank\">10.1097\/01.prs.0000237013.50283.d2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17016195\" target=\"_blank\">17016195<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Capsular+Contracture+in+Subglandular+Breast+Augmentation+with+Textured+versus+Smooth+Breast+Implants%3A+a+Systematic+Review&rft.volume=118&rft.issue=5&rft.pages=1224-1236&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000237013.50283.d2&rft_id=info%3Apmid%2F17016195&rft.aulast=Wong&rft.aufirst=CH&rft.au=Samuel%2C+M&rft.au=Tan%2C+BK&rft.au=Song%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HandelGut2006-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HandelGut2006_68-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Handel N, Gutierrez J (May 2006). \"Long-term safety and efficacy of polyurethane foam-covered breast implants\". <i>Journal of Aesthetic Surgery<\/i>. <b>26<\/b> (3): 265\u2013274. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.asj.2006.04.001\" target=\"_blank\">10.1016\/j.asj.2006.04.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19338905\" target=\"_blank\">19338905<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Aesthetic+Surgery&rft.atitle=Long-term+safety+and+efficacy+of+polyurethane+foam-covered+breast+implants&rft.volume=26&rft.issue=3&rft.pages=265-274&rft.date=2006-05&rft_id=info%3Adoi%2F10.1016%2Fj.asj.2006.04.001&rft_id=info%3Apmid%2F19338905&rft.aulast=Handel&rft.aufirst=N&rft.au=Gutierrez%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mladick1993-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mladick1993_69-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mladick RA (1993). \"<span class=\"cs1-kern-left\">\"<\/span>No-touch\" submuscular saline breast augmentation technique\". <i>Journal of Aesthetic Surgery<\/i>. <b>17<\/b> (3): 183\u2013192. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF00636260\" target=\"_blank\">10.1007\/BF00636260<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8213311\" target=\"_blank\">8213311<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Aesthetic+Surgery&rft.atitle=%22No-touch%22+submuscular+saline+breast+augmentation+technique&rft.volume=17&rft.issue=3&rft.pages=183-192&rft.date=1993&rft_id=info%3Adoi%2F10.1007%2FBF00636260&rft_id=info%3Apmid%2F8213311&rft.au=Mladick+RA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Adams2006-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Adams2006_70-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Adams WP, Rios JL, Smith SJ (2006). \"Enhancing Patient Outcomes in Aesthetic and Reconstructive Breast Surgery using Triple Antibiotic Breast Irrigation: Six-year Prospective Clinical Study\". <i>Plastic and Reconstructive Surgery<\/i>. <b>117<\/b> (1): 30\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000185671.51993.7e\" target=\"_blank\">10.1097\/01.prs.0000185671.51993.7e<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16404244\" target=\"_blank\">16404244<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Enhancing+Patient+Outcomes+in+Aesthetic+and+Reconstructive+Breast+Surgery+using+Triple+Antibiotic+Breast+Irrigation%3A+Six-year+Prospective+Clinical+Study&rft.volume=117&rft.issue=1&rft.pages=30-6&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000185671.51993.7e&rft_id=info%3Apmid%2F16404244&rft.aulast=Adams&rft.aufirst=WP&rft.au=Rios%2C+JL&rft.au=Smith%2C+SJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Planas2001-71\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Planas2001_71-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Planas J, Cervelli V, Planas G (2001). \"Five-year experience on ultrasonic treatment of breast contractures\". <i>Aesthetic Plastic Surgery<\/i>. <b>25<\/b> (2): 89\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs002660010102\" target=\"_blank\">10.1007\/s002660010102<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11349308\" target=\"_blank\">11349308<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Plastic+Surgery&rft.atitle=Five-year+experience+on+ultrasonic+treatment+of+breast+contractures&rft.volume=25&rft.issue=2&rft.pages=89-93&rft.date=2001&rft_id=info%3Adoi%2F10.1007%2Fs002660010102&rft_id=info%3Apmid%2F11349308&rft.aulast=Planas&rft.aufirst=J&rft.au=Cervelli%2C+V&rft.au=Planas%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Schlesinger2002-72\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Schlesinger2002_72-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schlesinger SL, Ellenbogen R, Desvigne MN, Svehlak S, Heck R (2002). \"Zafirlukast (Accolate): A new treatment for capsular contracture\". <i>Aesthetic Plast Surg<\/i>. <b>22<\/b> (4): 329\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1067%2Fmaj.2002.126753\" target=\"_blank\">10.1067\/maj.2002.126753<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19331987\" target=\"_blank\">19331987<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Plast+Surg.&rft.atitle=Zafirlukast+%28Accolate%29%3A+A+new+treatment+for+capsular+contracture&rft.volume=22&rft.issue=4&rft.pages=329-36&rft.date=2002&rft_id=info%3Adoi%2F10.1067%2Fmaj.2002.126753&rft_id=info%3Apmid%2F19331987&rft.aulast=Schlesinger&rft.aufirst=SL&rft.au=Ellenbogen%2C+R&rft.au=Desvigne%2C+MN&rft.au=Svehlak%2C+S&rft.au=Heck%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Scuderi-73\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Scuderi_73-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Scuderi N, Mazzocchi M, Fioramonti P, Bistoni G (2006). \"The effects of zafirlukast on capsular contracture: preliminary report\". <i>Aesthetic Plast Surg<\/i>. <b>30<\/b> (5): 513\u2013520. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00266-006-0038-3\" target=\"_blank\">10.1007\/s00266-006-0038-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16977359\" target=\"_blank\">16977359<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Plast+Surg.&rft.atitle=The+effects+of+zafirlukast+on+capsular+contracture%3A+preliminary+report&rft.volume=30&rft.issue=5&rft.pages=513-520&rft.date=2006&rft_id=info%3Adoi%2F10.1007%2Fs00266-006-0038-3&rft_id=info%3Apmid%2F16977359&rft.aulast=Scuderi&rft.aufirst=N&rft.au=Mazzocchi%2C+M&rft.au=Fioramonti%2C+P&rft.au=Bistoni%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Silver1982-74\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Silver1982_74-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Silver H (1982). \"Reduction of capsular contracture with two-stage augmentation mammaplasty and pulsed electromagnetic energy (Diapulse therapy)\". <i>Plastic and Reconstructive Surgery<\/i>. <b>69<\/b> (5): 802\u2013805. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-198205000-00013\" target=\"_blank\">10.1097\/00006534-198205000-00013<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7071225\" target=\"_blank\">7071225<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Reduction+of+capsular+contracture+with+two-stage+augmentation+mammaplasty+and+pulsed+electromagnetic+energy+%28Diapulse+therapy%29&rft.volume=69&rft.issue=5&rft.pages=802-805&rft.date=1982&rft_id=info%3Adoi%2F10.1097%2F00006534-198205000-00013&rft_id=info%3Apmid%2F7071225&rft.au=Silver+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Tebbets2006-75\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Tebbets2006_75-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB (October 2006). \"Out Points Criteria for Breast Implant Removal without Replacement and Criteria to Minimize Reoperations following Breast Augmentation\". <i>Plastic and Reconstructive Surgery<\/i>. <b>114<\/b> (5): 1258&ndash, 1262. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000136802.91357.cf\" target=\"_blank\">10.1097\/01.prs.0000136802.91357.cf<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15457046\" target=\"_blank\">15457046<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Out+Points+Criteria+for+Breast+Implant+Removal+without+Replacement+and+Criteria+to+Minimize+Reoperations+following+Breast+Augmentation&rft.volume=114&rft.issue=5&rft.pages=1258%26ndash%2C+1262&rft.date=2006-10&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000136802.91357.cf&rft_id=info%3Apmid%2F15457046&rft.au=Tebbetts+JB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Tebbets2-76\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Tebbets2_76-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tebbetts JB (December 2006). \"Achieving a Zero Percent Reoperation Rate at 3 years in a 50-consecutive-case Augmentation Mammaplasty Premarket Approval Study\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (6): 1453&ndash, 7. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000239602.99867.07\" target=\"_blank\">10.1097\/01.prs.0000239602.99867.07<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17051118\" target=\"_blank\">17051118<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Achieving+a+Zero+Percent+Reoperation+Rate+at+3+years+in+a+50-consecutive-case+Augmentation+Mammaplasty+Premarket+Approval+Study&rft.volume=118&rft.issue=6&rft.pages=1453%26ndash%2C+7&rft.date=2006-12&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000239602.99867.07&rft_id=info%3Apmid%2F17051118&rft.au=Tebbetts+JB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-77\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-77\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21369953\" target=\"_blank\">[1]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-78\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-78\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nArepelli S; et al. (2002). \"Allergic reactions to platinum in silicone breast implants\". J Long-Term Effects Medical Implants. 12 (4): 299\u2013306. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12627791\" target=\"_blank\">12627791<\/a><\/span>\n<\/li>\n<li id=\"cite_note-FDA_Backgrounder_on_Platinum_in_breast_implants-79\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDA_Backgrounder_on_Platinum_in_breast_implants_79-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.fda.gov\/cdrh\/breastimplants\/platinum.html\" target=\"_blank\">[2]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-80\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-80\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Commissioner, Office of the. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fda.gov\/Safety\/MedWatch\/SafetyInformation\/SafetyAlertsforHumanMedicalProducts\/ucm547622.htm\" target=\"_blank\">\"Safety Alerts for Human Medical Products - Breast Implants: Update - Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)\"<\/a>. <i>www.fda.gov<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20180428170514\/https:\/\/www.fda.gov\/Safety\/MedWatch\/SafetyInformation\/SafetyAlertsforHumanMedicalProducts\/ucm547622.htm\" target=\"_blank\">Archived<\/a> from the original on 28 April 2018<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Safety+Alerts+for+Human+Medical+Products+-+Breast+Implants%3A+Update+-+Breast+Implant-Associated+Anaplastic+Large+Cell+Lymphoma+%28BIA-ALCL%29&rft.aulast=Commissioner&rft.aufirst=Office+of+the&rft_id=https%3A%2F%2Fwww.fda.gov%2FSafety%2FMedWatch%2FSafetyInformation%2FSafetyAlertsforHumanMedicalProducts%2Fucm547622.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-81\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-81\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Health, Center for Devices and Radiological. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ImplantsandProsthetics\/BreastImplants\/ucm481899.htm?source=govdelivery\" target=\"_blank\">\"Breast Implants - Medical Device Reports of Breast Implant-Associated Anaplastic Large Cell Lymphoma\"<\/a>. <i>www.fda.gov<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20180428170514\/https:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ImplantsandProsthetics\/BreastImplants\/ucm481899.htm?source=govdelivery\" target=\"_blank\">Archived<\/a> from the original on 28 April 2018<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Breast+Implants+-+Medical+Device+Reports+of+Breast+Implant-Associated+Anaplastic+Large+Cell+Lymphoma&rft.aulast=Health&rft.aufirst=Center+for+Devices+and+Radiological&rft_id=https%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FProductsandMedicalProcedures%2FImplantsandProsthetics%2FBreastImplants%2Fucm481899.htm%3Fsource%3Dgovdelivery&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-plasticsurgery.org-82\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-plasticsurgery.org_82-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-plasticsurgery.org_82-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Clemens, Mark. \"<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.plasticsurgery.org\/for-medical-professionals\/quality-and-registries\/bia-alcl-by-the-numbers\" target=\"_blank\">Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170326231741\/https:\/\/www.plasticsurgery.org\/for-medical-professionals\/quality-and-registries\/bia-alcl-by-the-numbers\" target=\"_blank\">Archived<\/a> 2017-03-26 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.\" (2017).<\/span>\n<\/li>\n<li id=\"cite_note-83\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-83\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Clemens, Mark W.; Horwitz, Steven M. (2017-03-01). \"NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma\". <i>Aesthetic Surgery Journal<\/i>. <b>37<\/b> (3): 285\u2013289. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fasj%2Fsjw259\" target=\"_blank\">10.1093\/asj\/sjw259<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1527-330X\" target=\"_blank\">1527-330X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28184418\" target=\"_blank\">28184418<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Surgery+Journal&rft.atitle=NCCN+Consensus+Guidelines+for+the+Diagnosis+and+Management+of+Breast+Implant-Associated+Anaplastic+Large+Cell+Lymphoma&rft.volume=37&rft.issue=3&rft.pages=285-289&rft.date=2017-03-01&rft.issn=1527-330X&rft_id=info%3Apmid%2F28184418&rft_id=info%3Adoi%2F10.1093%2Fasj%2Fsjw259&rft.aulast=Clemens&rft.aufirst=Mark+W.&rft.au=Horwitz%2C+Steven+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-84\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-84\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.mdanderson.org\/cancer-types\/implant-associated-anaplastic-large-cell-lymphoma\/implant-associated-anaplastic-large-cell-lymphoma-facts.html\" target=\"_blank\">\"Implant-associated ALCL Facts | The MD Anderson Foundation\"<\/a>. <i>www.mdanderson.org<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20171209152413\/https:\/\/www.mdanderson.org\/cancer-types\/implant-associated-anaplastic-large-cell-lymphoma\/implant-associated-anaplastic-large-cell-lymphoma-facts.html\" target=\"_blank\">Archived<\/a> from the original on 2017-12-09<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-12-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.mdanderson.org&rft.atitle=Implant-associated+ALCL+Facts+%7C+The+MD+Anderson+Foundation&rft_id=https%3A%2F%2Fwww.mdanderson.org%2Fcancer-types%2Fimplant-associated-anaplastic-large-cell-lymphoma%2Fimplant-associated-anaplastic-large-cell-lymphoma-facts.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-85\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-85\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thepsf.org\/research\/clinical-impact\/profile.htm\" target=\"_blank\">\"Breast Implant Associated ALCL: PROFILE Project | The Plastic Surgery Foundation\"<\/a>. <i>www.thepsf.org<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170507235532\/http:\/\/www.thepsf.org\/research\/clinical-impact\/profile.htm\" target=\"_blank\">Archived<\/a> from the original on 2017-05-07<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-04-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.thepsf.org&rft.atitle=Breast+Implant+Associated+ALCL%3A+PROFILE+Project+%7C+The+Plastic+Surgery+Foundation&rft_id=http%3A%2F%2Fwww.thepsf.org%2Fresearch%2Fclinical-impact%2Fprofile.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-86\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-86\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.llli.org\/NB\/NBsurgery.html\" target=\"_blank\">Breastfeeding after Breast Surgery<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101230173437\/http:\/\/www.llli.org\/NB\/NBsurgery.html\" target=\"_blank\">Archived<\/a> 2010-12-30 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., La Leche League, contains references.<\/span>\n<\/li>\n<li id=\"cite_note-87\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-87\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.llli.org\/cbi\/bibimplant.html\" target=\"_blank\">Breastfeeding and Breast Implants<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101231121338\/http:\/\/www.llli.org\/cbi\/bibimplant.html\" target=\"_blank\">Archived<\/a> 2010-12-31 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., Selected Bibliography April 2003, LLLI Center for Breastfeeding Information<\/span>\n<\/li>\n<li id=\"cite_note-slate-88\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-slate_88-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-slate_88-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.slate.com\/id\/2238096\/\" target=\"_blank\">Inorganic Milk: Can Kendra Wilkinson breast-feed her baby even though she has implants?<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100125010657\/http:\/\/www.slate.com\/id\/2238096\" target=\"_blank\">Archived<\/a> 2010-01-25 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., Christopher Beam, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Slate.com\" class=\"mw-redirect\" title=\"Slate.com\" rel=\"external_link\" target=\"_blank\">Slate.com<\/a>, 11 December 2009<\/span>\n<\/li>\n<li id=\"cite_note-Handel1992-89\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Handel1992_89-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Handel N, Silverstein MJ, Gamagami P, Jensen JA, Collins A (1992). \"Factors Affecting Mammographic Visualization of the Breast after Augmentation Mammaplasty\". <i>JAMA<\/i>. <b>268<\/b> (14): 1913\u20131917. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.268.14.1913\" target=\"_blank\">10.1001\/jama.268.14.1913<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1404718\" target=\"_blank\">1404718<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=Factors+Affecting+Mammographic+Visualization+of+the+Breast+after+Augmentation+Mammaplasty&rft.volume=268&rft.issue=14&rft.pages=1913-1917&rft.date=1992&rft_id=info%3Adoi%2F10.1001%2Fjama.268.14.1913&rft_id=info%3Apmid%2F1404718&rft.aulast=Handel&rft.aufirst=N&rft.au=Silverstein%2C+MJ&rft.au=Gamagami%2C+P&rft.au=Jensen%2C+JA&rft.au=Collins%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Clark1993-90\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Clark1993_90-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Clark CP, Peters GN, O'Brien KM (1993). \"Cancer in the Augmented Breast: Diagnosis and Prognosis\". <i>Cancer<\/i>. <b>72<\/b> (7): 2170&ndash, 4. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F1097-0142%2819931001%2972%3A7%3C2170%3A%3AAID-CNCR2820720717%3E3.0.CO%3B2-1\" target=\"_blank\">10.1002\/1097-0142(19931001)72:7<2170::AID-CNCR2820720717>3.0.CO;2-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8374874\" target=\"_blank\">8374874<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cancer&rft.atitle=Cancer+in+the+Augmented+Breast%3A+Diagnosis+and+Prognosis&rft.volume=72&rft.issue=7&rft.pages=2170%26ndash%2C+4&rft.date=1993&rft_id=info%3Adoi%2F10.1002%2F1097-0142%2819931001%2972%3A7%3C2170%3A%3AAID-CNCR2820720717%3E3.0.CO%3B2-1&rft_id=info%3Apmid%2F8374874&rft.aulast=Clark&rft.aufirst=CP&rft.au=Peters%2C+GN&rft.au=O%27Brien%2C+KM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Skinner2001-91\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Skinner2001_91-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Skinner KA, Silberman H, Dougherty W, Gamagami P, Waisman J, Sposto R, Silverstein MJ (2001). \"Breast cancer after augmentation mammoplasty\". <i>Ann Surg Oncol<\/i>. <b>8<\/b> (2): 138&ndash, 44. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10434-001-0138-x\" target=\"_blank\">10.1007\/s10434-001-0138-x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11258778\" target=\"_blank\">11258778<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+Surg+Oncol&rft.atitle=Breast+cancer+after+augmentation+mammoplasty&rft.volume=8&rft.issue=2&rft.pages=138%26ndash%2C+44&rft.date=2001&rft_id=info%3Adoi%2F10.1007%2Fs10434-001-0138-x&rft_id=info%3Apmid%2F11258778&rft.aulast=Skinner&rft.aufirst=KA&rft.au=Silberman%2C+H&rft.au=Dougherty%2C+W&rft.au=Gamagami%2C+P&rft.au=Waisman%2C+J&rft.au=Sposto%2C+R&rft.au=Silverstein%2C+MJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lee2005-92\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Lee2005_92-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Lee2005_92-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Le GM, O'Malley CD, Glaser SL, Lynch CF, Stanford JL, Keegan TH, West DW (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1064128\" target=\"_blank\">\"Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival\"<\/a>. <i>Breast Cancer Res<\/i>. <b>7<\/b> (2): R184\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2Fbcr974\" target=\"_blank\">10.1186\/bcr974<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1064128\" target=\"_blank\">1064128<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15743498\" target=\"_blank\">15743498<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Breast+Cancer+Res.&rft.atitle=Breast+implants+following+mastectomy+in+women+with+early-stage+breast+cancer%3A+prevalence+and+impact+on+survival&rft.volume=7&rft.issue=2&rft.pages=R184-93&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1064128&rft_id=info%3Apmid%2F15743498&rft_id=info%3Adoi%2F10.1186%2Fbcr974&rft.aulast=Le&rft.aufirst=GM&rft.au=O%27Malley%2C+CD&rft.au=Glaser%2C+SL&rft.au=Lynch%2C+CF&rft.au=Stanford%2C+JL&rft.au=Keegan%2C+TH&rft.au=West%2C+DW&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1064128&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HandelSilver2006-93\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HandelSilver2006_93-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Handel N, Silverstein MJ (2006). \"Breast cancer diagnosis and prognosis in augmented women\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (3): 587&ndash, 93. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000233038.47009.04\" target=\"_blank\">10.1097\/01.prs.0000233038.47009.04<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16932162\" target=\"_blank\">16932162<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Breast+cancer+diagnosis+and+prognosis+in+augmented+women&rft.volume=118&rft.issue=3&rft.pages=587%26ndash%2C+93&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000233038.47009.04&rft_id=info%3Apmid%2F16932162&rft.aulast=Handel&rft.aufirst=N&rft.au=Silverstein%2C+MJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Cunningham2006-94\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Cunningham2006_94-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cunningham B (2006). \"Breast cancer diagnosis and prognosis in augmented women- Discussion\". <i>Plastic and Reconstructive Surgery<\/i>. <b>118<\/b> (3): 594\u2013595. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000233047.87102.8e\" target=\"_blank\">10.1097\/01.prs.0000233047.87102.8e<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Breast+cancer+diagnosis+and+prognosis+in+augmented+women-+Discussion&rft.volume=118&rft.issue=3&rft.pages=594-595&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000233047.87102.8e&rft.au=Cunningham+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Scwartz2006-95\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Scwartz2006_95-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schwartz GF, Veronesi U, Clough KB, Dixon JM, Fentiman IS, Heywang-K\u00f6brunner SH, Holland R, Hughes KS, Mansel RE, Margolese R, Mendelson EB, Olivotto IA, Palazzo JP, Solin LJ (2006). \"Consensus Conference on Breast Conservation\". <i>JACAS<\/i>. <b>203<\/b> (2): 198\u2013207. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jamcollsurg.2006.04.009\" target=\"_blank\">10.1016\/j.jamcollsurg.2006.04.009<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16864033\" target=\"_blank\">16864033<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JACAS&rft.atitle=Consensus+Conference+on+Breast+Conservation&rft.volume=203&rft.issue=2&rft.pages=198-207&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.jamcollsurg.2006.04.009&rft_id=info%3Apmid%2F16864033&rft.aulast=Schwartz&rft.aufirst=GF&rft.au=Veronesi%2C+U&rft.au=Clough%2C+KB&rft.au=Dixon%2C+JM&rft.au=Fentiman%2C+IS&rft.au=Heywang-K%C3%B6brunner%2C+SH&rft.au=Holland%2C+R&rft.au=Hughes%2C+KS&rft.au=Mansel%2C+RE&rft.au=Margolese%2C+R&rft.au=Mendelson%2C+EB&rft.au=Olivotto%2C+IA&rft.au=Palazzo%2C+JP&rft.au=Solin%2C+LJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-96\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-96\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hwang ES; et al. (April 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3604076\" target=\"_blank\">\"Survival after Lumpectomy and Mastectomy for Early stage Invasive Breast Cancer: The Effect of Age and Hormone receptor Status\"<\/a>. <i>Cancer<\/i>. <b>119<\/b>: 1402\u20131411. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fcncr.27795\" target=\"_blank\">10.1002\/cncr.27795<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3604076\" target=\"_blank\">3604076<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cancer&rft.atitle=Survival+after+Lumpectomy+and+Mastectomy+for+Early+stage+Invasive+Breast+Cancer%3A+The+Effect+of+Age+and+Hormone+receptor+Status&rft.volume=119&rft.pages=1402-1411&rft.date=2013-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3604076&rft_id=info%3Adoi%2F10.1002%2Fcncr.27795&rft.au=Hwang+ES&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3604076&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDABICH-97\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDABICH_97-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDABICH_97-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDABICH_97-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDABICH_97-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDABICH_97-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDABICH_97-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDABICH_97-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDABICH_97-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/breastimplants\/indexbip.html\" target=\"_blank\">FDA Breast Implant Consumer Handbook - 2004<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080917223436\/http:\/\/www.fda.gov\/cdrh\/breastimplants\/indexbip.html\" target=\"_blank\">Archived<\/a> 2008-09-17 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-98\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-98\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/books.nap.edu\/catalog\/9602.html\" target=\"_blank\">\"Safety of Silicone Breast Implants - The National Academies Press\"<\/a>. <i>nap.edu<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081119070548\/http:\/\/books.nap.edu\/catalog\/9602.html\" target=\"_blank\">Archived<\/a> from the original on 2008-11-19.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nap.edu&rft.atitle=Safety+of+Silicone+Breast+Implants+-+The+National+Academies+Press&rft_id=http%3A%2F%2Fbooks.nap.edu%2Fcatalog%2F9602.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-99\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-99\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Martha Grigg, Stuart Bondurant, Virginia L. Ernster, and Roger Herdman, Editors. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/books.nap.edu\/catalog\/9618.html\" target=\"_blank\">\"Information for Women about the Safety of Silicone Breast Implants - The National Academies Press\"<\/a>. <i>nap.edu<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080821134735\/http:\/\/books.nap.edu\/catalog\/9618.html\" target=\"_blank\">Archived<\/a> from the original on 2008-08-21.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nap.edu&rft.atitle=Information+for+Women+about+the+Safety+of+Silicone+Breast+Implants+-+The+National+Academies+Press&rft_id=http%3A%2F%2Fbooks.nap.edu%2Fcatalog%2F9618.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-100\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-100\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/NEW00727.html\" target=\"_blank\">FDA study<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080113143409\/http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/NEW00727.html\" target=\"_blank\">Archived<\/a> January 13, 2008, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-101\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-101\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/pdf\/p990075.html\" target=\"_blank\">\"FDA approval\"<\/a>. <i>fda.gov<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090330052802\/http:\/\/www.fda.gov\/cdrh\/pdf\/p990075.html\" target=\"_blank\">Archived<\/a> from the original on 30 March 2009<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=fda.gov&rft.atitle=FDA+approval&rft_id=http%3A%2F%2Fwww.fda.gov%2Fcdrh%2Fpdf%2Fp990075.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-102\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-102\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/pdf\/p990074.html\" target=\"_blank\">\"FDA approval\"<\/a>. <i>fda.gov<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090526013245\/http:\/\/www.fda.gov\/cdrh\/pdf\/p990074.html\" target=\"_blank\">Archived<\/a> from the original on 26 May 2009<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=fda.gov&rft.atitle=FDA+approval&rft_id=http%3A%2F%2Fwww.fda.gov%2Fcdrh%2Fpdf%2Fp990074.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-103\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-103\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/2006\/NEW01512.html\" target=\"_blank\">\"FDA Approves Silicone Gel-Filled Breast Implants\"<\/a>. FDA. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080726061002\/http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/2006\/NEW01512.html\" target=\"_blank\">Archived<\/a> from the original on 2008-07-26<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-07-01<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=FDA+Approves+Silicone+Gel-Filled+Breast+Implants&rft.pub=FDA&rft_id=http%3A%2F%2Fwww.fda.gov%2Fbbs%2Ftopics%2FNEWS%2F2006%2FNEW01512.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-104\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-104\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"#4\">[3]<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101112214319\/http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ImplantsandProsthetics\/BreastImplants\/ucm063719.htm\" target=\"_blank\">Archived<\/a> 2010-11-12 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-105\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-105\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"#5\">[4]<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101112214319\/http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ImplantsandProsthetics\/BreastImplants\/ucm063719.htm\" target=\"_blank\">Archived<\/a> 2010-11-12 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-Breiting2004-106\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Breiting2004_106-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Breiting VB, H\u00f6lmich LR, Brandt B, Fryzek JP, Wolthers MS, Kj\u00f8ller K, McLaughlin JK, Wiik A, Friis S (2004). \"Long-term Health Status of Danish Women with Silicone Breast Implants\". <i>Plastic and Reconstructive Surgery<\/i>. <b>114<\/b> (1): 217\u2013226. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PRS.0000128823.77637.8A\" target=\"_blank\">10.1097\/01.PRS.0000128823.77637.8A<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15220596\" target=\"_blank\">15220596<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Long-term+Health+Status+of+Danish+Women+with+Silicone+Breast+Implants&rft.volume=114&rft.issue=1&rft.pages=217-226&rft.date=2004&rft_id=info%3Adoi%2F10.1097%2F01.PRS.0000128823.77637.8A&rft_id=info%3Apmid%2F15220596&rft.aulast=Breiting&rft.aufirst=VB&rft.au=H%C3%B6lmich%2C+LR&rft.au=Brandt%2C+B&rft.au=Fryzek%2C+JP&rft.au=Wolthers%2C+MS&rft.au=Kj%C3%B8ller%2C+K&rft.au=McLaughlin%2C+JK&rft.au=Wiik%2C+A&rft.au=Friis%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Brinton2006-107\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Brinton2006_107-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brinton LA, Lubin JH, Murray MC, Colton T, Hoover RN (2006). \"Mortality Rates Among Augmentation Mammoplasty Patients: An Update\". <i>Epidemiology<\/i>. <b>17<\/b> (2): 162&ndash, 9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.ede.0000197056.84629.19\" target=\"_blank\">10.1097\/01.ede.0000197056.84629.19<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16477256\" target=\"_blank\">16477256<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Epidemiology&rft.atitle=Mortality+Rates+Among+Augmentation+Mammoplasty+Patients%3A+An+Update&rft.volume=17&rft.issue=2&rft.pages=162%26ndash%2C+9&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2F01.ede.0000197056.84629.19&rft_id=info%3Apmid%2F16477256&rft.aulast=Brinton&rft.aufirst=LA&rft.au=Lubin%2C+JH&rft.au=Murray%2C+MC&rft.au=Colton%2C+T&rft.au=Hoover%2C+RN&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Villenueve2006-108\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Villenueve2006_108-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Villeneuve PJ, Holowaty EJ, Brisson J, Xie L, Ugnat AM, Latulippe L, Mao Y (June 2006). \"Mortality Among Canadian Women with Cosmetic Breast Implants\". <i>American Journal of Epidemiology<\/i>. <b>164<\/b> (4): 334\u2013341. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Faje%2Fkwj214\" target=\"_blank\">10.1093\/aje\/kwj214<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16777929\" target=\"_blank\">16777929<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Epidemiology&rft.atitle=Mortality+Among+Canadian+Women+with+Cosmetic+Breast+Implants&rft.volume=164&rft.issue=4&rft.pages=334-341&rft.date=2006-06&rft_id=info%3Adoi%2F10.1093%2Faje%2Fkwj214&rft_id=info%3Apmid%2F16777929&rft.aulast=Villeneuve&rft.aufirst=PJ&rft.au=Holowaty%2C+EJ&rft.au=Brisson%2C+J&rft.au=Xie%2C+L&rft.au=Ugnat%2C+AM&rft.au=Latulippe%2C+L&rft.au=Mao%2C+Y&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Brinton1996-109\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Brinton1996_109-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brinton LA, Malone KE, Coates RJ, Schoenberg JB, Swanson CA, Daling JR, Stanford JL (1996). \"Breast Enlargement and Reduction: Results from a Breast Cancer Case-control Study\". <i>Plastic and Reconstructive Surgery<\/i>. <b>97<\/b> (2): 269\u2013275. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-199602000-00001\" target=\"_blank\">10.1097\/00006534-199602000-00001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8559808\" target=\"_blank\">8559808<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Breast+Enlargement+and+Reduction%3A+Results+from+a+Breast+Cancer+Case-control+Study&rft.volume=97&rft.issue=2&rft.pages=269-275&rft.date=1996&rft_id=info%3Adoi%2F10.1097%2F00006534-199602000-00001&rft_id=info%3Apmid%2F8559808&rft.aulast=Brinton&rft.aufirst=LA&rft.au=Malone%2C+KE&rft.au=Coates%2C+RJ&rft.au=Schoenberg%2C+JB&rft.au=Swanson%2C+CA&rft.au=Daling%2C+JR&rft.au=Stanford%2C+JL&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-110\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-110\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Benadiba, Laurent (2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150129035409\/http:\/\/laurent.benadiba.free.fr\/SITE%20These\/Analyse%20resultats.htm\" target=\"_blank\">\"Histoire des protheses mammaires\"<\/a> (in French). Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/laurent.benadiba.free.fr\/SITE%20These\/Analyse%20resultats.htm\" target=\"_blank\">the original<\/a> on 29 January 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 October<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Histoire+des+protheses+mammaires&rft.date=2004&rft.aulast=Benadiba&rft.aufirst=Laurent&rft_id=http%3A%2F%2Flaurent.benadiba.free.fr%2FSITE%2520These%2FAnalyse%2520resultats.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-111\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-111\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070101081442\/http:\/\/www.tga.gov.au\/docs\/pdf\/breasti4.pdf\" target=\"_blank\">\"Archived copy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tga.gov.au\/docs\/pdf\/breasti4.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2007-01-01<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2006-12-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.tga.gov.au%2Fdocs%2Fpdf%2Fbreasti4.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Germany1998-112\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Germany1998_112-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"German Society for Senology, Declaration of Consensus for the Security of Silicone Breast Implants-24 September 1998\". 1998.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=German+Society+for+Senology%2C+Declaration+of+Consensus+for+the+Security+of+Silicone+Breast+Implants-24+September+1998&rft.date=1998&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NEJM2000-Janowsky-113\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NEJM2000-Janowsky_113-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Janowsky EC, Kupper LL, Hulka BS (2000). \"Meta-analyses of the Relation between Silicone Breast Implants and the Risk of Connective-tissue Diseases\". <i>New England Journal of Medicine<\/i>. <b>342<\/b> (11): 781\u2013790. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJM200003163421105\" target=\"_blank\">10.1056\/NEJM200003163421105<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10717013\" target=\"_blank\">10717013<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Meta-analyses+of+the+Relation+between+Silicone+Breast+Implants+and+the+Risk+of+Connective-tissue+Diseases&rft.volume=342&rft.issue=11&rft.pages=781-790&rft.date=2000&rft_id=info%3Adoi%2F10.1056%2FNEJM200003163421105&rft_id=info%3Apmid%2F10717013&rft.aulast=Janowsky&rft.aufirst=EC&rft.au=Kupper%2C+LL&rft.au=Hulka%2C+BS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-114\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-114\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.secpre.org\/pdf\/equam.pdf\" target=\"_blank\">[5]<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20051227102900\/http:\/\/www.secpre.org\/pdf\/equam.pdf\" target=\"_blank\">Archived<\/a> December 27, 2005, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-115\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-115\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.silicone-review.gov.uk\/press_notice.htm\" target=\"_blank\">[6]<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060623053747\/http:\/\/www.silicone-review.gov.uk\/press_notice.htm\" target=\"_blank\">Archived<\/a> June 23, 2006, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-ArthritisRheum2001-Tugwell-116\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ArthritisRheum2001-Tugwell_116-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tugwell P, Wells G, Peterson J, Welch V, Page J, Davison C, McGowan J, Ramroth D, Shea B (2001). \"Do silicone Breast Implants Cause Rheumatologic Disorders? A Systematic Review for a Court-appointed National Science Panel\". <i>Arthritis Rheum<\/i>. <b>44<\/b> (11): 2477&ndash, 84. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F1529-0131%28200111%2944%3A11%3C2477%3A%3AAID-ART427%3E3.0.CO%3B2-Q\" target=\"_blank\">10.1002\/1529-0131(200111)44:11<2477::AID-ART427>3.0.CO;2-Q<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11710703\" target=\"_blank\">11710703<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arthritis+Rheum&rft.atitle=Do+silicone+Breast+Implants+Cause+Rheumatologic+Disorders%3F+A+Systematic+Review+for+a+Court-appointed+National+Science+Panel&rft.volume=44&rft.issue=11&rft.pages=2477%26ndash%2C+84&rft.date=2001&rft_id=info%3Adoi%2F10.1002%2F1529-0131%28200111%2944%3A11%3C2477%3A%3AAID-ART427%3E3.0.CO%3B2-Q&rft_id=info%3Apmid%2F11710703&rft.aulast=Tugwell&rft.aufirst=P&rft.au=Wells%2C+G&rft.au=Peterson%2C+J&rft.au=Welch%2C+V&rft.au=Page%2C+J&rft.au=Davison%2C+C&rft.au=McGowan%2C+J&rft.au=Ramroth%2C+D&rft.au=Shea%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-117\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-117\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/web.archive.org\/web\/20030829114951\/http:\/\/www.eucomed.be\/docs\/STOA-SILICONE%20BREAST%20IMPLANT%20Study%20update-30May03.pdf\" target=\"_blank\">https:\/\/web.archive.org\/web\/20030829114951\/http:\/\/www.eucomed.be\/docs\/STOA-SILICONE%20BREAST%20IMPLANT%20Study%20update-30May03.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-iquam2009-118\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-iquam2009_118-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Neuhann-Lorenz C, Fedeles J, Eisenman-Klein M, Kinney B, Cunningham BL (2001). \"Eighth IQUAM Consensus Position Statement: Transatlantic Innovations, April 2009\". <i>Plastic and Reconstructive Surgery<\/i>. <b>127<\/b> (3): 1368&ndash, 75. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FPRS.0b013e318206312e\" target=\"_blank\">10.1097\/PRS.0b013e318206312e<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21364439\" target=\"_blank\">21364439<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Eighth+IQUAM+Consensus+Position+Statement%3A+Transatlantic+Innovations%2C+April+2009&rft.volume=127&rft.issue=3&rft.pages=1368%26ndash%2C+75&rft.date=2001&rft_id=info%3Adoi%2F10.1097%2FPRS.0b013e318206312e&rft_id=info%3Apmid%2F21364439&rft.aulast=Neuhann-Lorenz&rft.aufirst=C&rft.au=Fedeles%2C+J&rft.au=Eisenman-Klein%2C+M&rft.au=Kinney%2C+B&rft.au=Cunningham%2C+BL&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABreast+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/emedicine.medscape.com\/article\/1273841-overview\" target=\"_blank\">Article \"Expander-Implant Breast Reconstruction\"<\/a> at Medscape<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1247\nCached time: 20181211210644\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.204 seconds\nReal time usage: 1.399 seconds\nPreprocessor visited node count: 5420\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 231535\/2097152 bytes\nTemplate argument size: 1350\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 315190\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.699\/10.000 seconds\nLua memory usage: 6.44 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1143.144 1 -total\n<\/p>\n<pre>73.94% 845.222 1 Template:Reflist\n50.36% 575.674 76 Template:Cite_journal\n 7.26% 82.950 21 Template:Cite_web\n 5.93% 67.765 1 Template:Explain\n 5.18% 59.206 2 Template:Fix\n 4.56% 52.074 1 Template:Commons_category\n 3.22% 36.860 3 Template:Category_handler\n 2.17% 24.823 11 Template:Webarchive\n 1.95% 22.261 3 Template:Cite_news\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4892591-1!canonical and timestamp 20181211210643 and revision id 873215383\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214639\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.046 seconds\nReal time usage: 0.235 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 222.106 1 - wikipedia:Breast_implant\n100.00% 222.106 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7998-0!*!*!*!*!*!* and timestamp 20181217214639 and revision id 24191\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Breast_implant\">https:\/\/www.limswiki.org\/index.php\/Breast_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","080c85ceaf86caa08168d9673750ed5c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Vincenz_Czerny.jpg\/370px-Vincenz_Czerny.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Saline-filled_breast_implants.jpeg\/440px-Saline-filled_breast_implants.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/7\/78\/Original_implant.jpg\/440px-Original_implant.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/32\/Silicone_gel-filled_breast_implants.jpeg\/440px-Silicone_gel-filled_breast_implants.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/24\/Subglandular_breast_implants.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a7\/Subpectoral_breast_implants.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/ff\/Submuscular_breast_implants.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/52\/Ruptured_implant.JPG\/500px-Ruptured_implant.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a6\/Capsular_fibrosis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fe\/BreastImplant09.JPG\/440px-BreastImplant09.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Breast_anatomy_normal_scheme.png\/440px-Breast_anatomy_normal_scheme.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Mammo_breast_cancer.jpg\/440px-Mammo_breast_cancer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Breast_MRI_Implant_T1FSE_T2FSE_InPhase_STIR_Silicon_23.jpg\/440px-Breast_MRI_Implant_T1FSE_T2FSE_InPhase_STIR_Silicon_23.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/79\/Seal_of_the_United_States_Department_of_Health_and_Human_Services.svg\/440px-Seal_of_the_United_States_Department_of_Health_and_Human_Services.svg.png"],"080c85ceaf86caa08168d9673750ed5c_timestamp":1545083199,"39938517ef6a79887757323425f0a04b_type":"article","39938517ef6a79887757323425f0a04b_title":"Biomesh","39938517ef6a79887757323425f0a04b_url":"https:\/\/www.limswiki.org\/index.php\/Biomesh","39938517ef6a79887757323425f0a04b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBiomesh\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t A biologic form of surgical mesh called biomesh has been used in inguinal and other types of hernia surgeries, particular in contaminated fields.\nBiologic mesh (or biomesh) is a type of surgical mesh made from an organic biomaterial (such as porcine dermis, porcine small intestine submucosa, bovine dermis or pericardium, and the dermis or fascia lata of a cadaveric human). Biologic mesh is primarily indicated for several types of hernia repair, including inguinal and ventral hernias, hernia prophylaxis, and contaminated hernia repairs.[1][2] However, it has also been used in pelvic floor dysfunction, parotidectomy, and reconstructive plastic surgery.[2] The development of biologic mesh largely has derived from the need of a biocompatible material that addresses \"the problems associated with a permanent synthetic mesh, including chronic inflammation, foreign body reaction, fibrosis, and mesh infection.\"[1][3] As of 2015[update], however, the efficacy and optimal use of biological mesh products remains in question.[2][3]\n\n Development, benefits, and drawbacks \nThe idea of using organic materials for surgical mesh has been around since at least the late 1950s, though researchers soon learned the materials they tested weren't biocompatible.[1] Research into more compatible biomaterials occurred in the proceeding decades, including the search for cellular-based materials extracted from humans and animals. For example, in 1980, research presented at the first ever World Biomaterials Congress detailed the examined use of dermal collagen of sheep to construct biological mesh for reconstructive surgery.[4] Since then, \"research for developing and improvising the biological material required for the production of these meshes\" has been ongoing.[1]\nTypical advantages attributed to biologic meshes include reducing the risk of infection (from using non-biologic surgical meshes) and is absorbed into the resulting scar as part of cellular ingrowth.[2][5] Commonly described drawbacks include the high cost of the material and its uncertain clinical effectiveness, particularly in regards to the cost.[1][2][5] An August 2015 follow-up literature review published by the Canadian Agency for Drugs and Technologies in Health in particular addressed these drawbacks, concluding:\n\nBased on the publications identified for the current report, there remains a lack of sufficient evidence to guide clinical practice regarding the use of biological mesh products ... Several surgical indications are addressed by this collection of [randomized controlled trials (RCTs)] with relatively few studies per indication. Therefore, it is not immediately apparent whether this represents a significant amount of research on the clinical effectiveness of any particular mesh product or for any specific patient population that would support clinical decision making. Further rigorously designed RCTs are required to clarify comparative clinical effectiveness and safety of the many available biological mesh products for most surgical indications in which their use has been suggested.[2]\nContamination considerations \nThe presence of contamination may limit the applicability of permanent synthetic mesh in some procedures such as hernia repair. Biologic mesh may be acceptable for this purpose or for placement in open wounds as a staged closure in complex abdominal wall reconstruction. There is limited data in both of these areas, with some noting a high risk of hernia recurrence and associated infection. The data is mostly limited to animal models and case series.[6][7][8][9] However, the lack of suitable alternatives has made biologic mesh attractive for contaminated field hernia repair.[1]\n\nReferences \n\n\n^ a b c d e f Chowbey, P., ed. (2012). \"Chapter 6: Prosthetics and fixations devices\". Endoscopic Repair of Abdominal Wall Hernias (2nd ed.). Delhi, India: Byword Books Private Limited. pp. 63\u201386. ISBN 9788181930880. Retrieved 16 March 2016 . \n\n^ a b c d e f Canadian Agency for Drugs and Technologies in Health (11 August 2015). \"Biological Mesh: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines \u2013 An Update\". PubMed Health. U.S. National Library of Medicine. Retrieved 16 March 2016 . \n\n^ a b Carbonell-Tatay, F.; Gonz\u00e1lez, \u00c1.Z. (2015). \"Chapter 47: Surgical Advances in the Treatment of Abdominal Wall Hernias\". In Latifi, R.; Rhee, P.; Gruessner, R.W.G. Technological Advances in Surgery, Trauma and Critical Care. New York: Springer. pp. 573\u2013597. ISBN 9781493926718. Retrieved 16 March 2016 . \n\n^ van Gulik, T.M.; Klopper, P.J.; van der Hooff, A.; Bantjes, A. (1980). \"Processed Sheep Dermal Collagen as a Biomaterial: An Experimental Study\". In World Biomaterials Congress. Final Programme, Book Of Abstracts: First World Biomaterials Congress, Baden Near Vienna, Austria, April 8-12, 1980 In Conjunction With The Twelfth International Biomaterials Symposium And The Sixth Annual Meeting Of The Society For Biomaterials. European Society for Biomaterials. p. 2.107. ISBN 9782902590025. Retrieved 16 March 2016 . In our search for a biological mesh for reconstructive surgery, we investigated sheep dermal collagen. \n\n^ a b Sturt, N.J.H.; Windsor, A.C.J.; Engledow, A.H. (2011). \"Chapter 8: Modern Management of an Intestinal Fistula\". In Taylor, I; Johnson, C.D. Recent Advances in Surgery 34. New Delhi, India: Jaypee Brothers Medical Publishers. pp. 109\u2013124. ISBN 9789350253021. Retrieved 16 March 2016 . \n\n^ Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ. Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia. 2007 Jun;11(3):279-85. \n\n^ Candage R, Jones K, Luchette FA, Sinacore JM, Vandevender D, Reed RL 2nd. Use of human acellular dermal matrix for hernia repair: friend or foe? Surgery. 2008 Oct;144(4):703-9. \n\n^ Rosen MJ. Biologic mesh for abdominal wall reconstruction: a critical appraisal. Am Surg. 2010 Jan;76(1):1-6. \n\n^ Harth KC, Rosen MJ. Major complications associated with xenograft biologic mesh implantation in abdominal wall reconstruction. Surg Innov. 2009 Dec;16(4):324-9. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biomesh\">https:\/\/www.limswiki.org\/index.php\/Biomesh<\/a>\n\t\t\t\t\tCategories: BiomaterialsImplants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Biomesh<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tensionsfree_Wantz_Operation.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ac\/Tensionsfree_Wantz_Operation.jpg\/250px-Tensionsfree_Wantz_Operation.jpg\" width=\"250\" height=\"348\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tensionsfree_Wantz_Operation.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A biologic form of surgical mesh called biomesh has been used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inguinal_hernia\" title=\"Inguinal hernia\" rel=\"external_link\" target=\"_blank\">inguinal<\/a> and other types of hernia surgeries, particular in contaminated fields.<\/div><\/div><\/div>\n<p><b>Biologic mesh<\/b> (or <b>biomesh<\/b>) is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_mesh\" title=\"Surgical mesh\" rel=\"external_link\" target=\"_blank\">surgical mesh<\/a> made from an organic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">biomaterial<\/a> (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porcine\" class=\"mw-redirect\" title=\"Porcine\" rel=\"external_link\" target=\"_blank\">porcine<\/a> dermis, porcine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Submucosa#Small_intestinal_submucosa\" title=\"Submucosa\" rel=\"external_link\" target=\"_blank\">small intestine submucosa<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovine\" class=\"mw-redirect\" title=\"Bovine\" rel=\"external_link\" target=\"_blank\">bovine<\/a> dermis or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericardium\" title=\"Pericardium\" rel=\"external_link\" target=\"_blank\">pericardium<\/a>, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dermis\" title=\"Dermis\" rel=\"external_link\" target=\"_blank\">dermis<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fascia_lata\" title=\"Fascia lata\" rel=\"external_link\" target=\"_blank\">fascia lata<\/a> of a cadaveric human). Biologic mesh is primarily indicated for several types of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hernia\" title=\"Hernia\" rel=\"external_link\" target=\"_blank\">hernia<\/a> repair, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inguinal_hernia\" title=\"Inguinal hernia\" rel=\"external_link\" target=\"_blank\">inguinal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incisional_hernia\" title=\"Incisional hernia\" rel=\"external_link\" target=\"_blank\">ventral<\/a> hernias, hernia prophylaxis, and contaminated hernia repairs.<sup id=\"rdp-ebb-cite_ref-ChowbeyEndo12_1-0\" class=\"reference\"><a href=\"#cite_note-ChowbeyEndo12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-CADTHBio15_2-0\" class=\"reference\"><a href=\"#cite_note-CADTHBio15-2\" rel=\"external_link\">[2]<\/a><\/sup> However, it has also been used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvic_floor_dysfunction\" title=\"Pelvic floor dysfunction\" rel=\"external_link\" target=\"_blank\">pelvic floor dysfunction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parotidectomy\" title=\"Parotidectomy\" rel=\"external_link\" target=\"_blank\">parotidectomy<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">reconstructive plastic surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-CADTHBio15_2-1\" class=\"reference\"><a href=\"#cite_note-CADTHBio15-2\" rel=\"external_link\">[2]<\/a><\/sup> The development of biologic mesh largely has derived from the need of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a> material that addresses \"the problems associated with a permanent synthetic mesh, including chronic inflammation, foreign body reaction, fibrosis, and mesh infection.\"<sup id=\"rdp-ebb-cite_ref-ChowbeyEndo12_1-1\" class=\"reference\"><a href=\"#cite_note-ChowbeyEndo12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Carbonell-TataySurg15_3-0\" class=\"reference\"><a href=\"#cite_note-Carbonell-TataySurg15-3\" rel=\"external_link\">[3]<\/a><\/sup> As of 2015<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, however, the efficacy and optimal use of biological mesh products remains in question.<sup id=\"rdp-ebb-cite_ref-CADTHBio15_2-2\" class=\"reference\"><a href=\"#cite_note-CADTHBio15-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Carbonell-TataySurg15_3-1\" class=\"reference\"><a href=\"#cite_note-Carbonell-TataySurg15-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-Development.2C_benefits.2C_and_drawbacks\"><\/span><span class=\"mw-headline\" id=\"Development,_benefits,_and_drawbacks\">Development, benefits, and drawbacks<\/span><\/h2>\n<p>The idea of using organic materials for surgical mesh has been around since at least the late 1950s, though researchers soon learned the materials they tested weren't <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a>.<sup id=\"rdp-ebb-cite_ref-ChowbeyEndo12_1-2\" class=\"reference\"><a href=\"#cite_note-ChowbeyEndo12-1\" rel=\"external_link\">[1]<\/a><\/sup> Research into more compatible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a> occurred in the proceeding decades, including the search for cellular-based materials extracted from humans and animals. For example, in 1980, research presented at the first ever World Biomaterials Congress detailed the examined use of dermal collagen of sheep to construct biological mesh for reconstructive surgery.<sup id=\"rdp-ebb-cite_ref-ESBBio80_4-0\" class=\"reference\"><a href=\"#cite_note-ESBBio80-4\" rel=\"external_link\">[4]<\/a><\/sup> Since then, \"research for developing and improvising the biological material required for the production of these meshes\" has been ongoing.<sup id=\"rdp-ebb-cite_ref-ChowbeyEndo12_1-3\" class=\"reference\"><a href=\"#cite_note-ChowbeyEndo12-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Typical advantages attributed to biologic meshes include reducing the risk of infection (from using non-biologic surgical meshes) and is absorbed into the resulting scar as part of cellular ingrowth.<sup id=\"rdp-ebb-cite_ref-CADTHBio15_2-3\" class=\"reference\"><a href=\"#cite_note-CADTHBio15-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SturtModern06_5-0\" class=\"reference\"><a href=\"#cite_note-SturtModern06-5\" rel=\"external_link\">[5]<\/a><\/sup> Commonly described drawbacks include the high cost of the material and its uncertain clinical effectiveness, particularly in regards to the cost.<sup id=\"rdp-ebb-cite_ref-ChowbeyEndo12_1-4\" class=\"reference\"><a href=\"#cite_note-ChowbeyEndo12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-CADTHBio15_2-4\" class=\"reference\"><a href=\"#cite_note-CADTHBio15-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SturtModern06_5-1\" class=\"reference\"><a href=\"#cite_note-SturtModern06-5\" rel=\"external_link\">[5]<\/a><\/sup> An August 2015 follow-up literature review published by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canadian_Agency_for_Drugs_and_Technologies_in_Health\" title=\"Canadian Agency for Drugs and Technologies in Health\" rel=\"external_link\" target=\"_blank\">Canadian Agency for Drugs and Technologies in Health<\/a> in particular addressed these drawbacks, concluding:\n<\/p>\n<blockquote><p>Based on the publications identified for the current report, there remains a lack of sufficient evidence to guide clinical practice regarding the use of biological mesh products ... Several surgical indications are addressed by this collection of [randomized controlled trials (RCTs)] with relatively few studies per indication. Therefore, it is not immediately apparent whether this represents a significant amount of research on the clinical effectiveness of any particular mesh product or for any specific patient population that would support clinical decision making. Further rigorously designed RCTs are required to clarify comparative clinical effectiveness and safety of the many available biological mesh products for most surgical indications in which their use has been suggested.<sup id=\"rdp-ebb-cite_ref-CADTHBio15_2-5\" class=\"reference\"><a href=\"#cite_note-CADTHBio15-2\" rel=\"external_link\">[2]<\/a><\/sup><\/p><\/blockquote>\n<h3><span class=\"mw-headline\" id=\"Contamination_considerations\">Contamination considerations<\/span><\/h3>\n<p>The presence of contamination may limit the applicability of permanent synthetic mesh in some procedures such as hernia repair. Biologic mesh may be acceptable for this purpose or for placement in open wounds as a staged closure in complex abdominal wall reconstruction. There is limited data in both of these areas, with some noting a high risk of hernia recurrence and associated infection. The data is mostly limited to animal models and case series.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> However, the lack of suitable alternatives has made biologic mesh attractive for contaminated field hernia repair.<sup id=\"rdp-ebb-cite_ref-ChowbeyEndo12_1-5\" class=\"reference\"><a href=\"#cite_note-ChowbeyEndo12-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-ChowbeyEndo12-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ChowbeyEndo12_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ChowbeyEndo12_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ChowbeyEndo12_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ChowbeyEndo12_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ChowbeyEndo12_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ChowbeyEndo12_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Chowbey, P., ed. (2012). \"Chapter 6: Prosthetics and fixations devices\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=2G3wJoqnFAMC&pg=PA76\" target=\"_blank\"><i>Endoscopic Repair of Abdominal Wall Hernias<\/i><\/a> (2nd ed.). Delhi, India: Byword Books Private Limited. pp. 63\u201386. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9788181930880<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+6%3A+Prosthetics+and+fixations+devices&rft.btitle=Endoscopic+Repair+of+Abdominal+Wall+Hernias&rft.place=Delhi%2C+India&rft.pages=63-86&rft.edition=2nd&rft.pub=Byword+Books+Private+Limited&rft.date=2012&rft.isbn=9788181930880&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D2G3wJoqnFAMC%26pg%3DPA76&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomesh\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-CADTHBio15-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CADTHBio15_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTHBio15_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTHBio15_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTHBio15_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTHBio15_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTHBio15_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Canadian Agency for Drugs and Technologies in Health (11 August 2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmedhealth\/PMH0079059\/\" target=\"_blank\">\"Biological Mesh: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines \u2013 An Update\"<\/a>. <i>PubMed Health<\/i>. U.S. National Library of Medicine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=PubMed+Health&rft.atitle=Biological+Mesh%3A+A+Review+of+Clinical+Effectiveness%2C+Cost-Effectiveness+and+Guidelines+%E2%80%93+An+Update&rft.date=2015-08-11&rft.au=Canadian+Agency+for+Drugs+and+Technologies+in+Health&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmedhealth%2FPMH0079059%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Carbonell-TataySurg15-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Carbonell-TataySurg15_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carbonell-TataySurg15_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Carbonell-Tatay, F.; Gonz\u00e1lez, \u00c1.Z. (2015). \"Chapter 47: Surgical Advances in the Treatment of Abdominal Wall Hernias\". In Latifi, R.; Rhee, P.; Gruessner, R.W.G. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=FgWhCgAAQBAJ&pg=PA591\" target=\"_blank\"><i>Technological Advances in Surgery, Trauma and Critical Care<\/i><\/a>. New York: Springer. pp. 573\u2013597. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781493926718<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+47%3A+Surgical+Advances+in+the+Treatment+of+Abdominal+Wall+Hernias&rft.btitle=Technological+Advances+in+Surgery%2C+Trauma+and+Critical+Care&rft.place=New+York&rft.pages=573-597&rft.pub=Springer&rft.date=2015&rft.isbn=9781493926718&rft.au=Carbonell-Tatay%2C+F.&rft.au=Gonz%C3%A1lez%2C+%C3%81.Z.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DFgWhCgAAQBAJ%26pg%3DPA591&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ESBBio80-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ESBBio80_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">van Gulik, T.M.; Klopper, P.J.; van der Hooff, A.; Bantjes, A. (1980). \"Processed Sheep Dermal Collagen as a Biomaterial: An Experimental Study\". In World Biomaterials Congress. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=UMVpAAAAMAAJ&q=%22biological+mesh%22&dq=%22biological+mesh%22&hl=en&sa=X&ved=0ahUKEwiboeehlcbLAhUJsYMKHZXrAQ4Q6AEILTAC\" target=\"_blank\"><i>Final Programme, Book Of Abstracts: First World Biomaterials Congress, Baden Near Vienna, Austria, April 8-12, 1980 In Conjunction With The Twelfth International Biomaterials Symposium And The Sixth Annual Meeting Of The Society For Biomaterials<\/i><\/a>. European Society for Biomaterials. p. 2.107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9782902590025<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 March<\/span> 2016<\/span>. <q>In our search for a biological mesh for reconstructive surgery, we investigated sheep dermal collagen.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Processed+Sheep+Dermal+Collagen+as+a+Biomaterial%3A+An+Experimental+Study&rft.btitle=Final+Programme%2C+Book+Of+Abstracts%3A+First+World+Biomaterials+Congress%2C+Baden+Near+Vienna%2C+Austria%2C+April+8-12%2C+1980+In+Conjunction+With+The+Twelfth+International+Biomaterials+Symposium+And+The+Sixth+Annual+Meeting+Of+The+Society+For+Biomaterials&rft.pages=2.107&rft.pub=European+Society+for+Biomaterials&rft.date=1980&rft.isbn=9782902590025&rft.au=van+Gulik%2C+T.M.&rft.au=Klopper%2C+P.J.&rft.au=van+der+Hooff%2C+A.&rft.au=Bantjes%2C+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DUMVpAAAAMAAJ%26q%3D%2522biological%2Bmesh%2522%26dq%3D%2522biological%2Bmesh%2522%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwiboeehlcbLAhUJsYMKHZXrAQ4Q6AEILTAC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SturtModern06-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-SturtModern06_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-SturtModern06_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Sturt, N.J.H.; Windsor, A.C.J.; Engledow, A.H. (2011). \"Chapter 8: Modern Management of an Intestinal Fistula\". In Taylor, I; Johnson, C.D. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=EtJtBAAAQBAJ&pg=PA121\" target=\"_blank\"><i>Recent Advances in Surgery 34<\/i><\/a>. New Delhi, India: Jaypee Brothers Medical Publishers. pp. 109\u2013124. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789350253021<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+8%3A+Modern+Management+of+an+Intestinal+Fistula&rft.btitle=Recent+Advances+in+Surgery+34&rft.place=New+Delhi%2C+India&rft.pages=109-124&rft.pub=Jaypee+Brothers+Medical+Publishers&rft.date=2011&rft.isbn=9789350253021&rft.au=Sturt%2C+N.J.H.&rft.au=Windsor%2C+A.C.J.&rft.au=Engledow%2C+A.H.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DEtJtBAAAQBAJ%26pg%3DPA121&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ. Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia. 2007 Jun;11(3):279-85.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Candage R, Jones K, Luchette FA, Sinacore JM, Vandevender D, Reed RL 2nd. Use of human acellular dermal matrix for hernia repair: friend or foe? Surgery. 2008 Oct;144(4):703-9.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rosen MJ. Biologic mesh for abdominal wall reconstruction: a critical appraisal. Am Surg. 2010 Jan;76(1):1-6.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Harth KC, Rosen MJ. Major complications associated with xenograft biologic mesh implantation in abdominal wall reconstruction. Surg Innov. 2009 Dec;16(4):324-9.<\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181217110819\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.144 seconds\nReal time usage: 0.189 seconds\nPreprocessor visited node count: 562\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 14298\/2097152 bytes\nTemplate argument size: 446\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 19895\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.065\/10.000 seconds\nLua memory usage: 2.5 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.167 1 -total\n<\/p>\n<pre>72.85% 115.219 1 Template:Reflist\n52.15% 82.485 4 Template:Cite_book\n21.48% 33.981 1 Template:As_of\n17.54% 27.740 1 Template:DMCA\n15.95% 25.226 1 Template:Dated_maintenance_category\n13.34% 21.093 1 Template:FULLROOTPAGENAME\n11.42% 18.057 1 Template:Ns_has_subpages\n 4.62% 7.305 1 Template:Cite_web\n 2.07% 3.274 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:35754260-1!canonical and timestamp 20181217110819 and revision id 813539514\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biomesh\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214638\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.024 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 168.858 1 - wikipedia:Biomesh\n100.00% 168.858 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7991-0!*!*!*!*!*!* and timestamp 20181217214638 and revision id 24103\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biomesh\">https:\/\/www.limswiki.org\/index.php\/Biomesh<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","39938517ef6a79887757323425f0a04b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ac\/Tensionsfree_Wantz_Operation.jpg\/500px-Tensionsfree_Wantz_Operation.jpg"],"39938517ef6a79887757323425f0a04b_timestamp":1545083198,"71da9a445fe27824deb1b95cf92c4832_type":"article","71da9a445fe27824deb1b95cf92c4832_title":"Artificial heart","71da9a445fe27824deb1b95cf92c4832_url":"https:\/\/www.limswiki.org\/index.php\/Artificial_heart","71da9a445fe27824deb1b95cf92c4832_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tArtificial heart\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the mechanical device. For the Jonathan Coulton album, see Artificial Heart (album).\n The SynCardia temporary Total Artificial Heart\n An artificial heart displayed at the London Science Museum\nAn artificial heart is a device that replaces the heart. Artificial hearts are typically used to bridge the time to heart transplantation, or to permanently replace the heart in case heart transplantation is impossible. Although other similar inventions preceded it from the late 1940s, the first artificial heart to be successfully implanted in a human was the Jarvik-7 in 1982, designed by a team including Willem Johan Kolff and Robert Jarvik.\nAn artificial heart is distinct from a ventricular assist device (VAD) designed to support a failing heart. It is also distinct from a cardiopulmonary bypass machine, which is an external device used to provide the functions of both the heart and lungs and are used only for a few hours at a time, most commonly during cardiac surgery.\n\nContents \n\n1 History \n\n1.1 Origins \n1.2 Early development \n1.3 Early designs of total artificial hearts \n1.4 First clinical implantation of a total artificial heart \n1.5 First clinical applications of a permanent pneumatic total artificial heart \n1.6 First clinical application of an intrathoracic pump \n1.7 First clinical application of a paracorporeal pump \n1.8 First VAD patient with FDA approved hospital discharge \n\n\n2 Total artificial heart prototypes \n\n2.1 Total artificial heart pump \n2.2 POLVAD \n2.3 Phoenix-7 \n2.4 Abiomed AbioCor \n2.5 SynCardia \n2.6 MagScrew \n2.7 Cleveland Heart \n2.8 Abiomed AbioCor II \n2.9 Carmat bioprosthetic heart \n2.10 Frazier-Cohn \n2.11 Soft Artificial Heart \n\n\n3 Others \n\n3.1 Hybrid assistive devices \n\n\n4 See also \n5 References \n\n5.1 General references \n5.2 Inline citations \n\n\n6 External links \n\n\nHistory \nThis section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2018) (Learn how and when to remove this template message)\nOrigins \nA synthetic replacement for the heart remains a long-sought \"holy grail\" of modern medicine. The obvious benefit of a functional artificial heart would be to lower the need for heart transplants, because the demand for organs always greatly exceeds supply (rather necessary for transplant are normally unfit for transfer).\nAlthough the heart is conceptually a pump, it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. Consequences of these issues include severe foreign-body rejection and external batteries that limit mobility. These complications limited the lifespan of early human recipients to hours or days.\n\nEarly development \nThe first artificial heart was made by the Soviet scientist Vladimir Demikhov in 1937. It was transplanted to a dog.\nOn July 2, 1952, 41-year-old Henry Opitek, suffering from shortness of breath, made medical history at Harper University Hospital at Wayne State University in Michigan. The Dodrill-GMR heart machine, considered to be the first operational mechanical heart, was successfully used while performing heart surgery.[1][2]\nOngoing research was done on young male cows at Hershey Medical Center, Animal Research Facility in Hershey, PA during the 1970's.\n\n<\/p>Forest Dewey Dodrill, working closely with Matthew Dudley, used the machine in 1952 to bypass Henry Opitek's left ventricle for 50 minutes while he opened the patient's left atrium and worked to repair the mitral valve. In Dodrill's post-operative report, he notes, \"To our knowledge, this is the first instance of survival of a patient when a mechanicaly heart mechanism was used to take over the complete body function of maintaining the blood supply of the body while the heart was open and operated on.\"[3]\nA heart\u2013lung machine was first used in 1953 during a successful open heart surgery. John Heysham Gibbon, the inventor of the machine, performed the operation and developed the heart\u2013lung substitute himself.\nFollowing these advances, scientific interest for the development of a solution for heart disease developed in numerous research groups worldwide.\n\nEarly designs of total artificial hearts \nIn 1949, a precursor to the modern artificial heart pump was built by doctors William Sewell and William Glenn of the Yale School of Medicine using an Erector Set, assorted odds and ends, and dime-store toys. The external pump successfully bypassed the heart of a dog for more than an hour.[4]\nPaul Winchell invented an artificial heart with the assistance of Henry Heimlich (the inventor of the Heimlich maneuver) and held the first patent for such a device. The University of Utah developed a similar apparatus around the same time, but when they tried to patent it, Winchell's heart was cited as prior art. The university requested that Winchell donate the heart to the University of Utah, which he did.\nThere is some debate as to how much of Winchell's design Robert Jarvik used in creating Jarvik's artificial heart. Heimlich states, \"I saw the heart, I saw the patent and I saw the letters. The basic principle used in Winchell's heart and Jarvik's heart is exactly the same.[5]\" Jarvik denies that any of Winchell's design elements were incorporated into the device he fabricated for humans which was successfully implanted into Barney Clark in 1982.\n\n<\/p>On December 12, 1957, Willem Johan Kolff, the world's most prolific inventor of artificial organs, implanted an artificial heart into a dog at Cleveland Clinic. The dog lived for 90 minutes.\nIn 1958, Domingo Liotta initiated the studies of TAH replacement at Lyon, France, and in 1959\u201360 at the National University of C\u00f3rdoba, Argentina. He presented his work at the meeting of the American Society for Artificial Internal Organs held in Atlantic City in March 1961. At that meeting, Liotta described the implantation of three types of orthotopic (inside the pericardial sac) TAHs in dogs, each of which used a different source of external energy: an implantable electric motor, an implantable rotating pump with an external electric motor, and a pneumatic pump.[6][7]\nIn 1964, the National Institutes of Health started the Artificial Heart Program, with the goal of putting a man-made heart into a human by the end of the decade.[8] The purpose of the program was to develop an implantable artificial heart, including the power source, to replace a failing heart.[9]\nIn February 1966, Adrian Kantrowitz rose to international prominence when he performed the world's first permanent implantation of a partial mechanical heart (left ventricular assist device) at Maimonides Medical Center.[10]\n In 1967, Kolff left Cleveland Clinic to start the Division of Artificial Organs at the University of Utah and pursue his work on the artificial heart.\n\nIn 1973, a calf named Tony survived for 30 days on an early Kolff heart.\nIn 1975, a bull named Burk survived 90 days on the artificial heart.\nIn 1976, a calf named Abebe lived for 184 days on the Jarvik 5 artificial heart.\nIn 1981, a calf named Alfred Lord Tennyson lived for 268 days on the Jarvik 5.\nOver the years, more than 200 physicians, engineers, students and faculty developed, tested and improved Kolff's artificial heart. To help manage his many endeavors, Kolff assigned project managers. Each project was named after its manager. Graduate student Robert Jarvik was the project manager for the artificial heart, which was subsequently renamed the Jarvik 7.\nIn 1981, William DeVries submitted a request to the FDA for permission to implant the Jarvik 7 into a human being. On December 2, 1982, Kolff implanted the Jarvik 7 artificial heart into Barney Clark, a dentist from Seattle who was suffering from severe congestive heart failure. Clark lived for 112 days tethered to an external pneumatic compressor, a device weighing some 400 pounds (180 kg), but during that time he suffered prolonged periods of confusion and a number of instances of bleeding, and asked several times to be allowed to die.[11]\n\nFirst clinical implantation of a total artificial heart \nOn April 4, 1969, Domingo Liotta and Denton A. Cooley replaced a dying man's heart with a mechanical heart inside the chest at The Texas Heart Institute in Houston as a bridge for a transplant. The man woke up and began to recover. After 64 hours, the pneumatic-powered artificial heart was removed and replaced by a donor heart. However thirty-two hours after transplantation, the man died of what was later proved to be an acute pulmonary infection, extended to both lungs, caused by fungi, most likely caused by an immunosuppressive drug complication.[12]\nThe original prototype of Liotta-Cooley artificial heart used in this historic operation is prominently displayed in the Smithsonian Institution's National Museum of American History \"Treasures of American History\" exhibit in Washington, D.C.[13]\n\nFirst clinical applications of a permanent pneumatic total artificial heart \nThe first clinical use of an artificial heart designed for permanent implantation rather than a bridge to transplant occurred in 1982 at the University of Utah. Artificial kidney pioneer Willem Johan Kolff started the Utah artificial organs program in 1967.[14] There, physician-engineer Clifford Kwan-Gett invented two components of an integrated pneumatic artificial heart system: a ventricle with hemispherical diaphragms that did not crush red blood cells (a problem with previous artificial hearts) and an external heart driver that inherently regulated blood flow without needing complex control systems.[15] Independently, Paul Winchell designed and patented a similarly shaped ventricle and donated the patent to the Utah program.[16] Throughout the 1970s and early 1980s, veterinarian Donald Olsen led a series of calf experiments that refined the artificial heart and its surgical care. During that time, as a student at the University of Utah, Robert Jarvik combined several modifications: an ovoid shape to fit inside the human chest, a more blood-compatible polyurethane developed by biomedical engineer Donald Lyman, and a fabrication method by Kwan-Gett that made the inside of the ventricles smooth and seamless to reduce dangerous stroke-causing blood clots.[17] On December 2, 1982, William DeVries implanted the artificial heart into retired dentist Barney Bailey Clark (born January 21, 1921), who survived 112 days with the device, dying on March 23, 1983. Bill Schroeder became the second recipient and lived for a record 620 days.\nContrary to popular belief and erroneous articles in several periodicals, the Jarvik heart was not banned for permanent use. Today, the modern version of the Jarvik 7 is known as the SynCardia temporary Total Artificial Heart. It has been implanted in more than 1,350 people as a bridge to transplantation.\nIn the mid-1980s, artificial hearts were powered by dishwasher-sized pneumatic power sources whose lineage went back to Alfa Laval milking machines. Moreover, two sizable catheters had to cross the body wall to carry the pneumatic pulses to the implanted heart, greatly increasing the risk of infection. To speed development of a new generation of technologies, the National Heart, Lung, and Blood Institute opened a competition for implantable electrically powered artificial hearts. Three groups received funding: Cleveland Clinic in Cleveland, Ohio; the College of Medicine of Pennsylvania State University (Penn State Hershey Medical Center) in Hershey, Pennsylvania; and AbioMed, Inc. of Danvers, Massachusetts. Despite considerable progress, the Cleveland program was discontinued after the first five years.\nPolymeric trileaflet valves ensure unidirectional blood flow with a low pressure gradient and good longevity. State-of-the-art transcutaneous energy transfer eliminates the need for electric wires crossing the chest wall.\n\nFirst clinical application of an intrathoracic pump \nOn July 19, 1963, E. Stanley Crawford and Domingo Liotta implanted the first clinical Left Ventricular Assist Device (LVAD) at The Methodist Hospital in Houston, Texas, in a patient who had a cardiac arrest after surgery. The patient survived for four days under mechanical support but did not recover from the complications of the cardiac arrest; finally, the pump was discontinued, and the patient died.\n\nFirst clinical application of a paracorporeal pump \n 1966 DeBakey ventricular assist device.[18]\nOn April 21, 1966, Michael DeBakey and Liotta implanted the first clinical LVAD in a paracorporeal position (where the external pump rests at the side of the patient) at The Methodist Hospital in Houston, in a patient experiencing cardiogenic shock after heart surgery. The patient developed neurological and pulmonary complications and died after few days of LVAD mechanical support. In October 1966, DeBakey and Liotta implanted the paracorporeal Liotta-DeBakey LVAD in a new patient who recovered well and was discharged from the hospital after 10 days of mechanical support, thus constituting the first successful use of an LVAD for postcardiotomy shock.\n\nFirst VAD patient with FDA approved hospital discharge \nIn 1990 Brian Williams was discharged from the University of Pittsburgh Medical Center (UPMC), becoming the first VAD patient to be discharged with Food and Drug Administration (FDA) approval.[19] The patient was supported in part by bioengineers from the University of Pittsburgh's McGowan Institute.[19][20]\n\nTotal artificial heart prototypes \nTotal artificial heart pump \nThe Army artificial heart pump was a compact, air-powered unit developed by Dr. Kenneth Woodward at Harry Diamond Laboratories in the early to mid-1960s.[21][22] The Army\u2019s heart pump was partially made of Lucite, also called Plexiglass, and consisted of two valves, a chamber, and a suction flapper.[21] The pump operated without any moving parts under the principle of fluid amplification \u2013 providing a pulsating air pressure source resembling a heartbeat.[22] Harry Diamond Laboratories was later merged with Army Research Laboratory in 1992.[23]\n\nPOLVAD \nSince 1991, the Foundation for Cardiac Surgery Development (FRK) in Zabrze, Poland has been working on developing an artificial heart. Nowadays, the Polish system for heart support POLCAS consists of the artificial ventricle POLVAD-MEV and the three controllers POLPDU-401, POLPDU-402 and POLPDU-501. Presented devices are designed to handle only one patient. The control units of the 401 and 402 series may be used only in hospital due to its big size, method of control and type of power supply. The control[24] unit of 501 series is the latest product of FRK. Due to its much smaller size and weight, it is significantly more mobile solution. For this reason, it can be also used during supervised treatment conducted outside the hospital.\n\nPhoenix-7 \nIn June 1996, a 46-year-old man received a total artificial heart implantation done by Jeng Wei at Cheng-Hsin General Hospital[25] in the Republic of China (Taiwan). This technologically advanced pneumatic Phoenix-7 Total Artificial Heart was manufactured by a Taiwanese dentist Kelvin K. Cheng, a Chinese physician T. M. Kao and colleagues at the Taiwan TAH Research Center in Tainan, Republic of China (Taiwan). With this experimental artificial heart, the patient's BP was maintained at 90-100\/40-55 mmHg and cardiac output at 4.2\u20135.8 L\/min.[26] The patient then received the world's first successful combined heart and kidney transplantation after bridging with a total artificial heart.[27]\n\nAbiomed AbioCor \nThe first AbioCor to be surgically implanted in a patient was on July 3, 2001.\n[28] The AbioCor is made of titanium and plastic with a weight of 0,9 kg (two pounds), and its internal battery can be recharged with a transduction device that sends power through the skin.[28] The internal battery lasts for half an hour, and a wearable external battery pack lasts for four hours.[29] The FDA announced on September 5, 2006, that the AbioCor could be implanted for humanitarian uses after the device had been tested on 15 patients.[30] It is intended for critically ill patients who cannot receive a heart transplant.[30] Some limitations of the current AbioCor are that its size makes it suitable for less than 50% of the female population and only about 50% of the male population, and its useful life is only 1\u20132 years.[31]\n\nSynCardia \nSynCardia is a company based in Tucson, Arizona which currently has two separate models available. It is available in a 70cc and 50cc size. The 70 cc is used for biventricular heart failure in adult men, while the 50cc is for children and women.[32] As good results with the TAH as a bridge to heart transplant accumulated, a trial of the CardioWest TAH (developed from the Jarvik 7 and now marketed as the Syncardia TAH) was initiated in 1993 and completed in 2002.[33] As of 2014, more than 1,250 patients have received SynCardia artificial hearts.[34][35][34] The device requires the use of the Companion 2 hospital driver or the Freedom portable driver to power the heart with pulses of air. The drivers also monitor blood flow for each ventricle.[36]\n\nMagScrew \nAnother U.S. team has a prototype called the 2005 MagScrew Total Artificial Heart. Teams in Japan and South Korea are also racing to produce similar devices.[37][38][39][40]\n\nCleveland Heart \nThe Cleveland Heart is a continuous-flow total artificial heart (CFTAH)[citation needed ]\n\nAbiomed AbioCor II \nBy combining its valved ventricles with the control technology and roller screw developed at Penn State, AbioMed has designed a smaller, more stable heart, the AbioCor II. This pump, which should be implantable in most men and 50% of women with a life span of up to five years,[31] had animal trials in 2005, and the company hoped to get FDA approval for human use in 2008.[41]\n\nCarmat bioprosthetic heart \nOn October 27, 2008, French professor and leading heart transplant specialist Alain F. Carpentier announced that a fully implantable artificial heart would be ready for clinical trial by 2011 and for alternative transplant in 2013. It was developed and would be manufactured by him, biomedical firm CARMAT SA,[42] and venture capital firm Truffle Capital. The prototype used embedded electronic sensors and was made from chemically treated animal tissues, called \"biomaterials\", or a \"pseudo-skin\" of biosynthetic, microporous materials.[43]\nAccording to a press-release by Carmat dated December 20, 2013, the first implantation of its artificial heart in a 75-year-old patient was performed on December 18, 2013 by the Georges Pompidou European Hospital team in Paris (France).[44] The patient died 75 days after the operation.[45]\nIn Carmat's design, two chambers are each divided by a membrane that holds hydraulic fluid on one side. A motorized pump moves hydraulic fluid in and out of the chambers, and that fluid causes the membrane to move; blood flows through the other side of each membrane. The blood-facing side of the membrane is made of tissue obtained from a sac that surrounds a cow's heart, to make the device more biocompatible. The Carmat device also uses valves made from cow heart tissue and has sensors to detect increased pressure within the device. That information is sent to an internal control system that can adjust the flow rate in response to increased demand, such as when a patient is exercising.[46] This distinguishes it from previous designs that maintain a constant flow rate.\nThe Carmat device, unlike previous designs, is meant to be used in cases of terminal heart failure, instead of being used as a bridge device while the patient awaits a transplant.[47] At 900 grams it weighs nearly three times the typical heart and is targeted primarily towards obese men. It also requires the patient to carry around an additional Li-Ion battery. The projected lifetime of the artificial heart is around 5 years (230 million beats).[48]\n\nFrazier-Cohn \nOn 12 March 2011, an experimental artificial heart was implanted in 55-year-old Craig Lewis at The Texas Heart Institute in Houston by Drs. O. H. Frazier and William Cohn. The device is a combination of two modified HeartMate II pumps that is currently undergoing bovine trials.[49]\nFrazier and Cohn are on the board of the BiVACOR company that develops an artificial heart.[50][51] BiVACOR has been tested as a replacement for a heart in a sheep.[52][53]\nSo far, only one person has benefited from Frazier and Cohn's artificial heart. Craig Lewis was suffering from amyloidosis in 2011 when his heart gave out and doctors pronounced that he had only 12 to 24 hours to live. After obtaining permission from his family, Frazier and Cohn replaced his heart with their device. Lewis survived for another 5 weeks after the operation; he eventually succumbed to liver and kidney failure due to his amyloidosis, after which his family asked that his artificial heart be unplugged.[54]\n\r\n\n\n Soft Total Artificial Heart, developed in the functional material laboratory at ETH Z\u00fcrich\nSoft Artificial Heart \nOn 10 July 2017, Cohrs and colleagues presented a new concept of a soft total artificial heart in the Journal of Artificial Organs.[55] The heart was developed in the Functionals Materials Laboratory at ETH Zurich.[56] The soft artificial heart (SAH) was created from silicone with the help of 3D printing technology. The SAH is a silicone monoblock. It weighs 390g, has a volume of 679 cm^3 and is operated through pressurized air. \"Our goal is to develop an artificial heart that is roughly the same size as the patient\u2019s own one and which imitates the human heart as closely as possible in form and function\" says Cohrs in an interview.[57] The SAH fundamentally moves and works like a real heart but currently only beats for 3000 beats.[58]\n\nOthers \nA centrifugal pump[59][60] or an axial-flow pump[61][62] can be used as an artificial heart, resulting in the patient being alive without a pulse.\nA centrifugal artificial heart which alternately pumps the pulmonary circulation and the systemic circulation, causing a pulse, has been described.[63]\nResearchers have constructed a heart out of foam. The heart is made out of flexible silicone and works with an external pump to push air and fluids through the heart. It currently cannot be implanted into humans, but it is a promising start for artificial hearts.[64]\n\nHybrid assistive devices \nMain article: Ventricular assist device\nPatients who have some remaining heart function but who can no longer live normally may be candidates for ventricular assist devices (VAD), which do not replace the human heart but complement it by taking up much of the function.\nThe first Left Ventricular Assist Device (LVAD) system was created by Domingo Liotta at Baylor College of Medicine in Houston in 1962.[65]\nAnother VAD, the Kantrowitz CardioVad, designed by Adrian Kantrowitz boosts the native heart by taking up over 50% of its function.[66] Additionally, the VAD can help patients on the wait list for a heart transplant. In a young person, this device could delay the need for a transplant by 10\u201315 years, or even allow the heart to recover, in which case the VAD can be removed.[66]\nThe artificial heart is powered by a battery that needs to be changed several times while still working.\n\n<\/p>The first heart assist device was approved by the FDA in 1994, and two more received approval in 1998.[67]\nWhile the original assist devices emulated the pulsating heart, newer versions, such as the Heartmate II,[68] developed by The Texas Heart Institute of Houston, provide continuous flow. These pumps (which may be centrifugal or axial flow) are smaller and potentially more durable and last longer than the current generation of total heart replacement pumps. Another major advantage of a VAD is that the patient keeps the natural heart, which may still function for temporary back-up support if the mechanical pump were to stop. This may provide enough support to keep the patient alive until a solution to the problem is implemented.\n\n<\/p>In August 2006, an artificial heart was implanted into a 15-year-old girl at the Stollery Children's Hospital in Edmonton, Alberta. It was intended to act as a temporary fixture until a donor heart could be found. Instead, the artificial heart (called a Berlin Heart) allowed for natural processes to occur and her heart healed on its own. After 146 days, the Berlin Heart was removed, and the girl's heart functioned properly on its own.[69] On December 16, 2011 the Berlin Heart gained U.S. FDA approval. The device has since been successfully implanted in several children including a 4-year-old Honduran girl at Children's Hospital Boston.[70]\nSeveral continuous-flow ventricular assist devices have been approved for use in the European Union, and, as of August 2007, were undergoing clinical trials for FDA approval.\nIn 2012, a study published in the New England Journal of Medicine compared the Berlin Heart to extracorporeal membrane oxygenation (ECMO) and concluded that \"a ventricular assist device available in several sizes for use in children as a bridge to heart transplantation [such as the Berlin Heart] was associated with a significantly higher rate of survival as compared with ECMO.\"[71] The study's primary author, Charles D. Fraser, Jr., surgeon in chief at Texas Children's Hospital, explained: \"With the Berlin Heart, we have a more effective therapy to offer patients earlier in the management of their heart failure. When we sit with parents, we have real data to offer so they can make an informed decision. This is a giant step forward.\" [72]\nSuffering from end-stage heart failure, former Vice President Dick Cheney underwent a procedure in July 2010 to have a VAD implanted at INOVA Fairfax Hospital, in Fairfax Virginia. In 2012, he received a heart transplant at age 71 after 20 months on a waiting list.\n\nSee also \nArtificial heart valve\nReferences \nGeneral references \nGeorge B. Griffenhagen and Calvin H. Hughes. The History of the Mechanical Heart. Smithsonian Report for 1955, (Pub. 4241): 339\u2013356, 1956.\n\"Donor saves Detroit pastor living on artificial heart\". Fox News. May 18, 2018\nInline citations \n\n\n^ \"The Mechanical Heart celebrates 50 lifesaving years\". American Heart Association. 9 Feb 2008. Archived from the original on 2010-11-21. Retrieved 2013-03-08 . and \"Mechanical Heart Celebrates 50 Lifesaving Years\". Archived from the original on 2016-08-19. Retrieved 2015-06-03 . . \n\n^ \"50th Anniversary of First Open Heart Surgery \u2013 Newsroom\". Archived from the original on 2015-05-01. \n\n^ Stephenson Larry W; et al. (2002). \"The Michigan Heart: The World's First Successful Open Heart Operation?\". Journal of Cardiac Surgery. 17 (3): 238\u2013246. doi:10.1111\/j.1540-8191.2002.tb01209.x. PMID 12489911. \n\n^ Lavietes, Stuart. William Glenn, 88, Surgeon Who Invented Heart Procedure Archived 2017-08-10 at the Wayback Machine., The New York Times, March 17, 2003. Accessed May 21, 2009. \n\n^ \"jarvik7.jpg (625x800 pixels)\". emory.edu. 18 August 2016. Archived from the original on 18 August 2016. \n\n^ \"Artificial Heart in the chest: Preliminary report\". Trans. Amer. Soc. Inter. Organs. 7: 318. 1961. \n\n^ \"Ablation experimentale et replacement du coeur par un coer artificial intra-thoracique\". Lyon Cirurgical. 57: 704. 1961. \n\n^ Sandeep Jauhar: The Artificial Heart. New England Journal of Medicine (2004): 542\u2013544. \n\n^ Hwang, Ned H. C.; Woo, Savio L.-Y. (31 December 2003). \"Frontiers in Biomedical Engineering: Proceedings of the World Congress for Chinese Biomedical Engineers\". Springer Science & Business Media – via Google Books. \n\n^ \"In Memoriam: Adrian Kantrowitz 1918\u20132008\". Texas Heart Institute Journal. 36 (1): 1. PMC 2676518 . \n\n^ Barron H. Lerner, MD (December 1, 2007). \"The 25th Anniversary of Barney Clark's Artificial Heart\". Celebrity Health. HealthDiaries.com. Archived from the original on 29 June 2011. Retrieved 15 November 2010 . \n\n^ Orthotopic cardiac prosthesis for two-staged cardiac replacement. Am J Cardio 1969; 24:723\u2013730. \n\n^ \"Treasures of American History\" Archived 2011-06-29 at Wikiwix, National Museum of American History \n\n^ Spare Parts: Organ Replacement in American Society. Renee C. Fox and Judith P. Swazey. New York: Oxford University Press; 1992, pp. 102\u2013104 \n\n^ Kwan-Gett CS, Van Kampen KR, Kawai J, Eastwood N, Kolff WJ (Dec 1971). \"Results of total artificial heart implantation in calves\". Journal of Thoracic and Cardiovascular Surgery. 62 (6): 880\u2013889. \n\n^ \"Winchell's Heart\". Time. March 12, 1973. Archived from the original on September 6, 2010. Retrieved April 25, 2010 . \n\n^ \"Kolff\". Archived from the original on 2008-10-07. \n\n^ \"Dr. Denton Cooley and Dr. Michael E. DeBakey: Rock stars of Houston medicine\". Houston Chronicle. 3 April 2014. Archived from the original on 14 March 2015. Retrieved 7 March 2015 . \n\n^ a b \"Revolutionizing Care for Failing Hearts \u2013 William G. McGowan Charitable Fund\". Archived from the original on 2016-05-13. \n\n^ \"Pittsburgh's 25th Anniversary of First VAD Patient to Be Discharged from a Hospital \u2013 Regenerative Medicine at the McGowan Institute\". Archived from the original on 2016-06-29. \n\n^ a b McKellar, Shelley (2018-01-03). Artificial Hearts: The Allure and Ambivalence of a Controversial Medical Technology. JHU Press. ISBN 9781421423555. \n\n^ a b Mechanical Devices to Assist the Failing Heart: Proceedings. National Academies. 1966. \n\n^ \"Wayback Machine\" (PDF) . 2008-11-12. Retrieved 2018-07-30 . \n\n^ Fajdek, Bartlomiej; Janiszowski, Krzysztof. \"Automatic control system for ventricular assist device\". IEEE. doi:10.1109\/MMAR.2014.6957472. \n\n^ \"Cheng-Hsin General Hospital\". Archived from the original on 2015-02-01. \n\n^ Hsu, Cheung-Hwa (2001). \"In Vivo and Clinical Study of Phoenix-7 Total Artificial Heart\". Biomedical Engineering - Applications, Basis & Communications. 13:133 - 139, worldscientific..com. \n\n^ Wei J.; Cheng K. K.; Tung D. Y.; Chang C. Y.; Wan W. M.; Chuang Y. C. (1998). \"Successful Use of Phoenix-7 Total Artificial Heart\". Transplantation Proceedings. 30: 3403\u20134. doi:10.1016\/s0041-1345(98)01078-1. \n\n^ a b \"Patient gets first totally implanted artificial heart\". CNN.com. 2001-07-03. Archived from the original on 7 June 2008. Retrieved 2008-07-13 . \n\n^ \"AbioCor FAQs\". AbioMed. Archived from the original on 3 July 2008. Retrieved 2008-07-13 . \n\n^ a b \"FDA Approves First Totally Implanted Permanent Artificial Heart for Humanitarian Uses\". FDA.gov. 2006-09-05. Archived from the original on 2008-10-08. Retrieved 2008-07-13 . \n\n^ a b \"Will We Merge With Machines?\". popsci.com. 2005-08-01. Archived from the original on 19 July 2008. Retrieved 2008-07-13 . \n\n^ \"Two Sizes Intended to Treat Most Patients\". SynCardia. November 16, 2015. Archived from the original on November 17, 2015. \n\n^ Copeland JG, Smith RG, Arabia FA, et al. (2004). \"Cardiac replacement with a total artificial heart as a bridge to transplantation\". N Engl J Med. 351: 859\u201367. doi:10.1056\/nejmoa040186. \n\n^ a b \"New Record of 161 SynCardia Total Artificial Heart Implants Set In 2013\". SynCardia. 2014-01-07. Archived from the original on 2016-01-13. Retrieved 2016-06-11 . \n\n^ Torregrossa G, Morshuis M, Varghese R; et al. (2014). \"Results with SynCardia total artificial heart beyond 1 year\". ASAIO J. 60: 626\u201334. CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) One patient had the artificial heart for 1,374 days, that is, nearly four years. \n\n^ \"UCLA Transplantation Services, Los Angeles, CA\". transplants.ucla.edu. Archived from the original on 2016-08-06. \n\n^ Weber S, Kamohara K, Klatte RS, Luangphakdy V, Flick C, Chen JF, Casas F, Ootaki Y, Kopcak M, Akiyama M, Hirschman GB, Chapman PA, Donahue A, Wetterau W, Prisco C, Mast R, Sherman C, Fukamachi K, Smith WA. \"MagScrew TAH: an update\". ASAIO J. 51: xxxvi\u2013xlvi. doi:10.1097\/01.mat.0000187395.29817.36. PMID 16340348. \n\n^ \"Japanese Researchers Advance Artificial Heart Design\". ptc.com. 15 December 2014. Archived from the original on 6 October 2016. \n\n^ \"Artificial heart\". www.bme.gr.jp. Archived from the original on 2016-08-22. \n\n^ \"A moving-actuator type electromechanical total artificial heart. II. Circular type and animal experiment - IEEE Journals & Magazine\". ieeexplore.ieee.org. Archived from the original on 2016-09-19. \n\n^ \"14th Artificial Heart Patient Dies: A Newsmaker Interview With Robert Kung, PhD\". medscape.com. 2004-11-11. Archived from the original on 2013-04-25. Retrieved 2008-07-13 . \n\n^ atorsoli, Albertina Torsoli. \"A Synthetic Heart That Keeps on Ticking\". Archived from the original on 2016-08-06. \n\n^ \"The Carmat Heart,- The technology behind the prosthesis\". Archived from the original on 2013-06-29. \n\n^ \"First-in-man implantation of CARMAT's bioprosthetic artificial heart\". Archived from the original on 2013-12-24. \n\n^ \"First patient fitted with Carmat artificial heart dies\". Reuters. March 3, 2014. Archived from the original on September 30, 2015. \n\n^ Rojahn, Susan Young. \"Biology and Machine Come Together in a New Artificial Heart\". \n\n^ \"Carmat artificial heart patient in good condition: hospital\". Reuters. December 30, 2013. Archived from the original on September 24, 2015. \n\n^ Polska, Wirtualna. \"Pierwsze wszczepione na sta\u0142e sztuczne serce bije ju\u017c w ludzkiej piersi \u2013 TechTrendy.pl\". Archived from the original on 2013-12-30. \n\n^ Berger, Eric. \"New artificial heart 'a leap forward' \". Houston Chronicle. Archived from the original on 26 March 2011. Retrieved 23 March 2011 . \n\n^ \"Donor brings inventor of artificial heart closer to Houston\". Houston Chronicle. 14 Jan 2013. Archived from the original on 2015-09-25. \n\n^ \"Living without a pulse: Engineering a better artificial heart\". CNN. 4 Dec 2013. Archived from the original on 2014-04-09. \n\n^ \"BiVACOR beatless artificial heart appeal hopes to raise $5 million\". Courier Mail. 7 March 2015. \n\n^ \"Bionic heart breakthrough: Scientists transplant device into sheep, hope for clinical trials\". ABC News. Australian Broadcasting Corporation. 7 March 2015. Archived from the original on 9 March 2015. \n\n^ \"Walking Dead \u2013 The First Human Able to Survive Without a Heart OR a Pulse\". Bam Marguera. Archived from the original on 5 April 2015. Retrieved 4 April 2015 . \n\n^ Cohrs Nicholas H. \"A Soft Total Artificial Heart-First Concept Evaluation on a Hybrid Mock Circulation\". Artificial Organs. doi:10.1111\/aor.12956. \n\n^ \"Our work on soft artificial hearts highlighted in the media\". www.fml.ethz.ch. Archived from the original on 2017-08-05. \n\n^ \"Testing a soft artificial heart\". www.ethz.ch. Archived from the original on 2017-07-21. \n\n^ ETH Z\u00fcrich (12 July 2017). \"Testing a soft artificial heart\". Archived from the original on 21 July 2017 – via YouTube. \n\n^ Black, Rosemary (January 5, 2011). \"Former vice president Dick Cheney now has no pulse\". Daily News. New York. Archived from the original on April 18, 2012. \n\n^ \"Pulseless Pumps & Artificial Hearts\". Archived from the original on 2016-03-07. \n\n^ European-Hospital. \"The pulseless life on healthcare in europe\". Archived from the original on 2011-10-05. \n\n^ Dan Baum: No Pulse: How Doctors Reinvented The Human Heart Archived 2012-11-04 at the Wayback Machine.. 2012-02-29. \n\n^ Imachi K, Chinzei T, Abe Y, Mabuchi K, Imanishi K, Yonezawa T, Kouno A, Ono T, Atsumi K, Isoyama T. \"A new pulsatile total artificial heart using a single centrifugal pump\". ASAIO Trans. 37: M242\u20133. PMID 1751129. \n\n^ \"New Artificial Heart is Made of Foam\". Popular Science. 1 October 2015. Archived from the original on 5 December 2015. \n\n^ Prolonged Assisted circulation after cardiac or aortic surgery. Prolonged partial left ventricular bypass by means of intracorporeal circulation. This paper was finalist in The Young Investigators Award Contest of the American College of Cardiology. Denver, May 1962 Am. J. Cardiol. 1963, 12:399\u2013404 \n\n^ a b Mitka Mike (2001). \"Midwest Trials of Heart-Assist Device\". Journal of the American Medical Association. 286 (21): 2661. doi:10.1001\/jama.286.21.2661. \n\n^ FDA APPROVES TWO PORTABLE HEART-ASSIST DEVICES Archived 2007-06-14 at the Wayback Machine. at FDA.gov \n\n^ An Artificial Heart That Doesn't Beat at TechnologyReview.com \n\n^ \"Berlin Heart\". Archived from the original on 2007-10-16. Retrieved 2007-08-29 . CS1 maint: BOT: original-url status unknown (link) (August 28, 2007), Capital Health, Edmonton (archived from \"Berlin Heart\". Archived from the original on 2007-09-27. Retrieved 2007-08-29 . the original) on 2007-10-01. \n\n^ \"Newly approved Berlin Heart helps patients waiting for a transplant \u2013 Vector\". 30 December 2011. \n\n^ Fraser, Charles D.; Jaquiss, Robert D.B.; Rosenthal, David N.; Humpl, Tilman; Canter, Charles E.; Blackstone, Eugene H.; Naftel, David C.; Ichord, Rebecca N.; Bomgaars, Lisa; Tweddell, James S.; Massicotte, M. Patricia; Turrentine, Mark W.; Cohen, Gordon A.; Devaney, Eric J.; Pearce, F. Bennett; Carberry, Kathleen E.; Kroslowitz, Robert; Almond, Christopher S. \"Prospective Trial of a Pediatric Ventricular Assist Device\". New England Journal of Medicine. 367 (6): 532\u2013541. doi:10.1056\/nejmoa1014164. Archived from the original on 2013-06-22. \n\n^ \"News \u2013 Texas Children's Hospital\". Archived from the original on 2013-04-25. \n\n\nExternal links \nArtificial heart. on YouTube\nArtificial hearts and heart assist devices currently in use\nKembrey, Melanie (August 17, 2010). \"Artificial heart a medical marvel\". Fairfield City Champion. Archived July 6, 2011.\nHow a total artificial heart works physics.org\nA Change of Heart by Retro Report\nWorld's Only Approved Total Artificial Heart\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Artificial_heart\">https:\/\/www.limswiki.org\/index.php\/Artificial_heart<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 21:42.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 985 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","71da9a445fe27824deb1b95cf92c4832_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Artificial_heart skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Artificial heart<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the mechanical device. For the Jonathan Coulton album, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_Heart_(album)\" title=\"Artificial Heart (album)\" rel=\"external_link\" target=\"_blank\">Artificial Heart (album)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:The_SynCardia_temporary_Total_Artificial_Heart_with_pink_heart_background.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/The_SynCardia_temporary_Total_Artificial_Heart_with_pink_heart_background.jpg\/220px-The_SynCardia_temporary_Total_Artificial_Heart_with_pink_heart_background.jpg\" width=\"220\" height=\"267\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:The_SynCardia_temporary_Total_Artificial_Heart_with_pink_heart_background.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The SynCardia temporary Total Artificial Heart<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Artificial-heart-london.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Artificial-heart-london.JPG\/200px-Artificial-heart-london.JPG\" width=\"200\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Artificial-heart-london.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An artificial heart displayed at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/London_Science_Museum\" class=\"mw-redirect\" title=\"London Science Museum\" rel=\"external_link\" target=\"_blank\">London Science Museum<\/a><\/div><\/div><\/div>\n<p>An <b>artificial heart<\/b> is a device that replaces the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_heart\" class=\"mw-redirect\" title=\"Human heart\" rel=\"external_link\" target=\"_blank\">heart<\/a>. Artificial hearts are typically used to bridge the time to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_transplantation\" title=\"Heart transplantation\" rel=\"external_link\" target=\"_blank\">heart transplantation<\/a>, or to permanently replace the heart in case heart transplantation is impossible. Although other similar inventions preceded it from the late 1940s, the first artificial heart to be successfully implanted in a human was the Jarvik-7 in 1982, designed by a team including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Willem_Johan_Kolff\" title=\"Willem Johan Kolff\" rel=\"external_link\" target=\"_blank\">Willem Johan Kolff<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Jarvik\" title=\"Robert Jarvik\" rel=\"external_link\" target=\"_blank\">Robert Jarvik<\/a>.\n<\/p><p>An artificial heart is distinct from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_assist_device\" title=\"Ventricular assist device\" rel=\"external_link\" target=\"_blank\">ventricular assist device<\/a> (VAD) designed to support a failing heart. It is also distinct from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_bypass\" title=\"Cardiopulmonary bypass\" rel=\"external_link\" target=\"_blank\">cardiopulmonary bypass<\/a> machine, which is an external device used to provide the functions of both the heart and lungs and are used only for a few hours at a time, most commonly during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">cardiac surgery<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n\n<h3><span class=\"mw-headline\" id=\"Origins\">Origins<\/span><\/h3>\n<p>A synthetic replacement for the heart remains a long-sought \"holy grail\" of modern medicine. The obvious benefit of a functional artificial heart would be to lower the need for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_transplantation\" title=\"Heart transplantation\" rel=\"external_link\" target=\"_blank\">heart transplants<\/a>, because the demand for organs always greatly exceeds supply (rather necessary for transplant are normally unfit for transfer).\n<\/p><p>Although the heart is conceptually a pump, it embodies subtleties that defy straightforward emulation with synthetic materials and power supplies. Consequences of these issues include severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transplant_rejection\" title=\"Transplant rejection\" rel=\"external_link\" target=\"_blank\">foreign-body rejection<\/a> and external batteries that limit mobility. These complications limited the lifespan of early human recipients to hours or days.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Early_development\">Early development<\/span><\/h3>\n<p>The first artificial heart was made by the Soviet scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vladimir_Demikhov\" title=\"Vladimir Demikhov\" rel=\"external_link\" target=\"_blank\">Vladimir Demikhov<\/a> in 1937. It was transplanted to a dog.\n<\/p><p>On July 2, 1952, 41-year-old <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Opitek\" title=\"Henry Opitek\" rel=\"external_link\" target=\"_blank\">Henry Opitek<\/a>, suffering from shortness of breath, made medical history at <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070820123708\/http:\/\/www.harperhospital.org\/harper\/\" target=\"_blank\">Harper University Hospital<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayne_State_University\" title=\"Wayne State University\" rel=\"external_link\" target=\"_blank\">Wayne State University<\/a> in Michigan. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dodrill-GMR\" class=\"mw-redirect\" title=\"Dodrill-GMR\" rel=\"external_link\" target=\"_blank\">Dodrill-GMR<\/a> heart machine, considered to be the first operational mechanical heart, was successfully used while performing heart surgery.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<p>Ongoing research was done on young male cows at Hershey Medical Center, Animal Research Facility in Hershey, PA during the 1970's.\n<\/p>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Forest_Dewey_Dodrill\" title=\"Forest Dewey Dodrill\" rel=\"external_link\" target=\"_blank\">Forest Dewey Dodrill<\/a>, working closely with Matthew Dudley, used the machine in 1952 to bypass Henry Opitek's left ventricle for 50 minutes while he opened the patient's left atrium and worked to repair the mitral valve. In Dodrill's post-operative report, he notes, \"To our knowledge, this is the first instance of survival of a patient when a mechanicaly heart mechanism was used to take over the complete body function of maintaining the blood supply of the body while the heart was open and operated on.\"<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_bypass\" title=\"Cardiopulmonary bypass\" rel=\"external_link\" target=\"_blank\">heart\u2013lung machine<\/a> was first used in 1953 during a successful open heart surgery. <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Heysham_Gibbon\" title=\"John Heysham Gibbon\" rel=\"external_link\" target=\"_blank\">John Heysham Gibbon<\/a>, the inventor of the machine, performed the operation and developed the heart\u2013lung substitute himself.\n<\/p><p>Following these advances, scientific interest for the development of a solution for heart disease developed in numerous research groups worldwide.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Early_designs_of_total_artificial_hearts\">Early designs of total artificial hearts<\/span><\/h3>\n<p>In 1949, a precursor to the modern artificial heart pump was built by doctors William Sewell and <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Glenn\" title=\"William Glenn\" rel=\"external_link\" target=\"_blank\">William Glenn<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yale_School_of_Medicine\" title=\"Yale School of Medicine\" rel=\"external_link\" target=\"_blank\">Yale School of Medicine<\/a> using an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erector_Set\" title=\"Erector Set\" rel=\"external_link\" target=\"_blank\">Erector Set<\/a>, assorted odds and ends, and dime-store toys. The external pump successfully bypassed the heart of a dog for more than an hour.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_Winchell\" title=\"Paul Winchell\" rel=\"external_link\" target=\"_blank\">Paul Winchell<\/a> invented an artificial heart with the assistance of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Heimlich\" title=\"Henry Heimlich\" rel=\"external_link\" target=\"_blank\">Henry Heimlich<\/a> (the inventor of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_thrusts\" title=\"Abdominal thrusts\" rel=\"external_link\" target=\"_blank\">Heimlich maneuver<\/a>) and held the first patent for such a device. The University of Utah developed a similar apparatus around the same time, but when they tried to patent it, Winchell's heart was cited as prior art. The university requested that Winchell donate the heart to the University of Utah, which he did.\n<p>There is some debate as to how much of Winchell's design Robert Jarvik used in creating Jarvik's artificial heart. Heimlich states, \"I saw the heart, I saw the patent and I saw the letters. The basic principle used in Winchell's heart and Jarvik's heart is exactly the same.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\" Jarvik denies that any of Winchell's design elements were incorporated into the device he fabricated for humans which was successfully implanted into Barney Clark in 1982.\n<\/p>\n<\/p><p>On December 12, 1957, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Willem_Johan_Kolff\" title=\"Willem Johan Kolff\" rel=\"external_link\" target=\"_blank\">Willem Johan Kolff<\/a>, the world's most prolific inventor of artificial organs, implanted an artificial heart into a dog at Cleveland Clinic. The dog lived for 90 minutes.\n<\/p><p>In 1958, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Domingo_Liotta\" title=\"Domingo Liotta\" rel=\"external_link\" target=\"_blank\">Domingo Liotta<\/a> initiated the studies of TAH replacement at Lyon, France, and in 1959\u201360 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_University_of_C%C3%B3rdoba\" title=\"National University of C\u00f3rdoba\" rel=\"external_link\" target=\"_blank\">National University of C\u00f3rdoba<\/a>, Argentina. He presented his work at the meeting of the American Society for Artificial Internal Organs held in Atlantic City in March 1961. At that meeting, Liotta described the implantation of three types of orthotopic (inside the pericardial sac) TAHs in dogs, each of which used a different source of external energy: an implantable electric motor, an implantable rotating pump with an external electric motor, and a pneumatic pump.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>In 1964, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institutes_of_Health\" title=\"National Institutes of Health\" rel=\"external_link\" target=\"_blank\">National Institutes of Health<\/a> started the Artificial Heart Program, with the goal of putting a man-made heart into a human by the end of the decade.<sup id=\"rdp-ebb-cite_ref-autogenerated1_8-0\" class=\"reference\"><a href=\"#cite_note-autogenerated1-8\" rel=\"external_link\">[8]<\/a><\/sup> The purpose of the program was to develop an implantable artificial heart, including the power source, to replace a failing heart.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>In February 1966, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adrian_Kantrowitz\" title=\"Adrian Kantrowitz\" rel=\"external_link\" target=\"_blank\">Adrian Kantrowitz<\/a> rose to international prominence when he performed the world's first permanent implantation of a partial mechanical heart (left ventricular assist device) at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maimonides_Medical_Center\" title=\"Maimonides Medical Center\" rel=\"external_link\" target=\"_blank\">Maimonides Medical Center<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p><span id=\"rdp-ebb-Jarvik\"><\/span>In 1967, Kolff left Cleveland Clinic to start the Division of Artificial Organs at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Utah\" title=\"University of Utah\" rel=\"external_link\" target=\"_blank\">University of Utah<\/a> and pursue his work on the artificial heart.\n<\/p>\n<ol><li>In 1973, a calf named Tony survived for 30 days on an early Kolff heart.<\/li>\n<li>In 1975, a bull named Burk survived 90 days on the artificial heart.<\/li>\n<li>In 1976, a calf named Abebe lived for 184 days on the Jarvik 5 artificial heart.<\/li>\n<li>In 1981, a calf named Alfred Lord Tennyson lived for 268 days on the Jarvik 5.<\/li><\/ol>\n<p>Over the years, more than 200 physicians, engineers, students and faculty developed, tested and improved Kolff's artificial heart. To help manage his many endeavors, Kolff assigned project managers. Each project was named after its manager. Graduate student Robert Jarvik was the project manager for the artificial heart, which was subsequently renamed the Jarvik 7.\n<\/p><p>In 1981, <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_DeVries\" title=\"William DeVries\" rel=\"external_link\" target=\"_blank\">William DeVries<\/a> submitted a request to the FDA for permission to implant the Jarvik 7 into a human being. On December 2, 1982, Kolff implanted the Jarvik 7 artificial heart into Barney Clark, a dentist from Seattle who was suffering from severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congestive_heart_failure\" class=\"mw-redirect\" title=\"Congestive heart failure\" rel=\"external_link\" target=\"_blank\">congestive heart failure<\/a>. Clark lived for 112 days tethered to an external pneumatic compressor, a device weighing some 400 pounds (180 kg), but during that time he suffered prolonged periods of confusion and a number of instances of bleeding, and asked several times to be allowed to die.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"First_clinical_implantation_of_a_total_artificial_heart\">First clinical implantation of a total artificial heart<\/span><\/h3>\n<p>On April 4, 1969, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Domingo_Liotta\" title=\"Domingo Liotta\" rel=\"external_link\" target=\"_blank\">Domingo Liotta<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Denton_Cooley\" title=\"Denton Cooley\" rel=\"external_link\" target=\"_blank\">Denton A. Cooley<\/a> replaced a dying man's heart with a mechanical heart inside the chest at <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Texas_Heart_Institute\" title=\"The Texas Heart Institute\" rel=\"external_link\" target=\"_blank\">The Texas Heart Institute<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Houston\" title=\"Houston\" rel=\"external_link\" target=\"_blank\">Houston<\/a> as a bridge for a transplant. The man woke up and began to recover. After 64 hours, the pneumatic-powered artificial heart was removed and replaced by a donor heart. However thirty-two hours after transplantation, the man died of what was later proved to be an acute pulmonary infection, extended to both lungs, caused by fungi, most likely caused by an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immunosuppressive_drug\" title=\"Immunosuppressive drug\" rel=\"external_link\" target=\"_blank\">immunosuppressive drug<\/a> complication.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>The original prototype of Liotta-Cooley artificial heart used in this historic operation is prominently displayed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smithsonian_Institution\" title=\"Smithsonian Institution\" rel=\"external_link\" target=\"_blank\">Smithsonian Institution<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Museum_of_American_History\" title=\"National Museum of American History\" rel=\"external_link\" target=\"_blank\">National Museum of American History<\/a> \"Treasures of American History\" exhibit in Washington, D.C.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"First_clinical_applications_of_a_permanent_pneumatic_total_artificial_heart\">First clinical applications of a permanent pneumatic total artificial heart<\/span><\/h3>\n<p>The first clinical use of an artificial heart designed for permanent implantation rather than a bridge to transplant occurred in 1982 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Utah\" title=\"University of Utah\" rel=\"external_link\" target=\"_blank\">University of Utah<\/a>. Artificial kidney pioneer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Willem_Johan_Kolff\" title=\"Willem Johan Kolff\" rel=\"external_link\" target=\"_blank\">Willem Johan Kolff<\/a> started the Utah artificial organs program in 1967.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> There, physician-engineer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clifford_Kwan-Gett\" title=\"Clifford Kwan-Gett\" rel=\"external_link\" target=\"_blank\">Clifford Kwan-Gett<\/a> invented two components of an integrated pneumatic artificial heart system: a ventricle with hemispherical diaphragms that did not crush red blood cells (a problem with previous artificial hearts) and an external heart driver that inherently regulated blood flow without needing complex control systems.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Independently, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_Winchell\" title=\"Paul Winchell\" rel=\"external_link\" target=\"_blank\">Paul Winchell<\/a> designed and patented a similarly shaped ventricle and donated the patent to the Utah program.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Throughout the 1970s and early 1980s, veterinarian Donald Olsen led a series of calf experiments that refined the artificial heart and its surgical care. During that time, as a student at the University of Utah, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Jarvik\" title=\"Robert Jarvik\" rel=\"external_link\" target=\"_blank\">Robert Jarvik<\/a> combined several modifications: an ovoid shape to fit inside the human chest, a more blood-compatible polyurethane developed by biomedical engineer Donald Lyman, and a fabrication method by Kwan-Gett that made the inside of the ventricles smooth and seamless to reduce dangerous stroke-causing blood clots.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> On December 2, 1982, <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_DeVries\" title=\"William DeVries\" rel=\"external_link\" target=\"_blank\">William DeVries<\/a> implanted the artificial heart into retired dentist Barney Bailey Clark (born January 21, 1921), who survived 112 days with the device, dying on March 23, 1983. <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_J._Schroeder\" title=\"William J. Schroeder\" rel=\"external_link\" target=\"_blank\">Bill Schroeder<\/a> became the second recipient and lived for a record 620 days.\n<\/p><p>Contrary to popular belief and erroneous articles in several periodicals, the Jarvik heart was not banned for permanent use. Today, the modern version of the Jarvik 7 is known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/SynCardia_Systems\" title=\"SynCardia Systems\" rel=\"external_link\" target=\"_blank\">SynCardia<\/a> temporary Total Artificial Heart. It has been implanted in more than 1,350 people as a bridge to transplantation.\n<\/p><p>In the mid-1980s, artificial hearts were powered by dishwasher-sized pneumatic power sources whose lineage went back to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alfa_Laval\" title=\"Alfa Laval\" rel=\"external_link\" target=\"_blank\">Alfa Laval<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dairy#Milking_machines\" title=\"Dairy\" rel=\"external_link\" target=\"_blank\">milking machines<\/a>. Moreover, two sizable catheters had to cross the body wall to carry the pneumatic pulses to the implanted heart, greatly increasing the risk of infection. To speed development of a new generation of technologies, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Heart,_Lung,_and_Blood_Institute\" title=\"National Heart, Lung, and Blood Institute\" rel=\"external_link\" target=\"_blank\">National Heart, Lung, and Blood Institute<\/a> opened a competition for implantable electrically powered artificial hearts. Three groups received funding: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleveland_Clinic\" title=\"Cleveland Clinic\" rel=\"external_link\" target=\"_blank\">Cleveland Clinic<\/a> in Cleveland, Ohio; the College of Medicine of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pennsylvania_State_University\" title=\"Pennsylvania State University\" rel=\"external_link\" target=\"_blank\">Pennsylvania State University<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Penn_State_Hershey_Medical_Center\" class=\"mw-redirect\" title=\"Penn State Hershey Medical Center\" rel=\"external_link\" target=\"_blank\">Penn State Hershey Medical Center<\/a>) in Hershey, Pennsylvania; and AbioMed, Inc. of Danvers, Massachusetts. Despite considerable progress, the Cleveland program was discontinued after the first five years.\n<\/p><p>Polymeric trileaflet valves ensure unidirectional blood flow with a low pressure gradient and good longevity. State-of-the-art transcutaneous energy transfer eliminates the need for electric wires crossing the chest wall.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"First_clinical_application_of_an_intrathoracic_pump\">First clinical application of an intrathoracic pump<\/span><\/h3>\n<p>On July 19, 1963, E. Stanley Crawford and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Domingo_Liotta\" title=\"Domingo Liotta\" rel=\"external_link\" target=\"_blank\">Domingo Liotta<\/a> implanted the first clinical Left Ventricular Assist Device (LVAD) at <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Methodist_Hospital\" class=\"mw-redirect\" title=\"The Methodist Hospital\" rel=\"external_link\" target=\"_blank\">The Methodist Hospital<\/a> in Houston, Texas, in a patient who had a cardiac arrest after surgery. The patient survived for four days under mechanical support but did not recover from the complications of the cardiac arrest; finally, the pump was discontinued, and the patient died.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"First_clinical_application_of_a_paracorporeal_pump\">First clinical application of a paracorporeal pump<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:122px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:1966_DeBakey_ventricular_assist_device.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/1966_DeBakey_ventricular_assist_device.jpg\/120px-1966_DeBakey_ventricular_assist_device.jpg\" width=\"120\" height=\"338\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:1966_DeBakey_ventricular_assist_device.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>1966 DeBakey <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_assist_device\" title=\"Ventricular assist device\" rel=\"external_link\" target=\"_blank\">ventricular assist device<\/a>.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup><\/div><\/div><\/div>\n<p>On April 21, 1966, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Michael_E._DeBakey\" class=\"mw-redirect\" title=\"Michael E. DeBakey\" rel=\"external_link\" target=\"_blank\">Michael DeBakey<\/a> and Liotta implanted the first clinical LVAD in a paracorporeal position (where the external pump rests at the side of the patient) at The Methodist Hospital in Houston, in a patient experiencing cardiogenic shock after heart surgery. The patient developed neurological and pulmonary complications and died after few days of LVAD mechanical support. In October 1966, DeBakey and Liotta implanted the paracorporeal Liotta-DeBakey LVAD in a new patient who recovered well and was discharged from the hospital after 10 days of mechanical support, thus constituting the first successful use of an LVAD for postcardiotomy shock.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"First_VAD_patient_with_FDA_approved_hospital_discharge\">First VAD patient with FDA approved hospital discharge<\/span><\/h3>\n<p>In 1990 Brian Williams was discharged from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Pittsburgh_Medical_Center\" title=\"University of Pittsburgh Medical Center\" rel=\"external_link\" target=\"_blank\">University of Pittsburgh Medical Center<\/a> (UPMC), becoming the first VAD patient to be discharged with Food and Drug Administration (FDA) approval.<sup id=\"rdp-ebb-cite_ref-williamgmcgowanfund.org_19-0\" class=\"reference\"><a href=\"#cite_note-williamgmcgowanfund.org-19\" rel=\"external_link\">[19]<\/a><\/sup> The patient was supported in part by bioengineers from the University of Pittsburgh's McGowan Institute.<sup id=\"rdp-ebb-cite_ref-williamgmcgowanfund.org_19-1\" class=\"reference\"><a href=\"#cite_note-williamgmcgowanfund.org-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Total_artificial_heart_prototypes\">Total artificial heart prototypes<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Total_artificial_heart_pump\">Total artificial heart pump<\/span><\/h3>\n<p>The Army artificial heart pump was a compact, air-powered unit developed by Dr. Kenneth Woodward at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harry_Diamond_Laboratories\" title=\"Harry Diamond Laboratories\" rel=\"external_link\" target=\"_blank\">Harry Diamond Laboratories<\/a> in the early to mid-1960s.<sup id=\"rdp-ebb-cite_ref-ShelleyMcKellar_21-0\" class=\"reference\"><a href=\"#cite_note-ShelleyMcKellar-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-NationalAcademies_22-0\" class=\"reference\"><a href=\"#cite_note-NationalAcademies-22\" rel=\"external_link\">[22]<\/a><\/sup> The Army\u2019s heart pump was partially made of Lucite, also called Plexiglass, and consisted of two valves, a chamber, and a suction flapper.<sup id=\"rdp-ebb-cite_ref-ShelleyMcKellar_21-1\" class=\"reference\"><a href=\"#cite_note-ShelleyMcKellar-21\" rel=\"external_link\">[21]<\/a><\/sup> The pump operated without any moving parts under the principle of fluid amplification \u2013 providing a pulsating air pressure source resembling a heartbeat.<sup id=\"rdp-ebb-cite_ref-NationalAcademies_22-1\" class=\"reference\"><a href=\"#cite_note-NationalAcademies-22\" rel=\"external_link\">[22]<\/a><\/sup> Harry Diamond Laboratories was later merged with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Army_Research_Laboratory\" class=\"mw-redirect\" title=\"Army Research Laboratory\" rel=\"external_link\" target=\"_blank\">Army Research Laboratory<\/a> in 1992.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"POLVAD\">POLVAD<\/span><\/h3>\n<p>Since 1991, the Foundation for Cardiac Surgery Development (FRK) in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zabrze\" title=\"Zabrze\" rel=\"external_link\" target=\"_blank\">Zabrze<\/a>, Poland has been working on developing an artificial heart. Nowadays, the Polish system for heart support POLCAS consists of the artificial ventricle POLVAD-MEV and the three controllers POLPDU-401, POLPDU-402 and POLPDU-501. Presented devices are designed to handle only one patient. The control units of the 401 and 402 series may be used only in hospital due to its big size, method of control and type of power supply. The control<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> unit of 501 series is the latest product of FRK. Due to its much smaller size and weight, it is significantly more mobile solution. For this reason, it can be also used during supervised treatment conducted outside the hospital.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Phoenix-7\">Phoenix-7<\/span><\/h3>\n<p>In June 1996, a 46-year-old man received a total artificial heart implantation done by at Cheng-Hsin General Hospital<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Taiwan\" title=\"Taiwan\" rel=\"external_link\" target=\"_blank\">Republic of China (Taiwan)<\/a>. This technologically advanced pneumatic was manufactured by a Taiwanese dentist , a Chinese physician and colleagues at the in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tainan\" title=\"Tainan\" rel=\"external_link\" target=\"_blank\">Tainan<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Taiwan\" title=\"Taiwan\" rel=\"external_link\" target=\"_blank\">Republic of China (Taiwan)<\/a>. With this experimental artificial heart, the patient's BP was maintained at 90-100\/40-55 mmHg and cardiac output at 4.2\u20135.8 L\/min.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> The patient then received the world's first successful combined heart and kidney transplantation after bridging with a total artificial heart.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Abiomed_AbioCor\">Abiomed AbioCor<\/span><\/h3>\n<p>The first <a href=\"https:\/\/en.wikipedia.org\/wiki\/AbioCor\" title=\"AbioCor\" rel=\"external_link\" target=\"_blank\">AbioCor<\/a> to be surgically implanted in a patient was on July 3, 2001.\n<sup id=\"rdp-ebb-cite_ref-CNN2001AbioCorSurgery_28-0\" class=\"reference\"><a href=\"#cite_note-CNN2001AbioCorSurgery-28\" rel=\"external_link\">[28]<\/a><\/sup> The AbioCor is made of titanium and plastic with a weight of 0,9 kg (two pounds), and its internal battery can be recharged with a transduction device that sends power through the skin.<sup id=\"rdp-ebb-cite_ref-CNN2001AbioCorSurgery_28-1\" class=\"reference\"><a href=\"#cite_note-CNN2001AbioCorSurgery-28\" rel=\"external_link\">[28]<\/a><\/sup> The internal battery lasts for half an hour, and a wearable external battery pack lasts for four hours.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> The FDA announced on September 5, 2006, that the AbioCor could be implanted for humanitarian uses after the device had been tested on 15 patients.<sup id=\"rdp-ebb-cite_ref-FDA2006_30-0\" class=\"reference\"><a href=\"#cite_note-FDA2006-30\" rel=\"external_link\">[30]<\/a><\/sup> It is intended for critically ill patients who cannot receive a heart transplant.<sup id=\"rdp-ebb-cite_ref-FDA2006_30-1\" class=\"reference\"><a href=\"#cite_note-FDA2006-30\" rel=\"external_link\">[30]<\/a><\/sup> Some limitations of the current AbioCor are that its size makes it suitable for less than 50% of the female population and only about 50% of the male population, and its useful life is only 1\u20132 years.<sup id=\"rdp-ebb-cite_ref-PopSciAbioCor_31-0\" class=\"reference\"><a href=\"#cite_note-PopSciAbioCor-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"SynCardia\">SynCardia<\/span><\/h3>\n<p>SynCardia is a company based in Tucson, Arizona which currently has two separate models available. It is available in a 70cc and 50cc size. The 70 cc is used for biventricular heart failure in adult men, while the 50cc is for children and women.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> As good results with the TAH as a bridge to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_transplant\" class=\"mw-redirect\" title=\"Heart transplant\" rel=\"external_link\" target=\"_blank\">heart transplant<\/a> accumulated, a trial of the CardioWest TAH (developed from the Jarvik 7 and now marketed as the Syncardia TAH) was initiated in 1993 and completed in 2002.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> As of 2014, more than 1,250 patients have received SynCardia artificial hearts.<sup id=\"rdp-ebb-cite_ref-syncardia_34-0\" class=\"reference\"><a href=\"#cite_note-syncardia-34\" rel=\"external_link\">[34]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-syncardia_34-1\" class=\"reference\"><a href=\"#cite_note-syncardia-34\" rel=\"external_link\">[34]<\/a><\/sup> The device requires the use of the Companion 2 hospital driver or the Freedom portable driver to power the heart with pulses of air. The drivers also monitor blood flow for each ventricle.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"MagScrew\">MagScrew<\/span><\/h3>\n<p>Another U.S. team has a prototype called the 2005 MagScrew Total Artificial Heart. Teams in Japan and South Korea are also racing to produce similar devices.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cleveland_Heart\">Cleveland Heart<\/span><\/h3>\n<p>The Cleveland Heart is a continuous-flow total artificial heart (CFTAH)<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Abiomed_AbioCor_II\">Abiomed AbioCor II<\/span><\/h3>\n<p>By combining its valved ventricles with the control technology and roller screw developed at Penn State, AbioMed has designed a smaller, more stable heart, the AbioCor II. This pump, which should be implantable in most men and 50% of women with a life span of up to five years,<sup id=\"rdp-ebb-cite_ref-PopSciAbioCor_31-1\" class=\"reference\"><a href=\"#cite_note-PopSciAbioCor-31\" rel=\"external_link\">[31]<\/a><\/sup> had animal trials in 2005, and the company hoped to get FDA approval for human use in 2008.<sup id=\"rdp-ebb-cite_ref-InterviewAbioCor_41-0\" class=\"reference\"><a href=\"#cite_note-InterviewAbioCor-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Carmat_bioprosthetic_heart\">Carmat bioprosthetic heart<\/span><\/h3>\n<p>On October 27, 2008, French professor and leading <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_transplantation\" title=\"Heart transplantation\" rel=\"external_link\" target=\"_blank\">heart transplant<\/a> specialist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alain_F._Carpentier\" class=\"mw-redirect\" title=\"Alain F. Carpentier\" rel=\"external_link\" target=\"_blank\">Alain F. Carpentier<\/a> announced that a fully implantable artificial heart would be ready for clinical trial by 2011 and for alternative transplant in 2013. It was developed and would be manufactured by him, biomedical firm <a href=\"https:\/\/fr.wikipedia.org\/wiki\/Carmat\" class=\"extiw\" title=\"fr:Carmat\" rel=\"external_link\" target=\"_blank\">CARMAT SA<\/a>,<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> and venture capital firm Truffle Capital. The prototype used embedded electronic sensors and was made from chemically treated animal tissues, called \"biomaterials\", or a \"pseudo-skin\" of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biosynthesis\" title=\"Biosynthesis\" rel=\"external_link\" target=\"_blank\">biosynthetic<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microporous_material\" title=\"Microporous material\" rel=\"external_link\" target=\"_blank\">microporous materials<\/a>.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup>\n<\/p><p>According to a press-release by Carmat dated December 20, 2013, the first implantation of its artificial heart in a 75-year-old patient was performed on December 18, 2013 by the Georges Pompidou European Hospital team in Paris (France).<sup id=\"rdp-ebb-cite_ref-Carpentier_44-0\" class=\"reference\"><a href=\"#cite_note-Carpentier-44\" rel=\"external_link\">[44]<\/a><\/sup> The patient died 75 days after the operation.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p><p>In Carmat's design, two chambers are each divided by a membrane that holds hydraulic fluid on one side. A motorized pump moves hydraulic fluid in and out of the chambers, and that fluid causes the membrane to move; blood flows through the other side of each membrane. The blood-facing side of the membrane is made of tissue obtained from a sac that surrounds a cow's heart, to make the device more biocompatible. The Carmat device also uses valves made from cow heart tissue and has sensors to detect increased pressure within the device. That information is sent to an internal control system that can adjust the flow rate in response to increased demand, such as when a patient is exercising.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> This distinguishes it from previous designs that maintain a constant flow rate.\n<\/p><p>The Carmat device, unlike previous designs, is meant to be used in cases of terminal heart failure, instead of being used as a bridge device while the patient awaits a transplant.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> At 900 grams it weighs nearly three times the typical heart and is targeted primarily towards obese men. It also requires the patient to carry around an additional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Li-Ion\" class=\"mw-redirect\" title=\"Li-Ion\" rel=\"external_link\" target=\"_blank\">Li-Ion<\/a> battery. The projected lifetime of the artificial heart is around 5 years (230 million beats).<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Frazier-Cohn\">Frazier-Cohn<\/span><\/h3>\n<p>On 12 March 2011, an experimental artificial heart was implanted in 55-year-old Craig Lewis at The Texas Heart Institute in Houston by Drs. <a href=\"https:\/\/en.wikipedia.org\/wiki\/O._H._Frazier\" title=\"O. H. Frazier\" rel=\"external_link\" target=\"_blank\">O. H. Frazier<\/a> and . The device is a combination of two modified <a href=\"https:\/\/en.wikipedia.org\/wiki\/HeartMate\" class=\"mw-redirect\" title=\"HeartMate\" rel=\"external_link\" target=\"_blank\">HeartMate II<\/a> pumps that is currently undergoing bovine trials.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p><p>Frazier and Cohn are on the board of the BiVACOR company that develops an artificial heart.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup> BiVACOR has been tested as a replacement for a heart in a sheep.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup>\n<\/p><p>So far, only one person has benefited from Frazier and Cohn's artificial heart. Craig Lewis was suffering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amyloidosis\" title=\"Amyloidosis\" rel=\"external_link\" target=\"_blank\">amyloidosis<\/a> in 2011 when his heart gave out and doctors pronounced that he had only 12 to 24 hours to live. After obtaining permission from his family, Frazier and Cohn replaced his heart with their device. Lewis survived for another 5 weeks after the operation; he eventually succumbed to liver and kidney failure due to his amyloidosis, after which his family asked that his artificial heart be unplugged.<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/p><p><br \/>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Soft_Total_Artificial_Heart_sTAH.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/39\/Soft_Total_Artificial_Heart_sTAH.jpg\/200px-Soft_Total_Artificial_Heart_sTAH.jpg\" width=\"200\" height=\"133\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Soft_Total_Artificial_Heart_sTAH.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Soft Total Artificial Heart, developed in the functional material laboratory at ETH Z\u00fcrich<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Soft_Artificial_Heart\">Soft Artificial Heart<\/span><\/h3>\n<p>On 10 July 2017, Cohrs and colleagues presented a new concept of a soft total artificial heart in the Journal of Artificial Organs.<sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup> The heart was developed in the Functionals Materials Laboratory at <a href=\"https:\/\/en.wikipedia.org\/wiki\/ETH_Zurich\" title=\"ETH Zurich\" rel=\"external_link\" target=\"_blank\">ETH Zurich<\/a>.<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> The soft artificial heart (SAH) was created from silicone with the help of 3D printing technology. The SAH is a silicone monoblock. It weighs 390g, has a volume of 679 cm^3 and is operated through pressurized air. \"Our goal is to develop an artificial heart that is roughly the same size as the patient\u2019s own one and which imitates the human heart as closely as possible in form and function\" says Cohrs in an interview.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup> The SAH fundamentally moves and works like a real heart but currently only beats for 3000 beats.<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Others\">Others<\/span><\/h2>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centrifugal_pump\" title=\"Centrifugal pump\" rel=\"external_link\" target=\"_blank\">centrifugal pump<\/a><sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup> or an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axial-flow_pump\" title=\"Axial-flow pump\" rel=\"external_link\" target=\"_blank\">axial-flow pump<\/a><sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup> can be used as an artificial heart, resulting in the patient being alive without a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse\" title=\"Pulse\" rel=\"external_link\" target=\"_blank\">pulse<\/a>.\n<\/p><p>A centrifugal artificial heart which alternately pumps the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_circulation\" title=\"Pulmonary circulation\" rel=\"external_link\" target=\"_blank\">pulmonary circulation<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Systemic_circulation\" class=\"mw-redirect\" title=\"Systemic circulation\" rel=\"external_link\" target=\"_blank\">systemic circulation<\/a>, causing a pulse, has been described.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p><p>Researchers have constructed a heart out of foam. The heart is made out of flexible silicone and works with an external pump to push air and fluids through the heart. It currently cannot be implanted into humans, but it is a promising start for artificial hearts.<sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hybrid_assistive_devices\">Hybrid assistive devices<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_assist_device\" title=\"Ventricular assist device\" rel=\"external_link\" target=\"_blank\">Ventricular assist device<\/a><\/div>\n<p>Patients who have some remaining heart function but who can no longer live normally may be candidates for ventricular assist devices (VAD), which do not replace the human heart but complement it by taking up much of the function.\n<\/p><p>The first Left Ventricular Assist Device (LVAD) system was created by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Domingo_Liotta\" title=\"Domingo Liotta\" rel=\"external_link\" target=\"_blank\">Domingo Liotta<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baylor_College_of_Medicine\" title=\"Baylor College of Medicine\" rel=\"external_link\" target=\"_blank\">Baylor College of Medicine<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Houston\" title=\"Houston\" rel=\"external_link\" target=\"_blank\">Houston<\/a> in 1962.<sup id=\"rdp-ebb-cite_ref-65\" class=\"reference\"><a href=\"#cite_note-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/p><p>Another VAD, the Kantrowitz CardioVad, designed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adrian_Kantrowitz\" title=\"Adrian Kantrowitz\" rel=\"external_link\" target=\"_blank\">Adrian Kantrowitz<\/a> boosts the native heart by taking up over 50% of its function.<sup id=\"rdp-ebb-cite_ref-Mitka_66-0\" class=\"reference\"><a href=\"#cite_note-Mitka-66\" rel=\"external_link\">[66]<\/a><\/sup> Additionally, the VAD can help patients on the wait list for a heart transplant. In a young person, this device could delay the need for a transplant by 10\u201315 years, or even allow the heart to recover, in which case the VAD can be removed.<sup id=\"rdp-ebb-cite_ref-Mitka_66-1\" class=\"reference\"><a href=\"#cite_note-Mitka-66\" rel=\"external_link\">[66]<\/a><\/sup>\n<p>The artificial heart is powered by a battery that needs to be changed several times while still working.\n<\/p>\n<\/p><p>The first heart assist device was approved by the FDA in 1994, and two more received approval in 1998.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup>\n<p>While the original assist devices emulated the pulsating heart, newer versions, such as the Heartmate II,<sup id=\"rdp-ebb-cite_ref-68\" class=\"reference\"><a href=\"#cite_note-68\" rel=\"external_link\">[68]<\/a><\/sup> developed by The Texas Heart Institute of Houston, provide continuous flow. These pumps (which may be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centrifugal_pump\" title=\"Centrifugal pump\" rel=\"external_link\" target=\"_blank\">centrifugal<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axial_flow\" class=\"mw-redirect\" title=\"Axial flow\" rel=\"external_link\" target=\"_blank\">axial flow<\/a>) are smaller and potentially more durable and last longer than the current generation of total heart replacement pumps. Another major advantage of a VAD is that the patient keeps the natural heart, which may still function for temporary back-up support if the mechanical pump were to stop. This may provide enough support to keep the patient alive until a solution to the problem is implemented.\n<\/p>\n<\/p><p>In August 2006, an artificial heart was implanted into a 15-year-old girl at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stollery_Children%27s_Hospital\" title=\"Stollery Children's Hospital\" rel=\"external_link\" target=\"_blank\">Stollery Children's Hospital<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edmonton\" title=\"Edmonton\" rel=\"external_link\" target=\"_blank\">Edmonton<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alberta\" title=\"Alberta\" rel=\"external_link\" target=\"_blank\">Alberta<\/a>. It was intended to act as a temporary fixture until a donor heart could be found. Instead, the artificial heart (called a Berlin Heart) allowed for natural processes to occur and her heart healed on its own. After 146 days, the Berlin Heart was removed, and the girl's heart functioned properly on its own.<sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup> On December 16, 2011 the Berlin Heart gained U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/FDA\" class=\"mw-redirect\" title=\"FDA\" rel=\"external_link\" target=\"_blank\">FDA<\/a> approval. The device has since been successfully implanted in several children including a 4-year-old Honduran girl at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Children%27s_Hospital_Boston\" class=\"mw-redirect\" title=\"Children's Hospital Boston\" rel=\"external_link\" target=\"_blank\">Children's Hospital Boston<\/a>.<sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup>\n<\/p><p>Several continuous-flow ventricular assist devices have been approved for use in the European Union, and, as of August 2007, were undergoing clinical trials for FDA approval.\n<\/p><p>In 2012, a study published in the New England Journal of Medicine compared the Berlin Heart to extracorporeal membrane oxygenation (ECMO) and concluded that \"a ventricular assist device available in several sizes for use in children as a bridge to heart transplantation [such as the Berlin Heart] was associated with a significantly higher rate of survival as compared with ECMO.\"<sup id=\"rdp-ebb-cite_ref-71\" class=\"reference\"><a href=\"#cite_note-71\" rel=\"external_link\">[71]<\/a><\/sup> The study's primary author, Charles D. Fraser, Jr., surgeon in chief at Texas Children's Hospital, explained: \"With the Berlin Heart, we have a more effective therapy to offer patients earlier in the management of their heart failure. When we sit with parents, we have real data to offer so they can make an informed decision. This is a giant step forward.\" <sup id=\"rdp-ebb-cite_ref-72\" class=\"reference\"><a href=\"#cite_note-72\" rel=\"external_link\">[72]<\/a><\/sup>\n<\/p><p>Suffering from end-stage heart failure, former Vice President <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dick_Cheney\" title=\"Dick Cheney\" rel=\"external_link\" target=\"_blank\">Dick Cheney<\/a> underwent a procedure in July 2010 to have a VAD implanted at INOVA Fairfax Hospital, in Fairfax Virginia. In 2012, he received a heart transplant at age 71 after 20 months on a waiting list.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">Artificial heart valve<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"General_references\">General references<\/span><\/h3>\n<ul><li>George B. Griffenhagen and Calvin H. Hughes. <i>The History of the Mechanical Heart<\/i>. Smithsonian Report for 1955, (Pub. 4241): 339\u2013356, 1956.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fox2detroit.com\/news\/local-news\/donor-saves-detroit-pastor-living-on-artificial-heart\" target=\"_blank\">\"Donor saves Detroit pastor living on artificial heart\"<\/a>. Fox News. May 18, 2018<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Inline_citations\">Inline citations<\/span><\/h3>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.americanheart.org\/presenter.jhtml;jsessionid=EFNP3NSFUBXLICQFCXQCDSQ?identifier=3005888\" target=\"_blank\">\"The Mechanical Heart celebrates 50 lifesaving years\"<\/a>. American Heart Association. 9 Feb 2008. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101121031801\/http:\/\/charitywire.com\/charity8\/03284.html\" target=\"_blank\">Archived<\/a> from the original on 2010-11-21<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-03-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Mechanical+Heart+celebrates+50+lifesaving+years&rft.pub=American+Heart+Association&rft.date=2008-02-09&rft_id=http%3A%2F%2Fwww.americanheart.org%2Fpresenter.jhtml%3Bjsessionid%3DEFNP3NSFUBXLICQFCXQCDSQ%3Fidentifier%3D3005888&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span> and <cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.prnewswire.com\/news-releases\/the-mechanical-heart-celebrates-50-lifesaving-years-76402127.html\" target=\"_blank\">\"Mechanical Heart Celebrates 50 Lifesaving Years\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160819065533\/http:\/\/www.prnewswire.com\/news-releases\/the-mechanical-heart-celebrates-50-lifesaving-years-76402127.html\" target=\"_blank\">Archived<\/a> from the original on 2016-08-19<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-06-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Mechanical+Heart+Celebrates+50+Lifesaving+Years&rft_id=http%3A%2F%2Fwww.prnewswire.com%2Fnews-releases%2Fthe-mechanical-heart-celebrates-50-lifesaving-years-76402127.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/media.wayne.edu\/2002\/10\/22\/50th-anniversary-of-first-open-heart-surgery\" target=\"_blank\">\"50th Anniversary of First Open Heart Surgery \u2013 Newsroom\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150501210102\/http:\/\/media.wayne.edu\/2002\/10\/22\/50th-anniversary-of-first-open-heart-surgery\" target=\"_blank\">Archived<\/a> from the original on 2015-05-01.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=50th+Anniversary+of+First+Open+Heart+Surgery+%E2%80%93+Newsroom&rft_id=http%3A%2F%2Fmedia.wayne.edu%2F2002%2F10%2F22%2F50th-anniversary-of-first-open-heart-surgery&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stephenson Larry W; et al. (2002). \"The Michigan Heart: The World's First Successful Open Heart Operation?\". <i>Journal of Cardiac Surgery<\/i>. <b>17<\/b> (3): 238\u2013246. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1540-8191.2002.tb01209.x\" target=\"_blank\">10.1111\/j.1540-8191.2002.tb01209.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12489911\" target=\"_blank\">12489911<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Cardiac+Surgery&rft.atitle=The+Michigan+Heart%3A+The+World%27s+First+Successful+Open+Heart+Operation%3F&rft.volume=17&rft.issue=3&rft.pages=238-246&rft.date=2002&rft_id=info%3Adoi%2F10.1111%2Fj.1540-8191.2002.tb01209.x&rft_id=info%3Apmid%2F12489911&rft.au=Stephenson+Larry+W&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lavietes, Stuart. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2003\/03\/17\/us\/william-glenn-88-surgeon-who-invented-heart-procedure.html\" target=\"_blank\"><i>William Glenn, 88, Surgeon Who Invented Heart Procedure<\/i><\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170810091621\/http:\/\/www.nytimes.com\/2003\/03\/17\/us\/william-glenn-88-surgeon-who-invented-heart-procedure.html\" target=\"_blank\">Archived<\/a> 2017-08-10 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times\" title=\"The New York Times\" rel=\"external_link\" target=\"_blank\">The New York Times<\/a>, March 17, 2003. Accessed May 21, 2009.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.today\/20160818074549\/https:\/\/scholarblogs.emory.edu\/phil116bioethics\/files\/2015\/02\/jarvik7.jpg\" target=\"_blank\">\"jarvik7.jpg (625x800 pixels)\"<\/a>. <i>emory.edu<\/i>. 18 August 2016. Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/scholarblogs.emory.edu\/phil116bioethics\/files\/2015\/02\/jarvik7.jpg\" target=\"_blank\">the original<\/a> on 18 August 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=emory.edu&rft.atitle=jarvik7.jpg+%28625x800+pixels%29&rft.date=2016-08-18&rft_id=https%3A%2F%2Fscholarblogs.emory.edu%2Fphil116bioethics%2Ffiles%2F2015%2F02%2Fjarvik7.jpg&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Artificial Heart in the chest: Preliminary report\". <i>Trans. Amer. Soc. Inter. Organs<\/i>. <b>7<\/b>: 318. 1961.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Trans.+Amer.+Soc.+Inter.+Organs&rft.atitle=Artificial+Heart+in+the+chest%3A+Preliminary+report&rft.volume=7&rft.pages=318&rft.date=1961&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Ablation experimentale et replacement du coeur par un coer artificial intra-thoracique\". <i>Lyon Cirurgical<\/i>. <b>57<\/b>: 704. 1961.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lyon+Cirurgical&rft.atitle=Ablation+experimentale+et+replacement+du+coeur+par+un+coer+artificial+intra-thoracique&rft.volume=57&rft.pages=704&rft.date=1961&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-autogenerated1-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-autogenerated1_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Sandeep Jauhar: <i>The Artificial Heart.<\/i> New England Journal of Medicine (2004): 542\u2013544.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Hwang, Ned H. C.; Woo, Savio L.-Y. (31 December 2003). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=zVYYAvEQtNcC\" target=\"_blank\">\"Frontiers in Biomedical Engineering: Proceedings of the World Congress for Chinese Biomedical Engineers\"<\/a>. 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Lerner, MD (December 1, 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archive.wikiwix.com\/cache\/20110629033333\/http:\/\/celebrities.healthdiaries.com\/the-25th-anniversary-of-barney-clarks-artificial-heart.html\" target=\"_blank\">\"The 25th Anniversary of Barney Clark's Artificial Heart\"<\/a>. <i>Celebrity Health<\/i>. HealthDiaries.com. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/celebrities.healthdiaries.com\/the-25th-anniversary-of-barney-clarks-artificial-heart.html\" target=\"_blank\">the original<\/a> on 29 June 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 November<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Celebrity+Health&rft.atitle=The+25th+Anniversary+of+Barney+Clark%27s+Artificial+Heart&rft.date=2007-12-01&rft.au=Barron+H.+Lerner%2C+MD&rft_id=http%3A%2F%2Fcelebrities.healthdiaries.com%2Fthe-25th-anniversary-of-barney-clarks-artificial-heart.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Orthotopic cardiac prosthesis for two-staged cardiac replacement. <i>Am J Cardio<\/i> 1969; 24:723\u2013730.<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/americanhistory.si.edu\/exhibitions\/small_exhibition.cfm?key=1267&exkey=143&pagekey=216\" target=\"_blank\">\"Treasures of American History\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archive.wikiwix.com\/cache\/20110629033315\/http:\/\/americanhistory.si.edu\/exhibitions\/small_exhibition.cfm?key=1267&exkey=143&pagekey=216\" target=\"_blank\">Archived<\/a> 2011-06-29 at Wikiwix, National Museum of American History<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Spare Parts: Organ Replacement in American Society. Renee C. Fox and Judith P. Swazey. New York: Oxford University Press; 1992, pp. 102\u2013104<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kwan-Gett CS, Van Kampen KR, Kawai J, Eastwood N, Kolff WJ (Dec 1971). \"Results of total artificial heart implantation in calves\". <i>Journal of Thoracic and Cardiovascular Surgery<\/i>. <b>62<\/b> (6): 880\u2013889.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Thoracic+and+Cardiovascular+Surgery&rft.atitle=Results+of+total+artificial+heart+implantation+in+calves&rft.volume=62&rft.issue=6&rft.pages=880-889&rft.date=1971-12&rft.aulast=Kwan-Gett&rft.aufirst=CS&rft.au=Van+Kampen%2C+KR&rft.au=Kawai%2C+J&rft.au=Eastwood%2C+N&rft.au=Kolff%2C+WJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.time.com\/time\/magazine\/article\/0,9171,944609,00.html\" target=\"_blank\">\"Winchell's Heart\"<\/a>. <i>Time<\/i>. March 12, 1973. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100906160346\/http:\/\/www.time.com\/time\/magazine\/article\/0,9171,944609,00.html\" target=\"_blank\">Archived<\/a> from the original on September 6, 2010<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">April 25,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Time&rft.atitle=Winchell%27s+Heart&rft.date=1973-03-12&rft_id=http%3A%2F%2Fwww.time.com%2Ftime%2Fmagazine%2Farticle%2F0%2C9171%2C944609%2C00.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.stanford.edu\/dept\/HPS\/transplant\/html\/kolff.html\" target=\"_blank\">\"Kolff\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081007080038\/http:\/\/www.stanford.edu\/dept\/HPS\/transplant\/html\/kolff.html\" target=\"_blank\">Archived<\/a> from the original on 2008-10-07.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Kolff&rft_id=http%3A%2F%2Fwww.stanford.edu%2Fdept%2FHPS%2Ftransplant%2Fhtml%2Fkolff.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chron.com\/news\/health\/slideshow\/Dr-Denton-Cooley-and-Dr-Michael-E-DeBakey-83220\/photo-6114896.php\" target=\"_blank\">\"Dr. Denton Cooley and Dr. Michael E. DeBakey: Rock stars of Houston medicine\"<\/a>. <i>Houston Chronicle<\/i>. 3 April 2014. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150314153029\/http:\/\/www.chron.com\/news\/health\/slideshow\/Dr-Denton-Cooley-and-Dr-Michael-E-DeBakey-83220\/photo-6114896.php\" target=\"_blank\">Archived<\/a> from the original on 14 March 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">7 March<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Houston+Chronicle&rft.atitle=Dr.+Denton+Cooley+and+Dr.+Michael+E.+DeBakey%3A+Rock+stars+of+Houston+medicine&rft.date=2014-04-03&rft_id=http%3A%2F%2Fwww.chron.com%2Fnews%2Fhealth%2Fslideshow%2FDr-Denton-Cooley-and-Dr-Michael-E-DeBakey-83220%2Fphoto-6114896.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-williamgmcgowanfund.org-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-williamgmcgowanfund.org_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-williamgmcgowanfund.org_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.williamgmcgowanfund.org\/care_for_failing_hearts.php\" target=\"_blank\">\"Revolutionizing Care for Failing Hearts \u2013 William G. McGowan Charitable Fund\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160513222830\/http:\/\/www.williamgmcgowanfund.org\/care_for_failing_hearts.php\" target=\"_blank\">Archived<\/a> from the original on 2016-05-13.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Revolutionizing+Care+for+Failing+Hearts+%E2%80%93+William+G.+McGowan+Charitable+Fund&rft_id=http%3A%2F%2Fwww.williamgmcgowanfund.org%2Fcare_for_failing_hearts.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mirm.pitt.edu\/news-archive\/pittsburghs-25th-anniversary-first-vad-patient-discharged-hospital\/\" target=\"_blank\">\"Pittsburgh's 25th Anniversary of First VAD Patient to Be Discharged from a Hospital \u2013 Regenerative Medicine at the McGowan Institute\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160629232509\/http:\/\/www.mirm.pitt.edu\/news-archive\/pittsburghs-25th-anniversary-first-vad-patient-discharged-hospital\/\" target=\"_blank\">Archived<\/a> from the original on 2016-06-29.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pittsburgh%E2%80%99s+25th+Anniversary+of+First+VAD+Patient+to+Be+Discharged+from+a+Hospital+%E2%80%93+Regenerative+Medicine+at+the+McGowan+Institute&rft_id=http%3A%2F%2Fwww.mirm.pitt.edu%2Fnews-archive%2Fpittsburghs-25th-anniversary-first-vad-patient-discharged-hospital%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ShelleyMcKellar-21\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ShelleyMcKellar_21-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ShelleyMcKellar_21-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">McKellar, Shelley (2018-01-03). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=harry%20diamond%20artificial%20heart&f=false\"><i>Artificial Hearts: The Allure and Ambivalence of a Controversial Medical Technology<\/i><\/a>. JHU Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781421423555.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Artificial+Hearts%3A+The+Allure+and+Ambivalence+of+a+Controversial+Medical+Technology&rft.pub=JHU+Press&rft.date=2018-01-03&rft.isbn=9781421423555&rft.aulast=McKellar&rft.aufirst=Shelley&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DXCZEDwAAQBAJ%26pg%3DPA130-IA2%26lpg%3DPA130-IA2%26dq%3Dharry%2Bdiamond%2Bartificial%2Bheart%26source%3Dbl%26ots%3DKU_2DC9xZa%26sig%3DZ6PPt7nkEIvZmY2hxVTwIIRdiT0%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwjCioPGrJLcAhVGJt8KHUpvBzoQ6AEIOTAG%23v%3Donepage%26q%3Dharry%2520diamond%2520artificial%2520heart%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NationalAcademies-22\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NationalAcademies_22-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NationalAcademies_22-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=harry%20diamond%20artificial%20heart&f=false\"><i>Mechanical Devices to Assist the Failing Heart: Proceedings<\/i><\/a>. National Academies. 1966.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mechanical+Devices+to+Assist+the+Failing+Heart%3A+Proceedings&rft.pub=National+Academies&rft.date=1966&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DkZMrAAAAYAAJ%26pg%3DPA95%26lpg%3DPA95%26dq%3Dharry%2Bdiamond%2Bartificial%2Bheart%26source%3Dbl%26ots%3Dq9V0DSixUe%26sig%3DCGGVLdD8MH6mBHe3rN06onV31n8%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwjCioPGrJLcAhVGJt8KHUpvBzoQ6AEINzAF%23v%3Donepage%26q%3Dharry%2520diamond%2520artificial%2520heart%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081112152506\/http:\/\/www.arl.army.mil\/www\/DownloadedInternetPages\/CurrentPages\/AboutARL\/ARL_History1992-2003.pdf\" target=\"_blank\">\"Wayback Machine\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2008-11-12<span class=\"reference-accessdate\">. 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Biomedical Engineering - Applications, Basis & Communications. 13:133 - 139, worldscientific..com.<\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wei J.; Cheng K. K.; Tung D. Y.; Chang C. Y.; Wan W. M.; Chuang Y. C. (1998). \"Successful Use of Phoenix-7 Total Artificial Heart\". <i>Transplantation Proceedings<\/i>. <b>30<\/b>: 3403\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0041-1345%2898%2901078-1\" target=\"_blank\">10.1016\/s0041-1345(98)01078-1<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Transplantation+Proceedings&rft.atitle=Successful+Use+of+Phoenix-7+Total+Artificial+Heart&rft.volume=30&rft.pages=3403-4&rft.date=1998&rft_id=info%3Adoi%2F10.1016%2Fs0041-1345%2898%2901078-1&rft.au=Wei+J.&rft.au=Cheng+K.+K.&rft.au=Tung+D.+Y.&rft.au=Chang+C.+Y.&rft.au=Wan+W.+M.&rft.au=Chuang+Y.+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CNN2001AbioCorSurgery-28\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CNN2001AbioCorSurgery_28-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CNN2001AbioCorSurgery_28-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archives.cnn.com\/2001\/HEALTH\/conditions\/07\/03\/artificial.heart\/\" target=\"_blank\">\"Patient gets first totally implanted artificial heart\"<\/a>. CNN.com. 2001-07-03. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080607052947\/http:\/\/archives.cnn.com\/2001\/HEALTH\/conditions\/07\/03\/artificial.heart\/\" target=\"_blank\">Archived<\/a> from the original on 7 June 2008<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">2008-07-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=AbioCor+FAQs&rft_id=http%3A%2F%2Fwww.abiomed.com%2Fproducts%2Ffaqs.cfm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDA2006-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDA2006_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA2006_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/2006\/NEW01443.html\" target=\"_blank\">\"FDA Approves First Totally Implanted Permanent Artificial Heart for Humanitarian Uses\"<\/a>. 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Retrieved <span class=\"nowrap\">2008-07-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Will+We+Merge+With+Machines%3F&rft.date=2005-08-01&rft_id=http%3A%2F%2Fwww.popsci.com%2Fscitech%2Farticle%2F2005-08%2Fwill-we-merge-machines&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.syncardia.com\/medical-professionals\/small-to-large-patients.html\" target=\"_blank\">\"Two Sizes Intended to Treat Most Patients\"<\/a>. <i>SynCardia<\/i>. November 16, 2015. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151117031548\/http:\/\/www.syncardia.com\/medical-professionals\/small-to-large-patients.html\" target=\"_blank\">Archived<\/a> from the original on November 17, 2015.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=SynCardia&rft.atitle=Two+Sizes+Intended+to+Treat+Most+Patients&rft.date=2015-11-16&rft_id=http%3A%2F%2Fwww.syncardia.com%2Fmedical-professionals%2Fsmall-to-large-patients.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Copeland JG, Smith RG, Arabia FA, et al. (2004). \"Cardiac replacement with a total artificial heart as a bridge to transplantation\". <i>N Engl J Med<\/i>. <b>351<\/b>: 859\u201367. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2Fnejmoa040186\" target=\"_blank\">10.1056\/nejmoa040186<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=N+Engl+J+Med&rft.atitle=Cardiac+replacement+with+a+total+artificial+heart+as+a+bridge+to+transplantation&rft.volume=351&rft.pages=859-67&rft.date=2004&rft_id=info%3Adoi%2F10.1056%2Fnejmoa040186&rft.aulast=Copeland&rft.aufirst=JG&rft.au=Smith%2C+RG&rft.au=Arabia%2C+FA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-syncardia-34\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-syncardia_34-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-syncardia_34-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.syncardia.com\/2014-press-releases\/new-record-of-161-syncardia-total-artificial-heart-implants-set-in-2013\/itemid-1658.html\" target=\"_blank\">\"New Record of 161 SynCardia Total Artificial Heart Implants Set In 2013\"<\/a>. <i><\/i>. 2014-01-07. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160113055339\/http:\/\/www.syncardia.com\/2014-press-releases\/new-record-of-161-syncardia-total-artificial-heart-implants-set-in-2013\/itemid-1658.html\" target=\"_blank\">Archived<\/a> from the original on 2016-01-13<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-06-11<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=SynCardia&rft.atitle=New+Record+of+161+SynCardia+Total+Artificial+Heart+Implants+Set+In+2013&rft.date=2014-01-07&rft_id=http%3A%2F%2Fwww.syncardia.com%2F2014-press-releases%2Fnew-record-of-161-syncardia-total-artificial-heart-implants-set-in-2013%2Fitemid-1658.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Torregrossa G, Morshuis M, Varghese R; et al. (2014). \"Results with SynCardia total artificial heart beyond 1 year\". <i>ASAIO J<\/i>. <b>60<\/b>: 626\u201334.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ASAIO+J&rft.atitle=Results+with+SynCardia+total+artificial+heart+beyond+1+year&rft.volume=60&rft.pages=626-34&rft.date=2014&rft.au=Torregrossa+G%2C+Morshuis+M%2C+Varghese+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> One patient had the artificial heart for 1,374 days, that is, nearly four years.<\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/transplants.ucla.edu\/body.cfm?id=223\" target=\"_blank\">\"UCLA Transplantation Services, Los Angeles, CA\"<\/a>. <i>transplants.ucla.edu<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160806164329\/http:\/\/transplants.ucla.edu\/body.cfm?id=223\" target=\"_blank\">Archived<\/a> from the original on 2016-08-06.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=transplants.ucla.edu&rft.atitle=UCLA+Transplantation+Services%2C+Los+Angeles%2C+CA&rft_id=http%3A%2F%2Ftransplants.ucla.edu%2Fbody.cfm%3Fid%3D223&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Weber S, Kamohara K, Klatte RS, Luangphakdy V, Flick C, Chen JF, Casas F, Ootaki Y, Kopcak M, Akiyama M, Hirschman GB, Chapman PA, Donahue A, Wetterau W, Prisco C, Mast R, Sherman C, Fukamachi K, Smith WA. \"MagScrew TAH: an update\". <i>ASAIO J<\/i>. <b>51<\/b>: xxxvi\u2013xlvi. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.mat.0000187395.29817.36\" target=\"_blank\">10.1097\/01.mat.0000187395.29817.36<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16340348\" target=\"_blank\">16340348<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ASAIO+J&rft.atitle=MagScrew+TAH%3A+an+update&rft.volume=51&rft.pages=xxxvi-xlvi&rft_id=info%3Adoi%2F10.1097%2F01.mat.0000187395.29817.36&rft_id=info%3Apmid%2F16340348&rft.aulast=Weber&rft.aufirst=S&rft.au=Kamohara%2C+K&rft.au=Klatte%2C+RS&rft.au=Luangphakdy%2C+V&rft.au=Flick%2C+C&rft.au=Chen%2C+JF&rft.au=Casas%2C+F&rft.au=Ootaki%2C+Y&rft.au=Kopcak%2C+M&rft.au=Akiyama%2C+M&rft.au=Hirschman%2C+GB&rft.au=Chapman%2C+PA&rft.au=Donahue%2C+A&rft.au=Wetterau%2C+W&rft.au=Prisco%2C+C&rft.au=Mast%2C+R&rft.au=Sherman%2C+C&rft.au=Fukamachi%2C+K&rft.au=Smith%2C+WA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/blogs.ptc.com\/2014\/12\/15\/japanese-researchers-advance-artificial-heart-design\/\" target=\"_blank\">\"Japanese Researchers Advance Artificial Heart Design\"<\/a>. <i>ptc.com<\/i>. 15 December 2014. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20161006104606\/http:\/\/blogs.ptc.com\/2014\/12\/15\/japanese-researchers-advance-artificial-heart-design\/\" target=\"_blank\">Archived<\/a> from the original on 6 October 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ptc.com&rft.atitle=Japanese+Researchers+Advance+Artificial+Heart+Design&rft.date=2014-12-15&rft_id=http%3A%2F%2Fblogs.ptc.com%2F2014%2F12%2F15%2Fjapanese-researchers-advance-artificial-heart-design%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bme.gr.jp\/Research_info_E\/AH.html\" target=\"_blank\">\"Artificial heart\"<\/a>. <i>www.bme.gr.jp<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160822124257\/http:\/\/www.bme.gr.jp\/Research_info_E\/AH.html\" target=\"_blank\">Archived<\/a> from the original on 2016-08-22.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.bme.gr.jp&rft.atitle=Artificial+heart&rft_id=http%3A%2F%2Fwww.bme.gr.jp%2FResearch_info_E%2FAH.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/xpl\/articleDetails.jsp?reload=true&arnumber=64462\" target=\"_blank\">\"A moving-actuator type electromechanical total artificial heart. II. Circular type and animal experiment - IEEE Journals & Magazine\"<\/a>. <i>ieeexplore.ieee.org<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160919193543\/http:\/\/ieeexplore.ieee.org\/xpl\/articleDetails.jsp?reload=true\" target=\"_blank\">Archived<\/a> from the original on 2016-09-19.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ieeexplore.ieee.org&rft.atitle=A+moving-actuator+type+electromechanical+total+artificial+heart.+II.+Circular+type+and+animal+experiment+-+IEEE+Journals+%26+Magazine&rft_id=http%3A%2F%2Fieeexplore.ieee.org%2Fxpl%2FarticleDetails.jsp%3Freload%3Dtrue%26arnumber%3D64462&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-InterviewAbioCor-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-InterviewAbioCor_41-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/viewarticle\/493622\" target=\"_blank\">\"14th Artificial Heart Patient Dies: A Newsmaker Interview With Robert Kung, PhD\"<\/a>. medscape.com. 2004-11-11. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130425063714\/http:\/\/www.medscape.com\/viewarticle\/493622\" target=\"_blank\">Archived<\/a> from the original on 2013-04-25<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-07-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=14th+Artificial+Heart+Patient+Dies%3A+A+Newsmaker+Interview+With+Robert+Kung%2C+PhD&rft.date=2004-11-11&rft_id=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F493622&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">atorsoli, Albertina Torsoli. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bloomberg.com\/news\/articles\/2013-10-10\/carmats-long-term-artificial-heart-nears-human-trials\" target=\"_blank\">\"A Synthetic Heart That Keeps on Ticking\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160806185711\/http:\/\/www.bloomberg.com\/news\/articles\/2013-10-10\/carmats-long-term-artificial-heart-nears-human-trials\" target=\"_blank\">Archived<\/a> from the original on 2016-08-06.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=A+Synthetic+Heart+That+Keeps+on+Ticking&rft.aulast=atorsoli&rft.aufirst=Albertina+Torsoli&rft_id=https%3A%2F%2Fwww.bloomberg.com%2Fnews%2Farticles%2F2013-10-10%2Fcarmats-long-term-artificial-heart-nears-human-trials&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130629175325\/http:\/\/www.carmatsa.com\/index.php?option=com_flexicontent&view=items&cid=40&id=349&Itemid=39&lang=en%2C\" target=\"_blank\">\"The Carmat Heart,- The technology behind the prosthesis\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.carmatsa.com\/index.php?option=com_flexicontent&view=items&cid=40&id=349&Itemid=39&lang=en,\" target=\"_blank\">the original<\/a> on 2013-06-29.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Carmat+Heart%2C-+The+technology+behind+the+prosthesis&rft_id=http%3A%2F%2Fwww.carmatsa.com%2Findex.php%3Foption%3Dcom_flexicontent%26view%3Ditems%26cid%3D40%26id%3D349%26Itemid%3D39%26lang%3Den%2C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Carpentier-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Carpentier_44-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131224102303\/http:\/\/www.carmatsa.com\/index.php?id=505&cid=689&fid=26&task=download&option=com_flexicontent&lang=en\" target=\"_blank\">\"First-in-man implantation of CARMAT's bioprosthetic artificial heart\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.carmatsa.com\/index.php?id=505&cid=689&fid=26&task=download&option=com_flexicontent&lang=en\" target=\"_blank\">the original<\/a> on 2013-12-24.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=First-in-man+implantation+of+CARMAT%27s+bioprosthetic+artificial+heart&rft_id=http%3A%2F%2Fwww.carmatsa.com%2Findex.php%3Fid%3D505%26cid%3D689%26fid%3D26%26task%3Ddownload%26option%3Dcom_flexicontent%26lang%3Den&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.reuters.com\/article\/2014\/03\/03\/us-carmat-death-idUSBREA221YB20140303\" target=\"_blank\">\"First patient fitted with Carmat artificial heart dies\"<\/a>. <i>Reuters<\/i>. March 3, 2014. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150930120126\/http:\/\/www.reuters.com\/article\/2014\/03\/03\/us-carmat-death-idUSBREA221YB20140303\" target=\"_blank\">Archived<\/a> from the original on September 30, 2015.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Reuters&rft.atitle=First+patient+fitted+with+Carmat+artificial+heart+dies&rft.date=2014-03-03&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2F2014%2F03%2F03%2Fus-carmat-death-idUSBREA221YB20140303&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Rojahn, Susan Young. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.technologyreview.com\/news\/515021\/the-latest-artificial-heart-part-cow-part-machine\/\" target=\"_blank\">\"Biology and Machine Come Together in a New Artificial Heart\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Biology+and+Machine+Come+Together+in+a+New+Artificial+Heart&rft.aulast=Rojahn&rft.aufirst=Susan+Young&rft_id=http%3A%2F%2Fwww.technologyreview.com%2Fnews%2F515021%2Fthe-latest-artificial-heart-part-cow-part-machine%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.reuters.com\/article\/2013\/12\/30\/us-carmat-patient-idUSBRE9BS07O20131230\" target=\"_blank\">\"Carmat artificial heart patient in good condition: hospital\"<\/a>. <i>Reuters<\/i>. December 30, 2013. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150924192055\/http:\/\/www.reuters.com\/article\/2013\/12\/30\/us-carmat-patient-idUSBRE9BS07O20131230\" target=\"_blank\">Archived<\/a> from the original on September 24, 2015.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Reuters&rft.atitle=Carmat+artificial+heart+patient+in+good+condition%3A+hospital&rft.date=2013-12-30&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2F2013%2F12%2F30%2Fus-carmat-patient-idUSBRE9BS07O20131230&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Polska, Wirtualna. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/techtrendy.pl\/wid,16287637,wiadomosc.html\" target=\"_blank\">\"Pierwsze wszczepione na sta\u0142e sztuczne serce bije ju\u017c w ludzkiej piersi \u2013 TechTrendy.pl\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131230110906\/http:\/\/techtrendy.pl\/wid,16287637,wiadomosc.html\" target=\"_blank\">Archived<\/a> from the original on 2013-12-30.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pierwsze+wszczepione+na+sta%C5%82e+sztuczne+serce+bije+ju%C5%BC+w+ludzkiej+piersi+%E2%80%93+TechTrendy.pl&rft.aulast=Polska&rft.aufirst=Wirtualna&rft_id=http%3A%2F%2Ftechtrendy.pl%2Fwid%2C16287637%2Cwiadomosc.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Berger, Eric. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chron.com\/disp\/story.mpl\/front\/7486853.html\" target=\"_blank\">\"New artificial heart 'a leap forward<span class=\"cs1-kern-right\">'<\/span>\"<\/a>. <i>Houston Chronicle<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110326020607\/http:\/\/www.chron.com\/disp\/story.mpl\/front\/7486853.html\" target=\"_blank\">Archived<\/a> from the original on 26 March 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 March<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=New+artificial+heart+%27a+leap+forward%27&rft.pub=%27%27Houston+Chronicle%27%27&rft.aulast=Berger&rft.aufirst=Eric&rft_id=http%3A%2F%2Fwww.chron.com%2Fdisp%2Fstory.mpl%2Ffront%2F7486853.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chron.com\/news\/health\/article\/Donor-brings-of-artificial-heart-closer-to-Houston-4189733.php\" target=\"_blank\">\"Donor brings inventor of artificial heart closer to Houston\"<\/a>. <i>Houston Chronicle<\/i>. 14 Jan 2013. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150925145723\/http:\/\/www.chron.com\/news\/health\/article\/Donor-brings-of-artificial-heart-closer-to-Houston-4189733.php\" target=\"_blank\">Archived<\/a> from the original on 2015-09-25.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Houston+Chronicle&rft.atitle=Donor+brings+inventor+of+artificial+heart+closer+to+Houston&rft.date=2013-01-14&rft_id=http%3A%2F%2Fwww.chron.com%2Fnews%2Fhealth%2Farticle%2FDonor-brings-of-artificial-heart-closer-to-Houston-4189733.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/edition.cnn.com\/2013\/12\/04\/health\/permanent-artificial-heart\/index.html\" target=\"_blank\">\"Living without a pulse: Engineering a better artificial heart\"<\/a>. <i>CNN<\/i>. 4 Dec 2013. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140409134224\/http:\/\/edition.cnn.com\/2013\/12\/04\/health\/permanent-artificial-heart\/index.html\" target=\"_blank\">Archived<\/a> from the original on 2014-04-09.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=CNN&rft.atitle=Living+without+a+pulse%3A+Engineering+a+better+artificial+heart&rft.date=2013-12-04&rft_id=http%3A%2F%2Fedition.cnn.com%2F2013%2F12%2F04%2Fhealth%2Fpermanent-artificial-heart%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.couriermail.com.au\/news\/queensland\/bivacor-beatless-artificial-heart-appeal-hopes-to-raise-5-million\/story-fnn8dlfs-1227252581778\" target=\"_blank\">\"BiVACOR beatless artificial heart appeal hopes to raise $5 million\"<\/a>. <i>Courier Mail<\/i>. 7 March 2015.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Courier+Mail&rft.atitle=BiVACOR+beatless+artificial+heart+appeal+hopes+to+raise+%245+million&rft.date=2015-03-07&rft_id=http%3A%2F%2Fwww.couriermail.com.au%2Fnews%2Fqueensland%2Fbivacor-beatless-artificial-heart-appeal-hopes-to-raise-5-million%2Fstory-fnn8dlfs-1227252581778&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.abc.net.au\/news\/2015-03-07\/bionic-heart-breakthrough-scientists-transplant-device-in-sheep\/6288126\" target=\"_blank\">\"Bionic heart breakthrough: Scientists transplant device into sheep, hope for clinical trials\"<\/a>. <i>ABC News<\/i>. Australian Broadcasting Corporation. 7 March 2015. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150309122537\/http:\/\/www.abc.net.au\/news\/2015-03-07\/bionic-heart-breakthrough-scientists-transplant-device-in-sheep\/6288126\" target=\"_blank\">Archived<\/a> from the original on 9 March 2015.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ABC+News&rft.atitle=Bionic+heart+breakthrough%3A+Scientists+transplant+device+into+sheep%2C+hope+for+clinical+trials&rft.date=2015-03-07&rft_id=http%3A%2F%2Fwww.abc.net.au%2Fnews%2F2015-03-07%2Fbionic-heart-breakthrough-scientists-transplant-device-in-sheep%2F6288126&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-54\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150405191846\/http:\/\/tv.bamargera.com\/walking-dead-the-first-human-able-to-survive-without-a-heart-or-a-pulse\/\" target=\"_blank\">\"Walking Dead \u2013 The First Human Able to Survive Without a Heart OR a Pulse\"<\/a>. <i>Bam Marguera<\/i>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/tv.bamargera.com\/walking-dead-the-first-human-able-to-survive-without-a-heart-or-a-pulse\/\" target=\"_blank\">the original<\/a> on 5 April 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 April<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Bam+Marguera&rft.atitle=Walking+Dead+%E2%80%93+The+First+Human+Able+to+Survive+Without+a+Heart+OR+a+Pulse&rft_id=http%3A%2F%2Ftv.bamargera.com%2Fwalking-dead-the-first-human-able-to-survive-without-a-heart-or-a-pulse%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cohrs Nicholas H. \"A Soft Total Artificial Heart-First Concept Evaluation on a Hybrid Mock Circulation\". <i>Artificial Organs<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Faor.12956\" target=\"_blank\">10.1111\/aor.12956<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Artificial+Organs&rft.atitle=A+Soft+Total+Artificial+Heart-First+Concept+Evaluation+on+a+Hybrid+Mock+Circulation&rft_id=info%3Adoi%2F10.1111%2Faor.12956&rft.au=Cohrs+Nicholas+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-56\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-56\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fml.ethz.ch\/news-and-events\/fml-news\/2017\/07\/news-article-featuring-nicholas-cohrs-and-his-soft-artificial-heart.html\" target=\"_blank\">\"Our work on soft artificial hearts highlighted in the media\"<\/a>. <i>www.fml.ethz.ch<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170805140320\/http:\/\/www.fml.ethz.ch\/news-and-events\/fml-news\/2017\/07\/news-article-featuring-nicholas-cohrs-and-his-soft-artificial-heart.html\" target=\"_blank\">Archived<\/a> from the original on 2017-08-05.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fml.ethz.ch&rft.atitle=Our+work+on+soft+artificial+hearts+highlighted+in+the+media&rft_id=http%3A%2F%2Fwww.fml.ethz.ch%2Fnews-and-events%2Ffml-news%2F2017%2F07%2Fnews-article-featuring-nicholas-cohrs-and-his-soft-artificial-heart.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-57\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ethz.ch\/en\/news-and-events\/eth-news\/news\/2017\/07\/artificial_heart.html\" target=\"_blank\">\"Testing a soft artificial heart\"<\/a>. <i>www.ethz.ch<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170721021751\/https:\/\/www.ethz.ch\/en\/news-and-events\/eth-news\/news\/2017\/07\/artificial_heart.html\" target=\"_blank\">Archived<\/a> from the original on 2017-07-21.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.ethz.ch&rft.atitle=Testing+a+soft+artificial+heart&rft_id=https%3A%2F%2Fwww.ethz.ch%2Fen%2Fnews-and-events%2Feth-news%2Fnews%2F2017%2F07%2Fartificial_heart.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-58\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-58\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">ETH Z\u00fcrich (12 July 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=YUYNXeHfTdQ\" target=\"_blank\">\"Testing a soft artificial heart\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170721050830\/https:\/\/www.youtube.com\/watch?v=YUYNXeHfTdQ\" target=\"_blank\">Archived<\/a> from the original on 21 July 2017 – via YouTube.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Testing+a+soft+artificial+heart&rft.date=2017-07-12&rft.au=ETH+Z%C3%BCrich&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DYUYNXeHfTdQ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-59\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-59\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Black, Rosemary (January 5, 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.nydailynews.com\/2011-01-05\/entertainment\/27086458_1_mechanical-heart-artificial-heart-surgical-director\" target=\"_blank\">\"Former vice president Dick Cheney now has no pulse\"<\/a>. <i>Daily News<\/i>. New York. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120418233927\/http:\/\/articles.nydailynews.com\/2011-01-05\/entertainment\/27086458_1_mechanical-heart-artificial-heart-surgical-director\" target=\"_blank\">Archived<\/a> from the original on April 18, 2012.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Daily+News&rft.atitle=Former+vice+president+Dick+Cheney+now+has+no+pulse&rft.date=2011-01-05&rft.aulast=Black&rft.aufirst=Rosemary&rft_id=http%3A%2F%2Farticles.nydailynews.com%2F2011-01-05%2Fentertainment%2F27086458_1_mechanical-heart-artificial-heart-surgical-director&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-60\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.scribd.com\/doc\/21241693\/Pulseless-Pumps-Artificial-Hearts\" target=\"_blank\">\"Pulseless Pumps & Artificial Hearts\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160307033951\/https:\/\/www.scribd.com\/doc\/21241693\/Pulseless-Pumps-Artificial-Hearts\" target=\"_blank\">Archived<\/a> from the original on 2016-03-07.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pulseless+Pumps+%26+Artificial+Hearts&rft_id=https%3A%2F%2Fwww.scribd.com%2Fdoc%2F21241693%2FPulseless-Pumps-Artificial-Hearts&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">European-Hospital. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.european-hospital.com\/en\/article\/709.html\" target=\"_blank\">\"The pulseless life on healthcare in europe\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20111005174951\/http:\/\/www.european-hospital.com\/en\/article\/709.html\" target=\"_blank\">Archived<\/a> from the original on 2011-10-05.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+pulseless+life+on+healthcare+in+europe&rft.au=European-Hospital&rft_id=http%3A%2F%2Fwww.european-hospital.com%2Fen%2Farticle%2F709.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dan Baum: <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.popsci.com\/science\/article\/2012-02\/no-pulse-how-doctors-reinvented-human-heart\" target=\"_blank\"><i>No Pulse: How Doctors Reinvented The Human Heart<\/i><\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20121104224503\/http:\/\/www.popsci.com\/science\/article\/2012-02\/no-pulse-how-doctors-reinvented-human-heart\" target=\"_blank\">Archived<\/a> 2012-11-04 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. 2012-02-29.<\/span>\n<\/li>\n<li id=\"cite_note-63\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-63\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Imachi K, Chinzei T, Abe Y, Mabuchi K, Imanishi K, Yonezawa T, Kouno A, Ono T, Atsumi K, Isoyama T. \"A new pulsatile total artificial heart using a single centrifugal pump\". <i>ASAIO Trans<\/i>. <b>37<\/b>: M242\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1751129\" target=\"_blank\">1751129<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ASAIO+Trans&rft.atitle=A+new+pulsatile+total+artificial+heart+using+a+single+centrifugal+pump&rft.volume=37&rft.pages=M242-3&rft_id=info%3Apmid%2F1751129&rft.aulast=Imachi&rft.aufirst=K&rft.au=Chinzei%2C+T&rft.au=Abe%2C+Y&rft.au=Mabuchi%2C+K&rft.au=Imanishi%2C+K&rft.au=Yonezawa%2C+T&rft.au=Kouno%2C+A&rft.au=Ono%2C+T&rft.au=Atsumi%2C+K&rft.au=Isoyama%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-64\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.popsci.com\/this-artificial-heart-is-made-foam\" target=\"_blank\">\"New Artificial Heart is Made of Foam\"<\/a>. <i>Popular Science<\/i>. 1 October 2015. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151205004101\/http:\/\/www.popsci.com\/this-artificial-heart-is-made-foam\" target=\"_blank\">Archived<\/a> from the original on 5 December 2015.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Popular+Science&rft.atitle=New+Artificial+Heart+is+Made+of+Foam&rft.date=2015-10-01&rft_id=http%3A%2F%2Fwww.popsci.com%2Fthis-artificial-heart-is-made-foam&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-65\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-65\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Prolonged Assisted circulation after cardiac or aortic surgery. Prolonged partial left ventricular bypass by means of intracorporeal circulation. This paper was finalist in The Young Investigators Award Contest of the American College of Cardiology. Denver, May 1962 Am. J. Cardiol. 1963, 12:399\u2013404<\/span>\n<\/li>\n<li id=\"cite_note-Mitka-66\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Mitka_66-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Mitka_66-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mitka Mike (2001). \"Midwest Trials of Heart-Assist Device\". <i>Journal of the American Medical Association<\/i>. <b>286<\/b> (21): 2661. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.286.21.2661\" target=\"_blank\">10.1001\/jama.286.21.2661<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Medical+Association&rft.atitle=Midwest+Trials+of+Heart-Assist+Device&rft.volume=286&rft.issue=21&rft.pages=2661&rft.date=2001&rft_id=info%3Adoi%2F10.1001%2Fjama.286.21.2661&rft.au=Mitka+Mike&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-67\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/NEW00656.html\" target=\"_blank\">FDA APPROVES TWO PORTABLE HEART-ASSIST DEVICES<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070614125759\/http:\/\/www.fda.gov\/bbs\/topics\/NEWS\/NEW00656.html\" target=\"_blank\">Archived<\/a> 2007-06-14 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. at FDA.gov<\/span>\n<\/li>\n<li id=\"cite_note-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-68\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.technologyreview.com\/read_article.aspx?id=17523&ch=biotech\" target=\"_blank\">An Artificial Heart That Doesn't Beat<\/a> at TechnologyReview.com<\/span>\n<\/li>\n<li id=\"cite_note-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-69\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071016205936\/http:\/\/capitalhealth.ca\/NewsAndEvents\/NewsReleases\/2007\/Berlin_Heart.htm\" target=\"_blank\">\"Berlin Heart\"<\/a>. Archived from the original on 2007-10-16<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-08-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Berlin+Heart&rft_id=http%3A%2F%2Fcapitalhealth.ca%2FNewsAndEvents%2FNewsReleases%2F2007%2FBerlin_Heart.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: BOT: original-url status unknown (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_BOT:_original-url_status_unknown\" title=\"Category:CS1 maint: BOT: original-url status unknown\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> (August 28, 2007), Capital Health, Edmonton (archived from <cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070927023043\/http:\/\/www.capitalhealth.ca\/NewsAndEvents\/NewsReleases\/2007\/Berlin_Heart.htm\" target=\"_blank\">\"Berlin Heart\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.capitalhealth.ca\/NewsAndEvents\/NewsReleases\/2007\/Berlin_Heart.htm\" target=\"_blank\">the original<\/a> on 2007-09-27<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-08-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Berlin+Heart&rft_id=http%3A%2F%2Fwww.capitalhealth.ca%2FNewsAndEvents%2FNewsReleases%2F2007%2FBerlin_Heart.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> the original) on 2007-10-01.<\/span>\n<\/li>\n<li id=\"cite_note-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-70\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/vectorblog.org\/2011\/12\/newly-approved-berlin-heart-prolongs-the-divide-between-life-and-death\/Newly\" target=\"_blank\">\"Newly approved Berlin Heart helps patients waiting for a transplant \u2013 Vector\"<\/a>. 30 December 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Newly+approved+Berlin+Heart+helps+patients+waiting+for+a+transplant+%E2%80%93+Vector&rft.date=2011-12-30&rft_id=http%3A%2F%2Fvectorblog.org%2F2011%2F12%2Fnewly-approved-berlin-heart-prolongs-the-divide-between-life-and-death%2FNewly&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-71\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-71\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fraser, Charles D.; Jaquiss, Robert D.B.; Rosenthal, David N.; Humpl, Tilman; Canter, Charles E.; Blackstone, Eugene H.; Naftel, David C.; Ichord, Rebecca N.; Bomgaars, Lisa; Tweddell, James S.; Massicotte, M. Patricia; Turrentine, Mark W.; Cohen, Gordon A.; Devaney, Eric J.; Pearce, F. Bennett; Carberry, Kathleen E.; Kroslowitz, Robert; Almond, Christopher S. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa1014164\" target=\"_blank\">\"Prospective Trial of a Pediatric Ventricular Assist Device\"<\/a>. <i>New England Journal of Medicine<\/i>. <b>367<\/b> (6): 532\u2013541. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2Fnejmoa1014164\" target=\"_blank\">10.1056\/nejmoa1014164<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130622224908\/http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa1014164\" target=\"_blank\">Archived<\/a> from the original on 2013-06-22.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Prospective+Trial+of+a+Pediatric+Ventricular+Assist+Device&rft.volume=367&rft.issue=6&rft.pages=532-541&rft_id=info%3Adoi%2F10.1056%2Fnejmoa1014164&rft.aulast=Fraser&rft.aufirst=Charles+D.&rft.au=Jaquiss%2C+Robert+D.B.&rft.au=Rosenthal%2C+David+N.&rft.au=Humpl%2C+Tilman&rft.au=Canter%2C+Charles+E.&rft.au=Blackstone%2C+Eugene+H.&rft.au=Naftel%2C+David+C.&rft.au=Ichord%2C+Rebecca+N.&rft.au=Bomgaars%2C+Lisa&rft.au=Tweddell%2C+James+S.&rft.au=Massicotte%2C+M.+Patricia&rft.au=Turrentine%2C+Mark+W.&rft.au=Cohen%2C+Gordon+A.&rft.au=Devaney%2C+Eric+J.&rft.au=Pearce%2C+F.+Bennett&rft.au=Carberry%2C+Kathleen+E.&rft.au=Kroslowitz%2C+Robert&rft.au=Almond%2C+Christopher+S.&rft_id=http%3A%2F%2Fwww.nejm.org%2Fdoi%2Fpdf%2F10.1056%2FNEJMoa1014164&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-72\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-72\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.texaschildrens.org\/About-Us\/News\/Berlin-Heart-NEJM-2012\/\" target=\"_blank\">\"News \u2013 Texas Children's Hospital\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130425075002\/http:\/\/www.texaschildrens.org\/About-Us\/News\/Berlin-Heart-NEJM-2012\/\" target=\"_blank\">Archived<\/a> from the original on 2013-04-25.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=News+%E2%80%93+Texas+Children%27s+Hospital&rft_id=http%3A%2F%2Fwww.texaschildrens.org%2FAbout-Us%2FNews%2FBerlin-Heart-NEJM-2012%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AArtificial+heart\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=PLPjEbT32U8\" target=\"_blank\"><span class=\"plainlinks\">Artificial heart.<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/texasheart.org\/Research\/Devices\/\" target=\"_blank\">Artificial hearts and heart assist devices<\/a> currently in use<\/li>\n<li>Kembrey, Melanie (August 17, 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110706104122\/http:\/\/www.fairfieldchampion.com.au\/news\/local\/news\/general\/artificial-heart-a-medical-marvel\/1915535.aspx?src=rss\" target=\"_blank\">\"Artificial heart a medical marvel\"<\/a>. <i>Fairfield City Champion<\/i>. Archived July 6, 2011.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.physics.org\/article-questions.asp?id=74\" target=\"_blank\">How a total artificial heart works<\/a> physics.org<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.retroreport.org\/video\/a-change-of-heart\/\" target=\"_blank\">A Change of Heart<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retro_Report\" title=\"Retro Report\" rel=\"external_link\" target=\"_blank\">Retro Report<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.syncardia.com\" target=\"_blank\">World's Only Approved Total Artificial Heart<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181129125736\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.648 seconds\nReal time usage: 0.772 seconds\nPreprocessor visited node count: 3235\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 116522\/2097152 bytes\nTemplate argument size: 714\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 181324\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.358\/10.000 seconds\nLua memory usage: 8.63 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 645.064 1 -total\n<\/p>\n<pre>63.88% 412.073 1 Template:Reflist\n27.84% 179.595 36 Template:Cite_web\n14.87% 95.905 14 Template:Cite_journal\n 8.72% 56.219 1 Template:About\n 7.49% 48.311 12 Template:Cite_news\n 6.98% 45.014 1 Template:Refimprove\n 5.25% 33.869 1 Template:Ambox\n 4.96% 31.996 1 Template:Cn\n 4.59% 29.636 1 Template:Convert\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:256461-1!canonical and timestamp 20181129125735 and revision id 870487174\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214638\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.031 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 165.037 1 - wikipedia:Artificial_heart\n100.00% 165.037 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7980-0!*!*!*!*!*!* and timestamp 20181217214638 and revision id 24092\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Artificial_heart\">https:\/\/www.limswiki.org\/index.php\/Artificial_heart<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","71da9a445fe27824deb1b95cf92c4832_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/The_SynCardia_temporary_Total_Artificial_Heart_with_pink_heart_background.jpg\/440px-The_SynCardia_temporary_Total_Artificial_Heart_with_pink_heart_background.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Artificial-heart-london.JPG\/400px-Artificial-heart-london.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/1966_DeBakey_ventricular_assist_device.jpg\/240px-1966_DeBakey_ventricular_assist_device.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/39\/Soft_Total_Artificial_Heart_sTAH.jpg\/400px-Soft_Total_Artificial_Heart_sTAH.jpg"],"71da9a445fe27824deb1b95cf92c4832_timestamp":1545083198,"afe457601e8fb0cacd689590ddf21827_type":"article","afe457601e8fb0cacd689590ddf21827_title":"Pulse oximeter","afe457601e8fb0cacd689590ddf21827_url":"https:\/\/www.limswiki.org\/index.php\/Pulse_oximetry","afe457601e8fb0cacd689590ddf21827_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPulse oximetry\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tPulse oximetryMedical diagnosticsA wrist mounted remote sensor pulse oximeter with plethysmograph.Purposemonitoring a person's oxygen saturation\nPulse oximetry is a noninvasive method for monitoring a person's oxygen saturation (SO2). Though its reading of SpO2 (peripheral oxygen saturation) is not always identical to the more desirable reading of SaO2 (arterial oxygen saturation) from arterial blood gas analysis, the two are correlated well enough that the safe, convenient, noninvasive, inexpensive pulse oximetry method is valuable for measuring oxygen saturation in clinical use.\nIn its most common (transmissive) application mode, a sensor device is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot. The device passes two wavelengths of light through the body part to a photodetector. It measures the changing absorbance at each of the wavelengths, allowing it to determine the absorbances due to the pulsing arterial blood alone, excluding venous blood, skin, bone, muscle, fat, and (in most cases) nail polish.[1]\nLess commonly, reflectance pulse oximetry is used as an alternative to transmissive pulse oximetery described above. This method does not require a thin section of the person's body and is therefore well suited to a universal application such as the feet, forehead, and chest, but it also has some limitations. Vasodilation and pooling of venous blood in the head due to compromised venous return to the heart can cause a combination of arterial and venous pulsations in the forehead region and lead to spurious SpO2 results. Such conditions occur while undergoing anesthesia with endotracheal intubation and mechanical ventilation or in patients in the Trendelenburg position.[2]\n\nContents \n\n1 History \n2 Function \n3 Indication \n\n3.1 Advantages \n3.2 Limitations \n3.3 Increasing usage \n\n\n4 Pleth variability index \n5 See also \n6 References \n7 External links \n\n\nHistory \nIn 1935, Karl Matthes (German physician 1905\u20131962) developed the first 2-wavelength ear O2 saturation meter with red and green filters (later switched to red and infrared filters). His meter was the first device to measure O2 saturation.[3]\nThe original oximeter was made by Glenn Allan Millikan in the 1940s.[4] In 1949 Wood added a pressure capsule to squeeze blood out of the ear so as to obtain an absolute O2 saturation value when blood was readmitted. The concept is similar to today's conventional pulse oximetry, but was difficult to implement because of unstable photocells and light sources; the method is not now used clinically. In 1964 Shaw assembled the first absolute reading ear oximeter by using eight wavelengths of light.\nPulse oximetry was developed in 1972, by Takuo Aoyagi and Michio Kishi, bioengineers, at Nihon Kohden using the ratio of red to infrared light absorption of pulsating components at the measuring site. Susumu Nakajima, a surgeon, and his associates first tested the device in patients, reporting it in 1975.[5] It was commercialized by Biox in 1980.[6][5][7]\nBy 1987, the standard of care for the administration of a general anesthetic in the U.S. included pulse oximetry. From the operating room, the use of pulse oximetry rapidly spread throughout the hospital, first to the recovery room, and then into the various intensive care units. Pulse oximetry was of particular value in the neonatal unit where the patients do not thrive with inadequate oxygenation, but too much oxygen and fluctuations in oxygen concentration can lead to vision impairment or blindness from retinopathy of prematurity (ROP). Furthermore, obtaining an arterial blood gas from a neonatal patient is painful to the patient and a major cause of neonatal anemia.[8] Motion artifact can be a significant limitation to pulse oximetry monitoring resulting in frequent false alarms and loss of data. The reason for this is that during motion and low peripheral perfusion, many pulse oximeters cannot distinguish between pulsating arterial blood and moving venous blood, leading to underestimation of oxygen saturation. Early studies of pulse oximetry performance during subject motion made clear the vulnerabilities of conventional pulse oximetry technologies to motion artifact.[9][10]\nIn 1995, Masimo introduced Signal Extraction Technology (SET) that could measure accurately during patient motion and low perfusion by separating the arterial signal from the venous and other signals. Since then, pulse oximetry manufacturers have developed new algorithms to reduce some false alarms during motion[11] such as extending averaging times or freezing values on the screen, but they do not claim to measure changing conditions during motion and low perfusion. So, there are still important differences in performance of pulse oximeters during challenging conditions.[12]\nPublished papers have compared signal extraction technology to other pulse oximetry technologies and have demonstrated consistently favorable results for signal extraction technology.[9][12][13] Signal extraction technology pulse oximetry performance has also been shown to translate into helping clinicians improve patient outcomes. In one study, retinopathy of prematurity (eye damage) was reduced by 58% in very low birth weight neonates at a center using signal extraction technology, while there was no decrease in retinopathy of prematurity at another center with the same clinicians using the same protocol but with non-signal extraction technology.[14] Other studies have shown that signal extraction technology pulse oximetry results in fewer arterial blood gas measurements, faster oxygen weaning time, lower sensor utilization, and lower length of stay.[15] The measure-through motion and low perfusion capabilities it has also allow it to be used in previously unmonitored areas such as the general floor, where false alarms have plagued conventional pulse oximetry. As evidence of this, a landmark study was published in 2010 showing clinicians using signal extraction technology pulse oximetry on the general floor were able to decrease rapid response team activations, ICU transfers, and ICU days.[16]\nIn 2011, an expert workgroup recommended newborn screening with pulse oximetry to increase the detection of critical congenital heart disease (CCHD).[17] The CCHD workgroup cited the results of two large, prospective studies of 59,876 subjects that exclusively used signal extraction technology to increase the identification of CCHD with minimal false positives.[18][19] The CCHD workgroup recommended newborn screening be performed with motion tolerant pulse oximetry that has also been validated in low perfusion conditions. In 2011, the US Secretary of Health and Human Services added pulse oximetry to the recommended uniform screening panel.[20] Before the evidence for screening using signal extraction technology, less than 1% of newborns in the United States were screened. Today, The Newborn Foundation has documented near universal screening in the United States and international screening is rapidly expanding.[21] In 2014, a third large study of 122, 738 newborns that also exclusively used signal extraction technology showed similar, positive results as the first two large studies.[22]\nHigh-resolution pulse oximetry (HRPO) has been developed for in-home sleep apnea screening and testing in patients for whom it is impractical to perform polysomnography.[23][24] It stores and records both pulse rate and SpO2 in 1 second intervals and has been shown in one study to help to detect sleep disordered breathing in surgical patients.[25]\nIn 1995 Masimo introduced perfusion index, quantifying the amplitude of the peripheral plethysmograph waveform. Perfusion index has been shown to help clinicians predict illness severity and early adverse respiratory outcomes in neonates,[26][27][28] predict low superior vena cava flow in very low birth weight infants,[29] provide an early indicator of sympathectomy after epidural anesthesia,[30] and improve detection of critical congenital heart disease in newborns.[31]\nIn 2007, Masimo introduced the first measurement of the pleth variability index (PVI), which multiple clinical studies have shown provides a new method for automatic, noninvasive assessment of a patient's ability to respond to fluid administration.[32][33][34] Appropriate fluid levels are vital to reducing postoperative risks and improving patient outcomes: fluid volumes that are too low (under-hydration) or too high (over-hydration) have been shown to decrease wound healing and increase the risk of infection or cardiac complications.[35] Recently, the National Health Service in the United Kingdom and the French Anesthesia and Critical Care Society listed PVI monitoring as part of their suggested strategies for intra-operative fluid management.[36][37]\n\nFunction \n Absorption spectra of oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (Hb) for red and infrared wavelengths\nA blood-oxygen monitor displays the percentage of blood that is loaded with oxygen. More specifically, it measures what percentage of hemoglobin, the protein in blood that carries oxygen, is loaded. Acceptable normal ranges for patients without pulmonary pathology are from 95 to 99 percent. For a patient breathing room air at or near sea level, an estimate of arterial pO2 can be made from the blood-oxygen monitor \"saturation of peripheral oxygen\" (SpO2) reading.\nA typical pulse oximeter uses an electronic processor and a pair of small light-emitting diodes (LEDs) facing a photodiode through a translucent part of the patient's body, usually a fingertip or an earlobe. One LED is red, with wavelength of 660 nm, and the other is infrared with a wavelength of 940 nm. Absorption of light at these wavelengths differs significantly between blood loaded with oxygen and blood lacking oxygen. Oxygenated hemoglobin absorbs more infrared light and allows more red light to pass through. Deoxygenated hemoglobin allows more infrared light to pass through and absorbs more red light. The LEDs sequence through their cycle of one on, then the other, then both off about thirty times per second which allows the photodiode to respond to the red and infrared light separately and also adjust for the ambient light baseline.[38] The amount of light that is transmitted (in other words, that is not absorbed) is measured, and separate normalized signals are produced for each wavelength. These signals fluctuate in time because the amount of arterial blood that is present increases (literally pulses) with each heartbeat. By subtracting the minimum transmitted light from the peak transmitted light in each wavelength, the effects of other tissues are corrected for.[39] The ratio of the red light measurement to the infrared light measurement is then calculated by the processor (which represents the ratio of oxygenated hemoglobin to deoxygenated hemoglobin), and this ratio is then converted to SpO2 by the processor via a lookup table[39] based on the Beer\u2013Lambert law.[38]\n\nIndication \n A pulse oximeter probe applied to a person's finger\nA pulse oximeter is a medical device that indirectly monitors the oxygen saturation of a patient's blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmogram. The pulse oximeter may be incorporated into a multiparameter patient monitor. Most monitors also display the pulse rate. Portable, battery-operated pulse oximeters are also available for transport or home blood-oxygen monitoring.[citation needed ]\n\nAdvantages \nPulse oximetry is particularly convenient for noninvasive continuous measurement of blood oxygen saturation. In contrast, blood gas levels must otherwise be determined in a laboratory on a drawn blood sample. Pulse oximetry is useful in any setting where a patient's oxygenation is unstable, including intensive care, operating, recovery, emergency and hospital ward settings, pilots in unpressurized aircraft, for assessment of any patient's oxygenation, and determining the effectiveness of or need for supplemental oxygen. Although a pulse oximeter is used to monitor oxygenation, it cannot determine the metabolism of oxygen, or the amount of oxygen being used by a patient. For this purpose, it is necessary to also measure carbon dioxide (CO2) levels. It is possible that it can also be used to detect abnormalities in ventilation. However, the use of a pulse oximeter to detect hypoventilation is impaired with the use of supplemental oxygen, as it is only when patients breathe room air that abnormalities in respiratory function can be detected reliably with its use. Therefore, the routine administration of supplemental oxygen may be unwarranted if the patient is able to maintain adequate oxygenation in room air, since it can result in hypoventilation going undetected.[40]\nBecause of their simplicity of use and the ability to provide continuous and immediate oxygen saturation values, pulse oximeters are of critical importance in emergency medicine and are also very useful for patients with respiratory or cardiac problems, especially COPD, or for diagnosis of some sleep disorders such as apnea and hypopnea.[41] Portable battery-operated pulse oximeters are useful for pilots operating in a non-pressurized aircraft above 10,000 feet (3,000 m) or 12,500 feet (3,800 m) in the U.S.[42] where supplemental oxygen is required. Portable pulse oximeters are also useful for mountain climbers and athletes whose oxygen levels may decrease at high altitudes or with exercise. Some portable pulse oximeters employ software that charts a patient's blood oxygen and pulse, serving as a reminder to check blood oxygen levels.\n\nLimitations \nPulse oximetry solely measures hemoglobin saturation, not ventilation and is not a complete measure of respiratory sufficiency. It is not a substitute for blood gases checked in a laboratory, because it gives no indication of base deficit, carbon dioxide levels, blood pH, or bicarbonate (HCO3\u2212) concentration. The metabolism of oxygen can be readily measured by monitoring expired CO2, but saturation figures give no information about blood oxygen content. Most of the oxygen in the blood is carried by hemoglobin; in severe anemia, the blood will carry less total oxygen, despite the hemoglobin being 100% saturated.[citation needed ]\nErroneously low readings may be caused by hypoperfusion of the extremity being used for monitoring (often due to a limb being cold, or from vasoconstriction secondary to the use of vasopressor agents); incorrect sensor application; highly calloused skin; or movement (such as shivering), especially during hypoperfusion. To ensure accuracy, the sensor should return a steady pulse and\/or pulse waveform. Pulse oximetry technologies differ in their abilities to provide accurate data during conditions of motion and low perfusion.[12][9]\nPulse oximetry also is not a complete measure of circulatory sufficiency. If there is insufficient bloodflow or insufficient hemoglobin in the blood (anemia), tissues can suffer hypoxia despite high oxygen saturation in the blood that does arrive. In 2008, a pulse oximeter that can measure hemoglobin levels in addition to oxygen saturation was introduced by Masimo. To quantify hemoglobin, the device uses additional wavelengths of light beyond the two standard ones.[citation needed ]\nSince pulse oximetry measures only the percentage of bound hemoglobin, a falsely high or falsely low reading will occur when hemoglobin binds to something other than oxygen:\n\nHemoglobin has a higher affinity to carbon monoxide than it does to oxygen, and a high reading may occur despite the patient's actually being hypoxemic. In cases of carbon monoxide poisoning, this inaccuracy may delay the recognition of hypoxia (low cellular oxygen level).\nCyanide poisoning gives a high reading because it reduces oxygen extraction from arterial blood. In this case, the reading is not false, as arterial blood oxygen is indeed high in early cyanide poisoning.\nMethemoglobinemia characteristically causes pulse oximetry readings in the mid-80s.\nCOPD [especially chronic bronchitis] may cause false readings.[43]\nA noninvasive method that allows continuous measurement of the dyshemoglobins is the pulse CO-oximeter, which was built in 2005 by Masimo using UK Patent GB 2320566 (1996) . It provides clinicians a way to measure the dyshemoglobins, carboxyhemoglobin, and methemoglobin along with total hemoglobin.\n\nIncreasing usage \nAccording to a report by iData Research the U.S. pulse oximetry monitoring market for equipment and sensors was over 700 million USD in 2011.[44]\nIn 2008, more than half of the major internationally exporting medical equipment manufacturers in China were producers of pulse oximeters.[45]\nThe Apple Watch uses this technology for its heart rate monitor.[46][47] The accuracy of the heart rate monitor has been debated, as different tests have shown it to be 91% as accurate as chest strap monitors.[48][49]\n\nPleth variability index \nPleth variability index (PVI) is a measure of the variability of the plethysmographic waveform amplitude.[33]\n\nSee also \n\nArterial blood gas\nCapnography\nIntegrated Pulmonary Index\nRespiratory monitoring\nMedical equipment\nMechanical ventilation\nOxygen sensor\nOxygen saturation\nPhotoplethysmogram, measuring of carbon dioxide (CO2) in the respiratory gases\nSleep apnea\n\nReferences \n\n\n^ Brand TM, Brand ME, Jay GD (February 2002). \"Enamel nail polish does not interfere with pulse oximetry among normoxic volunteers\". Journal of Clinical Monitoring and Computing. 17 (2): 93\u20136. doi:10.1023\/A:1016385222568. PMID 12212998. \n\n^ J\u00f8rgensen JS, Schmid ER, K\u00f6nig V, Faisst K, Huch A, Huch R (July 1995). \"Limitations of forehead pulse oximetry\". Journal of Clinical Monitoring. 11 (4): 253\u20136. doi:10.1007\/bf01617520. PMID 7561999. \n\n^ Matthes K (1935). \"Untersuchungen \u00fcber die Sauerstoffs\u00e4ttigung des menschlichen Arterienblutes\" [Studies on the Oxygen Saturation of Arterial Human Blood]. Naunyn-Schmiedeberg's Archives of Pharmacology (in German). 179 (6): 698\u2013711. doi:10.1007\/BF01862691. \n\n^ Millikan GA (1942). \"The oximeter: an instrument for measuring continuously oxygen saturation of arterial blood in man\". Review of Scientific Instruments. 13 (10): 434\u2013444. Bibcode:1942RScI...13..434M. doi:10.1063\/1.1769941. \n\n^ a b Severinghaus JW, Honda Y (April 1987). \"History of blood gas analysis. VII. Pulse oximetry\". Journal of Clinical Monitoring. 3 (2): 135\u20138. doi:10.1007\/bf00858362. PMID 3295125. \n\n^ \"510(k): Premarket Notification\". United States Food and Drug Administration. Retrieved 2017-02-23 . \n\n^ \"Fact vs. Fiction\". Masimo Corporation. Archived from the original on 13 April 2009. \n\n^ Lin JC, Strauss RG, Kulhavy JC, Johnson KJ, Zimmerman MB, Cress GA, Connolly NW, Widness JA (August 2000). \"Phlebotomy overdraw in the neonatal intensive care nursery\". Pediatrics. 106 (2): E19. doi:10.1542\/peds.106.2.e19. PMID 10920175. \n\n^ a b c Barker SJ (October 2002). \"\" Motion-resistant\" pulse oximetry: a comparison of new and old models\". Anesthesia and Analgesia. 95 (4): 967\u201372. doi:10.1213\/00000539-200210000-00033. PMID 12351278. \n\n^ Barker SJ, Shah NK (October 1996). \"Effects of motion on the performance of pulse oximeters in volunteers\". Anesthesiology. 85 (4): 774\u201381. doi:10.1097\/00000542-199701000-00014. PMID 8873547. \n\n^ Jopling MW, Mannheimer PD, Bebout DE (January 2002). \"Issues in the laboratory evaluation of pulse oximeter performance\". Anesthesia and Analgesia. 94 (1 Suppl): S62\u20138. PMID 11900041. \n\n^ a b c Shah N, Ragaswamy HB, Govindugari K, Estanol L (August 2012). \"Performance of three new-generation pulse oximeters during motion and low perfusion in volunteers\". Journal of Clinical Anesthesia. 24 (5): 385\u201391. doi:10.1016\/j.jclinane.2011.10.012. PMID 22626683. \n\n^ Hay WW, Rodden DJ, Collins SM, Melara DL, Hale KA, Fashaw LM (2002). \"Reliability of conventional and new pulse oximetry in neonatal patients\". Journal of Perinatology. 22 (5): 360\u20136. doi:10.1038\/sj.jp.7210740. PMID 12082469. \n\n^ Castillo A, Deulofeut R, Critz A, Sola A (February 2011). \"Prevention of retinopathy of prematurity in preterm infants through changes in clinical practice and SpO\u2082technology\". Acta Paediatrica. 100 (2): 188\u201392. doi:10.1111\/j.1651-2227.2010.02001.x. PMC 3040295 . PMID 20825604. \n\n^ Durbin CG, Rostow SK (August 2002). \"More reliable oximetry reduces the frequency of arterial blood gas analyses and hastens oxygen weaning after cardiac surgery: a prospective, randomized trial of the clinical impact of a new technology\". Critical Care Medicine. 30 (8): 1735\u201340. doi:10.1097\/00003246-200208000-00010. PMID 12163785. \n\n^ Taenzer AH, Pyke JB, McGrath SP, Blike GT (February 2010). \"Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study\". Anesthesiology. 112 (2): 282\u20137. doi:10.1097\/aln.0b013e3181ca7a9b. PMID 20098128. \n\n^ Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, Kelm K, Pearson GD, Glidewell J, Grosse SD, Howell RR (November 2011). \"Strategies for implementing screening for critical congenital heart disease\". Pediatrics. 128 (5): e1259\u201367. doi:10.1542\/peds.2011-1317. PMID 21987707. \n\n^ de-Wahl Granelli A, Wennergren M, Sandberg K, Mellander M, Bejlum C, Ingan\u00e4s L, Eriksson M, Segerdahl N, Agren A, Ekman-Joelsson BM, Sunneg\u00e5rdh J, Verdicchio M, Ostman-Smith I (January 2009). \"Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns\". BMJ. 338: a3037. doi:10.1136\/bmj.a3037. PMC 2627280 . PMID 19131383. \n\n^ Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, Deeks JJ, Khan KS (August 2011). \"Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study\". Lancet. 378 (9793): 785\u201394. doi:10.1016\/S0140-6736(11)60753-8. PMC 3860684 . PMID 21820732. \n\n^ Mahle WT, Martin GR, Beekman RH, Morrow WR (January 2012). \"Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease\". Pediatrics. 129 (1): 190\u20132. doi:10.1542\/peds.2011-3211. PMID 22201143. \n\n^ \"Newborn CCHD Screening Progress Map\". Cchdscreeningmap.org. 7 July 2014. Retrieved 2015-04-02 . \n\n^ Zhao QM, Ma XJ, Ge XL, Liu F, Yan WL, Wu L, Ye M, Liang XC, Zhang J, Gao Y, Jia B, Huang GY (August 2014). \"Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study\". Lancet. 384 (9945): 747\u201354. doi:10.1016\/S0140-6736(14)60198-7. PMID 24768155. \n\n^ Valenza T (April 2008). \"Keeping a Pulse on Oximetry\". Archived from the original on February 10, 2012. \n\n^ \"PULSOX -300i\" (PDF) . Maxtec Inc. Archived from the original (PDF) on January 7, 2009. \n\n^ Chung F, Liao P, Elsaid H, Islam S, Shapiro CM, Sun Y (May 2012). \"Oxygen desaturation index from nocturnal oximetry: a sensitive and specific tool to detect sleep-disordered breathing in surgical patients\". Anesthesia and Analgesia. 114 (5): 993\u20131000. doi:10.1213\/ane.0b013e318248f4f5. PMID 22366847. \n\n^ De Felice C, Leoni L, Tommasini E, Tonni G, Toti P, Del Vecchio A, Ladisa G, Latini G (March 2008). \"Maternal pulse oximetry perfusion index as a predictor of early adverse respiratory neonatal outcome after elective cesarean delivery\". Pediatric Critical Care Medicine. 9 (2): 203\u20138. doi:10.1097\/pcc.0b013e3181670021. PMID 18477934. \n\n^ De Felice C, Latini G, Vacca P, Kopotic RJ (October 2002). \"The pulse oximeter perfusion index as a predictor for high illness severity in neonates\". European Journal of Pediatrics. 161 (10): 561\u20132. doi:10.1007\/s00431-002-1042-5. PMID 12297906. \n\n^ De Felice C, Goldstein MR, Parrini S, Verrotti A, Criscuolo M, Latini G (March 2006). \"Early dynamic changes in pulse oximetry signals in preterm newborns with histologic chorioamnionitis\". Pediatric Critical Care Medicine. 7 (2): 138\u201342. doi:10.1097\/01.PCC.0000201002.50708.62. PMID 16474255. \n\n^ Takahashi S, Kakiuchi S, Nanba Y, Tsukamoto K, Nakamura T, Ito Y (April 2010). \"The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants\". Journal of Perinatology. 30 (4): 265\u20139. doi:10.1038\/jp.2009.159. PMC 2834357 . PMID 19907430. \n\n^ Ginosar Y, Weiniger CF, Meroz Y, Kurz V, Bdolah-Abram T, Babchenko A, Nitzan M, Davidson EM (September 2009). \"Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia\". Acta Anaesthesiologica Scandinavica. 53 (8): 1018\u201326. doi:10.1111\/j.1399-6576.2009.01968.x. PMID 19397502. \n\n^ Granelli A, Ostman-Smith I (October 2007). \"Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction\". Acta Paediatrica. 96 (10): 1455\u20139. doi:10.1111\/j.1651-2227.2007.00439.x. PMID 17727691. \n\n^ Zimmermann M, Feibicke T, Keyl C, Prasser C, Moritz S, Graf BM, Wiesenack C (June 2010). \"Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery\". European Journal of Anaesthesiology. 27 (6): 555\u201361. doi:10.1097\/EJA.0b013e328335fbd1. PMID 20035228. \n\n^ a b Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, Lehot JJ (August 2008). \"Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre\". British Journal of Anaesthesia. 101 (2): 200\u20136. doi:10.1093\/bja\/aen133. PMID 18522935. \n\n^ Forget P, Lois F, de Kock M (October 2010). \"Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management\". Anesthesia and Analgesia. 111 (4): 910\u20134. doi:10.1213\/ANE.0b013e3181eb624f. PMID 20705785. \n\n^ Ishii M, Ohno K (March 1977). \"Comparisons of body fluid volumes, plasma renin activity, hemodynamics and pressor responsiveness between juvenile and aged patients with essential hypertension\". Japanese Circulation Journal. 41 (3): 237\u201346. doi:10.1253\/jcj.41.237. PMID 870721. \n\n^ \"NHS Technology Adoption Centre\". Ntac.nhs.uk. Retrieved 2015-04-02 . \n\n^ Vallet B, Blanloeil Y, Cholley B, Orliaguet G, Pierre S, Tavernier B (October 2013). \"Guidelines for perioperative haemodynamic optimization\". Annales Francaises D'anesthesie Et De Reanimation. 32 (10): e151\u20138. doi:10.1016\/j.annfar.2013.09.010. PMID 24126197. \n\n^ a b \"Principles of pulse oximetry\". Anaesthesia UK. 11 Sep 2004. Archived from the original on 2015-02-24. Retrieved 2015-02-24 . \n\n^ a b \"Pulse Oximetry\". Oximetry.org. 2002-09-10. Archived from the original on 2015-03-18. Retrieved 2015-04-02 . \n\n^ Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA (November 2004). \"Supplemental oxygen impairs detection of hypoventilation by pulse oximetry\". Chest. 126 (5): 1552\u20138. doi:10.1378\/chest.126.5.1552. PMID 15539726. \n\n^ Schlosshan D, Elliott MW (April 2004). \"Sleep . 3: Clinical presentation and diagnosis of the obstructive sleep apnoea hypopnoea syndrome\". Thorax. 59 (4): 347\u201352. doi:10.1136\/thx.2003.007179. PMC 1763828 . PMID 15047962. \n\n^ \"FAR Part 91 Sec. 91.211 effective as of 09\/30\/1963\". Airweb.faa.gov. Retrieved 2015-04-02 . \n\n^ Amalakanti S, Pentakota MR (April 2016). \"Pulse Oximetry Overestimates Oxygen Saturation in COPD\". Respiratory Care. 61 (4): 423\u20137. doi:10.4187\/respcare.04435. PMID 26715772. \n\n^ U.S. Market for Patient Monitoring Equipment. iData Research. May 2012 \n\n^ \"Key Portable Medical Device Vendors Worldwide\". China Portable Medical Devices Report. ResearchInChina. December 2008. \n\n^ Lovejoy B (24 April 2015). \"Apple Watch teardown reveals pulse oximeter, suggesting future measurement of blood oxygen\". 9 to 5 Mac. \n\n^ \"Your heart rate. What it means, and where on Apple Watch you'll find it\". Apple. \n\n^ Ross E (15 October 2016). \"You Can Monitor Heart Rhythm With A Smartphone, But Should You?\". National Public Radio. \n\n^ Peloquin A. \"Chest Strap Vs Wristband Heart Rate Monitors\". Breaking Muscle. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Pulse oximeters.\nPrinciples of pulse oximetry explained using diagrams\nvteTests, surgery and other procedures involving the respiratory system (ICD-9-CM V3 21\u201322, 30\u201334, ICD-10-PCS 0B)Upper RT\nnose\n\nRhinoplasty\nSeptoplasty\nSomnoplasty\nAlarplasty\nRhinectomy\nRhinomanometry\nAcoustic rhinometry\nsinus\n\nSinusotomy\nlarynx\n\nLaryngoscopy\nLaryngectomy\nLaryngotomy\nThyrotomy<\/dd>\nLaryngotracheal reconstruction\nLower RT\ntrachea\n\nCricothyrotomy\nTracheoesophageal puncture\nTracheotomy\nbronchus\n\nBronchoscopy\nlung\n\nPneumonectomy\nLobectomy\nWedge resection\nLung transplantation\nDecortication of lung\nHeart\u2013lung transplant\nChest wall, pleura,\r\nmediastinum,\r\nand diaphragm\npleura\/pleural cavity\n\nThoracentesis\nPleurodesis\nThoracoscopy\nThoracotomy\nChest tube\nmediastinum\n\nMediastinoscopy\nNuss procedure\nMedical imaging\nBronchography\nCT pulmonary 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","afe457601e8fb0cacd689590ddf21827_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Pulse_oximetry skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Pulse oximetry<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Pulse oximetry<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Invasiveness_of_surgical_procedures\" class=\"mw-redirect\" title=\"Invasiveness of surgical procedures\" rel=\"external_link\" target=\"_blank\">noninvasive<\/a> method for monitoring a person's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_saturation_(medicine)\" title=\"Oxygen saturation (medicine)\" rel=\"external_link\" target=\"_blank\">oxygen saturation<\/a> (S<small>O<\/small><sub>2<\/sub>). Though its reading of Sp<small>O<\/small><sub>2<\/sub> (peripheral oxygen saturation) is not always identical to the more desirable reading of Sa<small>O<\/small><sub>2<\/sub> (arterial oxygen saturation) from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_blood_gas\" class=\"mw-redirect\" title=\"Arterial blood gas\" rel=\"external_link\" target=\"_blank\">arterial blood gas<\/a> analysis, the two are correlated well enough that the safe, convenient, noninvasive, inexpensive pulse oximetry method is valuable for measuring oxygen saturation in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine#Clinical_practice\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">clinical<\/a> use.\n<\/p><p>In its most common (transmissive) application mode, a sensor device is placed on a thin part of the patient's body, usually a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fingertip\" class=\"mw-redirect\" title=\"Fingertip\" rel=\"external_link\" target=\"_blank\">fingertip<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Earlobe\" title=\"Earlobe\" rel=\"external_link\" target=\"_blank\">earlobe<\/a>, or in the case of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infant\" title=\"Infant\" rel=\"external_link\" target=\"_blank\">infant<\/a>, across a foot. The device passes two wavelengths of light through the body part to a photodetector. It measures the changing absorbance at each of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wavelength\" title=\"Wavelength\" rel=\"external_link\" target=\"_blank\">wavelengths<\/a>, allowing it to determine the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Absorption_spectroscopy\" title=\"Absorption spectroscopy\" rel=\"external_link\" target=\"_blank\">absorbances<\/a> due to the pulsing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_blood\" title=\"Arterial blood\" rel=\"external_link\" target=\"_blank\">arterial blood<\/a> alone, excluding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Venous_blood\" title=\"Venous blood\" rel=\"external_link\" target=\"_blank\">venous blood<\/a>, skin, bone, muscle, fat, and (in most cases) nail polish.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Less commonly, reflectance pulse oximetry is used as an alternative to transmissive pulse oximetery described above. This method does not require a thin section of the person's body and is therefore well suited to a universal application such as the feet, forehead, and chest, but it also has some limitations. Vasodilation and pooling of venous blood in the head due to compromised venous return to the heart can cause a combination of arterial and venous pulsations in the forehead region and lead to spurious Sp<small>O<\/small><sub>2<\/sub> results. Such conditions occur while undergoing anesthesia with endotracheal intubation and mechanical ventilation or in patients in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trendelenburg_position\" title=\"Trendelenburg position\" rel=\"external_link\" target=\"_blank\">Trendelenburg position<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>In 1935, Karl Matthes (German physician 1905\u20131962) developed the first 2-wavelength ear O<sub>2<\/sub> saturation meter with red and green filters (later switched to red and infrared filters). His meter was the first device to measure O<sub>2<\/sub> saturation.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The original oximeter was made by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glenn_Allan_Millikan\" title=\"Glenn Allan Millikan\" rel=\"external_link\" target=\"_blank\">Glenn Allan Millikan<\/a> in the 1940s.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> In 1949 Wood added a pressure capsule to squeeze blood out of the ear so as to obtain an absolute O<sub>2<\/sub> saturation value when blood was readmitted. The concept is similar to today's conventional pulse oximetry, but was difficult to implement because of unstable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photocell\" class=\"mw-redirect\" title=\"Photocell\" rel=\"external_link\" target=\"_blank\">photocells<\/a> and light sources; the method is not now used clinically. In 1964 Shaw assembled the first absolute reading ear oximeter by using eight wavelengths of light.\n<\/p><p>Pulse oximetry was developed in 1972, by and Michio Kishi, bioengineers, at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nihon_Kohden\" title=\"Nihon Kohden\" rel=\"external_link\" target=\"_blank\">Nihon Kohden<\/a> using the ratio of red to infrared light absorption of pulsating components at the measuring site. Susumu Nakajima, a surgeon, and his associates first tested the device in patients, reporting it in 1975.<sup id=\"rdp-ebb-cite_ref-pmid3295125_5-0\" class=\"reference\"><a href=\"#cite_note-pmid3295125-5\" rel=\"external_link\">[5]<\/a><\/sup> It was commercialized by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biox\" title=\"Biox\" rel=\"external_link\" target=\"_blank\">Biox<\/a> in 1980.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid3295125_5-1\" class=\"reference\"><a href=\"#cite_note-pmid3295125-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>By 1987, the standard of care for the administration of a general anesthetic in the U.S. included pulse oximetry. From the operating room, the use of pulse oximetry rapidly spread throughout the hospital, first to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recovery_room\" class=\"mw-redirect\" title=\"Recovery room\" rel=\"external_link\" target=\"_blank\">recovery room<\/a>, and then into the various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intensive_care_unit\" title=\"Intensive care unit\" rel=\"external_link\" target=\"_blank\">intensive care units<\/a>. Pulse oximetry was of particular value in the neonatal unit where the patients do not thrive with inadequate oxygenation, but too much oxygen and fluctuations in oxygen concentration can lead to vision impairment or blindness from retinopathy of prematurity (ROP). Furthermore, obtaining an arterial blood gas from a neonatal patient is painful to the patient and a major cause of neonatal anemia.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Motion artifact can be a significant limitation to pulse oximetry monitoring resulting in frequent false alarms and loss of data. The reason for this is that during motion and low peripheral perfusion, many pulse oximeters cannot distinguish between pulsating arterial blood and moving venous blood, leading to underestimation of oxygen saturation. Early studies of pulse oximetry performance during subject motion made clear the vulnerabilities of conventional pulse oximetry technologies to motion artifact.<sup id=\"rdp-ebb-cite_ref-Barker_2002_9-0\" class=\"reference\"><a href=\"#cite_note-Barker_2002-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>In 1995, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Masimo\" title=\"Masimo\" rel=\"external_link\" target=\"_blank\">Masimo<\/a> introduced Signal Extraction Technology (SET) that could measure accurately during patient motion and low perfusion by separating the arterial signal from the venous and other signals. Since then, pulse oximetry manufacturers have developed new algorithms to reduce some false alarms during motion<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> such as extending averaging times or freezing values on the screen, but they do not claim to measure changing conditions during motion and low perfusion. So, there are still important differences in performance of pulse oximeters during challenging conditions.<sup id=\"rdp-ebb-cite_ref-Shah_2012_12-0\" class=\"reference\"><a href=\"#cite_note-Shah_2012-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>Published papers have compared signal extraction technology to other pulse oximetry technologies and have demonstrated consistently favorable results for signal extraction technology.<sup id=\"rdp-ebb-cite_ref-Barker_2002_9-1\" class=\"reference\"><a href=\"#cite_note-Barker_2002-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Shah_2012_12-1\" class=\"reference\"><a href=\"#cite_note-Shah_2012-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> Signal extraction technology pulse oximetry performance has also been shown to translate into helping clinicians improve patient outcomes. In one study, retinopathy of prematurity (eye damage) was reduced by 58% in very low birth weight neonates at a center using signal extraction technology, while there was no decrease in retinopathy of prematurity at another center with the same clinicians using the same protocol but with non-signal extraction technology.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Other studies have shown that signal extraction technology pulse oximetry results in fewer arterial blood gas measurements, faster oxygen weaning time, lower sensor utilization, and lower length of stay.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The measure-through motion and low perfusion capabilities it has also allow it to be used in previously unmonitored areas such as the general floor, where false alarms have plagued conventional pulse oximetry. As evidence of this, a landmark study was published in 2010 showing clinicians using signal extraction technology pulse oximetry on the general floor were able to decrease rapid response team activations, ICU transfers, and ICU days.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>In 2011, an expert workgroup recommended newborn screening with pulse oximetry to increase the detection of critical congenital heart disease (CCHD).<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> The CCHD workgroup cited the results of two large, prospective studies of 59,876 subjects that exclusively used signal extraction technology to increase the identification of CCHD with minimal false positives.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> The CCHD workgroup recommended newborn screening be performed with motion tolerant pulse oximetry that has also been validated in low perfusion conditions. In 2011, the US Secretary of Health and Human Services added pulse oximetry to the recommended uniform screening panel.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Before the evidence for screening using signal extraction technology, less than 1% of newborns in the United States were screened. Today, <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Newborn_Foundation\" class=\"mw-redirect\" title=\"The Newborn Foundation\" rel=\"external_link\" target=\"_blank\">The Newborn Foundation<\/a> has documented near universal screening in the United States and international screening is rapidly expanding.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> In 2014, a third large study of 122, 738 newborns that also exclusively used signal extraction technology showed similar, positive results as the first two large studies.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>High-resolution pulse oximetry (HRPO) has been developed for in-home sleep apnea screening and testing in patients for whom it is impractical to perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polysomnography\" title=\"Polysomnography\" rel=\"external_link\" target=\"_blank\">polysomnography<\/a>.<sup id=\"rdp-ebb-cite_ref-sleepreviewmag.com_23-0\" class=\"reference\"><a href=\"#cite_note-sleepreviewmag.com-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> It stores and records both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_rate\" class=\"mw-redirect\" title=\"Pulse rate\" rel=\"external_link\" target=\"_blank\">pulse rate<\/a> and SpO2 in 1 second intervals and has been shown in one study to help to detect sleep disordered breathing in surgical patients.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>In 1995 Masimo introduced perfusion index, quantifying the amplitude of the peripheral <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plethysmograph\" title=\"Plethysmograph\" rel=\"external_link\" target=\"_blank\">plethysmograph<\/a> waveform. Perfusion index has been shown to help clinicians predict illness severity and early adverse respiratory outcomes in neonates,<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-De_Felice_2006_28-0\" class=\"reference\"><a href=\"#cite_note-De_Felice_2006-28\" rel=\"external_link\">[28]<\/a><\/sup> predict low superior vena cava flow in very low birth weight infants,<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> provide an early indicator of sympathectomy after epidural anesthesia,<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> and improve detection of critical congenital heart disease in newborns.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>In 2007, Masimo introduced the first measurement of the pleth variability index (PVI), which multiple clinical studies have shown provides a new method for automatic, noninvasive assessment of a patient's ability to respond to fluid administration.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Cannesson_2008_33-0\" class=\"reference\"><a href=\"#cite_note-Cannesson_2008-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid20705785_34-0\" class=\"reference\"><a href=\"#cite_note-pmid20705785-34\" rel=\"external_link\">[34]<\/a><\/sup> Appropriate fluid levels are vital to reducing postoperative risks and improving patient outcomes: fluid volumes that are too low (under-hydration) or too high (over-hydration) have been shown to decrease wound healing and increase the risk of infection or cardiac complications.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> Recently, the National Health Service in the United Kingdom and the French Anesthesia and Critical Care Society listed PVI monitoring as part of their suggested strategies for intra-operative fluid management.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid24126197_37-0\" class=\"reference\"><a href=\"#cite_note-pmid24126197-37\" rel=\"external_link\">[37]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Function\">Function<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Oxy_and_Deoxy_Hemoglobin_Near-Infrared_absorption_spectra.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Oxy_and_Deoxy_Hemoglobin_Near-Infrared_absorption_spectra.png\/300px-Oxy_and_Deoxy_Hemoglobin_Near-Infrared_absorption_spectra.png\" width=\"300\" height=\"205\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Oxy_and_Deoxy_Hemoglobin_Near-Infrared_absorption_spectra.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Absorption spectra of oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (Hb) for red and infrared wavelengths<\/div><\/div><\/div>\n<p>A blood-oxygen monitor displays the percentage of blood that is loaded with oxygen. More specifically, it measures what percentage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemoglobin\" title=\"Hemoglobin\" rel=\"external_link\" target=\"_blank\">hemoglobin<\/a>, the protein in blood that carries oxygen, is loaded. Acceptable normal ranges for patients without pulmonary pathology are from 95 to 99 percent. For a patient breathing room air at or near <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sea_level\" title=\"Sea level\" rel=\"external_link\" target=\"_blank\">sea level<\/a>, an estimate of arterial pO<sub>2<\/sub> can be made from the blood-oxygen monitor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygenation_(medical)#Measurements\" class=\"mw-redirect\" title=\"Oxygenation (medical)\" rel=\"external_link\" target=\"_blank\">\"saturation of peripheral oxygen\"<\/a> (SpO<sub>2<\/sub>) reading.\n<\/p><p>A typical pulse oximeter uses an electronic processor and a pair of small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Light-emitting_diode\" title=\"Light-emitting diode\" rel=\"external_link\" target=\"_blank\">light-emitting diodes<\/a> (LEDs) facing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photodiode\" title=\"Photodiode\" rel=\"external_link\" target=\"_blank\">photodiode<\/a> through a translucent part of the patient's body, usually a fingertip or an earlobe. One LED is red, with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wavelength\" title=\"Wavelength\" rel=\"external_link\" target=\"_blank\">wavelength<\/a> of 660 nm, and the other is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a> with a wavelength of 940 nm. Absorption of light at these wavelengths differs significantly between blood loaded with oxygen and blood lacking oxygen. Oxygenated hemoglobin absorbs more infrared light and allows more red light to pass through. Deoxygenated hemoglobin allows more infrared light to pass through and absorbs more red light. The LEDs sequence through their cycle of one on, then the other, then both off about thirty times per second which allows the photodiode to respond to the red and infrared light separately and also adjust for the ambient light baseline.<sup id=\"rdp-ebb-cite_ref-oximetry_38-0\" class=\"reference\"><a href=\"#cite_note-oximetry-38\" rel=\"external_link\">[38]<\/a><\/sup> The amount of light that is transmitted (in other words, that is not absorbed) is measured, and separate normalized signals are produced for each wavelength. These signals fluctuate in time because the amount of arterial blood that is present increases (literally pulses) with each heartbeat. By subtracting the minimum transmitted light from the peak transmitted light in each wavelength, the effects of other tissues are corrected for.<sup id=\"rdp-ebb-cite_ref-Pulsimetry_39-0\" class=\"reference\"><a href=\"#cite_note-Pulsimetry-39\" rel=\"external_link\">[39]<\/a><\/sup> The ratio of the red light measurement to the infrared light measurement is then calculated by the processor (which represents the ratio of oxygenated hemoglobin to deoxygenated hemoglobin), and this ratio is then converted to SpO<sub>2<\/sub> by the processor via a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lookup_table\" title=\"Lookup table\" rel=\"external_link\" target=\"_blank\">lookup table<\/a><sup id=\"rdp-ebb-cite_ref-Pulsimetry_39-1\" class=\"reference\"><a href=\"#cite_note-Pulsimetry-39\" rel=\"external_link\">[39]<\/a><\/sup> based on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beer%E2%80%93Lambert_law\" title=\"Beer\u2013Lambert law\" rel=\"external_link\" target=\"_blank\">Beer\u2013Lambert law<\/a>.<sup id=\"rdp-ebb-cite_ref-oximetry_38-1\" class=\"reference\"><a href=\"#cite_note-oximetry-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indication\">Indication<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Saturometre_2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e5\/Saturometre_2.jpg\/220px-Saturometre_2.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Saturometre_2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A pulse oximeter probe applied to a person's finger<\/div><\/div><\/div>\n<p>A pulse oximeter is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> that indirectly monitors the oxygen saturation of a patient's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoplethysmogram\" title=\"Photoplethysmogram\" rel=\"external_link\" target=\"_blank\">photoplethysmogram<\/a>. The pulse oximeter may be incorporated into a multiparameter patient monitor. Most monitors also display the pulse rate. Portable, battery-operated pulse oximeters are also available for transport or home blood-oxygen monitoring.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h3>\n<p>Pulse oximetry is particularly convenient for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Noninvasive\" class=\"mw-redirect\" title=\"Noninvasive\" rel=\"external_link\" target=\"_blank\">noninvasive<\/a> continuous measurement of blood oxygen saturation. In contrast, blood gas levels must otherwise be determined in a laboratory on a drawn blood sample. Pulse oximetry is useful in any setting where a patient's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygenation_(medical)\" class=\"mw-redirect\" title=\"Oxygenation (medical)\" rel=\"external_link\" target=\"_blank\">oxygenation<\/a> is unstable, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intensive_care\" class=\"mw-redirect\" title=\"Intensive care\" rel=\"external_link\" target=\"_blank\">intensive care<\/a>, operating, recovery, emergency and hospital ward settings, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aircraft_pilot\" title=\"Aircraft pilot\" rel=\"external_link\" target=\"_blank\">pilots<\/a> in unpressurized aircraft, for assessment of any patient's oxygenation, and determining the effectiveness of or need for supplemental <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a>. Although a pulse oximeter is used to monitor oxygenation, it cannot determine the metabolism of oxygen, or the amount of oxygen being used by a patient. For this purpose, it is necessary to also measure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a> (CO<sub>2<\/sub>) levels. It is possible that it can also be used to detect abnormalities in ventilation. However, the use of a pulse oximeter to detect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoventilation\" title=\"Hypoventilation\" rel=\"external_link\" target=\"_blank\">hypoventilation<\/a> is impaired with the use of supplemental oxygen, as it is only when patients breathe room air that abnormalities in respiratory function can be detected reliably with its use. Therefore, the routine administration of supplemental oxygen may be unwarranted if the patient is able to maintain adequate oxygenation in room air, since it can result in hypoventilation going undetected.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p><p>Because of their simplicity of use and the ability to provide continuous and immediate oxygen saturation values, pulse oximeters are of critical importance in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_medicine\" title=\"Emergency medicine\" rel=\"external_link\" target=\"_blank\">emergency medicine<\/a> and are also very useful for patients with respiratory or cardiac problems, especially <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_obstructive_pulmonary_disease\" title=\"Chronic obstructive pulmonary disease\" rel=\"external_link\" target=\"_blank\">COPD<\/a>, or for diagnosis of some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sleep_disorders\" class=\"mw-redirect\" title=\"Sleep disorders\" rel=\"external_link\" target=\"_blank\">sleep disorders<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apnea\" title=\"Apnea\" rel=\"external_link\" target=\"_blank\">apnea<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypopnea\" title=\"Hypopnea\" rel=\"external_link\" target=\"_blank\">hypopnea<\/a>.<sup id=\"rdp-ebb-cite_ref-Schlosshan_2004_41-0\" class=\"reference\"><a href=\"#cite_note-Schlosshan_2004-41\" rel=\"external_link\">[41]<\/a><\/sup> Portable battery-operated pulse oximeters are useful for pilots operating in a non-pressurized aircraft above 10,000 feet (3,000 m) or 12,500 feet (3,800 m) in the U.S.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> where supplemental oxygen is required. Portable pulse oximeters are also useful for mountain climbers and athletes whose oxygen levels may decrease at high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Altitudes\" class=\"mw-redirect\" title=\"Altitudes\" rel=\"external_link\" target=\"_blank\">altitudes<\/a> or with exercise. Some portable pulse oximeters employ software that charts a patient's blood oxygen and pulse, serving as a reminder to check blood oxygen levels.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Limitations\">Limitations<\/span><\/h3>\n<p>Pulse oximetry solely measures hemoglobin saturation, not <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventilation_(physiology)\" class=\"mw-redirect\" title=\"Ventilation (physiology)\" rel=\"external_link\" target=\"_blank\">ventilation<\/a> and is not a complete measure of respiratory sufficiency. It is not a substitute for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_gases\" class=\"mw-redirect\" title=\"Blood gases\" rel=\"external_link\" target=\"_blank\">blood gases<\/a> checked in a laboratory, because it gives no indication of base deficit, carbon dioxide levels, blood <a href=\"https:\/\/en.wikipedia.org\/wiki\/PH\" title=\"PH\" rel=\"external_link\" target=\"_blank\">pH<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicarbonate\" title=\"Bicarbonate\" rel=\"external_link\" target=\"_blank\">bicarbonate<\/a> (HCO<sub>3<\/sub><sup>\u2212<\/sup>) concentration. The metabolism of oxygen can be readily measured by monitoring expired CO<sub>2<\/sub>, but saturation figures give no information about blood oxygen content. Most of the oxygen in the blood is carried by hemoglobin; in severe anemia, the blood will carry less total oxygen, despite the hemoglobin being 100% saturated.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Erroneously low readings may be caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoperfusion\" class=\"mw-redirect\" title=\"Hypoperfusion\" rel=\"external_link\" target=\"_blank\">hypoperfusion<\/a> of the extremity being used for monitoring (often due to a limb being cold, or from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vasoconstriction\" title=\"Vasoconstriction\" rel=\"external_link\" target=\"_blank\">vasoconstriction<\/a> secondary to the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vasopressor\" class=\"mw-redirect\" title=\"Vasopressor\" rel=\"external_link\" target=\"_blank\">vasopressor<\/a> agents); incorrect sensor application; highly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Callus\" title=\"Callus\" rel=\"external_link\" target=\"_blank\">calloused<\/a> skin; or movement (such as shivering), especially during hypoperfusion. To ensure accuracy, the sensor should return a steady pulse and\/or pulse waveform. Pulse oximetry technologies differ in their abilities to provide accurate data during conditions of motion and low perfusion.<sup id=\"rdp-ebb-cite_ref-Shah_2012_12-2\" class=\"reference\"><a href=\"#cite_note-Shah_2012-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Barker_2002_9-2\" class=\"reference\"><a href=\"#cite_note-Barker_2002-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Pulse oximetry also is not a complete measure of circulatory sufficiency. If there is insufficient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">bloodflow<\/a> or insufficient hemoglobin in the blood (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Anemia\" title=\"Anemia\" rel=\"external_link\" target=\"_blank\">anemia<\/a>), tissues can suffer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoxia_(medical)\" title=\"Hypoxia (medical)\" rel=\"external_link\" target=\"_blank\">hypoxia<\/a> despite high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_saturation\" title=\"Oxygen saturation\" rel=\"external_link\" target=\"_blank\">oxygen saturation<\/a> in the blood that does arrive. In 2008, a pulse oximeter that can measure hemoglobin levels in addition to oxygen saturation was introduced by Masimo. To quantify hemoglobin, the device uses additional wavelengths of light beyond the two standard ones.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Since pulse oximetry measures only the percentage of bound hemoglobin, a falsely high or falsely low reading will occur when hemoglobin binds to something other than oxygen:\n<\/p>\n<ul><li>Hemoglobin has a higher affinity to carbon monoxide than it does to oxygen, and a high reading may occur despite the patient's actually being hypoxemic. In cases of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_monoxide_poisoning\" title=\"Carbon monoxide poisoning\" rel=\"external_link\" target=\"_blank\">carbon monoxide poisoning<\/a>, this inaccuracy may delay the recognition of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoxia_(medical)\" title=\"Hypoxia (medical)\" rel=\"external_link\" target=\"_blank\">hypoxia<\/a> (low cellular oxygen level).<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanide_poisoning\" title=\"Cyanide poisoning\" rel=\"external_link\" target=\"_blank\">Cyanide poisoning<\/a> gives a high reading because it reduces oxygen extraction from arterial blood. In this case, the reading is not false, as arterial blood oxygen is indeed high in early cyanide poisoning.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Methemoglobinemia\" title=\"Methemoglobinemia\" rel=\"external_link\" target=\"_blank\">Methemoglobinemia<\/a> characteristically causes pulse oximetry readings in the mid-80s.<\/li>\n<li>COPD [especially chronic bronchitis] may cause false readings.<sup id=\"rdp-ebb-cite_ref-pmid26715772_43-0\" class=\"reference\"><a href=\"#cite_note-pmid26715772-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li><\/ul>\n<p>A noninvasive method that allows continuous measurement of the dyshemoglobins is the pulse <a href=\"https:\/\/en.wikipedia.org\/wiki\/CO-oximeter\" title=\"CO-oximeter\" rel=\"external_link\" target=\"_blank\">CO-oximeter<\/a>, which was built in 2005 by Masimo using UK Patent GB 2320566 (1996) . It provides clinicians a way to measure the dyshemoglobins, carboxyhemoglobin, and methemoglobin along with total hemoglobin.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Increasing_usage\">Increasing usage<\/span><\/h3>\n<p>According to a report by iData Research the U.S. pulse oximetry monitoring market for equipment and sensors was over <span class=\"nowrap\">700 million USD<\/span> in 2011.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup>\n<\/p><p>In 2008, more than half of the major internationally exporting medical equipment manufacturers in <a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a> were producers of pulse oximeters.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apple_Watch\" title=\"Apple Watch\" rel=\"external_link\" target=\"_blank\">Apple Watch<\/a> uses this technology for its heart rate monitor.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> The accuracy of the heart rate monitor has been debated, as different tests have shown it to be 91% as accurate as chest strap monitors.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Pleth_variability_index\">Pleth variability index<\/span><\/h2>\n<p>Pleth variability index (PVI) is a measure of the variability of the plethysmographic waveform amplitude.<sup id=\"rdp-ebb-cite_ref-Cannesson_2008_33-1\" class=\"reference\"><a href=\"#cite_note-Cannesson_2008-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 20em; -webkit-column-width: 20em; column-width: 20em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_blood_gas\" class=\"mw-redirect\" title=\"Arterial blood gas\" rel=\"external_link\" target=\"_blank\">Arterial blood gas<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Capnography\" title=\"Capnography\" rel=\"external_link\" target=\"_blank\">Capnography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_Pulmonary_Index\" title=\"Integrated Pulmonary Index\" rel=\"external_link\" target=\"_blank\">Integrated Pulmonary Index<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_monitoring\" class=\"mw-redirect\" title=\"Respiratory monitoring\" rel=\"external_link\" target=\"_blank\">Respiratory monitoring<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment\" title=\"Medical equipment\" rel=\"external_link\" target=\"_blank\">Medical equipment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_ventilation\" title=\"Mechanical ventilation\" rel=\"external_link\" target=\"_blank\">Mechanical ventilation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_sensor\" title=\"Oxygen sensor\" rel=\"external_link\" target=\"_blank\">Oxygen sensor<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_saturation\" title=\"Oxygen saturation\" rel=\"external_link\" target=\"_blank\">Oxygen saturation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoplethysmogram\" title=\"Photoplethysmogram\" rel=\"external_link\" target=\"_blank\">Photoplethysmogram<\/a>, measuring of carbon dioxide (CO<sub>2<\/sub>) in the respiratory gases<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sleep_apnea\" title=\"Sleep apnea\" rel=\"external_link\" target=\"_blank\">Sleep apnea<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brand TM, Brand ME, Jay GD (February 2002). \"Enamel nail polish does not interfere with pulse oximetry among normoxic volunteers\". <i>Journal of Clinical Monitoring and Computing<\/i>. <b>17<\/b> (2): 93\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1023%2FA%3A1016385222568\" target=\"_blank\">10.1023\/A:1016385222568<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12212998\" target=\"_blank\">12212998<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Monitoring+and+Computing&rft.atitle=Enamel+nail+polish+does+not+interfere+with+pulse+oximetry+among+normoxic+volunteers&rft.volume=17&rft.issue=2&rft.pages=93-6&rft.date=2002-02&rft_id=info%3Adoi%2F10.1023%2FA%3A1016385222568&rft_id=info%3Apmid%2F12212998&rft.aulast=Brand&rft.aufirst=TM&rft.au=Brand%2C+ME&rft.au=Jay%2C+GD&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">J\u00f8rgensen JS, Schmid ER, K\u00f6nig V, Faisst K, Huch A, Huch R (July 1995). \"Limitations of forehead pulse oximetry\". <i>Journal of Clinical Monitoring<\/i>. <b>11<\/b> (4): 253\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fbf01617520\" target=\"_blank\">10.1007\/bf01617520<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7561999\" target=\"_blank\">7561999<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Monitoring&rft.atitle=Limitations+of+forehead+pulse+oximetry&rft.volume=11&rft.issue=4&rft.pages=253-6&rft.date=1995-07&rft_id=info%3Adoi%2F10.1007%2Fbf01617520&rft_id=info%3Apmid%2F7561999&rft.aulast=J%C3%B8rgensen&rft.aufirst=JS&rft.au=Schmid%2C+ER&rft.au=K%C3%B6nig%2C+V&rft.au=Faisst%2C+K&rft.au=Huch%2C+A&rft.au=Huch%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Matthes K (1935). \"Untersuchungen \u00fcber die Sauerstoffs\u00e4ttigung des menschlichen Arterienblutes\" [Studies on the Oxygen Saturation of Arterial Human Blood]. <i>Naunyn-Schmiedeberg's Archives of Pharmacology<\/i> (in German). <b>179<\/b> (6): 698\u2013711. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF01862691\" target=\"_blank\">10.1007\/BF01862691<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Naunyn-Schmiedeberg%27s+Archives+of+Pharmacology&rft.atitle=Untersuchungen+%C3%BCber+die+Sauerstoffs%C3%A4ttigung+des+menschlichen+Arterienblutes&rft.volume=179&rft.issue=6&rft.pages=698-711&rft.date=1935&rft_id=info%3Adoi%2F10.1007%2FBF01862691&rft.aulast=Matthes&rft.aufirst=K&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glenn_Allan_Millikan\" title=\"Glenn Allan Millikan\" rel=\"external_link\" target=\"_blank\">Millikan GA<\/a> (1942). \"The oximeter: an instrument for measuring continuously oxygen saturation of arterial blood in man\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Review_of_Scientific_Instruments\" title=\"Review of Scientific Instruments\" rel=\"external_link\" target=\"_blank\">Review of Scientific Instruments<\/a><\/i>. <b>13<\/b> (10): 434\u2013444. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1942RScI...13..434M\" target=\"_blank\">1942RScI...13..434M<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.1769941\" target=\"_blank\">10.1063\/1.1769941<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Review+of+Scientific+Instruments&rft.atitle=The+oximeter%3A+an+instrument+for+measuring+continuously+oxygen+saturation+of+arterial+blood+in+man&rft.volume=13&rft.issue=10&rft.pages=434-444&rft.date=1942&rft_id=info%3Adoi%2F10.1063%2F1.1769941&rft_id=info%3Abibcode%2F1942RScI...13..434M&rft.aulast=Millikan&rft.aufirst=GA&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid3295125-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pmid3295125_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid3295125_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Severinghaus JW, Honda Y (April 1987). \"History of blood gas analysis. VII. Pulse oximetry\". <i>Journal of Clinical Monitoring<\/i>. <b>3<\/b> (2): 135\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fbf00858362\" target=\"_blank\">10.1007\/bf00858362<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3295125\" target=\"_blank\">3295125<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Monitoring&rft.atitle=History+of+blood+gas+analysis.+VII.+Pulse+oximetry&rft.volume=3&rft.issue=2&rft.pages=135-8&rft.date=1987-04&rft_id=info%3Adoi%2F10.1007%2Fbf00858362&rft_id=info%3Apmid%2F3295125&rft.aulast=Severinghaus&rft.aufirst=JW&rft.au=Honda%2C+Y&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfPMN\/pmn.cfm?ID=46970\" target=\"_blank\">\"510(k): Premarket Notification\"<\/a>. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.masimo.co.uk\/nellcorfiction\/index.htm\" target=\"_blank\">the original<\/a> on 13 April 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Fact+vs.+Fiction&rft.pub=Masimo+Corporation&rft_id=http%3A%2F%2Fwww.masimo.co.uk%2Fnellcorfiction%2Findex.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lin JC, Strauss RG, Kulhavy JC, Johnson KJ, Zimmerman MB, Cress GA, Connolly NW, Widness JA (August 2000). \"Phlebotomy overdraw in the neonatal intensive care nursery\". <i>Pediatrics<\/i>. <b>106<\/b> (2): E19. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1542%2Fpeds.106.2.e19\" target=\"_blank\">10.1542\/peds.106.2.e19<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10920175\" target=\"_blank\">10920175<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=Phlebotomy+overdraw+in+the+neonatal+intensive+care+nursery&rft.volume=106&rft.issue=2&rft.pages=E19&rft.date=2000-08&rft_id=info%3Adoi%2F10.1542%2Fpeds.106.2.e19&rft_id=info%3Apmid%2F10920175&rft.aulast=Lin&rft.aufirst=JC&rft.au=Strauss%2C+RG&rft.au=Kulhavy%2C+JC&rft.au=Johnson%2C+KJ&rft.au=Zimmerman%2C+MB&rft.au=Cress%2C+GA&rft.au=Connolly%2C+NW&rft.au=Widness%2C+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Barker_2002-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Barker_2002_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barker_2002_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barker_2002_9-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Barker SJ (October 2002). \"<span class=\"cs1-kern-left\">\"<\/span>Motion-resistant\" pulse oximetry: a comparison of new and old models\". <i>Anesthesia and Analgesia<\/i>. <b>95<\/b> (4): 967\u201372. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1213%2F00000539-200210000-00033\" target=\"_blank\">10.1213\/00000539-200210000-00033<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12351278\" target=\"_blank\">12351278<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+and+Analgesia&rft.atitle=%22Motion-resistant%22+pulse+oximetry%3A+a+comparison+of+new+and+old+models&rft.volume=95&rft.issue=4&rft.pages=967-72&rft.date=2002-10&rft_id=info%3Adoi%2F10.1213%2F00000539-200210000-00033&rft_id=info%3Apmid%2F12351278&rft.aulast=Barker&rft.aufirst=SJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Barker SJ, Shah NK (October 1996). \"Effects of motion on the performance of pulse oximeters in volunteers\". <i>Anesthesiology<\/i>. <b>85<\/b> (4): 774\u201381. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00000542-199701000-00014\" target=\"_blank\">10.1097\/00000542-199701000-00014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8873547\" target=\"_blank\">8873547<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology&rft.atitle=Effects+of+motion+on+the+performance+of+pulse+oximeters+in+volunteers&rft.volume=85&rft.issue=4&rft.pages=774-81&rft.date=1996-10&rft_id=info%3Adoi%2F10.1097%2F00000542-199701000-00014&rft_id=info%3Apmid%2F8873547&rft.aulast=Barker&rft.aufirst=SJ&rft.au=Shah%2C+NK&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jopling MW, Mannheimer PD, Bebout DE (January 2002). \"Issues in the laboratory evaluation of pulse oximeter performance\". <i>Anesthesia and Analgesia<\/i>. <b>94<\/b> (1 Suppl): S62\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11900041\" target=\"_blank\">11900041<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+and+Analgesia&rft.atitle=Issues+in+the+laboratory+evaluation+of+pulse+oximeter+performance&rft.volume=94&rft.issue=1+Suppl&rft.pages=S62-8&rft.date=2002-01&rft_id=info%3Apmid%2F11900041&rft.aulast=Jopling&rft.aufirst=MW&rft.au=Mannheimer%2C+PD&rft.au=Bebout%2C+DE&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Shah_2012-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Shah_2012_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Shah_2012_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Shah_2012_12-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shah N, Ragaswamy HB, Govindugari K, Estanol L (August 2012). \"Performance of three new-generation pulse oximeters during motion and low perfusion in volunteers\". <i>Journal of Clinical Anesthesia<\/i>. <b>24<\/b> (5): 385\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jclinane.2011.10.012\" target=\"_blank\">10.1016\/j.jclinane.2011.10.012<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22626683\" target=\"_blank\">22626683<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Anesthesia&rft.atitle=Performance+of+three+new-generation+pulse+oximeters+during+motion+and+low+perfusion+in+volunteers&rft.volume=24&rft.issue=5&rft.pages=385-91&rft.date=2012-08&rft_id=info%3Adoi%2F10.1016%2Fj.jclinane.2011.10.012&rft_id=info%3Apmid%2F22626683&rft.aulast=Shah&rft.aufirst=N&rft.au=Ragaswamy%2C+HB&rft.au=Govindugari%2C+K&rft.au=Estanol%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hay WW, Rodden DJ, Collins SM, Melara DL, Hale KA, Fashaw LM (2002). \"Reliability of conventional and new pulse oximetry in neonatal patients\". <i>Journal of Perinatology<\/i>. <b>22<\/b> (5): 360\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fsj.jp.7210740\" target=\"_blank\">10.1038\/sj.jp.7210740<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12082469\" target=\"_blank\">12082469<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Perinatology&rft.atitle=Reliability+of+conventional+and+new+pulse+oximetry+in+neonatal+patients&rft.volume=22&rft.issue=5&rft.pages=360-6&rft.date=2002&rft_id=info%3Adoi%2F10.1038%2Fsj.jp.7210740&rft_id=info%3Apmid%2F12082469&rft.aulast=Hay&rft.aufirst=WW&rft.au=Rodden%2C+DJ&rft.au=Collins%2C+SM&rft.au=Melara%2C+DL&rft.au=Hale%2C+KA&rft.au=Fashaw%2C+LM&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Castillo A, Deulofeut R, Critz A, Sola A (February 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3040295\" target=\"_blank\">\"Prevention of retinopathy of prematurity in preterm infants through changes in clinical practice and SpO\u2082technology\"<\/a>. <i>Acta Paediatrica<\/i>. <b>100<\/b> (2): 188\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1651-2227.2010.02001.x\" target=\"_blank\">10.1111\/j.1651-2227.2010.02001.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3040295\" target=\"_blank\">3040295<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20825604\" target=\"_blank\">20825604<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Paediatrica&rft.atitle=Prevention+of+retinopathy+of+prematurity+in+preterm+infants+through+changes+in+clinical+practice+and+SpO%E2%82%82technology&rft.volume=100&rft.issue=2&rft.pages=188-92&rft.date=2011-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3040295&rft_id=info%3Apmid%2F20825604&rft_id=info%3Adoi%2F10.1111%2Fj.1651-2227.2010.02001.x&rft.aulast=Castillo&rft.aufirst=A&rft.au=Deulofeut%2C+R&rft.au=Critz%2C+A&rft.au=Sola%2C+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3040295&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Durbin CG, Rostow SK (August 2002). \"More reliable oximetry reduces the frequency of arterial blood gas analyses and hastens oxygen weaning after cardiac surgery: a prospective, randomized trial of the clinical impact of a new technology\". <i>Critical Care Medicine<\/i>. <b>30<\/b> (8): 1735\u201340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00003246-200208000-00010\" target=\"_blank\">10.1097\/00003246-200208000-00010<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12163785\" target=\"_blank\">12163785<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Critical+Care+Medicine&rft.atitle=More+reliable+oximetry+reduces+the+frequency+of+arterial+blood+gas+analyses+and+hastens+oxygen+weaning+after+cardiac+surgery%3A+a+prospective%2C+randomized+trial+of+the+clinical+impact+of+a+new+technology&rft.volume=30&rft.issue=8&rft.pages=1735-40&rft.date=2002-08&rft_id=info%3Adoi%2F10.1097%2F00003246-200208000-00010&rft_id=info%3Apmid%2F12163785&rft.aulast=Durbin&rft.aufirst=CG&rft.au=Rostow%2C+SK&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Taenzer AH, Pyke JB, McGrath SP, Blike GT (February 2010). \"Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study\". <i>Anesthesiology<\/i>. <b>112<\/b> (2): 282\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Faln.0b013e3181ca7a9b\" target=\"_blank\">10.1097\/aln.0b013e3181ca7a9b<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20098128\" target=\"_blank\">20098128<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology&rft.atitle=Impact+of+pulse+oximetry+surveillance+on+rescue+events+and+intensive+care+unit+transfers%3A+a+before-and-after+concurrence+study&rft.volume=112&rft.issue=2&rft.pages=282-7&rft.date=2010-02&rft_id=info%3Adoi%2F10.1097%2Faln.0b013e3181ca7a9b&rft_id=info%3Apmid%2F20098128&rft.aulast=Taenzer&rft.aufirst=AH&rft.au=Pyke%2C+JB&rft.au=McGrath%2C+SP&rft.au=Blike%2C+GT&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=Strategies+for+implementing+screening+for+critical+congenital+heart+disease&rft.volume=128&rft.issue=5&rft.pages=e1259-67&rft.date=2011-11&rft_id=info%3Adoi%2F10.1542%2Fpeds.2011-1317&rft_id=info%3Apmid%2F21987707&rft.aulast=Kemper&rft.aufirst=AR&rft.au=Mahle%2C+WT&rft.au=Martin%2C+GR&rft.au=Cooley%2C+WC&rft.au=Kumar%2C+P&rft.au=Morrow%2C+WR&rft.au=Kelm%2C+K&rft.au=Pearson%2C+GD&rft.au=Glidewell%2C+J&rft.au=Grosse%2C+SD&rft.au=Howell%2C+RR&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">de-Wahl Granelli A, Wennergren M, Sandberg K, Mellander M, Bejlum C, Ingan\u00e4s L, Eriksson M, Segerdahl N, Agren A, Ekman-Joelsson BM, Sunneg\u00e5rdh J, Verdicchio M, Ostman-Smith I (January 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2627280\" target=\"_blank\">\"Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns\"<\/a>. <i>BMJ<\/i>. <b>338<\/b>: a3037. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.a3037\" target=\"_blank\">10.1136\/bmj.a3037<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2627280\" target=\"_blank\">2627280<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19131383\" target=\"_blank\">19131383<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ&rft.atitle=Impact+of+pulse+oximetry+screening+on+the+detection+of+duct+dependent+congenital+heart+disease%3A+a+Swedish+prospective+screening+study+in+39%2C821+newborns&rft.volume=338&rft.pages=a3037&rft.date=2009-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2627280&rft_id=info%3Apmid%2F19131383&rft_id=info%3Adoi%2F10.1136%2Fbmj.a3037&rft.aulast=de-Wahl+Granelli&rft.aufirst=A&rft.au=Wennergren%2C+M&rft.au=Sandberg%2C+K&rft.au=Mellander%2C+M&rft.au=Bejlum%2C+C&rft.au=Ingan%C3%A4s%2C+L&rft.au=Eriksson%2C+M&rft.au=Segerdahl%2C+N&rft.au=Agren%2C+A&rft.au=Ekman-Joelsson%2C+BM&rft.au=Sunneg%C3%A5rdh%2C+J&rft.au=Verdicchio%2C+M&rft.au=Ostman-Smith%2C+I&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2627280&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, Deeks JJ, Khan KS (August 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3860684\" target=\"_blank\">\"Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study\"<\/a>. <i>Lancet<\/i>. <b>378<\/b> (9793): 785\u201394. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0140-6736%2811%2960753-8\" target=\"_blank\">10.1016\/S0140-6736(11)60753-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3860684\" target=\"_blank\">3860684<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21820732\" target=\"_blank\">21820732<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lancet&rft.atitle=Pulse+oximetry+screening+for+congenital+heart+defects+in+newborn+infants+%28PulseOx%29%3A+a+test+accuracy+study&rft.volume=378&rft.issue=9793&rft.pages=785-94&rft.date=2011-08&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3860684&rft_id=info%3Apmid%2F21820732&rft_id=info%3Adoi%2F10.1016%2FS0140-6736%2811%2960753-8&rft.aulast=Ewer&rft.aufirst=AK&rft.au=Middleton%2C+LJ&rft.au=Furmston%2C+AT&rft.au=Bhoyar%2C+A&rft.au=Daniels%2C+JP&rft.au=Thangaratinam%2C+S&rft.au=Deeks%2C+JJ&rft.au=Khan%2C+KS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3860684&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mahle WT, Martin GR, Beekman RH, Morrow WR (January 2012). \"Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease\". <i>Pediatrics<\/i>. <b>129<\/b> (1): 190\u20132. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1542%2Fpeds.2011-3211\" target=\"_blank\">10.1542\/peds.2011-3211<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22201143\" target=\"_blank\">22201143<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=Endorsement+of+Health+and+Human+Services+recommendation+for+pulse+oximetry+screening+for+critical+congenital+heart+disease&rft.volume=129&rft.issue=1&rft.pages=190-2&rft.date=2012-01&rft_id=info%3Adoi%2F10.1542%2Fpeds.2011-3211&rft_id=info%3Apmid%2F22201143&rft.aulast=Mahle&rft.aufirst=WT&rft.au=Martin%2C+GR&rft.au=Beekman%2C+RH&rft.au=Morrow%2C+WR&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/cchdscreeningmap.org\/\" target=\"_blank\">\"Newborn CCHD Screening Progress Map\"<\/a>. Cchdscreeningmap.org. 7 July 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-04-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Newborn+CCHD+Screening+Progress+Map&rft.pub=Cchdscreeningmap.org&rft.date=2014-07-07&rft_id=http%3A%2F%2Fcchdscreeningmap.org%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhao QM, Ma XJ, Ge XL, Liu F, Yan WL, Wu L, Ye M, Liang XC, Zhang J, Gao Y, Jia B, Huang GY (August 2014). \"Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study\". <i>Lancet<\/i>. <b>384<\/b> (9945): 747\u201354. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0140-6736%2814%2960198-7\" target=\"_blank\">10.1016\/S0140-6736(14)60198-7<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24768155\" target=\"_blank\">24768155<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lancet&rft.atitle=Pulse+oximetry+with+clinical+assessment+to+screen+for+congenital+heart+disease+in+neonates+in+China%3A+a+prospective+study&rft.volume=384&rft.issue=9945&rft.pages=747-54&rft.date=2014-08&rft_id=info%3Adoi%2F10.1016%2FS0140-6736%2814%2960198-7&rft_id=info%3Apmid%2F24768155&rft.aulast=Zhao&rft.aufirst=QM&rft.au=Ma%2C+XJ&rft.au=Ge%2C+XL&rft.au=Liu%2C+F&rft.au=Yan%2C+WL&rft.au=Wu%2C+L&rft.au=Ye%2C+M&rft.au=Liang%2C+XC&rft.au=Zhang%2C+J&rft.au=Gao%2C+Y&rft.au=Jia%2C+B&rft.au=Huang%2C+GY&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-sleepreviewmag.com-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-sleepreviewmag.com_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Valenza T (April 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120210190044\/http:\/\/www.sleepreviewmag.com\/issues\/articles\/2008-04_10.asp\" target=\"_blank\">\"Keeping a Pulse on Oximetry\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sleepreviewmag.com\/issues\/articles\/2008-04_10.asp\" target=\"_blank\">the original<\/a> on February 10, 2012.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Keeping+a+Pulse+on+Oximetry&rft.date=2008-04&rft.aulast=Valenza&rft.aufirst=T&rft_id=http%3A%2F%2Fwww.sleepreviewmag.com%2Fissues%2Farticles%2F2008-04_10.asp&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090107051157\/http:\/\/www.maxtecinc.com\/assets\/docs\/pulsox\/ml187.p300iDataSheet.pdf\" target=\"_blank\">\"PULSOX -300i\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Maxtec Inc. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.maxtecinc.com\/assets\/docs\/pulsox\/ml187.p300iDataSheet.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on January 7, 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=PULSOX+-300i&rft.pub=Maxtec+Inc.&rft_id=http%3A%2F%2Fwww.maxtecinc.com%2Fassets%2Fdocs%2Fpulsox%2Fml187.p300iDataSheet.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chung F, Liao P, Elsaid H, Islam S, Shapiro CM, Sun Y (May 2012). \"Oxygen desaturation index from nocturnal oximetry: a sensitive and specific tool to detect sleep-disordered breathing in surgical patients\". <i>Anesthesia and Analgesia<\/i>. <b>114<\/b> (5): 993\u20131000. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1213%2Fane.0b013e318248f4f5\" target=\"_blank\">10.1213\/ane.0b013e318248f4f5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22366847\" target=\"_blank\">22366847<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+and+Analgesia&rft.atitle=Oxygen+desaturation+index+from+nocturnal+oximetry%3A+a+sensitive+and+specific+tool+to+detect+sleep-disordered+breathing+in+surgical+patients&rft.volume=114&rft.issue=5&rft.pages=993-1000&rft.date=2012-05&rft_id=info%3Adoi%2F10.1213%2Fane.0b013e318248f4f5&rft_id=info%3Apmid%2F22366847&rft.aulast=Chung&rft.aufirst=F&rft.au=Liao%2C+P&rft.au=Elsaid%2C+H&rft.au=Islam%2C+S&rft.au=Shapiro%2C+CM&rft.au=Sun%2C+Y&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">De Felice C, Leoni L, Tommasini E, Tonni G, Toti P, Del Vecchio A, Ladisa G, Latini G (March 2008). \"Maternal pulse oximetry perfusion index as a predictor of early adverse respiratory neonatal outcome after elective cesarean delivery\". <i>Pediatric Critical Care Medicine<\/i>. <b>9<\/b> (2): 203\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Fpcc.0b013e3181670021\" target=\"_blank\">10.1097\/pcc.0b013e3181670021<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18477934\" target=\"_blank\">18477934<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatric+Critical+Care+Medicine&rft.atitle=Maternal+pulse+oximetry+perfusion+index+as+a+predictor+of+early+adverse+respiratory+neonatal+outcome+after+elective+cesarean+delivery&rft.volume=9&rft.issue=2&rft.pages=203-8&rft.date=2008-03&rft_id=info%3Adoi%2F10.1097%2Fpcc.0b013e3181670021&rft_id=info%3Apmid%2F18477934&rft.aulast=De+Felice&rft.aufirst=C&rft.au=Leoni%2C+L&rft.au=Tommasini%2C+E&rft.au=Tonni%2C+G&rft.au=Toti%2C+P&rft.au=Del+Vecchio%2C+A&rft.au=Ladisa%2C+G&rft.au=Latini%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">De Felice C, Latini G, Vacca P, Kopotic RJ (October 2002). \"The pulse oximeter perfusion index as a predictor for high illness severity in neonates\". <i>European Journal of Pediatrics<\/i>. <b>161<\/b> (10): 561\u20132. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00431-002-1042-5\" target=\"_blank\">10.1007\/s00431-002-1042-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12297906\" target=\"_blank\">12297906<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Pediatrics&rft.atitle=The+pulse+oximeter+perfusion+index+as+a+predictor+for+high+illness+severity+in+neonates&rft.volume=161&rft.issue=10&rft.pages=561-2&rft.date=2002-10&rft_id=info%3Adoi%2F10.1007%2Fs00431-002-1042-5&rft_id=info%3Apmid%2F12297906&rft.aulast=De+Felice&rft.aufirst=C&rft.au=Latini%2C+G&rft.au=Vacca%2C+P&rft.au=Kopotic%2C+RJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-De_Felice_2006-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-De_Felice_2006_28-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">De Felice C, Goldstein MR, Parrini S, Verrotti A, Criscuolo M, Latini G (March 2006). \"Early dynamic changes in pulse oximetry signals in preterm newborns with histologic chorioamnionitis\". <i>Pediatric Critical Care Medicine<\/i>. <b>7<\/b> (2): 138\u201342. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.PCC.0000201002.50708.62\" target=\"_blank\">10.1097\/01.PCC.0000201002.50708.62<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16474255\" target=\"_blank\">16474255<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatric+Critical+Care+Medicine&rft.atitle=Early+dynamic+changes+in+pulse+oximetry+signals+in+preterm+newborns+with+histologic+chorioamnionitis&rft.volume=7&rft.issue=2&rft.pages=138-42&rft.date=2006-03&rft_id=info%3Adoi%2F10.1097%2F01.PCC.0000201002.50708.62&rft_id=info%3Apmid%2F16474255&rft.aulast=De+Felice&rft.aufirst=C&rft.au=Goldstein%2C+MR&rft.au=Parrini%2C+S&rft.au=Verrotti%2C+A&rft.au=Criscuolo%2C+M&rft.au=Latini%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Takahashi S, Kakiuchi S, Nanba Y, Tsukamoto K, Nakamura T, Ito Y (April 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2834357\" target=\"_blank\">\"The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants\"<\/a>. <i>Journal of Perinatology<\/i>. <b>30<\/b> (4): 265\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fjp.2009.159\" target=\"_blank\">10.1038\/jp.2009.159<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2834357\" target=\"_blank\">2834357<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19907430\" target=\"_blank\">19907430<\/a>.<\/cite><span 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Retrieved <span class=\"nowrap\">2015-04-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pulse+Oximetry&rft.pub=Oximetry.org&rft.date=2002-09-10&rft_id=http%3A%2F%2Fwww.oximetry.org%2Fpulseox%2Fprinciples.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA (November 2004). \"Supplemental oxygen impairs detection of hypoventilation by pulse oximetry\". <i>Chest<\/i>. <b>126<\/b> (5): 1552\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1378%2Fchest.126.5.1552\" target=\"_blank\">10.1378\/chest.126.5.1552<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15539726\" target=\"_blank\">15539726<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chest&rft.atitle=Supplemental+oxygen+impairs+detection+of+hypoventilation+by+pulse+oximetry&rft.volume=126&rft.issue=5&rft.pages=1552-8&rft.date=2004-11&rft_id=info%3Adoi%2F10.1378%2Fchest.126.5.1552&rft_id=info%3Apmid%2F15539726&rft.aulast=Fu&rft.aufirst=ES&rft.au=Downs%2C+JB&rft.au=Schweiger%2C+JW&rft.au=Miguel%2C+RV&rft.au=Smith%2C+RA&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Schlosshan_2004-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Schlosshan_2004_41-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schlosshan D, Elliott MW (April 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1763828\" target=\"_blank\">\"Sleep . 3: Clinical presentation and diagnosis of the obstructive sleep apnoea hypopnoea syndrome\"<\/a>. <i>Thorax<\/i>. <b>59<\/b> (4): 347\u201352. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fthx.2003.007179\" target=\"_blank\">10.1136\/thx.2003.007179<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1763828\" target=\"_blank\">1763828<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15047962\" target=\"_blank\">15047962<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Thorax&rft.atitle=Sleep+.+3%3A+Clinical+presentation+and+diagnosis+of+the+obstructive+sleep+apnoea+hypopnoea+syndrome&rft.volume=59&rft.issue=4&rft.pages=347-52&rft.date=2004-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1763828&rft_id=info%3Apmid%2F15047962&rft_id=info%3Adoi%2F10.1136%2Fthx.2003.007179&rft.aulast=Schlosshan&rft.aufirst=D&rft.au=Elliott%2C+MW&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1763828&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.airweb.faa.gov\/Regulatory_and_Guidance_Library\/rgFAR.nsf\/0\/BA9AFBF96DBC56F0852566CF006798F9?OpenDocument&Highlight=oxygen\" target=\"_blank\">\"FAR Part 91 Sec. 91.211 effective as of 09\/30\/1963\"<\/a>. Airweb.faa.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-04-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=FAR+Part+91+Sec.+91.211+effective+as+of+09%2F30%2F1963&rft.pub=Airweb.faa.gov&rft_id=http%3A%2F%2Fwww.airweb.faa.gov%2FRegulatory_and_Guidance_Library%2FrgFAR.nsf%2F0%2FBA9AFBF96DBC56F0852566CF006798F9%3FOpenDocument%26Highlight%3Doxygen&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid26715772-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid26715772_43-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Amalakanti S, Pentakota MR (April 2016). \"Pulse Oximetry Overestimates Oxygen Saturation in COPD\". <i>Respiratory Care<\/i>. <b>61<\/b> (4): 423\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4187%2Frespcare.04435\" target=\"_blank\">10.4187\/respcare.04435<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26715772\" target=\"_blank\">26715772<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Respiratory+Care&rft.atitle=Pulse+Oximetry+Overestimates+Oxygen+Saturation+in+COPD&rft.volume=61&rft.issue=4&rft.pages=423-7&rft.date=2016-04&rft_id=info%3Adoi%2F10.4187%2Frespcare.04435&rft_id=info%3Apmid%2F26715772&rft.aulast=Amalakanti&rft.aufirst=S&rft.au=Pentakota%2C+MR&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">U.S. Market for Patient Monitoring Equipment. iData Research. May 2012<\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Key Portable Medical Device Vendors Worldwide\". <i>China Portable Medical Devices Report<\/i>. ResearchInChina. December 2008.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=China+Portable+Medical+Devices+Report&rft.atitle=Key+Portable+Medical+Device+Vendors+Worldwide&rft.date=2008-12&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Lovejoy B (24 April 2015). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/9to5mac.com\/2015\/04\/24\/apple-watch-blood-oxygen\/\" target=\"_blank\">\"Apple Watch teardown reveals pulse oximeter, suggesting future measurement of blood oxygen\"<\/a>. <i>9 to 5 Mac<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=9+to+5+Mac&rft.atitle=Apple+Watch+teardown+reveals+pulse+oximeter%2C+suggesting+future+measurement+of+blood+oxygen&rft.date=2015-04-24&rft.aulast=Lovejoy&rft.aufirst=B&rft_id=http%3A%2F%2F9to5mac.com%2F2015%2F04%2F24%2Fapple-watch-blood-oxygen%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/support.apple.com\/en-us\/HT204666\" target=\"_blank\">\"Your heart rate. What it means, and where on Apple Watch you'll find it\"<\/a>. Apple.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Your+heart+rate.+What+it+means%2C+and+where+on+Apple+Watch+you%E2%80%99ll+find+it.&rft.pub=Apple&rft_id=https%3A%2F%2Fsupport.apple.com%2Fen-us%2FHT204666&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Ross E (15 October 2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2016\/10\/15\/497828894\/you-can-monitor-your-heart-with-a-smartphone-but-should-you\" target=\"_blank\">\"You Can Monitor Heart Rhythm With A Smartphone, But Should You?\"<\/a>. <i>National Public Radio<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=National+Public+Radio&rft.atitle=You+Can+Monitor+Heart+Rhythm+With+A+Smartphone%2C+But+Should+You%3F&rft.date=2016-10-15&rft.aulast=Ross&rft.aufirst=E&rft_id=https%3A%2F%2Fwww.npr.org%2Fsections%2Fhealth-shots%2F2016%2F10%2F15%2F497828894%2Fyou-can-monitor-your-heart-with-a-smartphone-but-should-you&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Peloquin A. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/breakingmuscle.com\/fitness\/chest-strap-vs-wristband-heart-rate-monitors\" target=\"_blank\">\"Chest Strap Vs Wristband Heart Rate Monitors\"<\/a>. <i>Breaking Muscle<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Breaking+Muscle&rft.atitle=Chest+Strap+Vs+Wristband+Heart+Rate+Monitors&rft.aulast=Peloquin&rft.aufirst=A&rft_id=https%3A%2F%2Fbreakingmuscle.com%2Ffitness%2Fchest-strap-vs-wristband-heart-rate-monitors&rfr_id=info%3Asid%2Fen.wikipedia.org%3APulse+oximetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.howequipmentworks.com\/physics\/respi_measurements\/oxygen\/oximeter\/pulse_oximeter.html\" target=\"_blank\">Principles of pulse oximetry explained using diagrams<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181213195401\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.732 seconds\nReal time usage: 0.842 seconds\nPreprocessor visited node count: 2876\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 122602\/2097152 bytes\nTemplate argument size: 1984\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 141639\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.476\/10.000 seconds\nLua memory usage: 7.81 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 734.552 1 -total\n<\/p>\n<pre>65.52% 481.275 1 Template:Reflist\n51.86% 380.942 36 Template:Cite_journal\n 8.34% 61.260 1 Template:Commons_category\n 8.17% 60.022 3 Template:Citation_needed\n 7.19% 52.811 3 Template:Fix\n 6.96% 51.161 12 Template:Cite_web\n 5.52% 40.519 1 Template:Infobox_diagnostic\n 5.06% 37.203 1 Template:Infobox\n 4.34% 31.864 6 Template:Category_handler\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:784642-1!canonical and timestamp 20181213195400 and revision id 873531790\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_oximetry\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214638\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.034 seconds\nReal time usage: 0.192 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 183.148 1 - wikipedia:Pulse_oximetry\n100.00% 183.148 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8543-0!*!*!*!*!*!* and timestamp 20181217214637 and revision id 24968\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Pulse_oximetry\">https:\/\/www.limswiki.org\/index.php\/Pulse_oximetry<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","afe457601e8fb0cacd689590ddf21827_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Wrist-oximeter.jpg\/580px-Wrist-oximeter.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/6\/6e\/Oxy_and_Deoxy_Hemoglobin_Near-Infrared_absorption_spectra.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e5\/Saturometre_2.jpg\/440px-Saturometre_2.jpg"],"afe457601e8fb0cacd689590ddf21827_timestamp":1545083197,"e5b27287eb61604be40d5337581d4097_type":"article","e5b27287eb61604be40d5337581d4097_title":"Pill splitter","e5b27287eb61604be40d5337581d4097_url":"https:\/\/www.limswiki.org\/index.php\/Pill_splitting","e5b27287eb61604be40d5337581d4097_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPill splitting\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t A pill-splitter holding a tablet ready to split.\nPill-splitting refers to the practice of splitting a tablet or pill to provide a lower dose of the active ingredient, or to obtain multiple smaller doses, either to reduce cost or because the pills available provide a larger dose than required. Many pills that are suitable for splitting (aspirin tablets for instance) come pre-scored so that they may easily be halved.\nIt is unsafe to split some prescription medications.[1]\n\n Blade (right of center) and V-shaped pill positioner.\nContents \n\n1 Pill splitters \n2 Pill scoring \n3 Dosage uniformity \n4 Cost savings \n\n4.1 Some potentially suitable medications \n4.2 Uniformity of split \n4.3 Alternative purpose \n\n\n5 Risks \n6 Lawsuits \n7 See also \n8 References \n9 External links \n\n\nPill splitters \nA pill-splitter is a simple and inexpensive device to split medicinal pills or tablets, comprising some means of holding the tablet in place, a blade, and usually a compartment in which to store the unused part. The tablet is positioned, and the blade pressed down to split it. With care it is often possible to cut a tablet into quarters. Also available as consumer items are multiple pill splitters, which cut numerous round or oblong pills in one operation.\n\nPill scoring \nA drug manufacturer may score pills with a groove to both indicate that a pill may be split and to aid the practice of splitting pills. When manufacturers do create grooves in pills, the groove must be consistent for consumers to be able to use them effectively. Many manufacturers choose to not use grooves. The United States government Center for Drug Evaluation and Research makes the following recommendations for manufacturers when scoring pills with grooves:[2]\n\nPills should only have grooves if the split dosage is at least the minimum therapeutic dosage of the medication\nThe split pill should not create a toxicity hazard\nDrugs which should not be split should not be scored with a groove\nThe split pill should be stable for the expected temperature and humidity\nThe split pill should have an equivalent effect to a full pill at an equivalent dose\nDosage uniformity \nIn the U.S. \"uniformity of dosage units\" is defined by the United States Pharmacopeia (USP), which describes itself as \"the official public standards-setting authority for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products manufactured and sold in the United States.\"[3] More than 140 countries develop or rely upon US pharmaceutical standards according to the USP.\nThe USP standard for dosage uniformity expresses statistical criteria in the complex language of sampling protocols. The pharmaceutical dosage literature sometimes boils this down as requiring a standard deviation in dosage weight of less than 6%, which roughly corresponds to the weaker rule-of-thumb offered for public consumption that the vast majority of dosage units should be within 15% of the dosage target. \"Dosage unit\" is a technical term which covers oral medications (tablets, pills, capsules), as well as non-oral delivery methods.[4]\nA 2002 study of pill-splitting as conducted in four American long-term care facilities determined that 15 of the 22 dispensed prescriptions evaluated (68%) had fragment weight variance in excess of USP standards.[5]\n\nCost savings \nPill-splitting can be used to save money on pharmaceutical costs, as many prescription pharmaceuticals are sold at prices less than proportional to the dose. For example, a 10 mg tablet of a drug might be sold for the same or nearly the same price as a 5 mg tablet. Splitting 10 mg tablets allows the patient to purchase half the number of tablets at a lower price than the same weight of 5 mg tablets.\n\r\n\n\n\nU.S. medications suitable for pill splitting\r\nAs listed in 2002 Stanford study\n\n\nMedication\n\nDrug class\n\n\nclonazepam\npsychiatric\n\n\ndoxazosin\nblood pressure\n\n\natorvastatin\ncholesterol\n\n\npravastatin\ncholesterol\n\n\ncitalopram\npsychiatric\n\n\nsertraline\npsychiatric\n\n\nparoxetine\npsychiatric\n\n\nlisinopril\nblood pressure\n\n\nnefazodone *\npsychiatric\n\n\nolanzapine\npsychiatric\n\n\nsildenafil\nerectile dysfunction\n\n\n* Serzone brand discontinued 2004 in U.S.\n\nBoth specialist and generalist physicians are not sufficiently aware of and do not communicate with patients about the cost to them of medication.[6]\n\nSome potentially suitable medications \nRandall Stafford of the Stanford School of Medicine published a study in 2002 of common prescription medications in the United States in which he evaluates pill splitting for \"potential cost savings and clinical appropriateness\". The study identifies eleven prescription medications that satisfied the study criteria, based on the American pharmaceutical cost structure, pill formulation, and dosages of the time.[7] Most of the medications listed in the table from the psychiatric drug class are antidepressants.\n\nUniformity of split \nNot all tablets split equally well. In a 2002 study, Paxil, Zestril and Zoloft split cleanly with 0% rejects. Glucophage was described as a hard tablet, requiring significant force, causing tablet halves to fly. Glyburide exhibited very poor splitting with many splitting into multiple pieces. Hydrodiuril and Oretic crumbled. Lipitor did not split cleanly, and the coating peeled. The diamond shaped Viagra tablets made location of the midline difficult. The worst result reported was Oretic 25 mg in which 60% of tablets failed to split to within 15% of target weight.[8][9]\n\nAlternative purpose \nSome drugs have few different uses, and are usually sold in different packages and different doses for different applications. The price for some applications may be very different from that for other purposes.[citation needed ] One example is Minoxidil, which is well known as a hair-growth stimulant; the same drug under the name Loniten is used for blood pressure control in much larger doses at a much lower price per unit weight.[citation needed ]\n\nRisks \nThe Food and Drug Administration has called pill splitting \"risky\".[10] At the same time, the FDA approves the manufacture of pills which are intended to be split.[10]\nSplitting pills may result in uneven splitting and creating pieces which will not deliver accurate dosage.[10] Pills which are split might not be correctly halved, making the cut pieces unequal in size.[10] Some pills are difficult to split.[10] Some pills (particularly some time release drugs)[11] are unsafe to split, and there could be mistakes in identifying when pills should not be split.[10]\n\nLawsuits \nIn a California court filing dated April 2001, Trial Lawyers for Public Justice (TLPJ) brought a class-action lawsuit against Kaiser Permanente (Timmis v. Kaiser Permanente) on the grounds that \"Kaiser's mandatory pill-splitting policy endangers patients' health solely to enhance the HMO's profits\" in violation of the California Unfair Competition Law (UCL) and the California Consumer Legal Remedies Act (CLRA).[12][13] In December 2004, the California Court of Appeal affirmed the trial court ruling that Kaiser's policy did not violate UCL or CLRA, noting the suit had failed to present evidence that the policy was unsafe.[14]\n\nSee also \nInverse benefit law\nReferences \n\n\n^ FDA viewpoint on pill splitting \n\n^ Center for Drug Evaluation and Research (March 2013), Guidance for Industry \u2014 Tablet Scoring: Nomenclature, Labeling, and Data for Evaluation (PDF) , Silver Spring, MD: Food and Drug Administration, retrieved 3 August 2016 \n\n^ About USP, USP web site, undated, accessed 25 Nov 2007 \n\n^ Explanatory Note: USP\u2013NF General Chapter <905> Uniformity of Dosage Units, United States Pharmacopeial Convention, 20 April 2007 \n\n^ Rosenberg JM, Nathan JP, Plakogiannis F (2002). \"Weight variability of pharmacist-dispensed split tablets\". J Am Pharm Assoc (Wash). 42 (2): 200\u20135. doi:10.1331\/108658002763508498. PMID 11926663. \n\n^ Alexander GC, Casalino LP, Metlzer DO. Physician strategies to reduce patients\u2019 out-of-pocket prescription costs. Archives of Internal Medicine. 2005;165:633-636 [alexander.uchicago.edu\/publications\/image\/...\/OOPC%20mail%20survey.pdf] \n\n^ Stafford RS, Radley DC (August 2002). \"The potential of pill splitting to achieve cost savings\". Am J Manag Care. 8 (8): 706\u201312. PMID 12212758. \n\n^ Cross M (February 2003). \"Two for the price of one beauty of pill-splitting catches on\". Manag Care. 12 (2): 36\u20138. PMID 12658856. \n\n^ Cohen JS (2002). \"Tablet splitting: imperfect perhaps, but better than excessive dosing\". J Am Pharm Assoc (Wash). 42 (2): 160\u20132. doi:10.1331\/108658002763508443. PMID 11926659. Archived from the original on 2007-10-14. \n\n^ a b c d e f Food and Drug Administration (21 July 2009). \"Tablet Splitting: A Risky Practice\". fda.gov. Retrieved 3 August 2016 . \n\n^ See here for more info and references \n\n^ TLPJ \u2014 Press \u2014 Timmis v. Kaiser Permanente (pill splitting) - Dec. 6, 2000 \n\n^ TLPJ \u2014 Briefs \u2014 Timmis v. Kaiser Permanente (pill splitting) - April 22, 2001 \n\n^ http:\/\/www.aishealth.com\/ManagedCare\/HMOLawsuitWatch\/TimmisvKaiser.html \n\n\nExternal links \nThis article's use of external links may not follow Wikipedia's policies or guidelines. Please improve this article by removing excessive or inappropriate external links, and converting useful links where appropriate into footnote references. (September 2015) (Learn how and when to remove this template message)\nDevon Herrick (June 2, 2003). \"Shopping for Drugs \u2014 Study #262\". NCPA. \nHareyan, Armen (August 17 2005), \"Pill Splitting: Know When To Avoid Splitting The Difference\", Emaxhealth.com\nLawrence, Sarah M. (25 July 2007), Health Care Hot Topic: Tablet Splitting, studentdoctor.net, adapted from Journal of Clinical Psychology 62:10\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Pill_splitting\">https:\/\/www.limswiki.org\/index.php\/Pill_splitting<\/a>\n\t\t\t\t\tCategories: Healthcare termsMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:23.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 787 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e5b27287eb61604be40d5337581d4097_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Pill_splitting skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Pill splitting<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pill_splitter_2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Pill_splitter_2.jpg\/170px-Pill_splitter_2.jpg\" width=\"170\" height=\"201\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pill_splitter_2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A pill-splitter holding a tablet ready to split.<\/div><\/div><\/div>\n<p><b>Pill-splitting<\/b> refers to the practice of splitting a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tablet_(pharmacy)\" title=\"Tablet (pharmacy)\" rel=\"external_link\" target=\"_blank\">tablet<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pill_(pharmacy)\" class=\"mw-redirect\" title=\"Pill (pharmacy)\" rel=\"external_link\" target=\"_blank\">pill<\/a> to provide a lower dose of the active ingredient, or to obtain multiple smaller doses, either to reduce cost or because the pills available provide a larger dose than required. Many pills that are suitable for splitting (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Aspirin\" title=\"Aspirin\" rel=\"external_link\" target=\"_blank\">aspirin<\/a> tablets for instance) come pre-scored so that they may easily be halved.\n<\/p><p>It is unsafe to split some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prescription_medication\" class=\"mw-redirect\" title=\"Prescription medication\" rel=\"external_link\" target=\"_blank\">prescription medications<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pill_splitter_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a6\/Pill_splitter_1.jpg\/220px-Pill_splitter_1.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pill_splitter_1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Blade (right of center) and V-shaped pill positioner.<\/div><\/div><\/div>\n\n<h2><span class=\"mw-headline\" id=\"Pill_splitters\">Pill splitters<\/span><\/h2>\n<p>A pill-splitter is a simple and inexpensive device to split medicinal pills or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tablet_(pharmacy)\" title=\"Tablet (pharmacy)\" rel=\"external_link\" target=\"_blank\">tablets<\/a>, comprising some means of holding the tablet in place, a blade, and usually a compartment in which to store the unused part. The tablet is positioned, and the blade pressed down to split it. With care it is often possible to cut a tablet into <a href=\"https:\/\/en.wikipedia.org\/wiki\/4_(number)\" class=\"mw-redirect\" title=\"4 (number)\" rel=\"external_link\" target=\"_blank\">quarters<\/a>. Also available as consumer items are <i>multiple pill splitters<\/i>, which cut numerous round or oblong pills in one operation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Pill_scoring\">Pill scoring<\/span><\/h2>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmaceutical_industry\" title=\"Pharmaceutical industry\" rel=\"external_link\" target=\"_blank\">drug manufacturer<\/a> may score pills with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Groove_(engineering)\" title=\"Groove (engineering)\" rel=\"external_link\" target=\"_blank\">groove<\/a> to both indicate that a pill may be split and to aid the practice of splitting pills. When manufacturers do create grooves in pills, the groove must be consistent for consumers to be able to use them effectively. Many manufacturers choose to not use grooves. The United States government <a href=\"https:\/\/en.wikipedia.org\/wiki\/Center_for_Drug_Evaluation_and_Research\" title=\"Center for Drug Evaluation and Research\" rel=\"external_link\" target=\"_blank\">Center for Drug Evaluation and Research<\/a> makes the following recommendations for manufacturers when scoring pills with grooves:<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<ol><li>Pills should only have grooves if the split dosage is at least the minimum therapeutic dosage of the medication<\/li>\n<li>The split pill should not create a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicity\" title=\"Toxicity\" rel=\"external_link\" target=\"_blank\">toxicity<\/a> hazard<\/li>\n<li>Drugs which should not be split should not be scored with a groove<\/li>\n<li>The split pill should be stable for the expected temperature and humidity<\/li>\n<li>The split pill should have an equivalent effect to a full pill at an equivalent dose<\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Dosage_uniformity\">Dosage uniformity<\/span><\/h2>\n<p>In the U.S. \"uniformity of dosage units\" is defined by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Pharmacopeia\" title=\"United States Pharmacopeia\" rel=\"external_link\" target=\"_blank\">United States Pharmacopeia<\/a> (USP), which describes itself as \"the official public standards-setting authority for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products manufactured and sold in the United States.\"<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> More than 140 countries develop or rely upon US pharmaceutical standards according to the USP.\n<\/p><p>The USP standard for dosage uniformity expresses statistical criteria in the complex language of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sampling_(statistics)\" title=\"Sampling (statistics)\" rel=\"external_link\" target=\"_blank\">sampling protocols<\/a>. The pharmaceutical dosage literature sometimes boils this down as requiring a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Standard_deviation\" title=\"Standard deviation\" rel=\"external_link\" target=\"_blank\">standard deviation<\/a> in dosage weight of less than 6%, which roughly corresponds to the weaker rule-of-thumb offered for public consumption that the vast majority of dosage units should be within 15% of the dosage target. \"Dosage unit\" is a technical term which covers oral medications (tablets, pills, capsules), as well as non-oral delivery methods.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>A 2002 study of pill-splitting as conducted in four American long-term care facilities determined that 15 of the 22 dispensed prescriptions evaluated (68%) had fragment weight variance in excess of USP standards.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cost_savings\">Cost savings<\/span><\/h2>\n<p>Pill-splitting can be used to save money on pharmaceutical costs, as many prescription pharmaceuticals are sold at prices less than proportional to the dose. For example, a 10 mg tablet of a drug might be sold for the same or nearly the same price as a 5 mg tablet. Splitting 10 mg tablets allows the patient to purchase half the number of tablets at a lower price than the same weight of 5 mg tablets.\n<br \/>\n<\/p>\n<table align=\"right\" border=\"1px\" class=\"wikitable\" style=\"width: 20em; font-size:80%; margin: 0em 2em 0em 4em\">\n<caption>U.S. medications suitable for pill splitting<br \/>As listed in 2002 Stanford study\n<\/caption>\n<tbody><tr>\n<th width=\"40%\">Medication\n<\/th>\n<th width=\"60%\">Drug class\n<\/th><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clonazepam\" title=\"Clonazepam\" rel=\"external_link\" target=\"_blank\">clonazepam<\/a><\/td>\n<td>psychiatric\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Doxazosin\" title=\"Doxazosin\" rel=\"external_link\" target=\"_blank\">doxazosin<\/a><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a>\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atorvastatin\" title=\"Atorvastatin\" rel=\"external_link\" target=\"_blank\">atorvastatin<\/a><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholesterol\" title=\"Cholesterol\" rel=\"external_link\" target=\"_blank\">cholesterol<\/a>\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pravastatin\" title=\"Pravastatin\" rel=\"external_link\" target=\"_blank\">pravastatin<\/a><\/td>\n<td>cholesterol\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Citalopram\" title=\"Citalopram\" rel=\"external_link\" target=\"_blank\">citalopram<\/a><\/td>\n<td>psychiatric\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sertraline\" title=\"Sertraline\" rel=\"external_link\" target=\"_blank\">sertraline<\/a><\/td>\n<td>psychiatric\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paroxetine\" title=\"Paroxetine\" rel=\"external_link\" target=\"_blank\">paroxetine<\/a><\/td>\n<td>psychiatric\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lisinopril\" title=\"Lisinopril\" rel=\"external_link\" target=\"_blank\">lisinopril<\/a><\/td>\n<td>blood pressure\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nefazodone\" title=\"Nefazodone\" rel=\"external_link\" target=\"_blank\">nefazodone<\/a> *<\/td>\n<td>psychiatric\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Olanzapine\" title=\"Olanzapine\" rel=\"external_link\" target=\"_blank\">olanzapine<\/a><\/td>\n<td>psychiatric\n<\/td><\/tr>\n<tr>\n<td style=\"background:#ffdead\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sildenafil\" title=\"Sildenafil\" rel=\"external_link\" target=\"_blank\">sildenafil<\/a><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Erectile_dysfunction\" title=\"Erectile dysfunction\" rel=\"external_link\" target=\"_blank\">erectile dysfunction<\/a>\n<\/td><\/tr>\n<tr>\n<td style=\"font-size:80%\" colspan=\"2\">* Serzone brand discontinued 2004 in U.S.\n<\/td><\/tr><\/tbody><\/table>\n<p>Both specialist and generalist physicians are not sufficiently aware of and do not communicate with patients about the cost to them of medication.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Some_potentially_suitable_medications\">Some potentially suitable medications<\/span><\/h3>\n<p>Randall Stafford of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stanford_School_of_Medicine\" class=\"mw-redirect\" title=\"Stanford School of Medicine\" rel=\"external_link\" target=\"_blank\">Stanford School of Medicine<\/a> published a study in 2002 of common prescription medications in the United States in which he evaluates pill splitting for \"potential cost savings and clinical appropriateness\". The study identifies eleven prescription medications that satisfied the study criteria, based on the American pharmaceutical cost structure, pill formulation, and dosages of the time.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Most of the medications listed in the table from the psychiatric drug class are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antidepressant\" title=\"Antidepressant\" rel=\"external_link\" target=\"_blank\">antidepressants<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Uniformity_of_split\">Uniformity of split<\/span><\/h3>\n<p>Not all tablets split equally well. In a 2002 study, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paxil\" class=\"mw-redirect\" title=\"Paxil\" rel=\"external_link\" target=\"_blank\">Paxil<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zestril\" class=\"mw-redirect\" title=\"Zestril\" rel=\"external_link\" target=\"_blank\">Zestril<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zoloft\" class=\"mw-redirect\" title=\"Zoloft\" rel=\"external_link\" target=\"_blank\">Zoloft<\/a> split cleanly with 0% rejects. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucophage\" class=\"mw-redirect\" title=\"Glucophage\" rel=\"external_link\" target=\"_blank\">Glucophage<\/a> was described as a hard tablet, requiring significant force, causing tablet halves to fly. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glyburide\" class=\"mw-redirect\" title=\"Glyburide\" rel=\"external_link\" target=\"_blank\">Glyburide<\/a> exhibited very poor splitting with many splitting into multiple pieces. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrodiuril\" class=\"mw-redirect\" title=\"Hydrodiuril\" rel=\"external_link\" target=\"_blank\">Hydrodiuril<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oretic\" class=\"mw-redirect\" title=\"Oretic\" rel=\"external_link\" target=\"_blank\">Oretic<\/a> crumbled. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lipitor\" class=\"mw-redirect\" title=\"Lipitor\" rel=\"external_link\" target=\"_blank\">Lipitor<\/a> did not split cleanly, and the coating peeled. The diamond shaped <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viagra\" class=\"mw-redirect\" title=\"Viagra\" rel=\"external_link\" target=\"_blank\">Viagra<\/a> tablets made location of the midline difficult. The worst result reported was Oretic 25 mg in which 60% of tablets failed to split to within 15% of target weight.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Alternative_purpose\">Alternative purpose<\/span><\/h3>\n<p>Some drugs have few different uses, and are usually sold in different packages and different doses for different applications. The price for some applications may be very different from that for other purposes.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> One example is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minoxidil\" title=\"Minoxidil\" rel=\"external_link\" target=\"_blank\">Minoxidil<\/a>, which is well known as a hair-growth stimulant; the same drug under the name Loniten is used for blood pressure control in much larger doses at a much lower price per unit weight.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2011)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> has called pill splitting \"risky\".<sup id=\"rdp-ebb-cite_ref-FDA_2009_10-0\" class=\"reference\"><a href=\"#cite_note-FDA_2009-10\" rel=\"external_link\">[10]<\/a><\/sup> At the same time, the FDA approves the manufacture of pills which are intended to be split.<sup id=\"rdp-ebb-cite_ref-FDA_2009_10-1\" class=\"reference\"><a href=\"#cite_note-FDA_2009-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Splitting pills may result in uneven splitting and creating pieces which will not deliver accurate dosage.<sup id=\"rdp-ebb-cite_ref-FDA_2009_10-2\" class=\"reference\"><a href=\"#cite_note-FDA_2009-10\" rel=\"external_link\">[10]<\/a><\/sup> Pills which are split might not be correctly halved, making the cut pieces unequal in size.<sup id=\"rdp-ebb-cite_ref-FDA_2009_10-3\" class=\"reference\"><a href=\"#cite_note-FDA_2009-10\" rel=\"external_link\">[10]<\/a><\/sup> Some pills are difficult to split.<sup id=\"rdp-ebb-cite_ref-FDA_2009_10-4\" class=\"reference\"><a href=\"#cite_note-FDA_2009-10\" rel=\"external_link\">[10]<\/a><\/sup> Some pills (particularly some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Time_release_drug\" class=\"mw-redirect\" title=\"Time release drug\" rel=\"external_link\" target=\"_blank\">time release drugs<\/a>)<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> are unsafe to split, and there could be mistakes in identifying when pills should not be split.<sup id=\"rdp-ebb-cite_ref-FDA_2009_10-5\" class=\"reference\"><a href=\"#cite_note-FDA_2009-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Lawsuits\">Lawsuits<\/span><\/h2>\n<p>In a <a href=\"https:\/\/en.wikipedia.org\/wiki\/California\" title=\"California\" rel=\"external_link\" target=\"_blank\">California<\/a> court filing dated April 2001, (TLPJ) brought a class-action lawsuit against <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kaiser_Permanente\" title=\"Kaiser Permanente\" rel=\"external_link\" target=\"_blank\">Kaiser Permanente<\/a> (<i>Timmis v. Kaiser Permanente<\/i>) on the grounds that \"Kaiser's mandatory pill-splitting policy endangers patients' health solely to enhance the HMO's profits\" in violation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/California_Unfair_Competition_Law\" title=\"California Unfair Competition Law\" rel=\"external_link\" target=\"_blank\">California Unfair Competition Law<\/a> (UCL) and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/California_Consumer_Legal_Remedies_Act\" class=\"mw-redirect\" title=\"California Consumer Legal Remedies Act\" rel=\"external_link\" target=\"_blank\">California Consumer Legal Remedies Act<\/a> (CLRA).<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> In December 2004, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/California_Court_of_Appeal\" class=\"mw-redirect\" title=\"California Court of Appeal\" rel=\"external_link\" target=\"_blank\">California Court of Appeal<\/a> affirmed the trial court ruling that Kaiser's policy did not violate UCL or CLRA, noting the suit had failed to present evidence that the policy was unsafe.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Inverse_benefit_law\" title=\"Inverse benefit law\" rel=\"external_link\" target=\"_blank\">Inverse benefit law<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pharmacytimes.com\/news\/FDA-Takes-on-Unsafe-Pill-Splitting\/\" target=\"_blank\">FDA viewpoint on pill splitting<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFCenter_for_Drug_Evaluation_and_Research2013\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Center_for_Drug_Evaluation_and_Research\" title=\"Center for Drug Evaluation and Research\" rel=\"external_link\" target=\"_blank\">Center for Drug Evaluation and Research<\/a> (March 2013), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/downloads\/Drugs\/GuidanceComplianceRegulatoryInformation\/Guidances\/UCM269921.pdf\" target=\"_blank\"><i>Guidance for Industry \u2014 Tablet Scoring: Nomenclature, Labeling, and Data for Evaluation<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>, Silver Spring, MD: Food and Drug Administration<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">3 August<\/span> 2016<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Guidance+for+Industry+%E2%80%94+Tablet+Scoring%3A+Nomenclature%2C+Labeling%2C+and+Data+for+Evaluation&rft.place=Silver+Spring%2C+MD&rft.pub=Food+and+Drug+Administration&rft.date=2013-03&rft.au=Center+for+Drug+Evaluation+and+Research&rft_id=http%3A%2F%2Fwww.fda.gov%2Fdownloads%2FDrugs%2FGuidanceComplianceRegulatoryInformation%2FGuidances%2FUCM269921.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APill+splitting\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usp.org\/aboutUSP\/\" target=\"_blank\">About USP<\/a>, USP web site, undated, accessed 25 Nov 2007<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usp.org\/USPNF\/notices\/generalChapter905.html\" target=\"_blank\">Explanatory Note: USP\u2013NF General Chapter <905> Uniformity of Dosage Units<\/a>, United States Pharmacopeial Convention, 20 April 2007<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rosenberg JM, Nathan JP, Plakogiannis F (2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/japha.metapress.com\/app\/home\/contribution.asp?referrer=parent&backto=issue,10,24;journal,7,9;linkingpublicationresults,1:120081,1\" target=\"_blank\">\"Weight variability of pharmacist-dispensed split tablets\"<\/a>. <i>J Am Pharm Assoc (Wash)<\/i>. <b>42<\/b> (2): 200\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1331%2F108658002763508498\" target=\"_blank\">10.1331\/108658002763508498<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11926663\" target=\"_blank\">11926663<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Am+Pharm+Assoc+%28Wash%29&rft.atitle=Weight+variability+of+pharmacist-dispensed+split+tablets&rft.volume=42&rft.issue=2&rft.pages=200-5&rft.date=2002&rft_id=info%3Adoi%2F10.1331%2F108658002763508498&rft_id=info%3Apmid%2F11926663&rft.aulast=Rosenberg&rft.aufirst=JM&rft.au=Nathan%2C+JP&rft.au=Plakogiannis%2C+F&rft_id=http%3A%2F%2Fjapha.metapress.com%2Fapp%2Fhome%2Fcontribution.asp%3Freferrer%3Dparent%26backto%3Dissue%2C10%2C24%3Bjournal%2C7%2C9%3Blinkingpublicationresults%2C1%3A120081%2C1&rfr_id=info%3Asid%2Fen.wikipedia.org%3APill+splitting\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Alexander GC, Casalino LP, Metlzer DO. Physician strategies to reduce patients\u2019 out-of-pocket prescription costs. Archives of Internal Medicine. 2005;165:633-636 [alexander.uchicago.edu\/publications\/image\/...\/OOPC%20mail%20survey.pdf]<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stafford RS, Radley DC (August 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ajmc.com\/pubMed.php?pii=228\" target=\"_blank\">\"The potential of pill splitting to achieve cost savings\"<\/a>. <i>Am J Manag Care<\/i>. <b>8<\/b> (8): 706\u201312. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12212758\" target=\"_blank\">12212758<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am+J+Manag+Care&rft.atitle=The+potential+of+pill+splitting+to+achieve+cost+savings&rft.volume=8&rft.issue=8&rft.pages=706-12&rft.date=2002-08&rft_id=info%3Apmid%2F12212758&rft.aulast=Stafford&rft.aufirst=RS&rft.au=Radley%2C+DC&rft_id=http%3A%2F%2Fwww.ajmc.com%2FpubMed.php%3Fpii%3D228&rfr_id=info%3Asid%2Fen.wikipedia.org%3APill+splitting\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cross M (February 2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.managedcaremag.com\/archives\/0302\/0302.pillsplitting.html\" target=\"_blank\">\"Two for the price of one beauty of pill-splitting catches on\"<\/a>. <i>Manag Care<\/i>. <b>12<\/b> (2): 36\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12658856\" target=\"_blank\">12658856<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Manag+Care&rft.atitle=Two+for+the+price+of+one+beauty+of+pill-splitting+catches+on&rft.volume=12&rft.issue=2&rft.pages=36-8&rft.date=2003-02&rft_id=info%3Apmid%2F12658856&rft.au=Cross+M&rft_id=http%3A%2F%2Fwww.managedcaremag.com%2Farchives%2F0302%2F0302.pillsplitting.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APill+splitting\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cohen JS (2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071014010300\/http:\/\/www.medicationsense.com\/about_cohen.html\" target=\"_blank\">\"Tablet splitting: imperfect perhaps, but better than excessive dosing\"<\/a>. <i>J Am Pharm Assoc (Wash)<\/i>. <b>42<\/b> (2): 160\u20132. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1331%2F108658002763508443\" target=\"_blank\">10.1331\/108658002763508443<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11926659\" target=\"_blank\">11926659<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medicationsense.com\/about_cohen.html\" target=\"_blank\">the original<\/a> on 2007-10-14.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Am+Pharm+Assoc+%28Wash%29&rft.atitle=Tablet+splitting%3A+imperfect+perhaps%2C+but+better+than+excessive+dosing&rft.volume=42&rft.issue=2&rft.pages=160-2&rft.date=2002&rft_id=info%3Adoi%2F10.1331%2F108658002763508443&rft_id=info%3Apmid%2F11926659&rft.au=Cohen+JS&rft_id=http%3A%2F%2Fwww.medicationsense.com%2Fabout_cohen.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APill+splitting\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDA_2009-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDA_2009_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_2009_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_2009_10-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_2009_10-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_2009_10-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_2009_10-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (21 July 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/ForConsumers\/ConsumerUpdates\/ucm171492.htm\" target=\"_blank\">\"Tablet Splitting: A Risky Practice\"<\/a>. <i>fda.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">3 August<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=fda.gov&rft.atitle=Tablet+Splitting%3A+A+Risky+Practice&rft.date=2009-07-21&rft.au=Food+and+Drug+Administration&rft_id=http%3A%2F%2Fwww.fda.gov%2FForConsumers%2FConsumerUpdates%2Fucm171492.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APill+splitting\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#Pill_splitting\" title=\"Modified-release dosage\" rel=\"external_link\">See here<\/a> for more info and references<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tlpj.org\/pr\/kaiser_split.htm\" target=\"_blank\">TLPJ \u2014 Press \u2014 Timmis v. Kaiser Permanente (pill splitting) - Dec. 6, 2000<\/a><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tlpj.org\/briefs\/timmis_kaiser.htm\" target=\"_blank\">TLPJ \u2014 Briefs \u2014 Timmis v. Kaiser Permanente (pill splitting) - April 22, 2001<\/a><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.aishealth.com\/ManagedCare\/HMOLawsuitWatch\/TimmisvKaiser.html\" target=\"_blank\">http:\/\/www.aishealth.com\/ManagedCare\/HMOLawsuitWatch\/TimmisvKaiser.html<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><cite class=\"citation web\">Devon Herrick (June 2, 2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ncpa.org\/pub\/st262\" target=\"_blank\">\"Shopping for Drugs \u2014 Study #262\"<\/a>. <i>NCPA<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=NCPA&rft.atitle=Shopping+for+Drugs+%E2%80%94+Study+%23262&rft.date=2003-06-02&rft.au=Devon+Herrick&rft_id=http%3A%2F%2Fwww.ncpa.org%2Fpub%2Fst262&rfr_id=info%3Asid%2Fen.wikipedia.org%3APill+splitting\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li>Hareyan, Armen (August 17 2005), \"<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.emaxhealth.com\/94\/2873.html\" target=\"_blank\">Pill Splitting: Know When To Avoid Splitting The Difference<\/a>\", Emaxhealth.com<\/li>\n<li>Lawrence, Sarah M. (25 July 2007), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.studentdoctor.net\/blog\/2007\/07\/25\/health-care-hot-topic-tablet-splitting\/\" target=\"_blank\">Health Care Hot Topic: Tablet Splitting<\/a>, studentdoctor.net, adapted from Journal of Clinical Psychology 62:10<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181129215724\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.280 seconds\nReal time usage: 0.364 seconds\nPreprocessor visited node count: 843\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 22649\/2097152 bytes\nTemplate argument size: 1096\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 22955\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.163\/10.000 seconds\nLua memory usage: 3.49 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 309.077 1 -total\n<\/p>\n<pre>62.51% 193.194 1 Template:Reflist\n30.36% 93.838 1 Template:Citation\n27.85% 86.084 2 Template:Citation_needed\n21.93% 67.769 2 Template:Fix\n18.86% 58.301 4 Template:Cite_journal\n14.07% 43.479 4 Template:Category_handler\n 6.40% 19.770 2 Template:Delink\n 5.85% 18.089 1 Template:External_links\n 5.17% 15.986 2 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:5175930-1!canonical and timestamp 20181129215723 and revision id 850845898\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pill_splitting\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214637\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.383 1 - wikipedia:Pill_splitting\n100.00% 163.383 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8542-0!*!*!*!*!*!* and timestamp 20181217214637 and revision id 24967\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Pill_splitting\">https:\/\/www.limswiki.org\/index.php\/Pill_splitting<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e5b27287eb61604be40d5337581d4097_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Pill_splitter_2.jpg\/340px-Pill_splitter_2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a6\/Pill_splitter_1.jpg\/440px-Pill_splitter_1.jpg"],"e5b27287eb61604be40d5337581d4097_timestamp":1545083197,"d0f3e2284a9329d6c83d4e7fbd2c254d_type":"article","d0f3e2284a9329d6c83d4e7fbd2c254d_title":"Oxygen cylinder","d0f3e2284a9329d6c83d4e7fbd2c254d_url":"https:\/\/www.limswiki.org\/index.php\/Gas_cylinder","d0f3e2284a9329d6c83d4e7fbd2c254d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tGas cylinder\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCylindrical container for storing pressurised gas \nFor the mechanical devices used to impart a force from a pressurized gas, see pneumatic cylinder. For the large structures used to store town gas, see gas holder.\n Industrial compressed gas cylinders used for oxy-fuel welding and cutting of steel.\nA gas cylinder or tank is a pressure vessel for storage and containment of gases at above atmospheric pressure. High-pressure gas cylinders are also called bottles. Inside the cylinder the stored contents may be in a state of compressed gas, vapor over liquid, supercritical fluid, or dissolved in a substrate material, depending on the physical characteristics of the contents. A typical gas cylinder design is elongated, standing upright on a flattened bottom end, with the valve and fitting at the top for connecting to the receiving apparatus.\n\nContents \n\n1 Nomenclature \n2 Materials \n3 Regulations and cylinder testing \n4 Valve connections \n5 Safety and standards \n\n5.1 International and national standards \n5.2 Color coding \n\n\n6 Common cylinder sizes \n7 See also \n8 References \n9 External links \n\n\nNomenclature \nIn the United States, \"bottled gas\" typically refers to liquefied petroleum gas. \"Bottled gas\" is sometimes used in medical supply, especially for portable oxygen tanks. Packaged industrial gases are frequently called \"cylinder gas\", though \"bottled gas\" is sometimes used.\nThe United Kingdom and other parts of Europe more commonly refer to \"bottled gas\" when discussing any usage whether industrial, medical, or liquefied petroleum. However, in contrast, what the United States calls liquefied petroleum gas is known generically in the United Kingdom as \"LPG\"; and it may be ordered by using one of several trade names, or specifically as butane or propane depending on the required heat output.\n\nMaterials \nFor a detailed discussion about the materials for gas cylinders see pressure vessel.\nDesign codes and application standards and the cost of materials dictated the choice of steel with no welds for most gas cylinders, treated to be anticorrosive. Some newly developed lightweight gas cylinders have been made from stainless steel and composite materials. Due to the very high tensile strength of carbon fiber, these vessels can be very light, but are much more difficult to manufacture.[1]\n\nRegulations and cylinder testing \nThe transportation of high-pressure cylinders is regulated by many governments throughout the world. Various levels of testing are generally required by the governing authority for the country in which it is to be transported. In the United States, this authority is the United States Department of Transportation (DOT). Similarly in the UK, the European transport regulations (ADR) are implemented by the Department for Transport (DfT). For Canada, this authority is Transport Canada (TC). Cylinders may have additional requirements placed on design and or performance from independent testing agencies such as Underwriter's Laboratory (UL). Each manufacturer of high-pressure cylinders is required to have an independent quality agent that will inspect the product for quality and safety.\nWithin the UK the \"competent authority\" \u2014 the DfT \u2014 implements the regulations and appointment of authorised cylinder testers is conducted by UKAS, who make recommendations to the VCA for approval of individual bodies.\nThere are a variety of tests that may be performed on various cylinders. Some of the most common types of tests are hydrostatic test, burst test, tensile strength, Charpy impact test and pressure cycling.\nDuring the manufacturing process, vital information is usually stamped or permanently marked on the cylinder. This information usually includes the type of cylinder, the working or service pressure, the serial number, date of manufacture, the manufacture's registered code and sometimes the test pressure. Other information may also be stamped depending on the regulation requirements.\nHigh-pressure cylinders that are used multiple times \u2014 as most are \u2014 can be hydrostatically or ultrasonically tested and visually examined every few years.[2] In the United States, hydrostatic\/ultrasonic testing is required either every five years or every ten years, depending on cylinder and its service. Helium gas cylinders have the highest pressures possible when full, around 1000 atmospheres.[citation needed ]\n\nValve connections \n A gas regulator attached to a nitrogen cylinder. From right \u2014 cylinder valve, cylinder pressure gauge, pressure control valve (yellow), outlet pressure gauge, 3-way outlet terminated by needle valves.\nGas cylinders have a stop angle valve at the end on top. During storage, transportation, and handling when the gas is not in use, a cap may be screwed over the protruding valve to protect it from damage or breaking off in case the cylinder were to fall over. Instead of a cap, cylinders commonly have a protective collar or neck ring around the service valve assembly.\nWhen the gas in the cylinder is to be used at low pressure, the cap is taken off and a pressure-regulating assembly is attached to the stop valve. This attachment typically has a pressure regulator with upstream (inlet) and downstream (outlet) pressure gauges and a further downstream needle valve and outlet connection. For gases that remain gaseous under ambient storage conditions, the upstream pressure gauge can be used to estimate how much gas is left in the cylinder according to pressure. For gases that are liquid under storage, e.g., propane, the outlet pressure is dependent on the vapor pressure of the gas, and does not fall until the cylinder is nearly exhausted although it will vary according to the temperature of the cylinder contents. The regulator is adjusted to control the downstream pressure, which will limit the maximum flow of gas out of the cylinder at the pressure shown by the downstream gauge. The outlet connection is attached to whatever needs the gas supply, such as a balloon for example. For some purposes, such as welding, the regulator will also have a flowmeter on the downstream side.\nThe valves on industrial, medical and diving cylinders are usually of different sizes and types, as are the valves for different categories of gases, making it more difficult to mistakenly misuse a gas. For example, a hydrogen cylinder does not fit an oxygen supply line which would end in catastrophic failure. Some fittings use a right-hand thread, while others use a left-hand thread; left-hand thread fittings are usually identifiable by notches or grooves cut into them.\nIn the United States, valve connections are sometimes referred to as \"CGA connections\", since the Compressed Gas Association (CGA) publishes guidelines on what connections to use for what products; e.g., in the United States, an argon cylinder will have a CGA 580 connection on the valve.\nHigh purity gases will sometimes use CGA-DISS (\"Diameter Index Safety System\") connections.\nMedical gases may use the pin-index system to prevent incorrect connection of gases to services.\nIn the EU, DIN connections are more common than in the United States.\nIn the UK, the British Standards Institution sets the standards. Included among the standards is the use left-hand threaded valves for flammable gas cylinders (most commonly brass, BS4, valves for non corrosive cylinder contents or stainless steel, BS15, valves for corrosive contents). Non flammable gas cylinders are fitted with right-hand threaded valves (most commonly brass, BS3, valves for non corrosive components or stainless steel, BS14, valves for corrosive components).[3]\n\n\nCommon cylinder valves\n\n\nGas type\nCGA Valve Outlet (USA)\nBS Valve Outlet (UK)[3]\n\n\nAcetylene\n510\n2,4\n\n\nAir, Breathing\n346,347\n3\n\n\nAir, Industrial\n590\n3\n\n\nArgon\n580,718,680(3500 psi),677(6000 psi)\n3\n\n\nButane\n510\n4\n\n\nCarbon dioxide\n320,716\n8\n\n\nCarbon monoxide\n350,724\n4\n\n\nChlorine\n660,728\n6\n\n\nHelium\n580,718,680(3500psi)\n3\n\n\nHydrogen\n350,724,695(3500psi)\n4\n\n\nMethane\n350\n4\n\n\nNeon\n580,718\n3\n\n\nNitrogen\n580,718,680(3500 psi),677(6000 psi)\n3\n\n\nNitrous oxide\n326,712\n13\n\n\nOxygen\n540,714\n3\n\n\nOxygen mixtures (>23.5%)\n296\nOther guides apply\n\n\nPropane\n510\n4\n\n\nXenon\n580,718\n3\n\nSafety and standards \n It would be safer to have cylinders individually anchored in a cool place, rather than chained in a cluster in the sun, as seen here.\nBecause the contents are under pressure and are sometimes hazardous materials, handling bottled gases are regulated. Regulations may include chaining bottles to prevent falling and damaging the valve, proper ventilation to prevent injury or death in case of leaks and signage to indicate the potential hazards If a compressed gas cylinder tips over, causing the valve block to be sheared off, the rapid release of high-pressure gas may cause the cylinder to be violently accelerated, potentially causing property damage, injury, or death. To prevent this, cylinders are normally secured to a fixed object or transport cart with a strap or chain.\nIn a fire, the pressure in a gas cylinder rises in direct proportion to its temperature. If the internal pressure exceeds the mechanical limitations of the cylinder and there are no means to safely vent the pressurized gas to the atmosphere, the vessel will fail mechanically. If the vessel contents are flammable, this event may result in a \"fireball\".[4] Oxidisers such as oxygen and fluorine will produce a similar effect by accelerating combustion in the area affected. If the cylinder's contents are liquid, but become a gas at ambient conditions, this is commonly referred to as a boiling liquid expanding vapour explosion (BLEVE).\nMedical gas cylinders in the UK and some other countries have a fusible plug of Wood's metal in the valve block between the valve seat and the cylinder.[citation needed ] This plug melts at a comparatively low temperature (70 \u00b0C) and allows the contents of the cylinder to escape to the surroundings before the cylinder is significantly weakened by the heat, lessening the risk of explosion.\nMore common pressure relief devices are a simple burst disc installed in the base of the valve between the cylinder and the valve seat. A burst disc is a small metal gasket engineered to rupture at a pre-determined pressure. Some burst discs are backed with a low-melting-point metal, so that the valve must be exposed to excessive heat before the burst disc can rupture.[citation needed ]\nThe Compressed Gas Association publishes a number of booklets and pamphlets on safe handling and use of bottled gases.\n\nInternational and national standards \nThere is a wide range of standards relating to the manufacture, use and testing of pressurised gas cylinders and related components. Some examples are listed here.\n\nISO 11439: Gas cylinders \u2014 High-pressure cylinders for the on-board storage of natural gas as a fuel for automotive vehicles [5]\nISO 15500-5: Road vehicles \u2014 Compressed natural gas (CNG) fuel system components \u2014 Part 5: Manual cylinder valve [6][7]\nUS DOT 3\/4\/8???: e-CFR (Electronic Code of Federal Regulations) Title 49, part 178, Subpart C - Specification for Cylinders [8]\nUS DOT Aluminum Tank Alloy 6351-T6 amendment for SCUBA, SCBA, Oxygen Service - Visual Eddy inspection [9]\nAS 2896-2011:Medical gas systems\u2014Installation and testing of non-flammable medical gas pipeline systems pipeline systems (Australian Standards).\nColor coding \nGas cylinders are often color-coded, but the codes are not standard across different jurisdictions, and sometimes are not regulated. Cylinder color can not safely be used for positive product identification; cylinders have labels to identify the gas they contain.\n\nCommon cylinder sizes \nIn scuba diving, the United States measures cylinder volume by the amount of free air that can be compressed into the cylinder; Europe and most of the rest of the world measure the cylinder volume as the internal volume of the cylinder: e.g. United States 19 cubic feet = European 3 liter at 180 bar.\nThe below are example cylinder sizes and do not constitute an industry standard.\n\n\n\n\nCyl. size\n\nDiameter \u00d7 height (inches), includes 5.5 inches for valve and cap\n\nNominal tare weight (lb), includes 4.5 lb for valve and cap\n\nWater capacity (lb)\n\nInternal volume @ 70 \u00b0F (21 \u00b0C), 1 atm liters (cubic feet)\n\nU.S. DOT Specs\n\n\n2HP\n\n9 \u00d7 51\n\n187\n\n\n\n43.3 (1.53)\n\n3AA3500\n\n\nK\n\n9.25 \u00d7 60\n\n135\n\n110\n\n49.9 (1.76)\n\n3AA2400\n\n\nA\n\n9 \u00d7 51\n\n115\n\n96\n\n43.8 (1.55)\n\n3AA2015\n\n\nB\n\n8.5 \u00d7 31\n\n60\n\n37.9\n\n17.2 (0.61)\n\n3AA2015\n\n\nC\n\n6 \u00d7 24\n\n27\n\n15.2\n\n6.88 (0.24)\n\n3AA2015\n\n\nD\n\n4 \u00d7 18\n\n12\n\n4.9\n\n2.24 (0.08)\n\n3AA2015\n\n\nAL\n\n8 \u00d7 53\n\n52\n\n64.8\n\n29.5 (1.04)\n\n3AL2015\n\n\nBL\n\n7.25 \u00d7 39\n\n33\n\n34.6\n\n15.7 (0.55)\n\n3AL2216\n\n\nCL\n\n6.9 \u00d7 21\n\n19\n\n13\n\n5.9 (0.21)\n\n3AL2216\n\n\nXL\n\n14.5 \u00d7 50\n\n75\n\n238\n\n108 (3.83)\n\n4BA240\n\n\nSSB\n\n8 \u00d7 37\n\n95\n\n41.6\n\n18.9 (0.67)\n\n3A1800\n\n\n10S\n\n4 \u00d7 31\n\n21\n\n8.3\n\n3.8 (0.13)\n\n3A1800\n\n\nLB\n\n2 \u00d7 15\n\n4\n\n1\n\n0.44 (0.016)\n\n3E1800\n\n\nXF\n\n12 \u00d7 46\n\n180\n\n\n\n60.9 (2.15)\n\n8AL\n\n\nXG\n\n15 \u00d7 56\n\n149\n\n278\n\n126.3 (4.46)\n\n4AA480\n\n\nXM\n\n10 \u00d7 49\n\n90\n\n120\n\n54.3 (1.92)\n\n3A480\n\n\nXP\n\n10 \u00d7 55\n\n55\n\n124\n\n55.7 (1.98)\n\n4BA300\n\n\nQT\n\n3 \u00d7 14 (includes 4.5 inches for valve)\n\n2.5 (includes 1.5 lb for valve)\n\n2.0\n\n0.900 (0.0318)\n\n4B-240ET\n\n\nLP5\n\n12.25 \u00d7 18.25\n\n18.5\n\n47.7\n\n21.68 (0.76)\n\n4BW240\n\n\nMedical E\n\n4 \u00d7 26 (excludes valve and cap)\n\n14 (excludes valve and cap)\n\n\n\n4.5 (0.16)\n\n3AA2015\n\n\r\n\n\nSee also \n\n\n\nWikimedia Commons has media related to Gas cylinders.\nBottled gas\nPressure vessel\nCarbon fiber\nComposite overwrapped pressure vessel\nFilling carousel\nIndustrial gas\nStorage tank\nUN Recommendations on the Transport of Dangerous Goods\nReferences \n\n\n^ See Composite overwrapped pressure vessel for details \n\n^ Henderson, N. C.; Berry, W. E.; Eiber, R. J.; Frink, D. W. (1970). \"Investigation of scuba cylinder corrosion, Phase 1\". National Underwater Accident Data Center Technical Report Number 1. University of Rhode Island. Retrieved 2016-01-11 . \n\n^ a b BS 341-3:2002, British Standards Institution, 389 Chiswick High Road, London, W4 4AL \n\n^ \"Incident Insights - Trust But Verify\". Divers Alert Network. \n\n^ \"ISO 11439:2000 - Gas cylinders -- High pressure cylinders for the on-board storage of natural gas as a fuel for automotive vehicles\". \n\n^ \"ISO 15500-5:2001 - Road vehicles -- Compressed natural gas (CNG) fuel system components -- Part 5: Manual cylinder valve\". \n\n^ \"CNG Cylinder Valve ISO 15500 -\". \n\n^ US DOT e-CFR (Electronic Code of Federal Regulations) Title 49, part 178, Subpart C - Specification for Cylinders - eg DOT 3AL = seamless aluminum \n\n^ Federal Register \/ Vol. 71, No. 167 \/ Tuesday, August 29, 2006 \/ Rules and Regulations Title 49 CFR Parts 173 and 180 Visual Edddy \n\n\n\n\nExternal links \nNASA - Safety Standards for Oxygen and Oxygen Handling\nvtePackagingGeneral topics\nActive packaging\nChild-resistant packaging\nContract packager\nModified atmosphere\/modified humidity packaging\nPackage pilferage\nPackage testing\nPackaging engineering\nReusable packaging\nShelf life\nShelf-ready packaging\nShelf-stable\nSustainable 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printing\nSecurity tape\nShock detector\nShock and vibration data logger\nShrink wrap\nSlip sheet\nStaple (fastener)\nStrapping\nStretch wrap\nSusceptor\nTamper-evident band\nTear tape\nTemperature data logger\nTime temperature indicator\nTinplate\nVelostat\nProcesses\nAseptic processing\nAuthentication\nAutomatic identification and data capture\nBlow fill seal\nBlow molding\nCalendering\nCanning\nCoating\nContainerization\nCorona treatment\nCurtain coating\nDie cutting\nDie forming (plastics)\nElectronic article surveillance\nExtrusion\nExtrusion coating\nFlame treatment\nGlass production\nGraphic design\nHACCP\nHermetic seal\nInduction sealing\nInjection moulding\nLamination\nLaser cutting\nMolding\nPapermaking\nPlastic welding\nPlastics extrusion\nPrinting\nQuality assurance\nRadio-frequency identification\nRoll slitting\nShearing (manufacturing)\nThermoforming\nTrack and trace\nVacuum forming\nUltrasonic welding\nVacuum packaging\nVerification and validation\nMachinery\nBarcode printer\nBarcode reader\nBottling line\nCalender\nCan seamer\nCartoning machine\nCase sealer\nCheck weigher\nConveyor system\nExtended core stretch wrapper\nFiller\nHeat gun\nHeat sealer\nIndustrial robot\nInjection molding machine\nLabel printer applicator\nLineshaft roller conveyor\nLogistics automation\nMaterial-handling equipment\nMechanical brake stretch wrapper\nMultihead weigher\nOrbital stretch wrapper\nPalletizer\nRotary wheel blow molding systems\nShrink tunnel\nStaple gun\nTape dispenser\nTurntable stretch wrapper\nVertical form fill sealing machine\nEnvironment,\r\n post-use\nBiodegradation\nEnvironmental engineering\nGlass recycling\nIndustrial ecology\nLife-cycle assessment\nLitter\nPaper recycling\nPlastic recycling\nRecycling\nReusable packaging\nReverse logistics\nSource reduction\nSustainable packaging\nWaste management\n Packaging portal •   Category: Packaging\nvteAnesthesia and anesthesiologyTypes\nGeneral\nSedation\nTwilight anesthesia\nLocal\nTopical\nIntercostal nerve block\nNeuraxial blockade\nSpinal\nEpidural\nDental\nInferior alveolar nerve\nTechniques\nAirway management\nAnesthesia provision in the US\nArterial catheter\nBronchoscopy\nCapnography\nDogliotti's principle\nDrug-induced amnesia\nIntraoperative neurophysiological monitoring\nNerve block\nPenthrox inhaler\nTracheal intubation\nScientific principles\nBlood\u2013gas partition coefficient\nConcentration effect\nFink effect\nMinimum alveolar concentration\nSecond gas effect\nMeasurements\nASA physical status classification system\nBaricity\nBispectral index\nEntropy monitoring\nFick principle\nGoldman index\nGuedel's classification\nMallampati score\nNeuromuscular monitoring\nThyromental distance\nInstruments\nAnaesthetic machine\nAnesthesia cart\nBoyle's machine\nGas cylinder\nLaryngeal mask airway\nLaryngeal tube\nMedical monitor\nOdom's indicator\nRelative analgesia machine\nVaporiser\nDouble-lumen endotracheal tube\nEndobronchial blocker\nComplications\nEmergence delirium\nAllergic reactions\nAnesthesia awareness\nLocal anesthetic toxicity\nMalignant hyperthermia\nPerioperative mortality\nPostanesthetic shivering\nPostoperative nausea and vomiting\nPostoperative residual curarization\nFields of study\nCardiothoracic\nGeriatric\nOral sedation dentistry\nProfessions\nAnesthesiologist\nAnesthesiologist assistant\nNurse anesthetist\nOperating Department Practitioners\nCertified Anesthesia Technician\nCertified Anesthesia Technologist\nAnaesthetic technician\nHistory\nA.C.E. mixture\nHelsinki Declaration for Patient Safety in Anaesthesiology\nHistory of general anesthesia\nHistory of neuraxial anesthesia\nHistory of tracheal intubation\nOrganizations\nAmerican Association of Nurse Anesthetists\nAmerican Society of Anesthesia Technologists & Technicians\nAmerican Society of Anesthesiologists\nAnaesthesia Trauma and Critical Care\nAssociation of Anaesthetists of Great Britain and Ireland\nAssociation of Veterinary Anaesthetists\nAustralian and New Zealand College of Anaesthetists\nAustralian Society of Anaesthetists\nInternational Anesthesia Research Society\n\n Category\n Portal\n Outline\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Gas_cylinder\">https:\/\/www.limswiki.org\/index.php\/Gas_cylinder<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:19.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 807 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d0f3e2284a9329d6c83d4e7fbd2c254d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Gas_cylinder skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Gas cylinder<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">Cylindrical container for storing pressurised gas <\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">For the mechanical devices used to impart a force from a pressurized gas, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumatic_cylinder\" title=\"Pneumatic cylinder\" rel=\"external_link\" target=\"_blank\">pneumatic cylinder<\/a>. For the large structures used to store town gas, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_holder\" title=\"Gas holder\" rel=\"external_link\" target=\"_blank\">gas holder<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Compressed_gas_cylinders.mapp_and_oxygen.triddle.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3b\/Compressed_gas_cylinders.mapp_and_oxygen.triddle.jpg\/220px-Compressed_gas_cylinders.mapp_and_oxygen.triddle.jpg\" width=\"220\" height=\"233\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Compressed_gas_cylinders.mapp_and_oxygen.triddle.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Industrial compressed gas cylinders used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxy-fuel_welding_and_cutting\" title=\"Oxy-fuel welding and cutting\" rel=\"external_link\" target=\"_blank\">oxy-fuel welding and cutting<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Steel\" title=\"Steel\" rel=\"external_link\" target=\"_blank\">steel<\/a>.<\/div><\/div><\/div>\n<p>A <b>gas cylinder<\/b> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Storage_tank\" title=\"Storage tank\" rel=\"external_link\" target=\"_blank\">tank<\/a> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_vessel\" title=\"Pressure vessel\" rel=\"external_link\" target=\"_blank\">pressure vessel<\/a> for storage and containment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas\" title=\"Gas\" rel=\"external_link\" target=\"_blank\">gases<\/a> at above <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atmospheric_pressure\" title=\"Atmospheric pressure\" rel=\"external_link\" target=\"_blank\">atmospheric pressure<\/a>. High-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure\" title=\"Pressure\" rel=\"external_link\" target=\"_blank\">pressure<\/a> gas cylinders are also called <i>bottles<\/i>. Inside the cylinder the stored contents may be in a state of compressed gas, vapor over liquid, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Supercritical_fluid\" title=\"Supercritical fluid\" rel=\"external_link\" target=\"_blank\">supercritical fluid<\/a>, or dissolved in a substrate material, depending on the physical characteristics of the contents. A typical gas cylinder design is elongated, standing upright on a flattened bottom end, with the valve and fitting at the top for connecting to the receiving apparatus.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Nomenclature\">Nomenclature<\/span><\/h2>\n<p>In the United States, \"bottled gas\" typically refers to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liquefied_petroleum_gas\" title=\"Liquefied petroleum gas\" rel=\"external_link\" target=\"_blank\">liquefied petroleum gas<\/a>. \"Bottled gas\" is sometimes used in medical supply, especially for portable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_tank\" title=\"Oxygen tank\" rel=\"external_link\" target=\"_blank\">oxygen tanks<\/a>. Packaged industrial gases are frequently called \"cylinder gas\", though \"bottled gas\" is sometimes used.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">United Kingdom<\/a> and other parts of Europe more commonly refer to \"bottled gas\" when discussing any usage whether industrial, medical, or liquefied petroleum. However, in contrast, what the United States calls liquefied petroleum gas is known generically in the United Kingdom as \"LPG\"; and it may be ordered by using one of several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trade_name\" title=\"Trade name\" rel=\"external_link\" target=\"_blank\">trade names<\/a>, or specifically as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butane\" title=\"Butane\" rel=\"external_link\" target=\"_blank\">butane<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Propane\" title=\"Propane\" rel=\"external_link\" target=\"_blank\">propane<\/a> depending on the required heat output.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h2>\n<p>For a detailed discussion about the materials for gas cylinders see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_vessel#Construction_materials\" title=\"Pressure vessel\" rel=\"external_link\" target=\"_blank\">pressure vessel<\/a>.\n<\/p><p>Design codes and application standards and the cost of materials dictated the choice of steel with no welds for most gas cylinders, treated to be . Some newly developed lightweight gas cylinders have been made from stainless steel and composite materials. Due to the very high tensile strength of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_fiber\" class=\"mw-redirect\" title=\"Carbon fiber\" rel=\"external_link\" target=\"_blank\">carbon fiber<\/a>, these vessels can be very light, but are much more difficult to manufacture.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Regulations_and_cylinder_testing\">Regulations and cylinder testing<\/span><\/h2>\n<p>The transportation of high-pressure cylinders is regulated by many governments throughout the world. Various levels of testing are generally required by the governing authority for the country in which it is to be transported. In the United States, this authority is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Department_of_Transportation\" title=\"United States Department of Transportation\" rel=\"external_link\" target=\"_blank\">United States Department of Transportation<\/a> (DOT). Similarly in the UK, the European transport regulations (ADR) are implemented by the Department for Transport (DfT). For Canada, this authority is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transport_Canada\" title=\"Transport Canada\" rel=\"external_link\" target=\"_blank\">Transport Canada<\/a> (TC). Cylinders may have additional requirements placed on design and or performance from independent testing agencies such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Underwriter%27s_Laboratory\" class=\"mw-redirect\" title=\"Underwriter's Laboratory\" rel=\"external_link\" target=\"_blank\">Underwriter's Laboratory<\/a> (UL). Each manufacturer of high-pressure cylinders is required to have an independent quality agent that will inspect the product for quality and safety.\n<\/p><p>Within the UK the <b>\"<\/b><a href=\"https:\/\/en.wikipedia.org\/wiki\/Competent_authority\" title=\"Competent authority\" rel=\"external_link\" target=\"_blank\">competent authority<\/a><b>\"<\/b> \u2014 the DfT \u2014 implements the regulations and appointment of authorised cylinder testers is conducted by UKAS, who make recommendations to the VCA for approval of individual bodies.\n<\/p><p>There are a variety of tests that may be performed on various cylinders. Some of the most common types of tests are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrostatic_test\" title=\"Hydrostatic test\" rel=\"external_link\" target=\"_blank\">hydrostatic test<\/a>, burst test, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charpy_impact_test\" title=\"Charpy impact test\" rel=\"external_link\" target=\"_blank\">Charpy impact test<\/a> and pressure cycling.\n<\/p><p>During the manufacturing process, vital information is usually stamped or permanently marked on the cylinder. This information usually includes the type of cylinder, the working or service pressure, the serial number, date of manufacture, the manufacture's registered code and sometimes the test pressure. Other information may also be stamped depending on the regulation requirements.\n<\/p><p>High-pressure cylinders that are used multiple times \u2014 as most are \u2014 can be hydrostatically or ultrasonically tested and visually examined every few years.<sup id=\"rdp-ebb-cite_ref-URIreport1_2-0\" class=\"reference\"><a href=\"#cite_note-URIreport1-2\" rel=\"external_link\">[2]<\/a><\/sup> In the United States, hydrostatic\/ultrasonic testing is required either every five years or every ten years, depending on cylinder and its service. Helium gas cylinders have the highest pressures possible when full, around 1000 atmospheres.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Valve_connections\">Valve connections<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gas_regulator.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4f\/Gas_regulator.jpg\/220px-Gas_regulator.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gas_regulator.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A gas regulator attached to a nitrogen cylinder. From right \u2014 cylinder valve, cylinder pressure gauge, pressure control valve (yellow), outlet pressure gauge, 3-way outlet terminated by needle valves.<\/div><\/div><\/div>\n<p>Gas cylinders have a stop angle <a href=\"https:\/\/en.wikipedia.org\/wiki\/Valve\" title=\"Valve\" rel=\"external_link\" target=\"_blank\">valve<\/a> at the end on top. During storage, transportation, and handling when the gas is not in use, a cap may be screwed over the protruding valve to protect it from damage or breaking off in case the cylinder were to fall over. Instead of a cap, cylinders commonly have a protective collar or neck ring around the service valve assembly.\n<\/p><p>When the gas in the cylinder is to be used at low pressure, the cap is taken off and a pressure-regulating assembly is attached to the stop valve. This attachment typically has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_regulator\" title=\"Pressure regulator\" rel=\"external_link\" target=\"_blank\">pressure regulator<\/a> with upstream (inlet) and downstream (outlet) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_gauge\" class=\"mw-redirect\" title=\"Pressure gauge\" rel=\"external_link\" target=\"_blank\">pressure gauges<\/a> and a further downstream <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_valve\" title=\"Needle valve\" rel=\"external_link\" target=\"_blank\">needle valve<\/a> and outlet connection. For gases that remain gaseous under ambient storage conditions, the upstream pressure gauge can be used to estimate how much gas is left in the cylinder according to pressure. For gases that are liquid under storage, e.g., propane, the outlet pressure is dependent on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vapor_pressure\" title=\"Vapor pressure\" rel=\"external_link\" target=\"_blank\">vapor pressure<\/a> of the gas, and does not fall until the cylinder is nearly exhausted although it will vary according to the temperature of the cylinder contents. The regulator is adjusted to control the downstream pressure, which will limit the maximum flow of gas out of the cylinder at the pressure shown by the downstream gauge. The outlet connection is attached to whatever needs the gas supply, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Balloon\" title=\"Balloon\" rel=\"external_link\" target=\"_blank\">balloon<\/a> for example. For some purposes, such as welding, the regulator will also have a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flowmeter\" class=\"mw-redirect\" title=\"Flowmeter\" rel=\"external_link\" target=\"_blank\">flowmeter<\/a> on the downstream side.\n<\/p><p>The valves on industrial, medical and diving cylinders are usually of different sizes and types, as are the valves for different categories of gases, making it more difficult to mistakenly misuse a gas. For example, a hydrogen cylinder does not fit an oxygen supply line which would end in catastrophic failure. Some fittings use a right-hand thread, while others use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screw_thread\" title=\"Screw thread\" rel=\"external_link\" target=\"_blank\">left-hand thread<\/a>; left-hand thread fittings are usually identifiable by notches or grooves cut into them.\n<\/p><p>In the United States, valve connections are sometimes referred to as \"CGA connections\", since the <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cganet.com\/\" target=\"_blank\">Compressed Gas Association<\/a> (CGA) publishes guidelines on what connections to use for what products; e.g., in the United States, an argon cylinder will have a CGA 580 connection on the valve.\n<\/p><p>High purity gases will sometimes use CGA-DISS (\"Diameter Index Safety System\") connections.\n<\/p><p>Medical gases may use the to prevent incorrect connection of gases to services.\n<\/p><p>In the EU, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deutsches_Institut_f%C3%BCr_Normung\" title=\"Deutsches Institut f\u00fcr Normung\" rel=\"external_link\" target=\"_blank\">DIN<\/a> connections are more common than in the United States.\n<\/p><p>In the UK, the British Standards Institution sets the standards. Included among the standards is the use left-hand threaded valves for flammable gas cylinders (most commonly brass, BS4, valves for non corrosive cylinder contents or stainless steel, BS15, valves for corrosive contents). Non flammable gas cylinders are fitted with right-hand threaded valves (most commonly brass, BS3, valves for non corrosive components or stainless steel, BS14, valves for corrosive components).<sup id=\"rdp-ebb-cite_ref-BS341-3:2002_3-0\" class=\"reference\"><a href=\"#cite_note-BS341-3:2002-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n<caption>Common cylinder valves\n<\/caption>\n<tbody><tr>\n<th>Gas type<\/th>\n<th>CGA Valve Outlet (USA)<\/th>\n<th>BS Valve Outlet (UK)<sup id=\"rdp-ebb-cite_ref-BS341-3:2002_3-1\" class=\"reference\"><a href=\"#cite_note-BS341-3:2002-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/th><\/tr>\n<tr>\n<td>Acetylene<\/td>\n<td>510<\/td>\n<td>2,4\n<\/td><\/tr>\n<tr>\n<td>Air, Breathing<\/td>\n<td>346,347<\/td>\n<td>3\n<\/td><\/tr>\n<tr>\n<td>Air, Industrial<\/td>\n<td>590<\/td>\n<td>3\n<\/td><\/tr>\n<tr>\n<td>Argon<\/td>\n<td>580,718,680(3500 psi),677(6000 psi)<\/td>\n<td>3\n<\/td><\/tr>\n<tr>\n<td>Butane<\/td>\n<td>510<\/td>\n<td>4\n<\/td><\/tr>\n<tr>\n<td>Carbon dioxide<\/td>\n<td>320,716<\/td>\n<td>8\n<\/td><\/tr>\n<tr>\n<td>Carbon monoxide<\/td>\n<td>350,724<\/td>\n<td>4\n<\/td><\/tr>\n<tr>\n<td>Chlorine<\/td>\n<td>660,728<\/td>\n<td>6\n<\/td><\/tr>\n<tr>\n<td>Helium<\/td>\n<td>580,718,680(3500psi)<\/td>\n<td>3\n<\/td><\/tr>\n<tr>\n<td>Hydrogen<\/td>\n<td>350,724,695(3500psi)<\/td>\n<td>4\n<\/td><\/tr>\n<tr>\n<td>Methane<\/td>\n<td>350<\/td>\n<td>4\n<\/td><\/tr>\n<tr>\n<td>Neon<\/td>\n<td>580,718<\/td>\n<td>3\n<\/td><\/tr>\n<tr>\n<td>Nitrogen<\/td>\n<td>580,718,680(3500 psi),677(6000 psi)<\/td>\n<td>3\n<\/td><\/tr>\n<tr>\n<td>Nitrous oxide<\/td>\n<td>326,712<\/td>\n<td>13\n<\/td><\/tr>\n<tr>\n<td>Oxygen<\/td>\n<td>540,714<\/td>\n<td>3\n<\/td><\/tr>\n<tr>\n<td>Oxygen mixtures (>23.5%)<\/td>\n<td>296<\/td>\n<td>Other guides apply\n<\/td><\/tr>\n<tr>\n<td>Propane<\/td>\n<td>510<\/td>\n<td>4\n<\/td><\/tr>\n<tr>\n<td>Xenon<\/td>\n<td>580,718<\/td>\n<td>3\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Safety_and_standards\">Safety and standards<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2008-07-24_Bundle_of_compressed_gas_bottles.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/97\/2008-07-24_Bundle_of_compressed_gas_bottles.jpg\/220px-2008-07-24_Bundle_of_compressed_gas_bottles.jpg\" width=\"220\" height=\"292\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2008-07-24_Bundle_of_compressed_gas_bottles.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>It would be safer to have cylinders individually anchored in a cool place, rather than chained in a cluster in the sun, as seen here.<\/div><\/div><\/div>\n<p>Because the contents are under pressure and are sometimes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hazardous_material\" class=\"mw-redirect\" title=\"Hazardous material\" rel=\"external_link\" target=\"_blank\">hazardous materials<\/a>, handling bottled gases are regulated. Regulations may include chaining bottles to prevent falling and damaging the valve, proper ventilation to prevent injury or death in case of leaks and signage to indicate the potential hazards If a compressed gas cylinder tips over, causing the valve block to be sheared off, the rapid release of high-pressure gas may cause the cylinder to be violently accelerated, potentially causing property damage, injury, or death. To prevent this, cylinders are normally secured to a fixed object or transport cart with a strap or chain.\n<\/p><p>In a fire, the pressure in a gas cylinder <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boyle%27s_law\" title=\"Boyle's law\" rel=\"external_link\" target=\"_blank\">rises in direct proportion to its temperature<\/a>. If the internal pressure exceeds the mechanical limitations of the cylinder and there are no means to safely vent the pressurized gas to the atmosphere, the vessel will fail mechanically. If the vessel contents are flammable, this event may result in a \"fireball\".<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Oxidisers such as oxygen and fluorine will produce a similar effect by accelerating combustion in the area affected. If the cylinder's contents are liquid, but become a gas at ambient conditions, this is commonly referred to as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boiling_liquid_expanding_vapour_explosion\" class=\"mw-redirect\" title=\"Boiling liquid expanding vapour explosion\" rel=\"external_link\" target=\"_blank\">boiling liquid expanding vapour explosion<\/a> (BLEVE).\n<\/p><p>Medical gas cylinders in the UK and some other countries have a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fusible_plug\" title=\"Fusible plug\" rel=\"external_link\" target=\"_blank\">fusible plug<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wood%27s_metal\" title=\"Wood's metal\" rel=\"external_link\" target=\"_blank\">Wood's metal<\/a> in the valve block between the valve seat and the cylinder.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> This plug melts at a comparatively low temperature (70 \u00b0C) and allows the contents of the cylinder to escape to the surroundings before the cylinder is significantly weakened by the heat, lessening the risk of explosion.\n<\/p><p>More common pressure relief devices are a simple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Burst_disc\" class=\"mw-redirect\" title=\"Burst disc\" rel=\"external_link\" target=\"_blank\">burst disc<\/a> installed in the base of the valve between the cylinder and the valve seat. A burst disc is a small metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gasket\" title=\"Gasket\" rel=\"external_link\" target=\"_blank\">gasket<\/a> engineered to rupture at a pre-determined pressure. Some burst discs are backed with a low-melting-point metal, so that the valve must be exposed to excessive heat before the burst disc can rupture.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressed_Gas_Association\" title=\"Compressed Gas Association\" rel=\"external_link\" target=\"_blank\">Compressed Gas Association<\/a> publishes a number of booklets and pamphlets on safe handling and use of bottled gases.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"International_and_national_standards\">International and national standards<\/span><\/h3>\n<p>There is a wide range of standards relating to the manufacture, use and testing of pressurised gas cylinders and related components. Some examples are listed here.\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_11439\" class=\"mw-redirect\" title=\"ISO 11439\" rel=\"external_link\" target=\"_blank\">ISO 11439<\/a>: Gas cylinders \u2014 High-pressure cylinders for the on-board storage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressed_natural_gas\" title=\"Compressed natural gas\" rel=\"external_link\" target=\"_blank\">natural gas<\/a> as a fuel for automotive vehicles <sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><\/li>\n<li>ISO 15500-5: Road vehicles \u2014 Compressed natural gas (CNG) fuel system components \u2014 Part 5: Manual cylinder valve <sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><\/li>\n<li>US DOT 3\/4\/8???: e-CFR (Electronic Code of Federal Regulations) Title 49, part 178, Subpart C - Specification for Cylinders <sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li>US DOT Aluminum Tank Alloy 6351-T6 amendment for SCUBA, SCBA, Oxygen Service - Visual Eddy inspection <sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>AS 2896-2011:Medical gas systems\u2014Installation and testing of non-flammable medical gas pipeline systems pipeline systems (Australian Standards).<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Color_coding\">Color coding<\/span><\/h3>\n<p>Gas cylinders are often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bottled_gas#Colour_coding\" title=\"Bottled gas\" rel=\"external_link\" target=\"_blank\">color-coded<\/a>, but the codes are not standard across different jurisdictions, and sometimes are not regulated. Cylinder color can not safely be used for positive product identification; cylinders have labels to identify the gas they contain.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Common_cylinder_sizes\">Common cylinder sizes<\/span><\/h2>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scuba_diving\" title=\"Scuba diving\" rel=\"external_link\" target=\"_blank\">scuba diving<\/a>, the United States measures cylinder volume by the amount of free air that can be compressed into the cylinder; Europe and most of the rest of the world measure the cylinder volume as the internal volume of the cylinder: e.g. United States 19 cubic feet = European 3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liter\" class=\"mw-redirect\" title=\"Liter\" rel=\"external_link\" target=\"_blank\">liter<\/a> at 180 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bar_(unit)\" title=\"Bar (unit)\" rel=\"external_link\" target=\"_blank\">bar<\/a>.\n<\/p><p>The below are example cylinder sizes and do not constitute an industry standard.\n<\/p>\n<table class=\"wikitable sortable\" style=\"\">\n\n<tbody><tr>\n<th>Cyl. size\n<\/th>\n<th>Diameter \u00d7 height (inches), includes 5.5 inches for valve and cap\n<\/th>\n<th>Nominal tare weight (lb), includes 4.5 lb for valve and cap\n<\/th>\n<th>Water capacity (lb)\n<\/th>\n<th>Internal volume @ 70 \u00b0F (21 \u00b0C), 1 atm liters (cubic feet)\n<\/th>\n<th>U.S. DOT Specs\n<\/th><\/tr>\n<tr>\n<td>2HP\n<\/td>\n<td>9 \u00d7 51\n<\/td>\n<td>187\n<\/td>\n<td>\n<\/td>\n<td>43.3 (1.53)\n<\/td>\n<td>3AA3500\n<\/td><\/tr>\n<tr>\n<td>K\n<\/td>\n<td>9.25 \u00d7 60\n<\/td>\n<td>135\n<\/td>\n<td>110\n<\/td>\n<td>49.9 (1.76)\n<\/td>\n<td>3AA2400\n<\/td><\/tr>\n<tr>\n<td>A\n<\/td>\n<td>9 \u00d7 51\n<\/td>\n<td>115\n<\/td>\n<td>96\n<\/td>\n<td>43.8 (1.55)\n<\/td>\n<td>3AA2015\n<\/td><\/tr>\n<tr>\n<td>B\n<\/td>\n<td>8.5 \u00d7 31\n<\/td>\n<td>60\n<\/td>\n<td>37.9\n<\/td>\n<td>17.2 (0.61)\n<\/td>\n<td>3AA2015\n<\/td><\/tr>\n<tr>\n<td>C\n<\/td>\n<td>6 \u00d7 24\n<\/td>\n<td>27\n<\/td>\n<td>15.2\n<\/td>\n<td>6.88 (0.24)\n<\/td>\n<td>3AA2015\n<\/td><\/tr>\n<tr>\n<td>D\n<\/td>\n<td>4 \u00d7 18\n<\/td>\n<td>12\n<\/td>\n<td>4.9\n<\/td>\n<td>2.24 (0.08)\n<\/td>\n<td>3AA2015\n<\/td><\/tr>\n<tr>\n<td>AL\n<\/td>\n<td>8 \u00d7 53\n<\/td>\n<td>52\n<\/td>\n<td>64.8\n<\/td>\n<td>29.5 (1.04)\n<\/td>\n<td>3AL2015\n<\/td><\/tr>\n<tr>\n<td>BL\n<\/td>\n<td>7.25 \u00d7 39\n<\/td>\n<td>33\n<\/td>\n<td>34.6\n<\/td>\n<td>15.7 (0.55)\n<\/td>\n<td>3AL2216\n<\/td><\/tr>\n<tr>\n<td>CL\n<\/td>\n<td>6.9 \u00d7 21\n<\/td>\n<td>19\n<\/td>\n<td>13\n<\/td>\n<td>5.9 (0.21)\n<\/td>\n<td>3AL2216\n<\/td><\/tr>\n<tr>\n<td>XL\n<\/td>\n<td>14.5 \u00d7 50\n<\/td>\n<td>75\n<\/td>\n<td>238\n<\/td>\n<td>108 (3.83)\n<\/td>\n<td>4BA240\n<\/td><\/tr>\n<tr>\n<td>SSB\n<\/td>\n<td>8 \u00d7 37\n<\/td>\n<td>95\n<\/td>\n<td>41.6\n<\/td>\n<td>18.9 (0.67)\n<\/td>\n<td>3A1800\n<\/td><\/tr>\n<tr>\n<td>10S\n<\/td>\n<td>4 \u00d7 31\n<\/td>\n<td>21\n<\/td>\n<td>8.3\n<\/td>\n<td>3.8 (0.13)\n<\/td>\n<td>3A1800\n<\/td><\/tr>\n<tr>\n<td>LB\n<\/td>\n<td>2 \u00d7 15\n<\/td>\n<td>4\n<\/td>\n<td>1\n<\/td>\n<td>0.44 (0.016)\n<\/td>\n<td>3E1800\n<\/td><\/tr>\n<tr>\n<td>XF\n<\/td>\n<td>12 \u00d7 46\n<\/td>\n<td>180\n<\/td>\n<td>\n<\/td>\n<td>60.9 (2.15)\n<\/td>\n<td>8AL\n<\/td><\/tr>\n<tr>\n<td>XG\n<\/td>\n<td>15 \u00d7 56\n<\/td>\n<td>149\n<\/td>\n<td>278\n<\/td>\n<td>126.3 (4.46)\n<\/td>\n<td>4AA480\n<\/td><\/tr>\n<tr>\n<td>XM\n<\/td>\n<td>10 \u00d7 49\n<\/td>\n<td>90\n<\/td>\n<td>120\n<\/td>\n<td>54.3 (1.92)\n<\/td>\n<td>3A480\n<\/td><\/tr>\n<tr>\n<td>XP\n<\/td>\n<td>10 \u00d7 55\n<\/td>\n<td>55\n<\/td>\n<td>124\n<\/td>\n<td>55.7 (1.98)\n<\/td>\n<td>4BA300\n<\/td><\/tr>\n<tr>\n<td>QT\n<\/td>\n<td>3 \u00d7 14 (includes 4.5 inches for valve)\n<\/td>\n<td>2.5 (includes 1.5 lb for valve)\n<\/td>\n<td>2.0\n<\/td>\n<td>0.900 (0.0318)\n<\/td>\n<td>4B-240ET\n<\/td><\/tr>\n<tr>\n<td>LP5\n<\/td>\n<td>12.25 \u00d7 18.25\n<\/td>\n<td>18.5\n<\/td>\n<td>47.7\n<\/td>\n<td>21.68 (0.76)\n<\/td>\n<td>4BW240\n<\/td><\/tr>\n<tr>\n<td>Medical E\n<\/td>\n<td>4 \u00d7 26 (excludes valve and cap)\n<\/td>\n<td>14 (excludes valve and cap)\n<\/td>\n<td>\n<\/td>\n<td>4.5 (0.16)\n<\/td>\n<td>3AA2015\n<\/td><\/tr><\/tbody><\/table>\n<p><br \/>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bottled_gas\" title=\"Bottled gas\" rel=\"external_link\" target=\"_blank\">Bottled gas<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_vessel\" title=\"Pressure vessel\" rel=\"external_link\" target=\"_blank\">Pressure vessel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_fiber\" class=\"mw-redirect\" title=\"Carbon fiber\" rel=\"external_link\" target=\"_blank\">Carbon fiber<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_overwrapped_pressure_vessel\" title=\"Composite overwrapped pressure vessel\" rel=\"external_link\" target=\"_blank\">Composite overwrapped pressure vessel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Filling_carousel\" title=\"Filling carousel\" rel=\"external_link\" target=\"_blank\">Filling carousel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Industrial_gas\" title=\"Industrial gas\" rel=\"external_link\" target=\"_blank\">Industrial gas<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Storage_tank\" title=\"Storage tank\" rel=\"external_link\" target=\"_blank\">Storage tank<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/UN_Recommendations_on_the_Transport_of_Dangerous_Goods\" title=\"UN Recommendations on the Transport of Dangerous Goods\" rel=\"external_link\" target=\"_blank\">UN Recommendations on the Transport of Dangerous Goods<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">See <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_overwrapped_pressure_vessel\" title=\"Composite overwrapped pressure vessel\" rel=\"external_link\" target=\"_blank\">Composite overwrapped pressure vessel<\/a> for details<\/span>\n<\/li>\n<li id=\"cite_note-URIreport1-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-URIreport1_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Henderson, N. C.; Berry, W. E.; Eiber, R. J.; Frink, D. W. (1970). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archive.rubicon-foundation.org\/9293\" target=\"_blank\">\"Investigation of scuba cylinder corrosion, Phase 1\"<\/a>. <i>National Underwater Accident Data Center Technical Report Number 1<\/i>. University of Rhode Island<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-01-11<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=National+Underwater+Accident+Data+Center+Technical+Report+Number+1&rft.atitle=Investigation+of+scuba+cylinder+corrosion%2C+Phase+1&rft.date=1970&rft.aulast=Henderson&rft.aufirst=N.+C.&rft.au=Berry%2C+W.+E.&rft.au=Eiber%2C+R.+J.&rft.au=Frink%2C+D.+W.&rft_id=http%3A%2F%2Farchive.rubicon-foundation.org%2F9293&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGas+cylinder\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-BS341-3:2002-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BS341-3:2002_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BS341-3:2002_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">BS 341-3:2002, British Standards Institution, 389 Chiswick High Road, London, W4 4AL<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.diversalertnetwork.org\/diving-incidents\/trust-but-verify\" target=\"_blank\">\"Incident Insights - Trust But Verify\"<\/a>. <i>Divers Alert Network<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Divers+Alert+Network&rft.atitle=Incident+Insights+-+Trust+But+Verify&rft_id=https%3A%2F%2Fwww.diversalertnetwork.org%2Fdiving-incidents%2Ftrust-but-verify&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGas+cylinder\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iso.org\/iso\/catalogue_detail?csnumber=33298\" target=\"_blank\">\"ISO 11439:2000 - Gas cylinders -- High pressure cylinders for the on-board storage of natural gas as a fuel for automotive vehicles\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ISO+11439%3A2000+-+Gas+cylinders+--+High+pressure+cylinders+for+the+on-board+storage+of+natural+gas+as+a+fuel+for+automotive+vehicles&rft_id=http%3A%2F%2Fwww.iso.org%2Fiso%2Fcatalogue_detail%3Fcsnumber%3D33298&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGas+cylinder\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iso.org\/iso\/iso_catalogue\/catalogue_tc\/catalogue_detail.htm?csnumber=30452\" target=\"_blank\">\"ISO 15500-5:2001 - Road vehicles -- Compressed natural gas (CNG) fuel system components -- Part 5: Manual cylinder valve\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ISO+15500-5%3A2001+-+Road+vehicles+--+Compressed+natural+gas+%28CNG%29+fuel+system+components+--+Part+5%3A+Manual+cylinder+valve&rft_id=http%3A%2F%2Fwww.iso.org%2Fiso%2Fiso_catalogue%2Fcatalogue_tc%2Fcatalogue_detail.htm%3Fcsnumber%3D30452&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGas+cylinder\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iso15500.com\/\" target=\"_blank\">\"CNG Cylinder Valve ISO 15500 -\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=CNG+Cylinder+Valve+ISO+15500+-&rft_id=http%3A%2F%2Fwww.iso15500.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGas+cylinder\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#49:2.1.1.3.14.3\/\">US DOT e-CFR (Electronic Code of Federal Regulations) Title 49, part 178, Subpart C - Specification for Cylinders - eg DOT 3AL = seamless aluminum<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/edocket.access.gpo.gov\/2006\/pdf\/E6-14255.pdf\" target=\"_blank\">Federal Register \/ Vol. 71, No. 167 \/ Tuesday, August 29, 2006 \/ Rules and Regulations Title 49 CFR Parts 173 and 180 Visual Edddy<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p class=\"mw-empty-elt\">\n<\/p>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hq.nasa.gov\/office\/codeq\/doctree\/canceled\/1740151.pdf\" target=\"_blank\">NASA - Safety Standards for Oxygen and Oxygen Handling<\/a><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1256\nCached time: 20181214124150\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.364 seconds\nReal time usage: 0.528 seconds\nPreprocessor visited node count: 1204\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 65295\/2097152 bytes\nTemplate argument size: 2071\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 14437\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.144\/10.000 seconds\nLua memory usage: 4.4 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 375.532 1 -total\n<\/p>\n<pre>27.16% 102.002 1 Template:Reflist\n20.10% 75.466 3 Template:Citation_needed\n17.96% 67.447 3 Template:Fix\n17.70% 66.471 1 Template:Cite_journal\n16.17% 60.725 1 Template:Commons_category\n12.57% 47.190 2 Template:Navbox\n11.80% 44.305 1 Template:Short_description\n11.13% 41.790 1 Template:Packaging\n10.50% 39.436 1 Template:Pagetype\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1179236-1!canonical and timestamp 20181214124149 and revision id 867383383\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_cylinder\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214637\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.028 seconds\nReal time usage: 0.191 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 182.144 1 - wikipedia:Gas_cylinder\n100.00% 182.144 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8541-0!*!*!*!*!*!* and timestamp 20181217214637 and revision id 24966\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Gas_cylinder\">https:\/\/www.limswiki.org\/index.php\/Gas_cylinder<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d0f3e2284a9329d6c83d4e7fbd2c254d_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3b\/Compressed_gas_cylinders.mapp_and_oxygen.triddle.jpg\/440px-Compressed_gas_cylinders.mapp_and_oxygen.triddle.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4f\/Gas_regulator.jpg\/440px-Gas_regulator.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/97\/2008-07-24_Bundle_of_compressed_gas_bottles.jpg\/440px-2008-07-24_Bundle_of_compressed_gas_bottles.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/Can%28Easy_Open_Can%29.JPG\/24px-Can%28Easy_Open_Can%29.JPG"],"d0f3e2284a9329d6c83d4e7fbd2c254d_timestamp":1545083197,"97b1f7e3aae6d4658e2698f7b5f6696e_type":"article","97b1f7e3aae6d4658e2698f7b5f6696e_title":"Infusion pump","97b1f7e3aae6d4658e2698f7b5f6696e_url":"https:\/\/www.limswiki.org\/index.php\/Infusion_pump","97b1f7e3aae6d4658e2698f7b5f6696e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tInfusion pump\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2011) (Learn how and when to remove this template message)\n A type of infusion pump, manufactured by Fresenius.\nAn infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used.\nInfusion pumps can administer fluids in ways that would be impractically expensive or unreliable if performed manually by nursing staff. For example, they can administer as little as 0.1 mL per hour injections (too small for a drip), injections every minute, injections with repeated boluses requested by the patient, up to maximum number per hour (e.g. in patient-controlled analgesia), or fluids whose volumes vary by the time of day.\nBecause they can also produce quite high but controlled pressures, they can inject controlled amounts of fluids subcutaneously (beneath the skin), or epidurally (just within the surface of the central nervous system \u2013 a very popular local spinal anesthesia for childbirth).\n\nContents \n\n1 Types of infusion \n2 Types of pump \n3 Safety features available on some pumps \n4 Safety issues \n5 See also \n6 References \n\n\nTypes of infusion \nThe user interface of pumps usually requests details on the type of infusion from the technician or nurse that sets them up:\n\nContinuous infusion usually consists of small pulses of infusion, usually between 500 nanoliters and 10 milliliters, depending on the pump's design, with the rate of these pulses depending on the programmed infusion speed.\nIntermittent infusion has a \"high\" infusion rate, alternating with a low programmable infusion rate to keep the cannula open. The timings are programmable. This mode is often used to administer antibiotics, or other drugs that can irritate a blood vessel.\nTo get the entire dose of antibiotics into the patient, the \"volume to be infused\" or VTBI must be programmed for at least 30 CCs more than is in the medication bag...or else up to half of the antibiotic will be left in the IV tubing.\n\nPatient-controlled is infusion on-demand, usually with a preprogrammed ceiling to avoid intoxication. The rate is controlled by a pressure pad or button that can be activated by the patient. It is the method of choice for patient-controlled analgesia (PCA), in which repeated small doses of opioid analgesics are delivered, with the device coded to stop administration before a dose that may cause hazardous respiratory depression is reached.\nTotal parenteral nutrition usually requires an infusion curve similar to normal mealtimes.\nSome pumps offer modes in which the amounts can be scaled or controlled based on the time of day. This allows for circadian cycles which may be required for certain types of medication.\n\nTypes of pump \n A Baxter International Colleague CX infusion pump\nThere are two basic classes of pumps. Large volume pumps can pump nutrient solutions large enough to feed a patient. Small-volume pumps infuse hormones, such as insulin, or other medicines, such as opiates.\nWithin these classes, some pumps are designed to be portable, others are designed to be used in a hospital, and there are special systems for charity and battlefield use.\nLarge-volume pumps usually use some form of peristaltic pump. Classically, they use computer-controlled rollers compressing a silicone-rubber tube through which the medicine flows. Another common form is a set of fingers that press on the tube in sequence.\nSmall-volume pumps usually use a computer-controlled motor turning a screw that pushes the plunger on a syringe.\nThe classic medical improvisation for an infusion pump is to place a blood pressure cuff around a bag of fluid. The battlefield equivalent is to place the bag under the patient. The pressure on the bag sets the infusion pressure. The pressure can actually be read-out at the cuff's indicator. The problem is that the flow varies dramatically with the cuff's pressure(or patient's weight), and the needed pressure varies with the administration route, potentially causing risk when attempted by an individual not trained in this method.\nPlaces that must provide the least-expensive care often use pressurized infusion systems. One common system has a purpose-designed plastic \"pressure bottle\" pressurized with a large disposable plastic syringe. A combined flow restrictor, air filter and drip chamber helps a nurse set the flow. The parts are reusable, mass-produced sterile plastic, and can be produced by the same machines that make plastic soft-drink bottles and caps. A pressure bottle, restrictor and chamber requires more nursing attention than electronically controlled pumps. In the areas where these are used, nurses are often volunteers, or very inexpensive.\nThe restrictor and high pressure helps control the flow better than the improvised schemes because the high pressure through the small restrictor orifice reduces the variation of flow caused by patients' blood pressures.\nAn air filter is an essential safety device in a pressure infusor, to keep air out of the patients' veins. Small bubbles could cause harm in arteries, but in the veins they pass through the heart and leave in the patients' lungs. The air filter is just a membrane that passes gas but not fluid or pathogens. When a large air bubble reaches it, it bleeds off.\nSome of the smallest infusion pumps use osmotic power. Basically, a bag of salt solution absorbs water through a membrane, swelling its volume. The bag presses medicine out. The rate is precisely controlled by the salt concentrations and pump volume. Osmotic pumps are usually recharged with a syringe.\nSpring-powered clockwork infusion pumps have been developed, and are sometimes still used in veterinary work and for ambulatory small-volume pumps. They generally have one spring to power the infusion, and another for the alarm bell when the infusion completes.\nBattlefields often have a need to perfuse large amounts of fluid quickly, with dramatically changing blood pressures and patient condition. Specialized infusion pumps have been designed for this purpose, although they have not been deployed.\nMany infusion pumps are controlled by a small embedded system. They are carefully designed so that no single cause of failure can harm the patient. For example, most have batteries in case the wall-socket power fails. Additional hazards are uncontrolled flow causing an overdose, uncontrolled lack of flow, causing an underdose, reverse flow, which can siphon blood from a patient, and air in the line, which can cause an air embolism.\n\nSafety features available on some pumps \nThis section has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n This article's factual accuracy may be compromised due to out-of-date information. Please update this article to reflect recent events or newly available information. (May 2012)\n \n (Learn how and when to remove this template message)\nThe range of safety features varies widely with the age and make of the pump. A state of the art pump in 2003[update] may have the following safety features:\n\nCertified to have no single point of failure. That is, no single cause of failure should cause the pump to silently fail to operate correctly. It should at least stop pumping and make at least an audible error indication. This is a minimum requirement on all human-rated infusion pumps of whatever age. It is not required for veterinary infusion pumps.\nBatteries, so the pump can operate if the power fails or is unplugged.\nAnti-free-flow devices prevent blood from draining from the patient, or infusate from freely entering the patient, when the infusion pump is being set up.\nA \"down pressure\" sensor will detect when the patient's vein is blocked, or the line to the patient is kinked. This may be configurable for high (subcutaneous and epidural) or low (venous) applications.\nAn \"air-in-line\" detector. A typical detector will use an ultrasonic transmitter and receiver to detect when air is being pumped. Some pumps actually measure the volume, and may even have configurable volumes, from 0.1 to 2 ml of air. None of these amounts can cause harm, but sometimes the air can interfere with the infusion of a low-dose medicine.\nAn \"up pressure\" sensor can detect when the bag or syringe is empty, or even if the bag or syringe is being squeezed.\nA drug library with customizable programmable limits for individual drugs that helps to avoid medication errors.\nMechanisms to avoid uncontrolled flow of drugs in large volume pumps (often in combination with a giving st based free flow clamp) and increasingly also in syringe pumps (piston-brake)\nMany pumps include an internal electronic log of the last several thousand therapy events. These are usually tagged with the time and date from the pump's clock. Usually, erasing the log is a feature protected by a security code, specifically to detect staff abuse of the pump or patient.\nMany makes of infusion pump can be configured to display only a small subset of features while they are operating, in order to prevent tampering by patients, untrained staff and visitors.\nSafety issues \nInfusion pumps have been a source of multiple patient safety concerns, and problems with such pumps have been linked to more than 56,000 adverse event reports from 2005 to 2009, including at least 500 deaths.[1] As a result, the U.S. Food and Drug Administration (FDA) has launched a comprehensive initiative to improve their safety, called the Infusion Pump Improvement Initiative.[2] The initiative proposed stricter regulation of infusion pumps. It cited software defects, user interface issues, and mechanical or electrical failures as the main causes of adverse events.\n\nSee also \nIntravenous drip\nPharmacy informatics\nSyringe driver\nTotal parenteral nutrition\nReferences \n\n\n^ Pharmacy Practice News, May 2010 \n\n^ http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/GeneralHospitalDevicesandSupplies\/InfusionPumps\/ucm205424.htm \n\n\nvteRoutes of administration, dosage formsOralDigestive\r\ntract (enteral)Solids\nPill\nTablet\nCapsule\nPastille\nTime release technology\nOsmotic delivery system (OROS)\n\r\nLiquids\nDecoction\nElixir\nElectuary\nEmulsion\nExtended-release syrup\nEffervescent powder or tablet\nHerbal tea\nHydrogel\nMolecular encapsulation\nPowder\nSoftgel\nSolution\nSuspension\nSyrup\nSyrup Concentrate for dilution and\/or addition of carbonated water\nTincture\nBuccal (sublabial), sublingualSolids\nOrally disintegrating tablet (ODT)\nFilm\nLollipop\nSublingual drops\nLozenges\nEffervescent buccal tablet\nChewing gum\nLiquids\nMouthwash\nToothpaste\nOintment\nOral spray\nRespiratory\r\ntractSolids\nSmoking device\nDry-powder inhaler (DPI)\n\r\n0 \r\n0 Liquids\nAnaesthetic vaporizer\nVaporizer\nNebulizer\nMetered-dose inhaler (MDI)\nGas\nOxygen mask and Nasal cannula\nOxygen concentrator\nAnaesthetic machine\nRelative analgesia machine\nOphthalmic,\r\notologic, nasal\nNasal spray\nEar drops\nEye drops\nOintment\nHydrogel\nNanosphere suspension\nInsufflation\nMucoadhesive microdisc (microsphere tablet)Urogenital\nOintment\nPessary (vaginal suppository)\nVaginal ring\nVaginal douche\nIntrauterine device (IUD)\nExtra-amniotic infusion\nIntravesical infusion\nRectal (enteral)\nOintment\nSuppository\nEnema\nSolution\nHydrogel\nMurphy drip\nNutrient enemaDermal\nOintment\nTopical cream\nTopical gel\nLiniment\nPaste\nFilm\nDMSO drug solution\nElectrophoretic dermal delivery system\nHydrogel\nLiposomes\nTransfersome vesicles\nCream\nLotion\nLip balm\nMedicated shampoo\nDermal patch\nTransdermal patch\nContact (rubbed into break in the skin)\nTransdermal spray\nJet injectorInjection,\r\ninfusion\r\n(into tissue\/blood)Skin\nIntradermal\nSubcutaneous\nTransdermal implant\nOrgans\nIntracavernous\nIntravitreal\nIntra-articular injection\nTransscleral\nCentral nervous system\nIntracerebral\nIntrathecal\nEpidural\nCirculatory, musculoskeletal\nIntravenous\nIntracardiac\nIntramuscular\nIntraosseous\nIntraperitoneal\nNanocell injection\nPatient-Controlled Analgesia pump\nPIC line\n\n Category\n WikiProject\n Pharmacy portal\n\nvteIntravenous therapyInfused substancesBlood-based product\nWhole blood\nPF24\/Fresh frozen plasma (Cryosupernatant + Cryoprecipitate)\nBlood substitute\nHemoglobin-based\nVolume expander\nLactated Ringer's\nNormal saline\nSugar solution\nBuffers\nLactated Ringer's, Sodium bicarbonate\nMedications\nIntravenous immunoglobulin\nParenteral nutrition\nSugar\nOther\nDrug injection\nAccess points\nPeripheral venous catheter\nPeripherally inserted central catheter (Seldinger technique)\nCentral venous catheter\nOther equipment\nInfusion pump\nCVC\nSLC\nMLC\nPICC\nImplantable catheters\nPorts\nThermodilution catheters\nHemodialysis catheters\nSpecific risks\nAir embolism\nExtravasation\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Infusion_pump\">https:\/\/www.limswiki.org\/index.php\/Infusion_pump<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal 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version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:19.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 382 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","97b1f7e3aae6d4658e2698f7b5f6696e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Infusion_pump skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Infusion pump<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Infusionspumpe.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ed\/Infusionspumpe.JPG\/250px-Infusionspumpe.JPG\" width=\"250\" height=\"325\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Infusionspumpe.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A type of infusion pump, manufactured by Fresenius.<\/div><\/div><\/div>\n<p>An <b>infusion pump<\/b> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_infusion\" class=\"mw-redirect\" title=\"Intravenous infusion\" rel=\"external_link\" target=\"_blank\">infuses<\/a> fluids, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medication\" title=\"Medication\" rel=\"external_link\" target=\"_blank\">medication<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nutrient\" title=\"Nutrient\" rel=\"external_link\" target=\"_blank\">nutrients<\/a> into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient\" title=\"Patient\" rel=\"external_link\" target=\"_blank\">patient's<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">circulatory system<\/a>. It is generally used <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous\" class=\"mw-redirect\" title=\"Intravenous\" rel=\"external_link\" target=\"_blank\">intravenously<\/a>, although <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_injection\" title=\"Subcutaneous injection\" rel=\"external_link\" target=\"_blank\">subcutaneous<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">arterial<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epidural\" class=\"mw-redirect\" title=\"Epidural\" rel=\"external_link\" target=\"_blank\">epidural<\/a> infusions are occasionally used.\n<\/p><p>Infusion pumps can administer fluids in ways that would be impractically expensive or unreliable if performed manually by nursing staff. For example, they can administer as little as 0.1 mL per hour injections (too small for a drip), injections every minute, injections with repeated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bolus_(medicine)\" title=\"Bolus (medicine)\" rel=\"external_link\" target=\"_blank\">boluses<\/a> requested by the patient, up to maximum number per hour (e.g. in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient-controlled_analgesia\" title=\"Patient-controlled analgesia\" rel=\"external_link\" target=\"_blank\">patient-controlled analgesia<\/a>), or fluids whose volumes vary by the time of day.\n<\/p><p>Because they can also produce quite high but controlled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure\" title=\"Pressure\" rel=\"external_link\" target=\"_blank\">pressures<\/a>, they can inject controlled amounts of fluids subcutaneously (beneath the skin), or epidurally (just within the surface of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a> \u2013 a very popular local spinal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia\" title=\"Anesthesia\" rel=\"external_link\" target=\"_blank\">anesthesia<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Childbirth\" title=\"Childbirth\" rel=\"external_link\" target=\"_blank\">childbirth<\/a>).\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_infusion\">Types of infusion<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/User_interface\" title=\"User interface\" rel=\"external_link\" target=\"_blank\">user interface<\/a> of pumps usually requests details on the type of infusion from the technician or nurse that sets them up:\n<\/p>\n<ul><li><i>Continuous infusion<\/i> usually consists of small pulses of infusion, usually between 500 nanoliters and 10 milliliters, depending on the pump's design, with the rate of these pulses depending on the programmed infusion speed.<\/li>\n<li><i>Intermittent infusion<\/i> has a \"high\" infusion rate, alternating with a low programmable infusion rate to keep the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">cannula<\/a> open. The timings are programmable. This mode is often used to administer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotic\" title=\"Antibiotic\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a>, or other drugs that can irritate a blood vessel.<\/li><\/ul>\n<p>To get the entire dose of antibiotics into the patient, the \"volume to be infused\" or VTBI must be programmed for at least 30 CCs more than is in the medication bag...or else up to half of the antibiotic will be left in the IV tubing.\n<\/p>\n<ul><li><i>Patient-controlled<\/i> is infusion on-demand, usually with a preprogrammed ceiling to avoid intoxication. The rate is controlled by a pressure pad or button that can be activated by the patient. It is the method of choice for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient-controlled_analgesia\" title=\"Patient-controlled analgesia\" rel=\"external_link\" target=\"_blank\">patient-controlled analgesia<\/a> (PCA), in which repeated small doses of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Opioid\" title=\"Opioid\" rel=\"external_link\" target=\"_blank\">opioid<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic\" title=\"Analgesic\" rel=\"external_link\" target=\"_blank\">analgesics<\/a> are delivered, with the device coded to stop administration before a dose that may cause hazardous respiratory depression is reached.<\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Total_parenteral_nutrition\" class=\"mw-redirect\" title=\"Total parenteral nutrition\" rel=\"external_link\" target=\"_blank\">Total parenteral nutrition<\/a><\/i> usually requires an infusion curve similar to normal mealtimes.<\/li><\/ul>\n<p>Some pumps offer modes in which the amounts can be scaled or controlled based on the time of day. This allows for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circadian_cycle\" class=\"mw-redirect\" title=\"Circadian cycle\" rel=\"external_link\" target=\"_blank\">circadian cycles<\/a> which may be required for certain types of medication.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_pump\">Types of pump<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Baxter_Colleague_CX_infusion_pump.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7e\/Baxter_Colleague_CX_infusion_pump.JPG\/170px-Baxter_Colleague_CX_infusion_pump.JPG\" width=\"170\" height=\"227\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Baxter_Colleague_CX_infusion_pump.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baxter_International\" title=\"Baxter International\" rel=\"external_link\" target=\"_blank\">Baxter International<\/a> Colleague CX infusion pump<\/div><\/div><\/div>\n<p>There are two basic classes of pumps. Large volume pumps can pump nutrient solutions large enough to feed a patient. Small-volume pumps infuse <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hormone\" title=\"Hormone\" rel=\"external_link\" target=\"_blank\">hormones<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a>, or other medicines, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Opiate\" title=\"Opiate\" rel=\"external_link\" target=\"_blank\">opiates<\/a>.\n<\/p><p>Within these classes, some pumps are designed to be portable, others are designed to be used in a hospital, and there are special systems for charity and battlefield use.\n<\/p><p>Large-volume pumps usually use some form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peristaltic_pump\" title=\"Peristaltic pump\" rel=\"external_link\" target=\"_blank\">peristaltic pump<\/a>. Classically, they use computer-controlled rollers compressing a silicone-rubber tube through which the medicine flows. Another common form is a set of fingers that press on the tube in sequence.\n<\/p><p>Small-volume pumps usually use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer\" title=\"Computer\" rel=\"external_link\" target=\"_blank\">computer<\/a>-controlled motor turning a screw that pushes the plunger on a syringe.\n<\/p><p>The classic medical improvisation for an infusion pump is to place a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a> cuff around a bag of fluid. The battlefield equivalent is to place the bag under the patient. The pressure on the bag sets the infusion pressure. The pressure can actually be read-out at the cuff's indicator. The problem is that the flow varies dramatically with the cuff's pressure(or patient's weight), and the needed pressure varies with the administration route, potentially causing risk when attempted by an individual not trained in this method.\n<\/p><p>Places that must provide the least-expensive care often use pressurized infusion systems. One common system has a purpose-designed plastic \"pressure bottle\" pressurized with a large disposable plastic syringe. A combined <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flow_restrictor\" class=\"mw-redirect\" title=\"Flow restrictor\" rel=\"external_link\" target=\"_blank\">flow restrictor<\/a>, air filter and drip chamber helps a nurse set the flow. The parts are reusable, mass-produced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterile<\/a> plastic, and can be produced by the same machines that make plastic soft-drink bottles and caps. A pressure bottle, restrictor and chamber requires more nursing attention than electronically controlled pumps. In the areas where these are used, nurses are often volunteers, or very inexpensive.\n<\/p><p>The restrictor and high pressure helps control the flow better than the improvised schemes because the high pressure through the small restrictor orifice reduces the variation of flow caused by patients' blood pressures.\n<\/p><p>An air filter is an essential safety device in a pressure infusor, to keep air out of the patients' veins. Small bubbles could cause harm in arteries, but in the veins they pass through the heart and leave in the patients' lungs. The air filter is just a membrane that passes gas but not fluid or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathogen\" title=\"Pathogen\" rel=\"external_link\" target=\"_blank\">pathogens<\/a>. When a large air bubble reaches it, it bleeds off.\n<\/p><p>Some of the smallest infusion pumps use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osmosis\" title=\"Osmosis\" rel=\"external_link\" target=\"_blank\">osmotic<\/a> power. Basically, a bag of salt solution absorbs water through a membrane, swelling its volume. The bag presses medicine out. The rate is precisely controlled by the salt concentrations and pump volume. Osmotic pumps are usually recharged with a syringe.\n<\/p><p>Spring-powered clockwork infusion pumps have been developed, and are sometimes still used in veterinary work and for ambulatory small-volume pumps. They generally have one spring to power the infusion, and another for the alarm bell when the infusion completes.\n<\/p><p>Battlefields often have a need to perfuse large amounts of fluid quickly, with dramatically changing blood pressures and patient condition. Specialized infusion pumps have been designed for this purpose, although they have not been deployed.\n<\/p><p>Many infusion pumps are controlled by a small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Embedded_system\" title=\"Embedded system\" rel=\"external_link\" target=\"_blank\">embedded system<\/a>. They are carefully designed so that no single cause of failure can harm the patient. For example, most have batteries in case the wall-socket power fails. Additional hazards are uncontrolled flow causing an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Overdose\" class=\"mw-redirect\" title=\"Overdose\" rel=\"external_link\" target=\"_blank\">overdose<\/a>, uncontrolled lack of flow, causing an underdose, reverse flow, which can siphon blood from a patient, and air in the line, which can cause an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Air_embolism\" title=\"Air embolism\" rel=\"external_link\" target=\"_blank\">air embolism<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Safety_features_available_on_some_pumps\">Safety features available on some pumps<\/span><\/h2>\n\n<p>The range of safety features varies widely with the age and make of the pump. A state of the art pump in 2003<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup> may have the following safety features:\n<\/p>\n<ul><li>Certified to have no <a href=\"https:\/\/en.wikipedia.org\/wiki\/Single_point_of_failure\" title=\"Single point of failure\" rel=\"external_link\" target=\"_blank\">single point of failure<\/a>. That is, no single cause of failure should cause the pump to silently fail to operate correctly. It should at least stop pumping and make at least an audible error indication. This is a minimum requirement on all human-rated infusion pumps of whatever age. It is not required for veterinary infusion pumps.<\/li>\n<li>Batteries, so the pump can operate if the power fails or is unplugged.<\/li>\n<li>Anti-free-flow devices prevent blood from draining from the patient, or infusate from freely entering the patient, when the infusion pump is being set up.<\/li>\n<li>A \"down pressure\" sensor will detect when the patient's vein is blocked, or the line to the patient is kinked. This may be configurable for high (subcutaneous and epidural) or low (venous) applications.<\/li>\n<li>An \"air-in-line\" detector. A typical detector will use an ultrasonic transmitter and receiver to detect when air is being pumped. Some pumps actually measure the volume, and may even have configurable volumes, from 0.1 to 2 ml of air. None of these amounts can cause harm, but sometimes the air can interfere with the infusion of a low-dose medicine.<\/li>\n<li>An \"up pressure\" sensor can detect when the bag or syringe is empty, or even if the bag or syringe is being squeezed.<\/li>\n<li>A drug library with customizable programmable limits for individual drugs that helps to avoid medication errors.<\/li>\n<li>Mechanisms to avoid uncontrolled flow of drugs in large volume pumps (often in combination with a giving st based free flow clamp) and increasingly also in syringe pumps (piston-brake)<\/li>\n<li>Many pumps include an internal electronic log of the last several thousand therapy events. These are usually tagged with the time and date from the pump's clock. Usually, erasing the log is a feature protected by a security code, specifically to detect staff abuse of the pump or patient.<\/li>\n<li>Many makes of infusion pump can be configured to display only a small subset of features while they are operating, in order to prevent tampering by patients, untrained staff and visitors.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Safety_issues\">Safety issues<\/span><\/h2>\n<p>Infusion pumps have been a source of multiple patient safety concerns, and problems with such pumps have been linked to more than 56,000 adverse event reports from 2005 to 2009, including at least 500 deaths.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> As a result, the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) has launched a comprehensive initiative to improve their safety, called the Infusion Pump Improvement Initiative.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> The initiative proposed stricter regulation of infusion pumps. It cited software defects, user interface issues, and mechanical or electrical failures as the main causes of adverse events.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_drip\" class=\"mw-redirect\" title=\"Intravenous drip\" rel=\"external_link\" target=\"_blank\">Intravenous drip<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacy_informatics\" class=\"mw-redirect\" title=\"Pharmacy informatics\" rel=\"external_link\" target=\"_blank\">Pharmacy informatics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Syringe_driver\" title=\"Syringe driver\" rel=\"external_link\" target=\"_blank\">Syringe driver<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Total_parenteral_nutrition\" class=\"mw-redirect\" title=\"Total parenteral nutrition\" rel=\"external_link\" target=\"_blank\">Total parenteral nutrition<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Pharmacy Practice News, May 2010<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/GeneralHospitalDevicesandSupplies\/InfusionPumps\/ucm205424.htm\" target=\"_blank\">http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/GeneralHospitalDevicesandSupplies\/InfusionPumps\/ucm205424.htm<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181216204226\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.220 seconds\nReal time usage: 0.318 seconds\nPreprocessor visited node count: 905\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 94604\/2097152 bytes\nTemplate argument size: 3333\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 840\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.064\/10.000 seconds\nLua memory usage: 2.53 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 202.367 1 -total\n<\/p>\n<pre>42.85% 86.707 8 Template:Navbox\n39.67% 80.275 3 Template:Ambox\n32.16% 65.080 1 Template:Refimprove\n29.78% 60.265 1 Template:Dosage_forms\n17.55% 35.517 1 Template:Multiple_issues\n11.05% 22.360 1 Template:As_of\n 8.61% 17.424 1 Template:Update\n 8.44% 17.085 1 Template:DMCA\n 7.04% 14.249 1 Template:Dated_maintenance_category\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2543416-1!canonical and timestamp 20181216204225 and revision id 855450445\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Infusion_pump\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214636\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 166.631 1 - wikipedia:Infusion_pump\n100.00% 166.631 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8540-0!*!*!*!*!*!* and timestamp 20181217214636 and revision id 24965\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Infusion_pump\">https:\/\/www.limswiki.org\/index.php\/Infusion_pump<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","97b1f7e3aae6d4658e2698f7b5f6696e_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ed\/Infusionspumpe.JPG\/500px-Infusionspumpe.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7e\/Baxter_Colleague_CX_infusion_pump.JPG\/340px-Baxter_Colleague_CX_infusion_pump.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/FlattenedRoundPills.jpg\/120px-FlattenedRoundPills.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Hexaaquatitanium%28III%29-solution.jpg\/120px-Hexaaquatitanium%28III%29-solution.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/Inhaler.jpg\/120px-Inhaler.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/Action_photo_of_nasal_spray_on_a_black_background.jpg\/60px-Action_photo_of_nasal_spray_on_a_black_background.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/98\/Glycerin_suppositories.jpg\/60px-Glycerin_suppositories.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/SPF15SunBlock.JPG\/80px-SPF15SunBlock.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Injection_Syringe_01.jpg\/120px-Injection_Syringe_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/Tabletten.JPG\/32px-Tabletten.JPG"],"97b1f7e3aae6d4658e2698f7b5f6696e_timestamp":1545083196,"56aa445928c2235a4557c4f66741b364_type":"article","56aa445928c2235a4557c4f66741b364_title":"Heating pad","56aa445928c2235a4557c4f66741b364_url":"https:\/\/www.limswiki.org\/index.php\/Heating_pad","56aa445928c2235a4557c4f66741b364_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHeating pad\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"HotBag\" redirects here. For the container used to keep pizzas warm, see Pizza delivery \u00a7 Delivery bags.\nA heating pad is a pad used for warming of parts of the body in order to manage pain. Localized application of heat causes the blood vessels in that area to dilate, enhancing perfusion to the targeted tissue. Types of heating pads include electrical, chemical and hot water bottles.\nSpecialized heating pads (mats) are also used in other settings. Heat mats in plant propagation stimulates seed germination and root development; they operate at cooler temperatures. Heat mats also are available in the pet trade, especially as warming spots for reptiles such as lizards and snakes.\n\nContents \n\n1 Types \n\n1.1 Electrical \n1.2 Chemical \n\n\n2 High specific-heat capacity materials \n\n2.1 Phase-change materials \n\n\n3 Function \n4 See also \n5 References \n\n\nTypes \n An electric heating pad\nElectrical \nElectric pads usually operate from household current and must have protection against overheating.\nA moist heating pad is used dry on the user's skin. These pads register temperatures from 76 to 82 \u00b0C (169 to 180 \u00b0F) and are intended for deep tissue treatment and can be dangerous if left on unattended. Moist heating pads are used mainly by physical therapists but can be found for home use. A moist cloth can be added with a stupe cover to add more moisture to the treatment.\n\nChemical \n A sodium acetate heat pad\nDisposable chemical pads employ a one-time exothermic chemical reaction. One type, frequently used for hand warmers, is triggered by unwrapping an air-tight packet containing slightly moist iron powder and salt or catalysts which rusts over a period of hours after being exposed to oxygen in the air. Another type contains separate compartments within the pad; when the user squeezes the pad, a barrier ruptures and the compartments mix, producing heat such as the enthalpy change of solution of calcium chloride dissolving.\nThe most common reusable heat pads contain a supersaturated solution of sodium acetate in water. Crystallization is triggered by flexing a small flat disc of notched ferrous metal embedded in the liquid. Pressing the disc releases very tiny adhered crystals of sodium acetate[1] into the solution which then act as nucleation sites for the crystallization of the sodium acetate into the hydrated salt (sodium acetate trihydrate, CH3COONa\u00b73H2O). Because the liquid is supersaturated, this makes the solution crystallize suddenly, thereby releasing the energy of the crystal lattice. The use of the metal disc was invented in 1978.[2]\nThe pad can be reused by placing it in boiling water for 10\u201315 minutes, which redissolves the sodium acetate trihydrate in the contained water and recreates a supersaturated solution. Once the pad has returned to room temperature it can be triggered again. Triggering the pad before it has reached room temperature results in the pad reaching a lower peak temperature, as compared to waiting until it had completely cooled.\n\nHigh specific-heat capacity materials \nHeating packs can also be made by filling a container with a material that has a high specific heat capacity, which then gradually releases the heat over time. A hot water bottle is the most familiar example of this type of heating pad.\nA microwavable heating pad is a heating pad that is warmed by placing it in a microwave oven before use. Microwavable heating pads are typically made out of a thick insulative fabric such as flannel and filled with grains such as wheat, buckwheat or flax seed. Due to their relative simplicity to make, they are frequently sewn by hand, often with a custom shape to fit the intended area of use.\nOften, aromatic compounds will also be added to the filler mixture to create a pleasant or soothing smell when heated. The source of these can vary significantly, ranging from adding essential oils to ground up spices such as cloves and nutmeg, or even dried rose petals.\n\nPhase-change materials \nMain article: Phase-change material\nPhase change materials can be used for heating pads intended to operate at a fixed temperature. The heat of fusion is used to release the thermal energy. This results in the pad heating up.\n\nFunction \nMany episodes of pain come from muscle exertion or strain, which creates tension in the muscles and soft tissues. This tension can constrict circulation, sending pain signals to the brain. Heat application eases pain by:\n\ndilating the blood vessels surrounding the painful area. Increased blood flow provides additional oxygen and nutrients to help heal the damaged muscle tissue.\nstimulating sensation in the skin and therefore decreasing the pain signals being transmitted to the brain\nincreasing the flexibility (and decreasing painful stiffness) of soft tissues surrounding the injured area, including muscles and connective tissue.\nAs many heating pads are portable, heat may be applied as needed at home, at work, or while traveling. Some physicians recommend alternating heat and ice for pain relief. As with any pain treatment, a physician should be consulted prior to beginning treatment.\n\nSee also \nElectric heating pouch\nHand warmer\nReferences \n\n\n^ Rogerson Mansel A (2003). \"Solidification in heat packs: III. Metallic trigger\". AIChE Journal. 49: 522\u2013529. doi:10.1002\/aic.690490222. \n\n^ Reusable heat pack containing supercooled solution and means for activating same. US Patent 4,077,390 (1978) \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Heating_pad\">https:\/\/www.limswiki.org\/index.php\/Heating_pad<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:38.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 387 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","56aa445928c2235a4557c4f66741b364_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Heating_pad skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Heating pad<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"HotBag\" redirects here. For the container used to keep pizzas warm, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pizza_delivery#Delivery_bags\" title=\"Pizza delivery\" rel=\"external_link\" target=\"_blank\">Pizza delivery \u00a7 Delivery bags<\/a>.<\/div>\n<p>A <b>heating pad<\/b> is a pad used for warming of parts of the body in order to manage <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a>. Localized application of heat causes the blood vessels in that area to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vasodilator\" class=\"mw-redirect\" title=\"Vasodilator\" rel=\"external_link\" target=\"_blank\">dilate<\/a>, enhancing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfusion\" title=\"Perfusion\" rel=\"external_link\" target=\"_blank\">perfusion<\/a> to the targeted tissue. Types of heating pads include <a href=\"#Electric\" rel=\"external_link\">electrical<\/a>, <a href=\"#Chemical\" rel=\"external_link\">chemical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hot_water_bottle\" title=\"Hot water bottle\" rel=\"external_link\" target=\"_blank\">hot water bottles<\/a>.\n<\/p><p>Specialized heating pads (mats) are also used in other settings. Heat mats in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plant_propagation\" title=\"Plant propagation\" rel=\"external_link\" target=\"_blank\">plant propagation<\/a> stimulates seed germination and root development; they operate at cooler temperatures. Heat mats also are available in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pet\" title=\"Pet\" rel=\"external_link\" target=\"_blank\">pet<\/a> trade, especially as warming spots for reptiles such as lizards and snakes.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Electric_heating_pad.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/44\/Electric_heating_pad.jpg\/220px-Electric_heating_pad.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Electric_heating_pad.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An electric heating pad<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Electrical\">Electrical<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric\" class=\"mw-redirect\" title=\"Electric\" rel=\"external_link\" target=\"_blank\">Electric<\/a> pads usually operate from household current and must have protection against overheating.\n<\/p><p>A <b>moist heating pad<\/b> is used dry on the user's skin. These pads register temperatures from 76 to 82 \u00b0C (169 to 180 \u00b0F) and are intended for deep tissue treatment and can be dangerous if left on unattended. Moist heating pads are used mainly by physical therapists but can be found for home use. A moist cloth can be added with a stupe cover to add more moisture to the treatment.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chemical\">Chemical<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hand_warmer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ab\/Hand_warmer.jpg\/220px-Hand_warmer.jpg\" width=\"220\" height=\"156\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hand_warmer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_acetate\" title=\"Sodium acetate\" rel=\"external_link\" target=\"_blank\">sodium acetate<\/a> heat pad<\/div><\/div><\/div>\n<p>Disposable chemical pads employ a one-time <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exothermic\" class=\"mw-redirect\" title=\"Exothermic\" rel=\"external_link\" target=\"_blank\">exothermic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_reaction\" title=\"Chemical reaction\" rel=\"external_link\" target=\"_blank\">chemical reaction<\/a>. One type, frequently used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hand_warmers\" class=\"mw-redirect\" title=\"Hand warmers\" rel=\"external_link\" target=\"_blank\">hand warmers<\/a>, is triggered by unwrapping an air-tight packet containing slightly moist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a> powder and salt or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalysts<\/a> which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rust\" title=\"Rust\" rel=\"external_link\" target=\"_blank\">rusts<\/a> over a period of hours after being exposed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a> in the air. Another type contains separate compartments within the pad; when the user squeezes the pad, a barrier ruptures and the compartments mix, producing heat such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enthalpy_change_of_solution\" title=\"Enthalpy change of solution\" rel=\"external_link\" target=\"_blank\">enthalpy change of solution<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_chloride\" title=\"Calcium chloride\" rel=\"external_link\" target=\"_blank\">calcium chloride<\/a> dissolving.\n<\/p><p>The most common reusable heat pads contain a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Supersaturation\" title=\"Supersaturation\" rel=\"external_link\" target=\"_blank\">supersaturated<\/a> solution of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_acetate\" title=\"Sodium acetate\" rel=\"external_link\" target=\"_blank\">sodium acetate<\/a> in water. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallization\" title=\"Crystallization\" rel=\"external_link\" target=\"_blank\">Crystallization<\/a> is triggered by flexing a small flat disc of notched <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferrous\" title=\"Ferrous\" rel=\"external_link\" target=\"_blank\">ferrous<\/a> metal embedded in the liquid. Pressing the disc releases very tiny adhered crystals of sodium acetate<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> into the solution which then act as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleation\" title=\"Nucleation\" rel=\"external_link\" target=\"_blank\">nucleation<\/a> sites for the crystallization of the sodium acetate into the hydrated salt (sodium acetate trihydrate, CH<sub>3<\/sub>COONa\u00b73H<sub>2<\/sub>O). Because the liquid is supersaturated, this makes the solution crystallize suddenly, thereby releasing the energy of the crystal lattice. The use of the metal disc was invented in 1978.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The pad can be reused by placing it in boiling water for 10\u201315 minutes, which redissolves the sodium acetate trihydrate in the contained water and recreates a supersaturated solution. Once the pad has returned to room temperature it can be triggered again. Triggering the pad before it has reached room temperature results in the pad reaching a lower peak temperature, as compared to waiting until it had completely cooled.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"High_specific-heat_capacity_materials\">High specific-heat capacity materials<\/span><\/h2>\n<p>Heating packs can also be made by filling a container with a material that has a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Specific_heat_capacity\" class=\"mw-redirect\" title=\"Specific heat capacity\" rel=\"external_link\" target=\"_blank\">specific heat capacity<\/a>, which then gradually releases the heat over time. A hot water bottle is the most familiar example of this type of heating pad.\n<\/p><p>A <b>microwavable heating pad<\/b> is a heating pad that is warmed by placing it in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microwave_oven\" title=\"Microwave oven\" rel=\"external_link\" target=\"_blank\">microwave oven<\/a> before use. Microwavable heating pads are typically made out of a thick insulative fabric such as flannel and filled with grains such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wheat\" title=\"Wheat\" rel=\"external_link\" target=\"_blank\">wheat<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buckwheat\" title=\"Buckwheat\" rel=\"external_link\" target=\"_blank\">buckwheat<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flax_seed\" class=\"mw-redirect\" title=\"Flax seed\" rel=\"external_link\" target=\"_blank\">flax seed<\/a>. Due to their relative simplicity to make, they are frequently sewn by hand, often with a custom shape to fit the intended area of use.\n<\/p><p>Often, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aroma_compound\" title=\"Aroma compound\" rel=\"external_link\" target=\"_blank\">aromatic compounds<\/a> will also be added to the filler mixture to create a pleasant or soothing smell when heated. The source of these can vary significantly, ranging from adding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Essential_oil\" title=\"Essential oil\" rel=\"external_link\" target=\"_blank\">essential oils<\/a> to ground up <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spices\" class=\"mw-redirect\" title=\"Spices\" rel=\"external_link\" target=\"_blank\">spices<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clove\" title=\"Clove\" rel=\"external_link\" target=\"_blank\">cloves<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nutmeg\" title=\"Nutmeg\" rel=\"external_link\" target=\"_blank\">nutmeg<\/a>, or even dried <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rose\" title=\"Rose\" rel=\"external_link\" target=\"_blank\">rose<\/a> petals.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Phase-change_materials\">Phase-change materials<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phase-change_material\" title=\"Phase-change material\" rel=\"external_link\" target=\"_blank\">Phase-change material<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phase_change_material\" class=\"mw-redirect\" title=\"Phase change material\" rel=\"external_link\" target=\"_blank\">Phase change materials<\/a> can be used for heating pads intended to operate at a fixed temperature. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_of_fusion\" class=\"mw-redirect\" title=\"Heat of fusion\" rel=\"external_link\" target=\"_blank\">heat of fusion<\/a> is used to release the thermal energy. This results in the pad heating up.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Function\">Function<\/span><\/h2>\n<p>Many episodes of pain come from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a> exertion or strain, which creates tension in the muscles and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_tissue\" title=\"Soft tissue\" rel=\"external_link\" target=\"_blank\">soft tissues<\/a>. This tension can constrict <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">circulation<\/a>, sending pain signals to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain\" title=\"Brain\" rel=\"external_link\" target=\"_blank\">brain<\/a>. Heat application eases pain by:\n<\/p>\n<ul><li>dilating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessel\" title=\"Blood vessel\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a> surrounding the painful area. Increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> flow provides additional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a> and nutrients to help heal the damaged muscle tissue.<\/li>\n<li>stimulating sensation in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> and therefore decreasing the pain signals being transmitted to the brain<\/li>\n<li>increasing the flexibility (and decreasing painful stiffness) of soft tissues surrounding the injured area, including muscles and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Connective_tissue\" title=\"Connective tissue\" rel=\"external_link\" target=\"_blank\">connective tissue<\/a>.<\/li><\/ul>\n<p>As many heating pads are portable, heat may be applied as needed at home, at work, or while traveling. Some physicians recommend alternating heat and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ice\" title=\"Ice\" rel=\"external_link\" target=\"_blank\">ice<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management\" title=\"Pain management\" rel=\"external_link\" target=\"_blank\">pain relief<\/a>. <i>As with any pain treatment, a physician should be consulted prior to beginning treatment.<\/i>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_heating_pouch\" title=\"Electric heating pouch\" rel=\"external_link\" target=\"_blank\">Electric heating pouch<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hand_warmer\" title=\"Hand warmer\" rel=\"external_link\" target=\"_blank\">Hand warmer<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rogerson Mansel A (2003). \"Solidification in heat packs: III. Metallic trigger\". <i>AIChE Journal<\/i>. <b>49<\/b>: 522\u2013529. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Faic.690490222\" target=\"_blank\">10.1002\/aic.690490222<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AIChE+Journal&rft.atitle=Solidification+in+heat+packs%3A+III.+Metallic+trigger&rft.volume=49&rft.pages=522-529&rft.date=2003&rft_id=info%3Adoi%2F10.1002%2Faic.690490222&rft.au=Rogerson+Mansel+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHeating+pad\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.google.com\/patents?id=unU7AAAAEBAJ\" target=\"_blank\">Reusable heat pack containing supercooled solution and means for activating same<\/a>. US Patent 4,077,390 (1978)<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1271\nCached time: 20181216230551\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.160 seconds\nReal time usage: 0.223 seconds\nPreprocessor visited node count: 213\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2379\/2097152 bytes\nTemplate argument size: 75\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 3011\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.092\/10.000 seconds\nLua memory usage: 2.81 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 186.507 1 -total\n<\/p>\n<pre>54.60% 101.833 1 Template:Reflist\n48.10% 89.702 1 Template:Cite_journal\n20.35% 37.950 1 Template:Convert\n20.32% 37.905 1 Template:Redirect\n 3.38% 6.302 1 Template:Main\n 1.59% 2.958 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1488293-1!canonical and timestamp 20181216230550 and revision id 852272891\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Heating_pad\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214636\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.028 seconds\nReal time usage: 0.153 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 147.493 1 - wikipedia:Heating_pad\n100.00% 147.493 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8539-0!*!*!*!*!*!* and timestamp 20181217214636 and revision id 24964\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Heating_pad\">https:\/\/www.limswiki.org\/index.php\/Heating_pad<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","56aa445928c2235a4557c4f66741b364_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/44\/Electric_heating_pad.jpg\/440px-Electric_heating_pad.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ab\/Hand_warmer.jpg\/440px-Hand_warmer.jpg"],"56aa445928c2235a4557c4f66741b364_timestamp":1545083196,"47c550f9fa082cb1d36fa03887181ce8_type":"article","47c550f9fa082cb1d36fa03887181ce8_title":"Glucose meter","47c550f9fa082cb1d36fa03887181ce8_url":"https:\/\/www.limswiki.org\/index.php\/Glucose_meter","47c550f9fa082cb1d36fa03887181ce8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tGlucose meter\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (November 2010) (Learn how and when to remove this template message)\nGlucose meterMedical diagnosticsFour generations of blood glucose meter, c. 1993\u20132005. Sample sizes vary from 30 to 0.3 \u03bcl. Test times vary from 5 seconds to 2 minutes (modern meters typically provide results in 5 seconds).Purposemeasure concentration of glucose in the blood\nA glucose meter is a medical device for determining the approximate concentration of glucose in the blood. It can also be a strip of glucose paper dipped into a substance and measured to the glucose chart. It is a key element of home blood glucose monitoring (HBGM) by people with diabetes mellitus or hypoglycemia. A small drop of blood, obtained by pricking the skin with a lancet, is placed on a disposable test strip that the meter reads and uses to calculate the blood glucose level. The meter then displays the level in units of mg\/dl or mmol\/l.\nSince approximately 1980, a primary goal of the management of type 1 diabetes and type 2 diabetes mellitus has been achieving closer-to-normal levels of glucose in the blood for as much of the time as possible, guided by HBGM several times a day. The benefits include a reduction in the occurrence rate and severity of long-term complications from hyperglycemia as well as a reduction in the short-term, potentially life-threatening complications of hypoglycemia.\n\nContents \n\n1 History \n\n1.1 Non-meter test strips \n\n\n2 Types of meters \n\n2.1 Hospital glucose meters \n2.2 Blood testing with meters using test strips \n\n2.2.1 Cost \n\n\n2.3 Noninvasive meters \n2.4 Continuous glucose monitors \n\n\n3 Accuracy \n4 Future \n5 Technology \n6 Meter use for hypoglycemia \n7 See also \n8 References \n\n\nHistory \nLeland Clark presented his first paper about the oxygen electrode, later named the Clark electrode, on 15 April 1956, at a meeting of the American Society for Artificial Organs during the annual meetings of the Federated Societies for Experimental Biology.[1][2]\nIn 1962, Clark and Ann Lyons from the Cincinnati Children\u2019s Hospital developed the first glucose enzyme electrode. This biosensor was based on a thin layer of glucose oxidase (GOx) on an oxygen electrode. Thus, the readout was the amount of oxygen consumed by GOx during the enzymatic reaction with the substrate glucose. This publication became one of the most often cited papers in life sciences. Due to this work he is considered the \u201cfather of biosensors,\u201d especially with respect to the glucose sensing for diabetes patients.[3][4]\n\n CDC image showing the usage of a lancet and a blood glucose meter\nAnother early glucose meter was the Ames Reflectance Meter by Anton H. Clemens. It was used in American hospitals in the 1970s. A moving needle indicated the blood glucose after about a minute.\nHome glucose monitoring was demonstrated to improve glycemic control of type 1 diabetes in the late 1970s, and the first meters were marketed for home use around 1981. The two models initially dominant in North America in the 1980s were the Glucometer, introduced in November 1981,[5] whose trademark is owned by Bayer, and the Accu-Chek meter (by Roche). Consequently, these brand names have become synonymous with the generic product to many health care professionals. In Britain, a health care professional or a patient may refer to \"taking a BM\": \"Mrs X's BM is 5\", etc. BM stands for Boehringer Mannheim, now part of Roche, who produce test strips called 'BM-test' for use in a meter.[6][7]\nIn North America, hospitals resisted adoption of meter glucose measurements for inpatient diabetes care for over a decade. Managers of laboratories argued that the superior accuracy of a laboratory glucose measurement outweighed the advantage of immediate availability and made meter glucose measurements unacceptable for inpatient diabetes management. Patients with diabetes and their endocrinologists eventually persuaded acceptance. Some health care policymakers still resist the idea that the society would be well advised to pay the consumables (reagents, lancets, etc.) needed.\nHome glucose testing was adopted for type 2 diabetes more slowly than for type 1, and a large proportion of people with type 2 diabetes have never been instructed in home glucose testing.[8] This has mainly come about because health authorities are reluctant to bear the cost of the test strips and lancets.\n\nNon-meter test strips \nTest strips that changed color and could be read visually, without a meter, have been widely used since the 1980s. They had the added advantage that they could be cut longitudinally to save money. Critics argued that test strips read by eye are not as accurate or convenient as meter testing. The manufacturer cited studies that show the product is just as effective despite not giving an answer to one decimal place, something they argue is unnecessary for control of blood sugar. This debate also happened in Germany where \"Glucoflex-R\" was an established strip for type 2 diabetes. As meter accuracy and insurance coverage improved, they lost popularity.\n\"Glucoflex-R\" is Australia manufacturer National Diagnostic Products alternative to the BM test strip. It has versions that can be used either in a meter or read visually. It is also marketed under the brand name Betachek. On May 1, 2009, the UK distributor Ambe Medical Group reduced the price of their \"Glucoflex-R\" test strip to the NHS, by approximately 50%. This was expected to allow the NHS to save money on strips and perhaps loosen the restrictions on supply a little. Another low cost visually read strip is soon to be available on prescription according to sources at the NHS.[when? ]\n\nTypes of meters \nHospital glucose meters \nSpecial glucose meters for multi-patient hospital use are now used. These provide more elaborate quality control records. Their data handling capabilities are designed to transfer glucose results into electronic medical records and the laboratory computer systems for billing purposes.\n\nBlood testing with meters using test strips \n Illustration depicting glucose monitoring with glucometer\n Illustration depicting glucose meter and test strips\nThis section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (November 2010) (Learn how and when to remove this template message)\nThere are several key characteristics of glucose meters which may differ from model to model:\n\nSize: The average size is now approximately the size of the palm of the hand, although hospital meters can be the size of a remote control. They are battery-powered.\nTest strips: A consumable element containing chemicals that react with glucose in the drop of blood is used for each measurement. For some models this element is a plastic test strip with a small spot impregnated with glucose oxidase and other components. Each strip is used once and then discarded. Instead of strips, some models use discs, drums, or cartridges that contain the consumable material for multiple tests.\nCoding: Since test strips may vary from batch to batch, some models require the user to manually enter in a code found on the vial of test strips or on a chip that comes with the test strip. By entering the coding or chip into the glucose meter, the meter will be calibrated to that batch of test strips. However, if this process is carried out incorrectly, the meter reading can be up to 4 mmol\/L (72 mg\/dL) inaccurate. The implications of an incorrectly coded meter can be serious for patients actively managing their diabetes. This may place patients at increased risk of hypoglycemia. Alternatively, some test strips contain the code information in the strip; others have a microchip in the vial of strips that can be inserted into the meter. These last two methods reduce the possibility of user error. One Touch has standardized their test strips around a single code number, so that, once set, there is no need to further change the code in their older meters, and in some of their newer meters, there is no way to change the code.\nVolume of blood sample: The size of the drop of blood needed by different models varies from 0.3 to 1 \u03bcl. (Older models required larger blood samples, usually defined as a \"hanging drop\" from the fingertip.) Smaller volume requirements reduce the frequency of unproductive pricks.\nAlternate site testing: Smaller drop volumes have enabled \"alternate site testing\" \u2013 pricking the forearms or other less sensitive areas instead of the fingertips. This type of testing should only be used when blood glucose levels are stable, such as when before meals, when fasting, or just before going to sleep.[9]\nTesting times: The times it takes to read a test strip may range from 3 to 60 seconds for different models.\nDisplay: The glucose value in mg\/dl or mmol\/l is displayed on a digital display. The preferred measurement unit varies by country: mg\/dl are preferred in the US, France, Japan, Israel, and India. mmol\/l are used in Canada, Australia and China. Germany is the only country where medical professionals routinely operate in both units of measure. (To convert mmol\/l to mg\/dl, multiply by 18. To convert mg\/dl to mmol\/l, divide by 18.) Many meters can display either unit of measure; there have been a couple of published instances[citation needed ] in which someone with diabetes has been misled into the wrong action by assuming that a reading in mmol\/l was really a very low reading in mg\/dl, or the converse. In general, if a value is presented with a decimal point, it is in mmol\/l, without a decimal it is most likely mg\/dl.\n\n\n\n\nTable of blood glucose units of measurement by country[10]This section needs to be updated. Please update this article to reflect recent events or newly available information. (January 2017)\n\n\n\nCountry\n\n\nUnit of measurement\r\n used\n\n\nCountry\n\n\nUnit of measurement\r\n used\n\n\nAlgeria\n\nmg\/dL\n\nMalaysia\n\nmmol\/L\n\n\nArgentina\n\nmg\/dL\n\nMalta\n\nmmol\/L\n\n\nAustralia\n\nmmol\/L\n\nMexico\n\nmg\/dL\n\n\nAustria\n\nmg\/dL\n\nNetherlands\n\nmmol\/L\n\n\nBahrain\n\nmg\/dL\n\nNew Zealand\n\nmmol\/L\n\n\nBangladesh\n\nmg\/dL\n\nNorway\n\nmmol\/L\n\n\nBelgium\n\nmg\/dL\n\nOman\n\nmg\/dL\n\n\nBrazil\n\nmg\/dL\n\nPeru\n\nmg\/dL\n\n\nCanada\n\nmmol\/L\n\nPhilippines\n\nmg\/dL\n\n\nCaribbean countries\n\nmg\/dL\n\nPoland\n\nmg\/dL\n\n\nChile\n\nmg\/dL\n\nPortugal\n\nmg\/dL\n\n\nChina\n\nmmol\/L\n\nQatar\n\nmmol\/L\n\n\nColombia\n\nmg\/dL\n\nRussia\n\nmmol\/L\n\n\nCzech Republic\n\nmmol\/L\n\nSaudi Arabia\n\nmg\/dL\n\n\nDenmark\n\nmmol\/L\n\nSingapore\n\nmmol\/L\n\n\nEcuador\n\nmg\/dL\n\nSlovakia\n\nmmol\/L\n\n\nEgypt\n\nmg\/dL\n\nSouth Africa\n\nmmol\/L\n\n\nFinland\n\nmmol\/L\n\nSpain\n\nmg\/dL\n\n\nFrance\n\nmg\/dL\n\nSub-Saharan Africa\n\nmg\/dL\r\nmmol\/L\n\n\nGeorgia\n\nmg\/dL\n\nSweden\n\nmmol\/L\n\n\nGermany\n\nmg\/dL\r\nmmol\/L\n\nSwitzerland\n\nmmol\/L\n\n\nGreece\n\nmg\/dL\n\nSyria\n\nmg\/dL\n\n\nHong Kong\n\nmmol\/L\n\nTaiwan\n\nmg\/dL\n\n\nIndia\n\nmg\/dL\n\nThailand\n\nmg\/dL\n\n\nIndonesia\n\nmg\/dL\n\nTunisia\n\nmg\/dL\n\n\nIreland\n\nmmol\/L\n\nTurkey\n\nmg\/dL\n\n\nIsrael\n\nmg\/dL\n\nUkraine\n\nmmol\/L\n\n\nItaly\n\nmg\/dL\n\nUnited Arab Emirates (UAE)\n\nmg\/dL\n\n\nJapan\n\nmg\/dL\n\nUnited Kingdom\n\nmmol\/L\n\n\nJordan\n\nmg\/dL\n\nUnited States\n\nmg\/dL\n\n\nKazakhstan\n\nmmol\/L\n\nUruguay\n\nmg\/dL\n\n\nKorea\n\nmg\/dL\n\nVenezuela\n\nmg\/dL\n\n\nKuwait\n\nmg\/dL\n\nVietnam\n\nmmol\/L\n\n\nLebanon\n\nmg\/dL\n\nYemen\n\nmg\/dL\n\n\nLuxembourg\n\nmg\/dL\n\n\n\n\n\nGlucose vs. plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10\u201315% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as \"plasma equivalent,\" even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for patients and their health care providers to know whether the meter gives its results as \"whole blood equivalent\" or \"plasma equivalent.\" One model measures beta-hydroxybutyrate in the blood to detect ketosis for measuring both unhealthy ketoacidosis and healthy nutritional ketosis.\nClock\/memory: Most meters now include a clock that is set by the user for date and time and a memory for past test results. The memory is an important aspect of diabetes care, as it enables the person with diabetes to keep a record of management and look for trends and patterns in blood glucose levels over days and weeks. Most memory chips can display an average of recent glucose readings. A known deficiency of all current meters is that the clock is often not set to the correct time (i.e., due to time changes, static electricity, etc.) and therefore has the potential to misrepresent the time of the past test results making pattern management difficult.\nData transfer: Many meters now have more sophisticated data handling capabilities. Many can be downloaded by a cable or infrared to a computer that has diabetes management software to display the test results. Some meters allow entry of additional data throughout the day, such as insulin dose, amounts of carbohydrates eaten, or exercise. A number of meters have been combined with other devices, such as insulin injection devices, PDAs, cellular transmitters,[11] and Game Boys.[12] A radio link to an insulin pump allows automatic transfer of glucose readings to a calculator that assists the wearer in deciding on an appropriate insulin dose.\nCost \nThe cost of home blood glucose monitoring can be substantial due to the cost of the test strips. In 2006, the consumer cost of each glucose strip ranged from about $0.35 to $1.00. Manufacturers often provide meters at no cost to induce use of the profitable test strips. Type 1 diabetics may test as often as 4 to 10 times a day due to the dynamics of insulin adjustment, whereas type 2 typically test less frequently, especially when insulin is not part of treatment. A recent study on the comparative cost-effectiveness of all options for the self-monitoring of blood glucose funded by the National Health Service in the UK uncovered considerable variation in the price paid, which could not be explained by the availability of advanced meter features. It estimated that a total of \u00a312 m was invested in providing 42 million self-monitoring of blood glucose tests with systems that fail to meet acceptable accuracy standards, and efficiency savings of \u00a323.2 m per annum are achievable if the National Health Service were to disinvest from technologies providing lesser functionality than available alternatives, but at a much higher price.[13]\nBatches of counterfeit test strips for some meters have been identified, which have been shown to produce inaccurate results.[14]\n\nNoninvasive meters \nMain article: Noninvasive glucose monitor\nThe search for a successful technique began about 1975 and has continued to the present without a clinically or commercially viable product.[15] As of 1999[update], only one such product had ever been approved for sale by the FDA, based on a technique for electrically pulling glucose through intact skin, and it was withdrawn after a short time owing to poor performance and occasional damage to the skin of users.[16]\n\nContinuous glucose monitors \n Continuous glucose monitor. The sensor and transmitter are fixed to the upper arm. The reader shows days to replacement of sensor, current blood glucose level and a diagram of the latest blood glucose levels.\nMain article: Continuous glucose monitorContinuous glucose monitor systems can consist of a disposable sensor placed under the skin, a transmitter connected to the sensor and a reader that receives and displays the measurements. The sensor can be used for several days before it needs to be replaced. The devices provide real-time measurements, and reduce the need for fingerprick testing of glucose levels. A drawback is that the meters are not as accurate because they read the glucose levels in the interstitial fluid which lags behind the levels in the blood.[17][18]\nAccuracy \nAccuracy of glucose meters is a common topic of clinical concern. Blood glucose meters must meet accuracy standards set by the International Organization for Standardization (ISO). According to ISO 15197 Blood glucose meters must provide results that are within \u00b115% of a laboratory standard for concentrations above 100 mg\/dL or within \u00b115 mg\/dL for concentrations below 100 mg\/dL at least 95% of the time.[19] However, a variety of factors can affect the accuracy of a test. Factors affecting accuracy of various meters include calibration of meter, ambient temperature, pressure use to wipe off strip (if applicable), size and quality of blood sample, high levels of certain substances (such as ascorbic acid) in blood, hematocrit, dirt on meter, humidity, and aging of test strips. Models vary in their susceptibility to these factors and in their ability to prevent or warn of inaccurate results with error messages. The Clarke Error Grid has been a common way of analyzing and displaying accuracy of readings related to management consequences. More recently an improved version of the Clarke Error Grid has come into use: It is known as the Consensus Error Grid. Older blood glucose meters often need to be \"coded\" with the lot of test strips used, otherwise, the accuracy of the blood glucose meter may be compromised due to lack of calibration.\n\nFuture \nParts of this article (those related to the Future section) need to be updated. Please update this article to reflect recent events or newly available information. (November 2017)\nOne noninvasive glucose meter has been approved by the U.S. FDA: The GlucoWatch G2 Biographer made by Cygnus Inc. The device was designed to be worn on the wrist and used electric fields to draw out body fluid for testing. The device did not replace conventional blood glucose monitoring. One limitation was that the GlucoWatch was not able to cope with perspiration at the measurement site. Sweat must be allowed to dry before measurement can resume. Due to this limitation and others, the product is no longer on the market.\nThe market introduction of noninvasive blood glucose measurement by spectroscopic measurement methods, in the field of near-infrared (NIR), by extracorporal measuring devices, has not been successful because the devices measure tissue sugar in body tissues and not the blood sugar in blood fluid. To determine blood glucose, the measuring beam of infrared light, for example, has to penetrate the tissue for measurement of blood glucose.\nThere are currently three CGMS (continuous glucose monitoring system) available. The first is Medtronic's Minimed Paradigm RTS with a sub-cutaneous probe attached to a small transmitter (roughly the size of a quarter) that sends interstitial glucose levels to a small pager sized receiver every five minutes. The Dexcom System is another system, available in two different generations in the US, the G4 and the G5. (1Q 2016). It is a hypodermic probe with a small transmitter. The receiver is about the size of a cell phone and can operate up to twenty feet from the transmitter. The Dexcom G4 transmits via radio frequency and requires a dedicated receiver.[20] The G5 version utilizes Bluetooth low energy for data transmission, and can transmit data directly to a compatible cellular telephone. Currently, only Apple's iPhone can be used as a receiver,[21] but Dexcom is in the process of getting an Android version approved, and anticipates availability in the second half of 2016. Aside from a two-hour calibration period, monitoring is logged at five-minute intervals for up to 1 week. The user can set the high and low glucose alarms. The third CGMS available is the FreeStyle Navigator from Abbott Laboratories.\nThere is currently an effort to develop an integrated treatment system with a glucose meter, insulin pump, and wristop controller, as well as an effort to integrate the glucose meter and a cell phone. These glucose meter\/cellular phone combinations are under testing and currently cost $149 USD retail.[when? ] Testing strips are proprietary and available only through the manufacturer (no insurance availability). These \"Glugophones\" are currently offered in three forms: as a dongle for the iPhone, an add-on pack for LG model UX5000, VX5200, and LX350 cell phones, as well as an add-on pack for the Motorola Razr cell phone. In US, this limits providers to AT&T and Verizon. Similar systems have been tested for a longer time in Finland.[citation needed ]\nRecent advances in cellular data communications technology have enabled the development of glucose meters that directly integrate cellular data transmission capability, enabling the user to both transmit glucose data to the medical caregiver and receive direct guidance from the caregiver on the screen of the glucose meter. The first such device, from Telcare, Inc., was exhibited at the 2010 CTIA International Wireless Expo,[22] where it won an E-Tech award. This device is currently undergoing clinical testing in the US and internationally.\nIn early 2014 Google reported testing prototypes of contact lenses that monitor glucose levels and alert users when glucose levels cross certain thresholds.[23][24][25]\n\nTechnology \n Two used Accu-Chek test strips. The lower one has had the cover peeled off to show the circuit.\nMany glucose meters employ the oxidation of glucose to gluconolactone catalyzed by glucose oxidase (sometimes known as GOx). Others use a similar reaction catalysed instead by another enzyme, glucose dehydrogenase (GDH). This has the advantage of sensitivity over glucose oxidase but is more susceptible to interfering reactions with other substances.[26]\nThe first-generation devices relied on the same colorimetric reaction that is still used nowadays in glucose test strips for urine. Besides glucose oxidase, the test kit contains a benzidine derivative, which is oxidized to a blue polymer by the hydrogen peroxide formed in the oxidation reaction. The disadvantage of this method was that the test strip had to be developed after a precise interval (the blood had to be washed away), and the meter needed to be calibrated frequently.\nMost glucometers today use an electrochemical method. Test strips contain a capillary that sucks up a reproducible amount of blood. The glucose in the blood reacts with an enzyme electrode containing glucose oxidase (or dehydrogenase). The enzyme is reoxidized with an excess of a mediator reagent, such as a ferricyanide ion, a ferrocene derivative or osmium bipyridyl complex. The mediator in turn is reoxidized by reaction at the electrode, which generates an electric current. The total charge passing through the electrode is proportional to the amount of glucose in the blood that has reacted with the enzyme. The coulometric method is a technique where the total amount of charge generated by the glucose oxidation reaction is measured over a period of time. The amperometric method is used by some meters and measures the electric current generated at a specific point in time by the glucose reaction. This is analogous to throwing a ball and using the speed at which it is travelling at a point in time to estimate how hard it was thrown. The coulometric method can allow for variable test times, whereas the test time on a meter using the amperometric method is always fixed. Both methods give an estimation of the concentration of glucose in the initial blood sample.\nThe same principle is used in test strips that have been commercialized for the detection of diabetic ketoacidosis (DKA). These test strips use a beta-hydroxybutyrate-dehydrogenase enzyme instead of a glucose oxidizing enzyme and have been used to detect and help treat some of the complications that can result from prolonged hyperglycemia.[27]\nBlood alcohol sensors using the same approach, but with alcohol dehydrogenase enzymes, have been tried and patented but have not yet been successfully commercially developed.\n\nMeter use for hypoglycemia \nAlthough the apparent value of immediate measurement of blood glucose might seem to be higher for hypoglycemia than hyperglycemia, meters have been less useful. The primary problems are precision and ratio of false positive and negative results. An imprecision of \u00b115% is less of a problem for high glucose levels than low. There is little difference in the management of a glucose of 200 mg\/dl compared with 260 (i.e., a \"true\" glucose of 230\u00b115%), but a \u00b115% error margin at a low glucose concentration brings greater ambiguity with regards to glucose management.\nThe imprecision is compounded by the relative likelihoods of false positives and negatives in populations with diabetes and those without. People with type 1 diabetes usually have a wider range of glucose levels, and glucose peaks above normal, often ranging from 40 to 500 mg\/dl (2.2 to 28 mmol\/l), and when a meter reading of 50 or 70 (2.8 or 3.9 mmol\/l) is accompanied by their usual hypoglycemic symptoms, there is little uncertainty about the reading representing a \"true positive\" and little harm done if it is a \"false positive.\" However, the incidence of hypoglycemia unawareness, hypoglycemia-associated autonomic failure (HAAF) and faulty counterregulatory response to hypoglycemia make the need for greater reliability at low levels particularly urgent in patients with type 1 diabetes mellitus, while this is seldom an issue in the more common form of the disease, type 2 diabetes mellitus.\nIn contrast, people who do not have diabetes may periodically have hypoglycemic symptoms but may also have a much higher rate of false positives to true, and a meter is not accurate enough to base a diagnosis of hypoglycemia upon. A meter can occasionally be useful in the monitoring of severe types of hypoglycemia (e.g., congenital hyperinsulinism) to ensure that the average glucose when fasting remains above 70 mg\/dl (3.9 mmol\/l).\n\nSee also \nISO\/IEEE 11073\nReferences \n\n\n^ Advances in Electrochemical Sciences and Engineering : Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Somerset, NJ, US: John Wiley & Sons, 2013. \n\n^ Lipkowski, J., Kolb, D. M., & Alkire, R. C. (2011). Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Weinheim: Wiley-VCH. \n\n^ Advances in Electrochemical Sciences and Engineering : Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Somerset, NJ, US: John Wiley & Sons, 2013. \n\n^ Lipkowski, J., Kolb, D. M., & Alkire, R. C. (2011). Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Weinheim: Wiley-VCH. \n\n^ \"Portable Meter To Aid Diabetics\", Pittsburgh Press, November 5, 1981, p. A-6 \n\n^ \"Insulin Pumpers UK: Glossary\". Insulin-pumpers.org.uk. Retrieved 2014-03-13 . \n\n^ \"Diabetic Seniors \u2013 Informational Resource for Seniors with Diabetes\". Diabetes-wise.net. Retrieved 2014-03-13 . \n\n^ \"Diabetes UK, UK Diabetes Resource, Diabetes Symptoms, Diabetes Diet, Gestational Diabetes\". Diabetes.co.uk. Retrieved 2014-03-13 . \n\n^ \"Alternate site testing\". Accu-Chek.com. Retrieved 2018-07-20 . \n\n^ \"Home | Freestyle\". Abbottdiabetescare.com.au. 2013-08-13. Archived from the original on February 19, 2011. Retrieved 2014-03-13 . \n\n^ \"Print Diabetes Self-Management\". Diabetesselfmanagement.com. Retrieved 2014-03-13 . \n\n^ \"Diabetes In Control : Newsletter\" (PDF) . Diabetesincontrol.com. Retrieved 2014-03-13 . \n\n^ Leigh, Simon; Idris, Iskandar; Collins, Brendan; Granby, Paul; Noble, Max; Parker, Mark (Nov 2015). \"Promoting health and reducing costs: a role for reform of self-monitoring of blood glucose provision within the National Health Service\". Diabetic Medicine. 33 (5): 681\u201390. doi:10.1111\/dme.12977. PMID 26443548. \n\n^ \"Bogus Diabetes Test Strips Traced to Chinese Distributor\". The New York Times. Retrieved 2014-03-13 . \n\n^ The Pursuit of Noninvasive Glucose, 3rd Edition, by John L. Smith, Ph.D., available at http:\/\/www.mendosa.com\/The%20Pursuit%20of%20Noninvasive%20Glucose%203rd%20Edition.pdf. \n\n^ Tamada JA, Garg S, Jovanovic L, Pitzer KR, Fermi S, Potts RO (November 1999). \"Noninvasive glucose monitoring: comprehensive clinical results. Cygnus Research Team\". JAMA. 282 (19): 1839\u201344. doi:10.1001\/jama.282.19.1839. PMID 10573275. \n\n^ \"Continuous Glucose Monitoring\". The National Institute of Diabetes and Digestive and Kidney Diseases. December 2008. Retrieved 21 February 2016 . \n\n^ \"FreeStyle Libre\". Abbott Laboratories. Retrieved 21 February 2016 . An example of a CGM \n\n^ Freckmann, G; Schmid, C; Baumstark, A; Rutschmann, M; Haug, C; Heinemann, L (July 2015). \"Analytical Performance Requirements for Systems for Self-Monitoring of Blood Glucose With Focus on System Accuracy: Relevant Differences Among ISO 15197:2003, ISO 15197:2013, and Current FDA Recommendations\". Journal of Diabetes Science and Technology. 9 (4): 885\u201394. doi:10.1177\/1932296815580160. PMC 4525642 . PMID 25872965. \n\n^ \"Dexcom G4 product website\". Retrieved 2016-01-30 . \n\n^ \"Dexcom Product Compatibility\". Retrieved 2016-01-30 . \n\n^ \"CTIA International Wireless 2010 Finds Telcare Inc. Measures Up to Emerging Technology Award for Cellular-enabled Blood Glucose Meter Solution\". Eworldwire. 2010-03-25. Retrieved 2014-03-13 . \n\n^ NM Farandos; AK Yetisen; MJ Monteiro; CR Lowe; SH Yun (2014). \"Contact Lens Sensors in Ocular Diagnostics\". Advanced Healthcare Materials. 4 (6): 792\u2013810. doi:10.1002\/adhm.201400504. PMID 25400274. \n\n^ Lardinois, Frederic (January 16, 2014). \"Google Unveils Smart Contact Lens That Lets Diabetics Measure Their Glucose Levels\". TechCrunch. Retrieved January 17, 2014 . \n\n^ Mendoza, Martha (January 16, 2014). \"Google develops contact lens glucose monitor\". Associated Press. Retrieved January 17, 2014 . \n\n^ \"How Do Blood-Glucose Meters Work?\". Retrieved 28 November 2012 . \n\n^ Ghoshdastider U, Wu R, Trzaskowski B, Mlynarczyk K, Miszta P, Gurusaran M, Viswanathan S, Renugopalakrishnan V, Filipek S (2015). \"Nano-Encapsulation of Glucose Oxidase Dimer by Graphene\". RSC Advances. 5 (18): 13570\u201378. doi:10.1039\/C4RA16852F. CS1 maint: Uses authors parameter (link) \n\n\n\n\n\nWikimedia Commons has media related to Glucose meters.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Glucose_meter\">https:\/\/www.limswiki.org\/index.php\/Glucose_meter<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:37.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,338 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","47c550f9fa082cb1d36fa03887181ce8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Glucose_meter skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Glucose meter<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p>A <b>glucose meter<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> for determining the approximate concentration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose\" title=\"Glucose\" rel=\"external_link\" target=\"_blank\">glucose<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a>. It can also be a strip of glucose paper dipped into a substance and measured to the glucose chart. It is a key element of home <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_glucose_monitoring\" title=\"Blood glucose monitoring\" rel=\"external_link\" target=\"_blank\">blood glucose monitoring<\/a> (HBGM) by people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus\" title=\"Diabetes mellitus\" rel=\"external_link\" target=\"_blank\">diabetes mellitus<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoglycemia\" title=\"Hypoglycemia\" rel=\"external_link\" target=\"_blank\">hypoglycemia<\/a>. A small drop of blood, obtained by pricking the skin with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_lancet\" title=\"Blood lancet\" rel=\"external_link\" target=\"_blank\">lancet<\/a>, is placed on a disposable test strip that the meter reads and uses to calculate the blood glucose level. The meter then displays the level in units of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mg\/dl\" class=\"mw-redirect\" title=\"Mg\/dl\" rel=\"external_link\" target=\"_blank\">mg\/dl<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mmol\/L\" class=\"mw-redirect\" title=\"Mmol\/L\" rel=\"external_link\" target=\"_blank\">mmol\/l<\/a>.\n<\/p><p>Since approximately 1980, a primary goal of the management of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_1_diabetes_mellitus\" class=\"mw-redirect\" title=\"Type 1 diabetes mellitus\" rel=\"external_link\" target=\"_blank\">type 1 diabetes<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes_mellitus\" class=\"mw-redirect\" title=\"Type 2 diabetes mellitus\" rel=\"external_link\" target=\"_blank\">type 2 diabetes mellitus<\/a> has been achieving closer-to-normal levels of glucose in the blood for as much of the time as possible, guided by HBGM several times a day. The benefits include a reduction in the occurrence rate and severity of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus#Long-term_complications\" title=\"Diabetes mellitus\" rel=\"external_link\" target=\"_blank\">long-term complications<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">hyperglycemia<\/a> as well as a reduction in the short-term, potentially life-threatening complications of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_hypoglycemia\" title=\"Diabetic hypoglycemia\" rel=\"external_link\" target=\"_blank\">hypoglycemia<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Leland_Clark\" title=\"Leland Clark\" rel=\"external_link\" target=\"_blank\">Leland Clark<\/a> presented his first paper about the oxygen electrode, later named the Clark electrode, on 15 April 1956, at a meeting of the American Society for Artificial Organs during the annual meetings of the Federated Societies for Experimental Biology.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\nIn 1962, Clark and Ann Lyons from the Cincinnati Children\u2019s Hospital developed the first glucose enzyme electrode. This biosensor was based on a thin layer of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_oxidase\" title=\"Glucose oxidase\" rel=\"external_link\" target=\"_blank\">glucose oxidase<\/a> (GOx) on an oxygen electrode. Thus, the readout was the amount of oxygen consumed by GOx during the enzymatic reaction with the substrate glucose. This publication became one of the most often cited papers in life sciences. Due to this work he is considered the \u201cfather of biosensors,\u201d especially with respect to the glucose sensing for diabetes patients.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CDC_Preventing_Chronic_Diseases_Diabetes.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/CDC_Preventing_Chronic_Diseases_Diabetes.jpg\/220px-CDC_Preventing_Chronic_Diseases_Diabetes.jpg\" width=\"220\" height=\"284\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CDC_Preventing_Chronic_Diseases_Diabetes.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>CDC image showing the usage of a lancet and a blood glucose meter<\/div><\/div><\/div>\n<p>Another early glucose meter was the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ames_Reflectance_Meter\" title=\"Ames Reflectance Meter\" rel=\"external_link\" target=\"_blank\">Ames Reflectance Meter<\/a> by Anton H. Clemens. It was used in American hospitals in the 1970s. A moving needle indicated the blood glucose after about a minute.\n<\/p><p>Home glucose monitoring was demonstrated to improve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_management#Glycemic_control\" title=\"Diabetes management\" rel=\"external_link\" target=\"_blank\">glycemic control<\/a> of type 1 diabetes in the late 1970s, and the first meters were marketed for home use around 1981. The two models initially dominant in North America in the 1980s were the Glucometer, introduced in November 1981,<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> whose <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trademark\" title=\"Trademark\" rel=\"external_link\" target=\"_blank\">trademark<\/a> is owned by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bayer\" title=\"Bayer\" rel=\"external_link\" target=\"_blank\">Bayer<\/a>, and the Accu-Chek meter (by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hoffmann%E2%80%93La_Roche\" class=\"mw-redirect\" title=\"Hoffmann\u2013La Roche\" rel=\"external_link\" target=\"_blank\">Roche<\/a>). Consequently, these <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brand\" title=\"Brand\" rel=\"external_link\" target=\"_blank\">brand<\/a> names have become <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genericized_trademark\" class=\"mw-redirect\" title=\"Genericized trademark\" rel=\"external_link\" target=\"_blank\">synonymous with the generic product<\/a> to many health care professionals. In <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">Britain<\/a>, a health care professional or a patient may refer to \"taking a BM\": \"Mrs X's BM is 5\", etc. BM stands for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boehringer_Mannheim\" class=\"mw-redirect\" title=\"Boehringer Mannheim\" rel=\"external_link\" target=\"_blank\">Boehringer Mannheim<\/a>, now part of Roche, who produce test strips called 'BM-test' for use in a meter.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>In North America, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospitals<\/a> resisted adoption of meter glucose measurements for inpatient diabetes care for over a decade. Managers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_laboratory\" title=\"Medical laboratory\" rel=\"external_link\" target=\"_blank\">laboratories<\/a> argued that the superior accuracy of a laboratory glucose measurement outweighed the advantage of immediate availability and made meter glucose measurements unacceptable for inpatient diabetes management. Patients with diabetes and their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocrinologist\" class=\"mw-redirect\" title=\"Endocrinologist\" rel=\"external_link\" target=\"_blank\">endocrinologists<\/a> eventually persuaded acceptance. Some health care policymakers still resist the idea that the society would be well advised to pay the consumables (reagents, lancets, etc.) needed.\n<\/p><p>Home glucose testing was adopted for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes\" class=\"mw-redirect\" title=\"Type 2 diabetes\" rel=\"external_link\" target=\"_blank\">type 2 diabetes<\/a> more slowly than for type 1, and a large proportion of people with type 2 diabetes have never been instructed in home glucose testing.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> This has mainly come about because health authorities are reluctant to bear the cost of the test strips and lancets.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Non-meter_test_strips\">Non-meter test strips<\/span><\/h3>\n<p>Test strips that changed color and could be read visually, without a meter, have been widely used since the 1980s. They had the added advantage that they could be cut longitudinally to save money. Critics argued that test strips read by eye are not as accurate or convenient as meter testing. The manufacturer cited studies that show the product is just as effective despite not giving an answer to one decimal place, something they argue is unnecessary for control of blood sugar. This debate also happened in Germany where \"Glucoflex-R\" was an established strip for type 2 diabetes. As meter accuracy and insurance coverage improved, they lost popularity.\n<\/p><p>\"Glucoflex-R\" is Australia manufacturer National Diagnostic Products alternative to the BM test strip. It has versions that can be used either in a meter or read visually. It is also marketed under the brand name Betachek. On May 1, 2009, the UK distributor Ambe Medical Group reduced the price of their \"Glucoflex-R\" test strip to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Health_Service\" title=\"National Health Service\" rel=\"external_link\" target=\"_blank\">NHS<\/a>, by approximately 50%. This was expected to allow the NHS to save money on strips and perhaps loosen the restrictions on supply a little. Another low cost visually read strip is soon to be available on prescription according to sources at the NHS.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (November 2014)\">when?<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_meters\">Types of meters<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Hospital_glucose_meters\">Hospital glucose meters<\/span><\/h3>\n<p>Special glucose meters for multi-patient hospital use are now used. These provide more elaborate quality control records. Their data handling capabilities are designed to transfer glucose results into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronic_medical_record\" class=\"mw-redirect\" title=\"Electronic medical record\" rel=\"external_link\" target=\"_blank\">electronic medical records<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_laboratory\" title=\"Medical laboratory\" rel=\"external_link\" target=\"_blank\">laboratory<\/a> computer systems for billing purposes.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Blood_testing_with_meters_using_test_strips\">Blood testing with meters using test strips<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0301_Diabetes_GlucoseMonitoring.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/62\/Blausen_0301_Diabetes_GlucoseMonitoring.png\/220px-Blausen_0301_Diabetes_GlucoseMonitoring.png\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0301_Diabetes_GlucoseMonitoring.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Illustration depicting glucose monitoring with glucometer<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0299_Diabetes_BloodGlucoseMeter.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e2\/Blausen_0299_Diabetes_BloodGlucoseMeter.png\/220px-Blausen_0299_Diabetes_BloodGlucoseMeter.png\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0299_Diabetes_BloodGlucoseMeter.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Illustration depicting glucose meter and test strips<\/div><\/div><\/div>\n\n<p>There are several key characteristics of glucose meters which may differ from model to model:\n<\/p>\n<ul><li><b>Size<\/b>: The average size is now approximately the size of the palm of the hand, although hospital meters can be the size of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_control\" title=\"Remote control\" rel=\"external_link\" target=\"_blank\">remote control<\/a>. They are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Battery_(electricity)\" class=\"mw-redirect\" title=\"Battery (electricity)\" rel=\"external_link\" target=\"_blank\">battery<\/a>-powered.<\/li>\n<li><b>Test strips<\/b>: A consumable element containing chemicals that react with glucose in the drop of blood is used for each measurement. For some models this element is a plastic test strip with a small spot impregnated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_oxidase\" title=\"Glucose oxidase\" rel=\"external_link\" target=\"_blank\">glucose oxidase<\/a> and other components. Each strip is used once and then discarded. Instead of strips, some models use discs, drums, or cartridges that contain the consumable material for multiple tests.<\/li><\/ul>\n<dl><dd><ul><li><b>Coding<\/b>: Since test strips may vary from batch to batch, some models require the user to manually enter in a code found on the vial of test strips or on a chip that comes with the test strip. By entering the coding or chip into the glucose meter, the meter will be calibrated to that batch of test strips. However, if this process is carried out incorrectly, the meter reading can be up to 4 mmol\/L (72 mg\/dL) inaccurate. The implications of an incorrectly coded meter can be serious for patients actively managing their diabetes. This may place patients at increased risk of hypoglycemia. Alternatively, some test strips contain the code information in the strip; others have a microchip in the vial of strips that can be inserted into the meter. These last two methods reduce the possibility of user error. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OneTouch_Ultra\" title=\"OneTouch Ultra\" rel=\"external_link\" target=\"_blank\">One Touch<\/a> has standardized their test strips around a single code number, so that, once set, there is no need to further change the code in their older meters, and in some of their newer meters, there is no way to change the code.<\/li><\/ul><\/dd><\/dl>\n<ul><li><b>Volume of blood sample<\/b>: The size of the drop of blood needed by different models varies from 0.3 to 1 \u03bcl. (Older models required larger blood samples, usually defined as a \"hanging drop\" from the fingertip.) Smaller volume requirements reduce the frequency of unproductive pricks.<\/li>\n<li><b>Alternate site testing<\/b>: Smaller drop volumes have enabled \"alternate site testing\" \u2013 pricking the forearms or other less sensitive areas instead of the fingertips. This type of testing should only be used when blood glucose levels are stable, such as when before meals, when fasting, or just before going to sleep.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li><b>Testing times<\/b>: The times it takes to read a test strip may range from 3 to 60 seconds for different models.<\/li>\n<li><b>Display<\/b>: The glucose value in mg\/dl or mmol\/l is displayed on a digital display. The preferred measurement unit varies by country: mg\/dl are preferred in the US, France, Japan, Israel, and India. mmol\/l are used in Canada, Australia and China. Germany is the only country where medical professionals routinely operate in both units of measure. (To convert mmol\/l to mg\/dl, multiply by 18. To convert mg\/dl to mmol\/l, divide by 18.) Many meters can display either unit of measure; there have been a couple of published instances<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> in which someone with diabetes has been misled into the wrong action by assuming that a reading in mmol\/l was really a very low reading in mg\/dl, or the converse. In general, if a value is presented with a decimal point, it is in mmol\/l, without a decimal it is most likely mg\/dl.<\/li><\/ul>\n<table class=\"wikitable collapsible collapsed\" align=\"center\" border=\"1\" style=\"background:powderblue;\">\n\n<tbody><tr>\n<th colspan=\"4\" style=\"text-align:center; background:#bcd2ee;\">\n<b>Table of blood glucose units of measurement by country<\/b><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:#cae1ff;\">\n<p><b>Country<\/b>\n<\/p>\n<\/th>\n<th style=\"text-align:center; width:150px; background:#cae1ff;\"><b>Unit of measurement<br \/> used<\/b>\n<\/th>\n<th style=\"text-align:center; width:150px; background:#cae1ff;\">\n<p><b>Country<\/b>\n<\/p>\n<\/th>\n<th style=\"text-align:center; width:150px; background:#cae1ff;\"><b>Unit of measurement<br \/> used<\/b>\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Algeria\" title=\"Algeria\" rel=\"external_link\" target=\"_blank\">Algeria<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Malaysia\" title=\"Malaysia\" rel=\"external_link\" target=\"_blank\">Malaysia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Argentina\" title=\"Argentina\" rel=\"external_link\" target=\"_blank\">Argentina<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Malta\" title=\"Malta\" rel=\"external_link\" target=\"_blank\">Malta<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Australia\" title=\"Australia\" rel=\"external_link\" target=\"_blank\">Australia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mexico\" title=\"Mexico\" rel=\"external_link\" target=\"_blank\">Mexico<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Austria\" title=\"Austria\" rel=\"external_link\" target=\"_blank\">Austria<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Netherlands\" title=\"Netherlands\" rel=\"external_link\" target=\"_blank\">Netherlands<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bahrain\" title=\"Bahrain\" rel=\"external_link\" target=\"_blank\">Bahrain<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/New_Zealand\" title=\"New Zealand\" rel=\"external_link\" target=\"_blank\">New Zealand<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bangladesh\" title=\"Bangladesh\" rel=\"external_link\" target=\"_blank\">Bangladesh<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Norway\" title=\"Norway\" rel=\"external_link\" target=\"_blank\">Norway<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Belgium\" title=\"Belgium\" rel=\"external_link\" target=\"_blank\">Belgium<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oman\" title=\"Oman\" rel=\"external_link\" target=\"_blank\">Oman<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brazil\" title=\"Brazil\" rel=\"external_link\" target=\"_blank\">Brazil<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peru\" title=\"Peru\" rel=\"external_link\" target=\"_blank\">Peru<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Canada\" title=\"Canada\" rel=\"external_link\" target=\"_blank\">Canada<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Philippines\" title=\"Philippines\" rel=\"external_link\" target=\"_blank\">Philippines<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Caribbean\" title=\"Caribbean\" rel=\"external_link\" target=\"_blank\">Caribbean countries<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Poland\" title=\"Poland\" rel=\"external_link\" target=\"_blank\">Poland<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chile\" title=\"Chile\" rel=\"external_link\" target=\"_blank\">Chile<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portugal\" title=\"Portugal\" rel=\"external_link\" target=\"_blank\">Portugal<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Qatar\" title=\"Qatar\" rel=\"external_link\" target=\"_blank\">Qatar<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Colombia\" title=\"Colombia\" rel=\"external_link\" target=\"_blank\">Colombia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Russia\" title=\"Russia\" rel=\"external_link\" target=\"_blank\">Russia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Czech_Republic\" title=\"Czech Republic\" rel=\"external_link\" target=\"_blank\">Czech Republic<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Saudi_Arabia\" title=\"Saudi Arabia\" rel=\"external_link\" target=\"_blank\">Saudi Arabia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Denmark\" title=\"Denmark\" rel=\"external_link\" target=\"_blank\">Denmark<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Singapore\" title=\"Singapore\" rel=\"external_link\" target=\"_blank\">Singapore<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ecuador\" title=\"Ecuador\" rel=\"external_link\" target=\"_blank\">Ecuador<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Slovakia\" title=\"Slovakia\" rel=\"external_link\" target=\"_blank\">Slovakia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Egypt\" title=\"Egypt\" rel=\"external_link\" target=\"_blank\">Egypt<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/South_Africa\" title=\"South Africa\" rel=\"external_link\" target=\"_blank\">South Africa<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Finland\" title=\"Finland\" rel=\"external_link\" target=\"_blank\">Finland<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Spain\" title=\"Spain\" rel=\"external_link\" target=\"_blank\">Spain<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/France\" title=\"France\" rel=\"external_link\" target=\"_blank\">France<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sub-Saharan_Africa\" title=\"Sub-Saharan Africa\" rel=\"external_link\" target=\"_blank\">Sub-Saharan Africa<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL<br \/>mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_(country)\" title=\"Georgia (country)\" rel=\"external_link\" target=\"_blank\">Georgia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sweden\" title=\"Sweden\" rel=\"external_link\" target=\"_blank\">Sweden<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Germany\" title=\"Germany\" rel=\"external_link\" target=\"_blank\">Germany<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL<br \/>mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Switzerland\" title=\"Switzerland\" rel=\"external_link\" target=\"_blank\">Switzerland<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Greece\" title=\"Greece\" rel=\"external_link\" target=\"_blank\">Greece<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Syria\" title=\"Syria\" rel=\"external_link\" target=\"_blank\">Syria<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hong_Kong\" title=\"Hong Kong\" rel=\"external_link\" target=\"_blank\">Hong Kong<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Taiwan\" title=\"Taiwan\" rel=\"external_link\" target=\"_blank\">Taiwan<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/India\" title=\"India\" rel=\"external_link\" target=\"_blank\">India<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thailand\" title=\"Thailand\" rel=\"external_link\" target=\"_blank\">Thailand<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Indonesia\" title=\"Indonesia\" rel=\"external_link\" target=\"_blank\">Indonesia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tunisia\" title=\"Tunisia\" rel=\"external_link\" target=\"_blank\">Tunisia<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ireland\" title=\"Ireland\" rel=\"external_link\" target=\"_blank\">Ireland<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Turkey\" title=\"Turkey\" rel=\"external_link\" target=\"_blank\">Turkey<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Israel\" title=\"Israel\" rel=\"external_link\" target=\"_blank\">Israel<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ukraine\" title=\"Ukraine\" rel=\"external_link\" target=\"_blank\">Ukraine<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Italy\" title=\"Italy\" rel=\"external_link\" target=\"_blank\">Italy<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Arab_Emirates\" title=\"United Arab Emirates\" rel=\"external_link\" target=\"_blank\">United Arab Emirates<\/a> (UAE)\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Japan\" title=\"Japan\" rel=\"external_link\" target=\"_blank\">Japan<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">United Kingdom<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jordan\" title=\"Jordan\" rel=\"external_link\" target=\"_blank\">Jordan<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kazakhstan\" title=\"Kazakhstan\" rel=\"external_link\" target=\"_blank\">Kazakhstan<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Uruguay\" title=\"Uruguay\" rel=\"external_link\" target=\"_blank\">Uruguay<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Korea\" title=\"Korea\" rel=\"external_link\" target=\"_blank\">Korea<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Venezuela\" title=\"Venezuela\" rel=\"external_link\" target=\"_blank\">Venezuela<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kuwait\" title=\"Kuwait\" rel=\"external_link\" target=\"_blank\">Kuwait<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vietnam\" title=\"Vietnam\" rel=\"external_link\" target=\"_blank\">Vietnam<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mmol\/L\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lebanon\" title=\"Lebanon\" rel=\"external_link\" target=\"_blank\">Lebanon<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Yemen\" title=\"Yemen\" rel=\"external_link\" target=\"_blank\">Yemen<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th><\/tr>\n<tr>\n<th style=\"text-align:center; width:150px; background:ivory;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Luxembourg\" title=\"Luxembourg\" rel=\"external_link\" target=\"_blank\">Luxembourg<\/a>\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">mg\/dL\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">\n<\/th>\n<th style=\"text-align:center; width:150px; background:ivory;\">\n<\/th><\/tr><\/tbody><\/table>\n<dl><dd><ul><li><b>Glucose vs. plasma glucose<\/b>: Glucose levels in plasma (one of the components of blood) are generally 10\u201315% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as \"plasma equivalent,\" even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for patients and their health care providers to know whether the meter gives its results as \"whole blood equivalent\" or \"plasma equivalent.\" One model measures <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beta-hydroxybutyrate\" class=\"mw-redirect\" title=\"Beta-hydroxybutyrate\" rel=\"external_link\" target=\"_blank\">beta-hydroxybutyrate<\/a> in the blood to detect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ketosis\" title=\"Ketosis\" rel=\"external_link\" target=\"_blank\">ketosis<\/a> for measuring both unhealthy ketoacidosis and healthy nutritional ketosis.<\/li><\/ul><\/dd><\/dl>\n<ul><li><b>Clock\/memory<\/b>: Most meters now include a clock that is set by the user for date and time and a memory for past test results. The memory is an important aspect of diabetes care, as it enables the person with diabetes to keep a record of management and look for trends and patterns in blood glucose levels over days and weeks. Most memory chips can display an average of recent glucose readings. A known deficiency of all current meters is that the clock is often not set to the correct time (i.e., due to time changes, static electricity, etc.) and therefore has the potential to misrepresent the time of the past test results making pattern management difficult.<\/li><\/ul>\n<dl><dd><ul><li><b>Data transfer<\/b>: Many meters now have more sophisticated data handling capabilities. Many can be downloaded by a cable or infrared to a computer that has <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_management_software\" title=\"Diabetes management software\" rel=\"external_link\" target=\"_blank\">diabetes management software<\/a> to display the test results. Some meters allow entry of additional data throughout the day, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a> dose, amounts of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbohydrate\" title=\"Carbohydrate\" rel=\"external_link\" target=\"_blank\">carbohydrates<\/a> eaten, or exercise. A number of meters have been combined with other devices, such as insulin injection devices, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personal_digital_assistant\" title=\"Personal digital assistant\" rel=\"external_link\" target=\"_blank\">PDAs<\/a>, cellular transmitters,<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Game_Boy\" title=\"Game Boy\" rel=\"external_link\" target=\"_blank\">Game Boys<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> A radio link to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin_pump\" title=\"Insulin pump\" rel=\"external_link\" target=\"_blank\">insulin pump<\/a> allows automatic transfer of glucose readings to a calculator that assists the wearer in deciding on an appropriate insulin dose.<\/li><\/ul><\/dd><\/dl>\n<h4><span class=\"mw-headline\" id=\"Cost\">Cost<\/span><\/h4>\n<p>The cost of home blood glucose monitoring can be substantial due to the cost of the test strips. In 2006, the consumer cost of each glucose strip ranged from about $0.35 to $1.00. Manufacturers often provide meters at no cost to induce use of the profitable test strips. Type 1 diabetics may test as often as 4 to 10 times a day due to the dynamics of insulin adjustment, whereas type 2 typically test less frequently, especially when insulin is not part of treatment. A recent study on the comparative cost-effectiveness of all options for the self-monitoring of blood glucose funded by the National Health Service in the UK uncovered considerable variation in the price paid, which could not be explained by the availability of advanced meter features. It estimated that a total of \u00a312 m was invested in providing 42 million self-monitoring of blood glucose tests with systems that fail to meet acceptable accuracy standards, and efficiency savings of \u00a323.2 m per annum are achievable if the National Health Service were to disinvest from technologies providing lesser functionality than available alternatives, but at a much higher price.<sup id=\"rdp-ebb-cite_ref-Leigh_2015_13-0\" class=\"reference\"><a href=\"#cite_note-Leigh_2015-13\" rel=\"external_link\">[13]<\/a><\/sup>\nBatches of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Counterfeit\" title=\"Counterfeit\" rel=\"external_link\" target=\"_blank\">counterfeit<\/a> test strips for some meters have been identified, which have been shown to produce inaccurate results.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Noninvasive_meters\">Noninvasive meters<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Noninvasive_glucose_monitor\" title=\"Noninvasive glucose monitor\" rel=\"external_link\" target=\"_blank\">Noninvasive glucose monitor<\/a><\/div>\n<p>The search for a successful technique began about 1975 and has continued to the present without a clinically or commercially viable product.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> As of 1999<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, only one such product had ever been approved for sale by the FDA, based on a technique for electrically pulling glucose through intact skin, and it was withdrawn after a short time owing to poor performance and occasional damage to the skin of users.<sup id=\"rdp-ebb-cite_ref-pmid10573275_16-0\" class=\"reference\"><a href=\"#cite_note-pmid10573275-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Continuous_glucose_monitors\">Continuous glucose monitors<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BGM_twopart.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7f\/BGM_twopart.JPG\/220px-BGM_twopart.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BGM_twopart.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Continuous glucose monitor. The sensor and transmitter are fixed to the upper arm. The reader shows days to replacement of sensor, current blood glucose level and a diagram of the latest blood glucose levels.<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Continuous_glucose_monitor\" title=\"Continuous glucose monitor\" rel=\"external_link\" target=\"_blank\">Continuous glucose monitor<\/a><\/div><p>Continuous glucose monitor systems can consist of a disposable sensor placed under the skin, a transmitter connected to the sensor and a reader that receives and displays the measurements. The sensor can be used for several days before it needs to be replaced. The devices provide real-time measurements, and reduce the need for fingerprick testing of glucose levels. A drawback is that the meters are not as accurate because they read the glucose levels in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interstitial_fluid\" class=\"mw-redirect\" title=\"Interstitial fluid\" rel=\"external_link\" target=\"_blank\">interstitial fluid<\/a> which lags behind the levels in the blood.<sup id=\"rdp-ebb-cite_ref-NIH_CGM_17-0\" class=\"reference\"><a href=\"#cite_note-NIH_CGM-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Abbot_FSL_18-0\" class=\"reference\"><a href=\"#cite_note-Abbot_FSL-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><h2><span class=\"mw-headline\" id=\"Accuracy\">Accuracy<\/span><\/h2>\n<p>Accuracy of glucose meters is a common topic of clinical concern. Blood glucose meters must meet accuracy standards set by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Organization_for_Standardization\" title=\"International Organization for Standardization\" rel=\"external_link\" target=\"_blank\">International Organization for Standardization<\/a> (ISO). According to ISO 15197 Blood glucose meters must provide results that are within \u00b115% of a laboratory standard for concentrations above 100 mg\/dL or within \u00b115 mg\/dL for concentrations below 100 mg\/dL at least 95% of the time.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> However, a variety of factors can affect the accuracy of a test. Factors affecting accuracy of various meters include calibration of meter, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ambient_temperature\" class=\"mw-redirect\" title=\"Ambient temperature\" rel=\"external_link\" target=\"_blank\">ambient temperature<\/a>, pressure use to wipe off strip (if applicable), size and quality of blood sample, high levels of certain substances (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ascorbic_acid\" class=\"mw-redirect\" title=\"Ascorbic acid\" rel=\"external_link\" target=\"_blank\">ascorbic acid<\/a>) in blood, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hematocrit\" title=\"Hematocrit\" rel=\"external_link\" target=\"_blank\">hematocrit<\/a>, dirt on meter, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Humidity\" title=\"Humidity\" rel=\"external_link\" target=\"_blank\">humidity<\/a>, and aging of test strips. Models vary in their susceptibility to these factors and in their ability to prevent or warn of inaccurate results with error messages. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clarke_Error_Grid\" title=\"Clarke Error Grid\" rel=\"external_link\" target=\"_blank\">Clarke Error Grid<\/a> has been a common way of analyzing and displaying accuracy of readings related to management consequences. More recently an improved version of the Clarke Error Grid has come into use: It is known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Consensus_Error_Grid\" class=\"mw-redirect\" title=\"Consensus Error Grid\" rel=\"external_link\" target=\"_blank\">Consensus Error Grid<\/a>. Older blood glucose meters often need to be \"coded\" with the lot of test strips used, otherwise, the accuracy of the blood glucose meter may be compromised due to lack of calibration.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Future\">Future<\/span><\/h2>\n\n<p>One noninvasive glucose meter has been approved by the U.S. FDA: The GlucoWatch G2 Biographer made by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cygnus_Inc\" title=\"Cygnus Inc\" rel=\"external_link\" target=\"_blank\">Cygnus Inc<\/a>. The device was designed to be worn on the wrist and used electric fields to draw out body fluid for testing. The device did not replace conventional blood glucose monitoring. One limitation was that the GlucoWatch was not able to cope with perspiration at the measurement site. Sweat must be allowed to dry before measurement can resume. Due to this limitation and others, the product is no longer on the market.\n<\/p><p>The market introduction of noninvasive blood glucose measurement by spectroscopic measurement methods, in the field of near-infrared (NIR), by extracorporal measuring devices, has not been successful because the devices measure tissue sugar in body tissues and not the blood sugar in blood fluid. To determine blood glucose, the measuring beam of infrared light, for example, has to penetrate the tissue for measurement of blood glucose.\n<\/p><p>There are currently three CGMS (continuous glucose monitoring system) available. The first is Medtronic's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimed_Paradigm\" title=\"Minimed Paradigm\" rel=\"external_link\" target=\"_blank\">Minimed Paradigm<\/a> RTS with a sub-cutaneous probe attached to a small transmitter (roughly the size of a quarter) that sends interstitial glucose levels to a small pager sized receiver every five minutes. The Dexcom System is another system, available in two different generations in the US, the G4 and the G5. (1Q 2016). It is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic\" class=\"mw-redirect\" title=\"Hypodermic\" rel=\"external_link\" target=\"_blank\">hypodermic<\/a> probe with a small transmitter. The receiver is about the size of a cell phone and can operate up to twenty feet from the transmitter. The Dexcom G4 transmits via radio frequency and requires a dedicated receiver.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> The G5 version utilizes Bluetooth low energy for data transmission, and can transmit data directly to a compatible cellular telephone. Currently, only Apple's iPhone can be used as a receiver,<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> but Dexcom is in the process of getting an Android version approved, and anticipates availability in the second half of 2016. Aside from a two-hour calibration period, monitoring is logged at five-minute intervals for up to 1 week. The user can set the high and low glucose alarms. The third CGMS available is the FreeStyle Navigator from Abbott Laboratories.\n<\/p><p>There is currently an effort to develop an integrated treatment system with a glucose meter, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin_pump\" title=\"Insulin pump\" rel=\"external_link\" target=\"_blank\">insulin pump<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wristop\" class=\"mw-redirect\" title=\"Wristop\" rel=\"external_link\" target=\"_blank\">wristop<\/a> controller, as well as an effort to integrate the glucose meter and a cell phone. These glucose meter\/cellular phone combinations are under testing and currently cost $149 USD retail.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (May 2012)\">when?<\/span><\/a><\/i>]<\/sup> Testing strips are proprietary and available only through the manufacturer (no insurance availability). These \"Glugophones\" are currently offered in three forms: as a dongle for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPhone\" title=\"IPhone\" rel=\"external_link\" target=\"_blank\">iPhone<\/a>, an add-on pack for <a href=\"https:\/\/en.wikipedia.org\/wiki\/LG\" class=\"mw-redirect\" title=\"LG\" rel=\"external_link\" target=\"_blank\">LG<\/a> model UX5000, VX5200, and LX350 cell phones, as well as an add-on pack for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motorola\" title=\"Motorola\" rel=\"external_link\" target=\"_blank\">Motorola<\/a> Razr cell phone. In US, this limits providers to <a href=\"https:\/\/en.wikipedia.org\/wiki\/AT%26T_Inc.\" class=\"mw-redirect\" title=\"AT&T Inc.\" rel=\"external_link\" target=\"_blank\">AT&T<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Verizon\" class=\"mw-redirect\" title=\"Verizon\" rel=\"external_link\" target=\"_blank\">Verizon<\/a>. Similar systems have been tested for a longer time in Finland.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Recent advances in cellular data communications technology have enabled the development of glucose meters that directly integrate cellular data transmission capability, enabling the user to both transmit glucose data to the medical caregiver and receive direct guidance from the caregiver on the screen of the glucose meter. The first such device, from Telcare, Inc., was exhibited at the 2010 CTIA International Wireless Expo,<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> where it won an E-Tech award. This device is currently undergoing clinical testing in the US and internationally.\n<\/p><p>In early 2014 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Google\" title=\"Google\" rel=\"external_link\" target=\"_blank\">Google<\/a> reported testing prototypes of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contact_lens\" title=\"Contact lens\" rel=\"external_link\" target=\"_blank\">contact lenses<\/a> that monitor glucose levels and alert users when glucose levels cross certain thresholds.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-TechCrunch201401_24-0\" class=\"reference\"><a href=\"#cite_note-TechCrunch201401-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-AP-20140116_25-0\" class=\"reference\"><a href=\"#cite_note-AP-20140116-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technology\">Technology<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Accu-chek_blood_glucose_test_strips.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Accu-chek_blood_glucose_test_strips.jpg\/220px-Accu-chek_blood_glucose_test_strips.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Accu-chek_blood_glucose_test_strips.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Two used Accu-Chek test strips. The lower one has had the cover peeled off to show the circuit.<\/div><\/div><\/div>\n<p>Many glucose meters employ the oxidation of glucose to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluconolactone\" class=\"mw-redirect\" title=\"Gluconolactone\" rel=\"external_link\" target=\"_blank\">gluconolactone<\/a> catalyzed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_oxidase\" title=\"Glucose oxidase\" rel=\"external_link\" target=\"_blank\">glucose oxidase<\/a> (sometimes known as GOx). Others use a similar reaction catalysed instead by another <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enzyme\" title=\"Enzyme\" rel=\"external_link\" target=\"_blank\">enzyme<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_dehydrogenase_(acceptor)\" title=\"Glucose dehydrogenase (acceptor)\" rel=\"external_link\" target=\"_blank\">glucose dehydrogenase<\/a> (GDH). This has the advantage of sensitivity over glucose oxidase but is more susceptible to interfering reactions with other substances.<sup id=\"rdp-ebb-cite_ref-Inteli_Health_26-0\" class=\"reference\"><a href=\"#cite_note-Inteli_Health-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>The first-generation devices relied on the same <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colorimetry\" title=\"Colorimetry\" rel=\"external_link\" target=\"_blank\">colorimetric<\/a> reaction that is still used nowadays in glucose test strips for urine. Besides glucose oxidase, the test kit contains a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benzidine\" title=\"Benzidine\" rel=\"external_link\" target=\"_blank\">benzidine<\/a> derivative, which is oxidized to a blue polymer by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen_peroxide\" title=\"Hydrogen peroxide\" rel=\"external_link\" target=\"_blank\">hydrogen peroxide<\/a> formed in the oxidation reaction. The disadvantage of this method was that the test strip had to be developed after a precise interval (the blood had to be washed away), and the meter needed to be calibrated frequently.\n<\/p><p>Most glucometers today use an electrochemical method. Test strips contain a capillary that sucks up a reproducible amount of blood. The glucose in the blood reacts with an enzyme electrode containing glucose oxidase (or dehydrogenase). The enzyme is reoxidized with an excess of a mediator reagent, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferricyanide\" title=\"Ferricyanide\" rel=\"external_link\" target=\"_blank\">ferricyanide<\/a> ion, a ferrocene derivative or osmium bipyridyl complex. The mediator in turn is reoxidized by reaction at the electrode, which generates an electric current. The total charge passing through the electrode is proportional to the amount of glucose in the blood that has reacted with the enzyme. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coulometry\" title=\"Coulometry\" rel=\"external_link\" target=\"_blank\">coulometric<\/a> method is a technique where the total amount of charge generated by the glucose oxidation reaction is measured over a period of time. The amperometric method is used by some meters and measures the electric current generated at a specific point in time by the glucose reaction. This is analogous to throwing a ball and using the speed at which it is travelling at a point in time to estimate how hard it was thrown. The coulometric method can allow for variable test times, whereas the test time on a meter using the amperometric method is always fixed. Both methods give an estimation of the concentration of glucose in the initial blood sample.\n<\/p><p>The same principle is used in test strips that have been commercialized for the detection of diabetic ketoacidosis (DKA). These test strips use a beta-hydroxybutyrate-dehydrogenase enzyme instead of a glucose oxidizing enzyme and have been used to detect and help treat some of the complications that can result from prolonged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">hyperglycemia<\/a>.<sup id=\"rdp-ebb-cite_ref-ghoshdastider_27-0\" class=\"reference\"><a href=\"#cite_note-ghoshdastider-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p><p>Blood alcohol sensors using the same approach, but with alcohol dehydrogenase enzymes, have been tried and patented but have not yet been successfully commercially developed.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Meter_use_for_hypoglycemia\">Meter use for hypoglycemia<\/span><\/h2>\n<p>Although the apparent value of immediate measurement of blood glucose might seem to be higher for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoglycemia\" title=\"Hypoglycemia\" rel=\"external_link\" target=\"_blank\">hypoglycemia<\/a> than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">hyperglycemia<\/a>, meters have been less useful. The primary problems are <i>precision<\/i> and <i>ratio of false positive and negative results<\/i>. An imprecision of \u00b115% is less of a problem for high glucose levels than low. There is little difference in the management of a glucose of 200 mg\/dl compared with 260 (i.e., a \"true\" glucose of 230\u00b115%), but a \u00b115% error margin at a low glucose concentration brings greater ambiguity with regards to glucose management.\n<\/p><p>The imprecision is compounded by the relative likelihoods of false positives and negatives in populations with diabetes and those without. People with type 1 diabetes usually have a wider range of glucose levels, and glucose peaks above normal, often ranging from 40 to 500 mg\/dl (2.2 to 28 mmol\/l), and when a meter reading of 50 or 70 (2.8 or 3.9 mmol\/l) is accompanied by their usual hypoglycemic symptoms, there is little uncertainty about the reading representing a \"true positive\" and little harm done if it is a \"false positive.\" However, the incidence of hypoglycemia unawareness, hypoglycemia-associated autonomic failure (HAAF) and faulty counterregulatory response to hypoglycemia make the need for greater reliability at low levels particularly urgent in patients with type 1 diabetes mellitus, while this is seldom an issue in the more common form of the disease, type 2 diabetes mellitus.\n<\/p><p>In contrast, people who do not have diabetes may periodically have hypoglycemic symptoms but may also have a much higher rate of false positives to true, and a meter is not accurate enough to base a diagnosis of hypoglycemia upon. A meter can occasionally be useful in the monitoring of severe types of hypoglycemia (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_hyperinsulinism\" title=\"Congenital hyperinsulinism\" rel=\"external_link\" target=\"_blank\">congenital hyperinsulinism<\/a>) to ensure that the average glucose when fasting remains above 70 mg\/dl (3.9 mmol\/l).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO\/IEEE_11073\" title=\"ISO\/IEEE 11073\" rel=\"external_link\" target=\"_blank\">ISO\/IEEE 11073<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Advances in Electrochemical Sciences and Engineering : Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Somerset, NJ, US: John Wiley & Sons, 2013.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lipkowski, J., Kolb, D. M., & Alkire, R. C. (2011). Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Weinheim: Wiley-VCH.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Advances in Electrochemical Sciences and Engineering : Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Somerset, NJ, US: John Wiley & Sons, 2013.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lipkowski, J., Kolb, D. M., & Alkire, R. C. (2011). Bioelectrochemistry : Fundamentals, Applications and Recent Developments. Weinheim: Wiley-VCH.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Portable Meter To Aid Diabetics\", <i>Pittsburgh Press<\/i>, November 5, 1981, p. A-6<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.insulin-pumpers.org.uk\/glossary\/\" target=\"_blank\">\"Insulin Pumpers UK: Glossary\"<\/a>. Insulin-pumpers.org.uk<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">21 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=FreeStyle+Libre&rft.pub=Abbott+Laboratories&rft_id=http%3A%2F%2Fwww.freestylelibre.co.uk%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> An example of a CGM<\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Freckmann, G; Schmid, C; Baumstark, A; Rutschmann, M; Haug, C; Heinemann, L (July 2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4525642\" target=\"_blank\">\"Analytical Performance Requirements for Systems for Self-Monitoring of Blood Glucose With Focus on System Accuracy: Relevant Differences Among ISO 15197:2003, ISO 15197:2013, and Current FDA Recommendations\"<\/a>. <i>Journal of Diabetes Science and Technology<\/i>. <b>9<\/b> (4): 885\u201394. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1932296815580160\" target=\"_blank\">10.1177\/1932296815580160<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4525642\" target=\"_blank\">4525642<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25872965\" target=\"_blank\">25872965<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Diabetes+Science+and+Technology&rft.atitle=Analytical+Performance+Requirements+for+Systems+for+Self-Monitoring+of+Blood+Glucose+With+Focus+on+System+Accuracy%3A+Relevant+Differences+Among+ISO+15197%3A2003%2C+ISO+15197%3A2013%2C+and+Current+FDA+Recommendations.&rft.volume=9&rft.issue=4&rft.pages=885-94&rft.date=2015-07&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4525642&rft_id=info%3Apmid%2F25872965&rft_id=info%3Adoi%2F10.1177%2F1932296815580160&rft.aulast=Freckmann&rft.aufirst=G&rft.au=Schmid%2C+C&rft.au=Baumstark%2C+A&rft.au=Rutschmann%2C+M&rft.au=Haug%2C+C&rft.au=Heinemann%2C+L&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4525642&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dexcom.com\/dexcom-g4-platinum-share\" target=\"_blank\">\"Dexcom G4 product website\"<\/a><span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">2016-01-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Dexcom+Product+Compatibility&rft_id=http%3A%2F%2Fwww.dexcom.com%2Ffaq%2Fwhat-devices-are-compatible-dexcom-cgm-apps&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.eworldwire.com\/pressrelease\/211548\" target=\"_blank\">\"CTIA International Wireless 2010 Finds Telcare Inc. Measures Up to Emerging Technology Award for Cellular-enabled Blood Glucose Meter Solution\"<\/a>. Eworldwire. 2010-03-25<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=CTIA+International+Wireless+2010+Finds+Telcare+Inc.+Measures+Up+to+Emerging+Technology+Award+for+Cellular-enabled+Blood+Glucose+Meter+Solution&rft.pub=Eworldwire&rft.date=2010-03-25&rft_id=http%3A%2F%2Fwww.eworldwire.com%2Fpressrelease%2F211548&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">NM Farandos; AK Yetisen; MJ Monteiro; CR Lowe; SH Yun (2014). \"Contact Lens Sensors in Ocular Diagnostics\". <i>Advanced Healthcare Materials<\/i>. <b>4<\/b> (6): 792\u2013810. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fadhm.201400504\" target=\"_blank\">10.1002\/adhm.201400504<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25400274\" target=\"_blank\">25400274<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advanced+Healthcare+Materials&rft.atitle=Contact+Lens+Sensors+in+Ocular+Diagnostics.&rft.volume=4&rft.issue=6&rft.pages=792-810&rft.date=2014&rft_id=info%3Adoi%2F10.1002%2Fadhm.201400504&rft_id=info%3Apmid%2F25400274&rft.au=NM+Farandos&rft.au=AK+Yetisen&rft.au=MJ+Monteiro&rft.au=CR+Lowe&rft.au=SH+Yun&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-TechCrunch201401-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-TechCrunch201401_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Lardinois, Frederic (January 16, 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/techcrunch.com\/2014\/01\/16\/google-shows-off-smart-contact-lens-that-lets-diabetics-measure-their-glucose-levels\/\" target=\"_blank\">\"Google Unveils Smart Contact Lens That Lets Diabetics Measure Their Glucose Levels\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/TechCrunch\" title=\"TechCrunch\" rel=\"external_link\" target=\"_blank\">TechCrunch<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 17,<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TechCrunch&rft.atitle=Google+Unveils+Smart+Contact+Lens+That+Lets+Diabetics+Measure+Their+Glucose+Levels&rft.date=2014-01-16&rft.aulast=Lardinois&rft.aufirst=Frederic&rft_id=https%3A%2F%2Ftechcrunch.com%2F2014%2F01%2F16%2Fgoogle-shows-off-smart-contact-lens-that-lets-diabetics-measure-their-glucose-levels%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AP-20140116-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AP-20140116_25-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Mendoza, Martha (January 16, 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/apnews.excite.com\/article\/20140117\/DABC8C484.html\" target=\"_blank\">\"Google develops contact lens glucose monitor\"<\/a>. Associated Press<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 17,<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Google+develops+contact+lens+glucose+monitor&rft.date=2014-01-16&rft.aulast=Mendoza&rft.aufirst=Martha&rft_id=http%3A%2F%2Fapnews.excite.com%2Farticle%2F20140117%2FDABC8C484.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Inteli_Health-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Inteli_Health_26-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.intelihealth.com\/IH\/ihtIH\/WSIHW000\/35072\/35116\/241327.html?d=dmtContent\" target=\"_blank\">\"How Do Blood-Glucose Meters Work?\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=How+Do+Blood-Glucose+Meters+Work%3F&rft_id=http%3A%2F%2Fwww.intelihealth.com%2FIH%2FihtIH%2FWSIHW000%2F35072%2F35116%2F241327.html%3Fd%3DdmtContent&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ghoshdastider-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ghoshdastider_27-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ghoshdastider U, Wu R, Trzaskowski B, Mlynarczyk K, Miszta P, Gurusaran M, Viswanathan S, Renugopalakrishnan V, Filipek S (2015). \"Nano-Encapsulation of Glucose Oxidase Dimer by Graphene\". <i>RSC Advances<\/i>. <b>5<\/b> (18): 13570\u201378. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1039%2FC4RA16852F\" target=\"_blank\">10.1039\/C4RA16852F<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=RSC+Advances&rft.atitle=Nano-Encapsulation+of+Glucose+Oxidase+Dimer+by+Graphene&rft.volume=5&rft.issue=18&rft.pages=13570-78&rft.date=2015&rft_id=info%3Adoi%2F10.1039%2FC4RA16852F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+meter\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181207023525\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.524 seconds\nReal time usage: 0.675 seconds\nPreprocessor visited node count: 2384\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 67045\/2097152 bytes\nTemplate argument size: 4222\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 10\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 58999\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.258\/10.000 seconds\nLua memory usage: 5.59 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 543.089 1 -total\n<\/p>\n<pre>40.06% 217.536 1 Template:Reflist\n21.33% 115.814 14 Template:Cite_web\n13.44% 72.976 2 Template:Refimprove\n11.17% 60.654 1 Template:Commons_category\n10.95% 59.482 5 Template:Cite_journal\n10.81% 58.718 4 Template:Ambox\n10.29% 55.909 4 Template:Fix\n 8.03% 43.592 2 Template:When\n 7.01% 38.060 1 Template:Infobox_diagnostic\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1627125-1!canonical and timestamp 20181207023524 and revision id 870407772\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_meter\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214636\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.027 seconds\nReal time usage: 0.182 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 173.665 1 - wikipedia:Glucose_meter\n100.00% 173.665 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8538-0!*!*!*!*!*!* and timestamp 20181217214636 and revision id 24963\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Glucose_meter\">https:\/\/www.limswiki.org\/index.php\/Glucose_meter<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","47c550f9fa082cb1d36fa03887181ce8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/38\/Glucose_meters.jpg\/580px-Glucose_meters.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/CDC_Preventing_Chronic_Diseases_Diabetes.jpg\/440px-CDC_Preventing_Chronic_Diseases_Diabetes.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/62\/Blausen_0301_Diabetes_GlucoseMonitoring.png\/440px-Blausen_0301_Diabetes_GlucoseMonitoring.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e2\/Blausen_0299_Diabetes_BloodGlucoseMeter.png\/440px-Blausen_0299_Diabetes_BloodGlucoseMeter.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7f\/BGM_twopart.JPG\/440px-BGM_twopart.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Accu-chek_blood_glucose_test_strips.jpg\/440px-Accu-chek_blood_glucose_test_strips.jpg"],"47c550f9fa082cb1d36fa03887181ce8_timestamp":1545083195,"a77e286e4af95b13abc7acf73113e96b_type":"article","a77e286e4af95b13abc7acf73113e96b_title":"Drug test","a77e286e4af95b13abc7acf73113e96b_url":"https:\/\/www.limswiki.org\/index.php\/Drug_test","a77e286e4af95b13abc7acf73113e96b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDrug test\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Drug testing (disambiguation).\n\n\nDrug testMedical diagnosticsMeSHD015813 \nA drug test is a technical analysis of a biological specimen, for example urine, hair, blood, breath, sweat, and\/or oral fluid\/saliva \u2014 to determine the presence or absence of specified parent drugs or their metabolites. Major applications of drug testing include detection of the presence of performance enhancing steroids in sport, employers and parole\/probation officers screening for drugs prohibited by law (such as cannabis, cocaine, methamphetamine, and heroin) and police officers testing for the presence and concentration of alcohol (ethanol) in the blood commonly referred to as BAC (blood alcohol content). BAC tests are typically administered via a breathalyzer while urinalysis is used for the vast majority of drug testing in sports and the workplace. Numerous other methods with varying degrees of accuracy, sensitivity (detection threshold\/cutoff), and detection periods exist.\nA drug test may also refer to a test that provides quantitative chemical analysis of an illegal drug, typically intended to help with responsible drug use.[1]\n\nContents \n\n1 Detection periods \n2 Types \n\n2.1 Urine drug screen \n2.2 Breath test \n2.3 Hair testing \n\n2.3.1 Alcohol \n\n\n2.4 Presumptive substance testing \n2.5 Saliva drug screen \/ Oral fluid-based drug screen \n2.6 Sweat drug screen \n2.7 Blood \n2.8 Anabolic steroids \n2.9 Random drug testing \n2.10 Diagnostic screening \n\n\n3 Methodologies \n\n3.1 Urine drug testing \n3.2 Spray drug testing \n3.3 Hair drug testing \n\n\n4 Legality, ethics and politics \n\n4.1 United Kingdom \n4.2 United States \n4.3 Australia \n\n\n5 Refusal \n\n5.1 Historical cases \n\n\n6 See also \n7 References \n8 External links \n\n\nDetection periods \nThe following chart gives approximate detection periods for each substance by test type.[2]\nThe detection windows depend upon multiple factors: drug class, amount and frequency of use, metabolic rate, body mass, age, overall health, and urine pH. For ease of use, the detection times of metabolites have been incorporated into each parent drug. For example, heroin and cocaine can only be detected for a few hours after use, but their metabolites can be detected for several days in urine. The chart depicts the longer detection times of the metabolites.\nOral fluid or saliva testing results for the most part mimic that of blood. The only exceptions are THC (tetrahydrocannabinol) and benzodiazepines. Oral fluid will likely detect THC from ingestion up to a maximum period of 6\u201312 hours. This continues to cause difficulty in oral fluid detection of THC and benzodiazepines.[3]\nBreath air for the most part mimics blood tests as well. Due to the very low levels of substances in the breath air, liquid chromatography\u2014mass spectrometry has to be used to analyze the sample according to a recent publication wherein 12 analytes were investigated.\nRapid oral fluid products are not approved for use in workplace drug testing programs and are not FDA cleared. Using rapid oral fluid drug tests in the workplace is prohibited in only:[4]\n\nCalifornia\nKansas\nMaine\nMinnesota\nNew York\nVermont\n\nApproximate values for detection periods[5]\n\n\nSubstance\nUrine\nHair\nBlood \/ Oral Fluid\n\n\nAlcohol\n\n6\u201324 hours[6] Note: Alcohol tests may measure ethyl glucuronide, which can stay in urine for up to 80 hours\nup to 90 days[7]\n12 to 24 hours\n\n\nAmphetamines (except methamphetamine)\n\n1 to 3 days[8]\nup to 90 days\n12 hours\n\n\nMethamphetamine\n\n3 to 5 days[9]\nup to 90 days\n1 to 3 days[9]\n\n\nMDMA (Ecstasy)\n\n3 to 4 days\nup to 90 days\n3 to 4 days\n\n\nBarbiturates (except phenobarbital)\n\n1 day\nup to 90 days\n1 to 2 days\n\n\nPhenobarbital\n\n2 to 3 weeks[10]\nup to 90 days\n4 to 7 days\n\n\nBenzodiazepines\n\nTherapeutic use: up to 7 days. Chronic use (over one year): 4 to 6 weeks\nup to 90 days\n6 to 48 hours\n\n\nCannabis\n\nPassive inhalation: up to 22 minutes** Infrequent users: 7-10 Days; Heavy users:30 to 100 days;[11][12][13]\nup to 90 days[11]\n2 to 3 days in blood, up to 2 weeks in blood of heavy users[11] However, it depends on whether actual THC or THC metabolites are being tested for, the latter having a much longer detection time than the former. THC (found in marijuana) may only be detectable in saliva\/oral fluid for 2 to 24 hours in most cases.\n\n\nCocaine\n\n2 to 5 days (with exceptions for heavy users who can test positive up to 7\u201310 days, and individuals with certain kidney disorders)\nup to 90 days\n2 to 10 days\n\n\nCodeine\n\n2 to 3 days\n\nup to 90 days\n\n1 to 4 days\n\n\nCotinine (a breakdown product of nicotine)\n\n2 to 4 days\nup to 90 days\n2 to 4 days\n\n\nMorphine\n\n2 to 4 days\nup to 90 days\n1 to 3 days\n\n\n\nTricyclic antidepressants (TCA's)\n\n7 to 10 days[14]\nUndetectable[15]\nDetectable but dose relationship not established[16]\n\n\nLSD\n\n2\u201324 hours\nup to 4 days[citation needed ]\n2 to 4 days\n\n\nMethadone\n\n7 to 10 days\nup to 90 days\n24 hours\n\n\nSteroids\n\n3 to 30 days\n\n\n\n\nPCP\n\n3 to 7 days for single use; up to 30 days in chronic users[17]\nup to 90 days\n1 to 3 days[17]\n\nTypes \nUrine drug screen \nMain article: Urinalysis\nUrine analysis is primarily used because of its low cost. Urine drug testing is one of the most common testing methods used. The enzyme-multiplied immune test is the most frequently used urinalysis. Complaints have been made about the relatively high rates of false positives using this test.[18]\nUrine drug tests screen the urine for the presence of a parent drug or its metabolites. The level of drug or its metabolites is not predictive of when the drug was taken or how much the patient used. Rather, it is simply a confirmatory report indicating the presence of the parent drug or its metabolites.[citation needed ]\nUrine drug testing is an immunoassay based on the principle of competitive binding. Drugs which may be present in the urine specimen compete against their respective drug conjugate for binding sites on their specific antibody. During testing, a urine specimen migrates upward by capillary action. A drug, if present in the urine specimen below its cut-off concentration, will not saturate the binding sites of its specific antibody. The antibody will then react with the drug-protein conjugate and a visible colored line will show up in the test line region of the specific drug strip.[citation needed ]\nWhen an employer requests a drug test from an employee, or a physician requests a drug test from a patient, the employee or patient is typically instructed to go to a collection site or their home. The urine sample goes through a specified 'chain of custody' to ensure that it is not tampered with or invalidated through lab or employee error. The patient or employee\u2019s urine is collected at a remote location in a specially designed secure cup, sealed with tamper-resistant tape, and sent to a testing laboratory to be screened for drugs (typically the Substance Abuse and Mental Health Services Administration 5 panel). The first step at the testing site is to split the urine into two aliquots. One aliquot is first screened for drugs using an analyzer that performs immunoassay as the initial screen. To ensure the specimen integrity and detecting possible adulterant, some other parameters such as, urine creatinine, pH, and specific gravity are tested along in this initial test. If the urine screen is positive then another aliquot of the sample is used to confirm the findings by gas chromatography\u2014mass spectrometry (GC-MS) or liquid chromatography - mass spectrometry methodology. If requested by the physician or employer, certain drugs are screened for individually; these are generally drugs part of a chemical class that are, for one of many reasons, considered more abuse-prone or of concern. For instance, oxycodone and diamorphine may be tested, both sedative analgesics. If such a test is not requested specifically, the more general test (in the preceding case, the test for opiates) will detect the drugs, but the employer or physician will not have the benefit of the identity of the drug.\nEmployment-related test results are relayed to a medical review office (MRO) where a medical physician reviews the results. If the result of the screen is negative, the MRO informs the employer that the employee has no detectable drug in the urine, typically within 24 hours. However, if the test result of the immunoassay and GC-MS are non-negative and show a concentration level of parent drug or metabolite above the established limit, the MRO contacts the employee to determine if there is any legitimate reason\u2014such as a medical treatment or prescription.[19]\nOn-site instant drug testing is a more cost-efficient method of effectively detecting drug abuse amongst employees, as well as in rehabilitation programs to monitor patient progress.[citation needed ] These instant tests can be used for both urine and saliva testing. Although the accuracy of such tests varies with the manufacturer, some kits boast extremely high rates of accuracy, correlating closely with laboratory test results.[20]\n\nBreath test \nMain article: Breathalyzer\n Breath test being used on a volunteer.\nBreath test is a widespread method for quickly determining alcohol intoxication. A breath test measures the alcohol concentration in the body by a deep-lung breath. There are different instruments used for measuring the alcohol content of an individual though their breath. Breathalyzer is a widely known instrument which was developed in 1954 and contained chemicals unlike other breath-testing instruments.[21] More modernly used instruments are the infrared light-absorption devices and fuel cell detectors, these two testers are microprocessor controlled meaning the operator only has to press the start button.\nTo get accurate readings on a breath-testing device the individual must blow for approximately 6 seconds and need to contain roughly 1.1 to 1.5 liters of breath. For a breath-test to result accurately and truly an operator must take steps such as avoiding measuring \u201cmouth alcohol\u201d which is a result from regurgitation, belching, or recent intake of an alcoholic beverage.[22] To avoid measuring \u201cmouth alcohol\u201d the operator must not allow the individual that\u2019s taking the test to consume any materials for at least fifteen minutes before the breath test. When pulled over for a driving violation if an individual in the United States refuses to take a breath test that individual's driver's license can be suspend for a 6 to 12 months time period.\n\nHair testing \nMain article: Hair analysis\nHair analysis to detect drugs of abuse has been used by court systems in the United States, United Kingdom, Canada, and other countries worldwide. In the United States, hair testing has been accepted in court cases as forensic evidence following the Frye Rule, the Federal Rules of Evidence, and the Daubert Rule. As such, hair testing results are legally and scientifically recognized as admissible evidence.[citation needed ]\nAlthough some lower courts may have accepted hair test evidence, there is no controlling judicial ruling in either the federal or any state system declaring any type of hair test as reliable.\nHair testing is now recognized in both the UK and US judicial systems. There are guidelines for hair testing that have been published by the Society of Hair Testing (a private company in France) that specify the markers to be tested for and the cutoff concentrations that need to be tested. Drugs of abuse that can be detected include Cannabis, Cocaine, Amphetamines and drugs new to the UK such as Mephedrone.\n\nAlcohol \nIn contrast to other drugs consumed, alcohol is deposited directly in the hair. For this reason the investigation procedure looks for direct products of ethanol metabolism. The main part of alcohol is oxidized in the human body. This means it is released as water and carbon dioxide. One part of the alcohol reacts with fatty acids to produce esters. The sum of the concentrations of four of these fatty acid ethyl esters (FAEEs: ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate) are used as indicators of the alcohol consumption. The amounts found in hair are measured in nanograms (one nanogram equals only one billionth of a gram), however with the benefit of modern technology, it is possible to detect such small amounts. In the detection of ethyl glucuronide, or EtG, testing can detect amounts in picograms (one picogram equals 0.001 nanograms).\nHowever, there is one major difference between most drugs and alcohol metabolites in the way in which they enter into the hair: on the one hand like other drugs FAEEs enter into the hair via the keratinocytes, the cells responsible for hair growth. These cells form the hair in the root and then grow through the skin surface taking any substances with them. On the other hand, the sebaceous glands produce FAEEs in the scalp and these migrate together with the sebum along the hair shaft (Auw\u00e4rter et al., 2001, Pragst et al., 2004). So these glands lubricate not only the part of the hair that is just growing at 0.3 mm per day on the skin surface, but also the more mature hair growth, providing it with a protective layer of fat.\nFAEEs (nanogram = one billionth of a gram) appear in hair in almost one order of magnitude lower than (the relevant order of magnitude of) EtG (picogram = one trillionth of a gram). It has been technically possible to measure FAEEs since 1993, and the first study reporting the detection of EtG in hair was done by Sachs in 1993.[23]\nIn practice, most hair which is sent for analysis has been cosmetically treated in some way (bleached, permed etc.). It has been proven that FAEEs are not significantly affected by such treatments (Hartwig et al., 2003a). FAEE concentrations in hair from other body sites can be interpreted in a similar fashion as scalp hair (Hartwig et al., 2003b).\n\nPresumptive substance testing \nPresumptive substance tests identify a suspicious substance, material or surface where traces of drugs are thought to be, instead of testing individuals through biological methods such as urine or hair testing. The test involves mixing the suspicious material with a chemical in order to trigger a color change to indicate if a drug is present. Most are now available over-the-counter, and do not require a lab to read results.\n\n Duquenois reagent\nBenefits to this method include that the person who is suspected of drug use does not need to be confronted or aware of testing. Only a very small amount of material is needed to obtain results, and can be used to test powder, pills, capsules, crystals, or organic material. There is also the ability to detect illicit material when mixed with other non-illicit materials. The tests are used for general screening purposes, offering a generic result for the presence of a wide range of drugs, including Heroin, Cocaine, Methamphetamine, Amphetamine, Ecstasy\/MDMA, Methadone, Ketamine, PCP, PMA, DMT, MDPV, and may detect rapidly evolving synthetic designer drugs. Separate tests for Marijuana\/Hashish are also available.[24]\nThere are five primary color-tests reagents used for general screening purposes. The Marquis reagent turns into a variety of colors when in the presence of different substances. Dille-Koppanyi reagent uses two chemical solutions which turns a violet-blue color in the presence of barbiturates. Duquenois-Levine reagent is a series of chemical solutions that turn to the color of purple when the vegetation of marijuana is added. Van Urk reagent turns blue-purple when in the presence of LSD. Scott Test's chemical solution shows up as a faint blue for cocaine base.[25]\n\n Saliva drug screen \/ Oral fluid-based drug screen \nSaliva \/ oral fluid-based drug tests can generally detect use during the previous few days. Is better at detecting very recent use of a substance. THC may only be detectable for 2\u201324 hours in most cases. On site drug tests are allowed per the Department of Labor.[citation needed ]\nDetection in saliva tests begins almost immediately upon use of the following substances, and lasts for approximately the following times:\n\nAlcohol: 6-12 h[26]\nMarijuana: 1-24h\nA disadvantage of saliva based drug testing is that it is not approved by FDA or SAMHSA for use with DOT \/ Federal Mandated Drug Testing. Oral fluid is not considered a bio-hazard unless there is visible blood; however, it should be treated with care.\n\nSweat drug screen \nSweat patches are attached to the skin to collect sweat over a long period of time (up to 14 days).[27] These are used by child protective services, parole departments, and other government institutions concerned with drug use over long periods, when urine testing is not practical.[28] There are also surface drug tests that test for the metabolite of parent drug groups in the residue of drugs left in sweat.\n\nBlood \nDrug-testing a blood sample measures whether or not a drug or a metabolite is in the body at a particular time. These types of tests are considered to be the most accurate way of telling if a person is intoxicated. Blood drug tests are not used very often because they need specialized equipment and medically trained administrators.\nDepending on how much marijuana was consumed, it can usually be detected in blood tests within six hours of consumption. After six hours has passed, the concentration of marijuana in the blood decreases significantly. It generally disappears completely within 30 days.\n\nAnabolic steroids \nAnabolic steroids are used to enhance performance in sports and as they are prohibited in most high-level competitions drug testing is used extensively in order to enforce this prohibition. This is particularly so in individual (rather than team) sports such as athletics and cycling.\n\nRandom drug testing \nCan occur at any time, usually when the investigator has reason to believe that a substance is possibly being abused by the subject by behavior or immediately after an employee-related incident occurs during work hours. Testing protocol typically conforms to the national medical standard, candidates are given up to 120 minutes to reasonably produce a urine sample from the time of commencement (in some instances this time frame may be extended at the examiners discretion).\n\nDiagnostic screening \nIn the case of life-threatening symptoms, unconsciousness, or bizarre behavior in an emergency situation, screening for common drugs and toxins may help find the cause, called a toxicology test or tox screen to denote the broader area of possible substances beyond just self-administered drugs. These tests can also be done post-mortem during an autopsy in cases where a death was not expected. The test is usually done within 96 hours (4 days) after the desire for the test is realized. Both a urine sample and a blood sample may be tested.[29] A blood sample is routinely used to detect ethanol\/methanol and ASA\/paracetamol intoxication. Various panels are used for screening urine samples for common substances, e.g. triage 8 that detects amphetamines, benzodiazepines, cocaine, methadone, opiates, cannabis, barbiturates and tricyclic antidepressants.[30] Results are given in 10\u201315 min.\nSimilar screenings may be used to evaluate the possible use of date rape drugs. This is usually done on a urine sample.[29]\n\nMethodologies \nBefore testing samples, the tamper-evident seal is checked for integrity. If it appears to have been tampered with or damaged, the laboratory rejects the sample and does not test it.\nNext, the sample must be made testable. Urine and oral fluid can be used \"as is\" for some tests, but other tests require the drugs to be extracted from urine. Strands of hair, patches, and blood must be prepared before testing. Hair is washed in order to eliminate second-hand sources of drugs on the surface of the hair, then the keratin is broken down using enzymes. Blood plasma may need to be separated by centrifuge from blood cells prior to testing. Sweat patches are opened and the sweat collection component is removed and soaked in a solvent to dissolve any drugs present.\nLaboratory-based drug testing is done in two steps. The first step is the screening test, which is an immunoassay based test applied to all samples. The second step, known as the confirmation test, is usually undertaken by a laboratory using highly specific chromatographic techniques and only applied to samples that test positive during the screening test.[31] Screening tests are usually done by immunoassay (EMIT, ELISA, and RIA are the most common). A \"dipstick\" drug testing method which could provide screening test capabilities to field investigators has been developed at the University of Illinois.[32]\nAfter a suspected positive sample is detected during screening, the sample is tested using a confirmation test. Samples that are negative on the screening test are discarded and reported as negative. The confirmation test in most laboratories (and all SAMHSA certified labs) is performed using mass spectrometry, and is precise but expensive. False positive samples from the screening test will almost always be negative on the confirmation test. Samples testing positive during both screening and confirmation tests are reported as positive to the entity that ordered the test. Most laboratories save positive samples for some period of months or years in the event of a disputed result or lawsuit. For workplace drug testing, a positive result is generally not confirmed without a review by a Medical Review Officer who will normally interview the subject of the drug test.\n\nUrine drug testing \nUrine drug test kits are available as on-site tests, or laboratory analysis. Urinalysis is the most common test type and used by federally mandated drug testing programs and is considered the Gold Standard of drug testing. Urine based tests have been upheld in most courts for more than 30 years. However, urinalysis conducted by the Department of Defense has been challenged for reliability of testing the metabolite of cocaine. There are two associated metabolites of cocaine, benzoylecgonine (BZ) and ecgonine methyl ester (EME), the first (BZ) is created by the presence of cocaine in an aqeous solution with a pH greater than 7.0, while the second (EME) results from the actual human metabolic process. The presence of EME confirms actual ingestion of cocaine by a human being, while the presence of BZ is indicative only. BZ without EME is evidence of sample contamination, however, the US Department of Defense has chosen not to test for EME in its urinalysis program.[33][relevant?   – discuss ]\nA number of different analyses (defined as the unknown substance being tested for) are available on Urine Drug Screens.\n\nSpray drug testing \nSpray (sweat) drug test kits are non-invasive. It is a simple process to collect the required specimen, no bathroom is needed, no laboratory is required for analysis, and the tests themselves are difficult to manipulate and relatively tamper-resistant. The detection window is long and can detect recent drug use within several hours.\nThere are also some disadvantages to spray or sweat testing. There is not much variety in these drug tests, only a limited number of drugs can be detected, prices tend to be higher, and inconclusive results can be produced by variations in sweat production rates in donors. They also have a relatively long specimen collection period and are more vulnerable to contamination than other common forms of testing.[27]\n\nHair drug testing \nHair drug testing is a method that can detect drug use over a much longer period of time,[34] and is often used for highly safety-critical positions where there is zero tolerance of illegal drug use.[35] Standard hair follicle screen covers a period of 30 to 90 days. The growth of head hair is usually at the rate of 0.5 inches per month.[36] The hair sample is cut close to the scalp and 80 to 120 strands of hair are needed for the test. In the absence of hair on the head, body hair can be used as an acceptable substitute.[34] This includes facial hair, the underarms, arms, and legs or even pubic hair. Because body hair grows at a different rate than head hair, the timeframe changes, with scientists estimating that drug use can be detected in body hair for up to 12 months. Currently, most entities that use hair testing have prescribed consequences for individuals removing hair to avoid a hair drug test.\nThe claim that a hair test cannot be tampered with has been shown to be debatable. One study has shown that THC does not readily deposit inside epithelial cells so it is possible for cosmetic and other forms of adulteration to reduce the amount of testable cannabinoids within a hair sample.[23]\n\n Legality, ethics and politics \nThe results of federally mandating drug testing were similar to the effects of simply extending to the trucking industry the right to perform drug tests, and it has been argued that the latter approach would have been as effective at lower cost.[37]\nPsychologist Tony Buon has criticized the use of workplace drug testing on a number of grounds, including:\n\nFlawed Technology: The real world performance of testing is much lower than that claimed by its promoters. Buon suggest that tests are probably adequate for rehabilitation and treatment situations, possibly adequate for pre-employment situations, but not for dismissing employees.\nEthical Issues: Because of the fairly simple ways that an employee can invalidate the test, drug testing must be strictly monitored. This means that the specimen must be observed leaving the body. Many legal objections currently being raised in the courts about drug testing are pointing to legal requirements of prior notice, consent, due process, and cause.[38][39]\nWrong focus: As has been shown with Employee Assistance Programs, the focus of management concern should be on work performance decline. Buon suggests effective management practices are an infinitely better approach to managing workplace alcohol and other drug issues.[40]\nTony Buon has also reported by the CIPD as stating that \"drug testing captures the stupid\u2014experienced drug users know how to beat the tests\".[41]\nFrom a penological standpoint, one purpose of drug testing is to help classify the \npeople taking the drug test within risk groups so that those who pose more of a danger to the public can be incapacitated through incarceration or other restrictions on liberty. Thus, the drug testing serves a crime control purpose even if there is no expectation of rehabilitating the drug user through treatment, deterring drug use through sanctions, or sending a message that drug use is a deviant behavior that will not be tolerated.[42]\n\n<\/p>\nUnited Kingdom \nA study in 2004 by the Independent Inquiry into Drug Testing at Work found that attempts by employers to force employees to take drug tests could potentially be challenged as a violation of privacy under the Human Rights Act 1998 and Article 8 of the European Convention of Human Rights.[43] However, this does not apply to industries where drug testing is a matter of personal and public safety or security rather than productivity.\n\nUnited States \nIn consultation with Dr. Carlton Turner, President Ronald Reagan issued Executive Order 12564. In doing so, he instituted mandatory drug-testing for all safety-sensitive executive-level and civil-service Federal employees. This was challenged in the courts by the National Treasury Employees Union. In 1988, this challenge was considered by the US Supreme Court.[44] A similar challenge resulted in the Court extending the drug-free workplace concept to the private sector.[45] These decisions were then incorporated into the White House Drug Control Strategy directive issued by President George H.W. Bush in 1989.[46] All defendants serving on federal probation or federal supervised release are required to submit to at least three drug tests. Failing a drug test can be construed as possession of a controlled substance, resulting in mandatory revocation and imprisonment.[47]\nThere have been inconsistent evaluation results as to whether continued pretrial drug testing has beneficial effects.[48]\nTesting positive can lead to bail not being granted, or if bail has already been granted, to bail revocation or other sanctions. Arizona also adopted a law in 1987 authorizing mandatory drug testing of felony arrestees for the purpose of informing the pretrial release decision, and the District of Columbia has had a similar law since the 1970s. It has been argued that one of the problems with such testing is that there is often not enough time between the arrest and the bail decision to confirm positive results using GC\/MS technology. It has also been argued that such testing potentially implicates the Fifth Amendment privilege against self-incrimination, the right to due process (including the prohibition against gathering evidence in a manner that shocks the conscience or constitutes outrageous government conduct), and the prohibition against unreasonable searches and seizures contained in the Fourth Amendment.[49]\nAccording to Henriksson, the anti-drug appeals of the Reagan administration \"created an environment in which many employers felt compelled to implement drug testing programs because failure to do so might be perceived as condoning drug use. This fear was easily exploited by aggressive marketing and sales forces, who often overstated the value of testing and painted a bleak picture of the consequences of failing to use the drug testing product or service being offered.\"[50] On March 10, 1986, the Commission on Organized Crime asked all U.S. companies to test employees for drug use. By 1987, nearly 25% of the Fortune 500 companies used drug tests.[51]\nAccording to an uncontrolled self-report study done by DATIA and Society for Human Resource Management in 2012 (sample of 6,000 randomly selected human resource professionals), human resource professionals reported the following results after implementing a drug testing program: 19% of companies reported a subjective increase in employee productivity, 16% reported a decrease in employee turnover (8% reported an increase), and unspecified percentages reported decreases in absenteeism and improvement of workers' compensation incidence rates.[52]\nAccording to US Chamber of Commerce 70% of all illicit drug users are employed.[53] Some industries have high rates of employee drug use such as construction (12.8%), repair (11.1%), and hospitality (7.9-16.3%).[54]\n\nAustralia \nA person conducting a business or undertaking (PCBU\u2014the new term that includes employers) has duties under the work health and safety (WHS) legislation to ensure a worker affected by alcohol or other drugs does not place themselves or other persons at risk of injury while at work. Workplace policies and prevention programs can help change the norms and culture around substance abuse.[citation needed ]\nAll organisations\u2014large and small\u2014can benefit from an agreed policy on alcohol and drug misuse that applies to all workers. Such a policy should form part of an organisations overall health and safety management system. PCBUs are encouraged to establish a policy and procedure, in consultation with workers, to constructively manage alcohol and other drug related hazards in their workplace. A comprehensive workplace alcohol and other drug policy should apply to everyone in the workplace and include prevention, education, counselling and rehabilitation arrangements. In addition, the roles and responsibilities of managers and supervisors should be clearly outlined.[citation needed ]\nAll Australian workplace drug testing must comply with Australian standard AS\/NZS4308:2008.[citation needed ]\nIn Victoria, roadside saliva tests detect drugs that contain:[55]\n\nTHC (Delta-9 tetrahydrocannabinol), the active component in cannabis.\nmethamphetamine, also known as \"ice\", \"crystal\" and \"crank\".\nMDMA (Methylenedioxymethamphetamine), which is known as ecstasy.\nIn February 2016 a New South Wales magistrate \"acquitted a man who tested positive for cannabis\". He had been arrested and charged after testing positive during a roadside drug test, despite not having smoked for nine days. He was relying on advice previously given to him by police.[56]\n\nRefusal \nIn the United States federal criminal system, refusing to take a drug test triggers an automatic revocation of probation or supervised release.[57][58]\nIn Victoria, Australia the driver of the car has the option to refuse the drug test. Refusing to undergo a drug test or refusing to undergo a secondary drug test after the first one, triggers an automatic suspension and disqualification for a period of 2 years and a fine of AUD$1000. The second refusal triggers an automatic suspension and disqualification for a period of 4 years and an even larger fine.\n\nHistorical cases \nIn 1993 Meritorious Marine Sergeant Steve Steinmetz refused to submit to further drug screening on the grounds that it violated his 4th and 5th Amendment Rights against unwarranted search and self-incrimination. He was court-martialed and given a Bad Conduct Discharge from the United States Marine Corps in 1994 for refusing to obey a \"lawful order\". He was threatened with forced medical procedures to obtain a sample if he was imprisoned. Said Marine stated, \"That won't happen\". He was discharged without being imprisoned.[citation needed ]\nIn 2000, an Australian Mining Company South Blackwater Coal Ltd with 400 employees, imposed drug-testing procedures, and the trade unions advised their members to refuse to take the tests, partly because a positive result does not necessarily indicate present impairment; the workers were stood-down by the company without pay for a week.[59]\nIn 2003, sixteen members of the Chicago White Sox considered refusing to take a drug test, in hopes of making steroid testing mandatory.[60]\nIn 2006, Levy County, Florida, volunteer librarians resigned en masse rather than take drug tests.[61]\nIn 2010, Iranian super heavyweight class weightlifters refused to submit to a drug test authorized by the Iran Weightlifting League.[62]\nSee also \n\nCannabis drug tests\nDrug-Free Workplace Act of 1988\nEquine drug testing\nForensic toxicology\nLacing (drugs)\nPresumptive and confirmatory tests\nSchool district drug policies\nUrinalysis\nOccupational health concerns of cannabis use\n\nReferences \n\n\n^ \"I spent my weekend testing drugs at a festival\". 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Retrieved on September 5, 2013. \n\n^ Erowid Barbiturates Vault : Drug Testing. Erowid.org. Retrieved on August 7, 2011. \n\n^ a b c Erowid Cannabis (Marijuana) Vault : Drug Testing. Erowid.org (2010-02-28). Retrieved on August 7, 2011. \n\n^ Marijuana Detection Time Shorter Than Previously Assumed. norml.org (2006-02-23). Retrieved on March 13, 2012. \n\n^ Susan Squibb (2016-03-09). \"How long does weed stay in your system?\". The Cannabist. Archived from the original on 2016-03-11. Retrieved 2016-05-25 . \n\n^ [1] \n\n^ \"2D6O - Clinical: Cytochrome P450 2D6 Genotype, Saliva\". mayomedicallaboratories.com. \n\n^ \"Employer Drug Testing Hair Test FAQs\". Omega Laboratories. \n\n^ a b Erowid PCP Vault : Drug Testing. Erowid.org (2009-11-03). Retrieved on August 7, 2011. \n\n^ Abadinsky, H. (2014). Drug use and abuse: A comprehensive introduction. Belmont: Wadsworth Cengage Learning. pp. 163\u2013165. ISBN 9781285070278. \n\n^ \"Medical Review Officer Manual\" (PDF) . Medical Review Officer Manual. SAMSHA Gov. Archived from the original (PDF) on February 15, 2013. \n\n^ Article in Confirm Biosciences \n\n^ Saferstein, R. (2013). Forensic science: From the crime scene to the crime lab. Upper Saddle River: Pearson Education Inc. pp. 295\u2013300. ISBN 978-0131391871. \n\n^ Saferstein, R. (2013). Forensic science: From the crime scene to the crime lab. Upper Saddle River: Pearson Education. pp. 295\u2013303. ISBN 978-0131391871. \n\n^ a b Pascal Kintz (August 30, 2006). Analytical and practical aspects of drug testing in hair. CRC Press. pp. 305\u2013. ISBN 978-0-8493-6450-1. \n\n^ \"Archived copy\". Archived from the original on March 10, 2014. Retrieved 2014-03-10 . CS1 maint: Archived copy as title (link) . Touch-know.com. Retrieved on March 10, 2014. \n\n^ Saferstein, Richard (2013). Forensic science:From the crime scene to the crime lab. Upper Saddle River: Pearson Education Inc. p. 271. ISBN 978-0131391871. \n\n^ http:\/\/www.erowid.org\/psychoactives\/testing\/testing_info1.shtml Drug Testing Basics \n\n^ a b \"Drug Test\". 2007. \n\n^ \"Federal Court Drug-Testing Device Under Fire, PharmChem Sweat Patch May Be \"Too Good\" \". January 5, 2001. \n\n^ a b WebMD --> Toxicology Tests Author: Jeannette Curtis. Primary Medical Reviewer: Kathleen Romito, MD\u2014Family Medicine. Specialist Medical Reviewer: R. Steven Tharratt, MD, MPVM, FACP, FCCP\u2014Pulmonology, Critical Care, Medical Toxicology. Last Updated: May 9, 2008 \n\n^ Sixteen devices for the detection of drugs of abuse in urine Archived August 11, 2011, at the Wayback Machine. MHRA Report No. MHRA 03078. Report Date: October 2003 \n\n^ \"Principles of Drug Testing Technology,\" Drug Tests Direct, Retrieved online Dec 07, 2012. \n\n^ Jim Barlow (November 2006). \"A Little Dab Will Do It\". LASNews. University of Illinois. Archived from the original on January 29, 2007. Retrieved November 29, 2006 . \n\n^ Maume, Chris (November 29, 2013). \"Books of the year 2013: Sport\". The Independent. London. \n\n^ a b \"How Did I Pass My Drug Test - Personal Story\". Best Way To Beat Any Drug Test!. \n\n^ Hatala, John W. (June 2003). \"The Feasibility of Testing Hair for Illicit Drug Use in the United States Marine Corps\" (PDF) . Monterey, California: Naval Postgraduate School: 2. Retrieved May 7, 2009 . \n\n^ Puiu, Tibi (August 23, 2018). \"How fast hair grows, and other hairy science\". www.zmescience.com. ZME Science. Retrieved September 28, 2018 . The hair on your head grows about 6 inches a year. \n\n^ Mireille Jacobson (April 2003). \"Drug Testing in the Trucking Industry: The Effect on Highway Safety\". Journal of Law and Economics. 46 (1): 131\u2013156. CiteSeerX 10.1.1.489.2439 . doi:10.1086\/345584. \n\n^ Buon, T (1996). Alcohol, Drug and Other Problems in Academia. Drugs In Society. 2\/96 June. ADFQ. 8-12. \n\n^ \"Does testing work?\". ebscohost.com. \n\n^ Buon, Y. and Compton, B. 1994. \"The Development of Alcohol and Other Drug Programs in the Workplace\". In Stone, R. J. (ed.). Readings in Human Resource Management (Volume 2): 240\u2013252. Brisbane: John Wiley Ltd. \n\n^ \"Does testing work? - People Management Magazine Online\". cipd.co.uk. \n\n^ \"The New Penology: Notes on the Emerging Strategy of Corrections and Its Implications\". Criminology. 30 (449). 1992. \n\n^ Independent Inquiry into Drug Testing at Work. \"Drug testing in the workplace: Summary conclusions of the Independent Inquiry into Drug Testing at Work\". Archived from the original on September 28, 2007. Retrieved January 17, 2008 . \n\n^ . National Treasury Employees Union v. von Raab. 86-1879, US Supreme Court, 1989. \n\n^ Skinner v. Railway Labor Executives Assoc. 87-15555. US Supreme Court, 1989 \n\n^ Miller, NS; Giannini, AJ; Gold, MS; Philomena, JA (1990). \"Drug testing: medical, legal, and ethical issues\". Journal of Substance Abuse Treatment. 7 (4): 239\u201344. doi:10.1016\/0740-5472(90)90047-T. PMID 2290186. \n\n^ 18 U.S.C. \u00a7 3563, 18 U.S.C. \u00a7 3583 \n\n^ Christy A. Visher. \"Pretrial Drug Testing: Panacea or Pandora's Box?\". Annals of the American Academy of Political and Social Science. 521. \n\n^ Cathryn Jo Rosen; John S. Goldkamp (Spring 1989). \"The Constitutionality of Drug Testing at the Bail Stage\". The Journal of Criminal Law and Criminology. 80 (1): 114\u2013176. doi:10.2307\/1143765. \n\n^ Lennart E. Henriksson (June 1991). \"The Unconvincing Case for Drug Testing\". Canadian Public Policy. 17 (2): 183\u2013196. doi:10.2307\/3551028. JSTOR 3551028. \n\n^ Deborah F. Crown; Joseph G. Rosse (Fall 1988). \"A Critical Review of the Assumptions Underlying Drug Testing\". Journal of Business and Psychology. 3 (1): 22\u201341. doi:10.1007\/BF01016746. \n\n^ \"Employee Drug Testing Study\" (PDF) . Global Drug Policy. \n\n^ \"EAP Employee and Supervisor Drug Education\" (PDF) . USUHS.mil. \n\n^ \"Substance Abuse in the hospitality industry\". Arkansas Small Business Development Center. Archived from the original on February 16, 2009. \n\n^ \"Roadside drug testing\". www.adf.org.au. Alcohol and Drug Foundation. Retrieved 2015-07-18 . \n\n^ Knowles, Lorna; Branley (2 February 2016). \"Acquittal of man caught drug-driving nine days after smoking cannabis throws NSW drug laws into doubt\". abc.net.au. Australian Broadcasting Corporation. Retrieved 2 February 2016 . A spokeswoman for NSW Roads Minister Duncan Gay said roadside tests were followed up with lab tests and 97 per cent of tests matched. She said the research they had indicated drugs were only detected in a person's saliva for 12 hours after being ingested. \n\n^ 18 U.S.C. \u00a7 3565(b)(5) \n\n^ 18 U.S.C. \u00a7 3583(g)(3) \n\n^ Holland, Peter. \"Case-Study. Drug Testing in the Australian Mining Industry\" (PDF) . Surveillance and Society: 204\u20139. \n\n^ \"White Sox Players Almost Refused Drug Test\". Los Angeles Times. Associated Press. March 12, 2003. \n\n^ Voyles, Karen (October 6, 2006). \"Library volunteers just say no to drug testing\". Gainesville Sun. \n\n^ \"Iranian weightlifters refuse drug testing\". February 16, 2010 \n\n\nExternal links \nNational Institute on Drug Abuse\nvteRecreational drug useMajor\r\n recreational\r\n drugsDepressants\nBarbiturates\nBenzodiazepines\nCarbamates\nEthanol (alcohol)\nAlcoholic drinks\nBeer\nWine\nGabapentinoids\nGHB\nInhalants\nMedical\nNitrous oxide\nHazardous solvents\ncontact adhesives\nGasoline\nnail polish remover\nPaint thinner\nOther\nFreon\nKava\nNonbenzodiazepines\nQuinazolinones\nOpioids\nBuprenorphine\nSuboxone\nSubutex\nCodeine\nDesomorphine\nKrokodil\nDextropropoxyphene\nDarvocet\nDarvon\nFentanyl\nDiamorphine\nHeroin\nHydrocodone\nHydromorphone\nDilaudid\nMethadone\nMitragyna speciosa\nKratom\nMorphine\nOpium\nOxycodone\n\/paracetamol\nTramadol\nStimulants\nAmphetamine\nArecoline\nAreca\nBetel\nCaffeine\nCoffee\nEnergy drinks\nTea\nCathinone\nKhat\nCocaine\nCoca\nCrack\nEphedrine\nEphedra\nMDPV\nMephedrone\nMethamphetamine\nMethylone\nMethylphenidate\nModafinil\nNicotine\nTobacco\nTheobromine\nCocoa\nChocolate\nEntactogens\n2C series\n6-APB\nBenzofury\nAMT\nMDA\nMDMA\nEcstasy\nHallucinogensPsychedelics\nBufotenin\nPsychoactive toads\nVilca\nYopo\nDMT\nAyahuasca\nLSA\nLSD-25\nMescaline\nPeruvian torch\nPeyote\nSan Pedro\nPsilocybin \/ Psilocin\nPsilocybin mushrooms\nDissociatives\nDXM\nGlaucine\nInhalants\nNitrous oxide\nalkyl nitrites\npoppers\namyl nitrite\nKetamine\nMXE\nMuscimol\nAmanita muscaria\nPCP\nSalvinorin A\nSalvia divinorum\nDeliriants\nAtropine and Scopolamine\nAtropa belladonna\nDatura\nHyoscyamus niger\nMandragora officinarum\nDimenhydrinate\nDiphenhydramine\nCannabinoids\nJWH-018\nTHC\nCannabis\nHashish\nHash oil\nMarijuana\nOneirogens\nCalea zacatechichi\nSilene capensis\nClub drugs\nCocaine\nQuaaludes\nMDMA (Ecstasy)\nNitrous oxide\nPoppers\nDrug cultureCannabis culture\n420\nCannabis cultivation\nCannabis smoking\nHead shop\nLegal history of cannabis in the United States\nLegality of cannabis\nMarijuana Policy Project\nMedical cannabis\nNORML\nCannabis and religion\nStoner film\nCoffee 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benefits\nUnemployment extension\nUnemployment insurance\nUnemployment rates\nEmployment rates\nEmployment-to-population ratio\nStructural unemployment\nTechnological unemployment\nWage curve\nYouth unemployment\n\n See also templates\nAspects of corporations\nAspects of jobs\nAspects of occupations\nAspects of organizations\nAspects of workplaces\nCorporate titles\nOrganized labor\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Drug_test\">https:\/\/www.limswiki.org\/index.php\/Drug_test<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView 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PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:35.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,498 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a77e286e4af95b13abc7acf73113e96b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Drug_test skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Drug test<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_testing_(disambiguation)\" class=\"mw-disambig\" title=\"Drug testing (disambiguation)\" rel=\"external_link\" target=\"_blank\">Drug testing (disambiguation)<\/a>.<\/div>\n<p class=\"mw-empty-elt\">\n<\/p>\n\n<p>A <b>drug test<\/b> is a technical analysis of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_specimen\" title=\"Biological specimen\" rel=\"external_link\" target=\"_blank\">biological specimen<\/a>, for example <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urine\" title=\"Urine\" rel=\"external_link\" target=\"_blank\">urine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hair\" title=\"Hair\" rel=\"external_link\" target=\"_blank\">hair<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breath\" class=\"mw-redirect\" title=\"Breath\" rel=\"external_link\" target=\"_blank\">breath<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sweat\" class=\"mw-redirect\" title=\"Sweat\" rel=\"external_link\" target=\"_blank\">sweat<\/a>, and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saliva\" title=\"Saliva\" rel=\"external_link\" target=\"_blank\">oral fluid\/saliva<\/a> \u2014 to determine the presence or absence of specified parent drugs or their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolite\" title=\"Metabolite\" rel=\"external_link\" target=\"_blank\">metabolites<\/a>. Major applications of drug testing include detection of the presence of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Use_of_performance-enhancing_drugs_in_sport\" class=\"mw-redirect\" title=\"Use of performance-enhancing drugs in sport\" rel=\"external_link\" target=\"_blank\">performance enhancing<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Steroid\" title=\"Steroid\" rel=\"external_link\" target=\"_blank\">steroids<\/a> in sport, employers and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parole\" title=\"Parole\" rel=\"external_link\" target=\"_blank\">parole<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Probation\" title=\"Probation\" rel=\"external_link\" target=\"_blank\">probation<\/a> officers screening for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prohibition_(drugs)\" class=\"mw-redirect\" title=\"Prohibition (drugs)\" rel=\"external_link\" target=\"_blank\">drugs prohibited<\/a> by law (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannabis_(drug)\" title=\"Cannabis (drug)\" rel=\"external_link\" target=\"_blank\">cannabis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cocaine\" title=\"Cocaine\" rel=\"external_link\" target=\"_blank\">cocaine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methamphetamine\" title=\"Methamphetamine\" rel=\"external_link\" target=\"_blank\">methamphetamine<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heroin\" title=\"Heroin\" rel=\"external_link\" target=\"_blank\">heroin<\/a>) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Police_officers\" class=\"mw-redirect\" title=\"Police officers\" rel=\"external_link\" target=\"_blank\">police officers<\/a> testing for the presence and concentration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcoholic_drink\" title=\"Alcoholic drink\" rel=\"external_link\" target=\"_blank\">alcohol<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethanol\" title=\"Ethanol\" rel=\"external_link\" target=\"_blank\">ethanol<\/a>) in the blood commonly referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_alcohol_content\" title=\"Blood alcohol content\" rel=\"external_link\" target=\"_blank\">BAC<\/a> (blood alcohol content). BAC tests are typically administered via a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breathalyzer\" title=\"Breathalyzer\" rel=\"external_link\" target=\"_blank\">breathalyzer<\/a> while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinalysis\" class=\"mw-redirect\" title=\"Urinalysis\" rel=\"external_link\" target=\"_blank\">urinalysis<\/a> is used for the vast majority of drug testing in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sports\" class=\"mw-redirect\" title=\"Sports\" rel=\"external_link\" target=\"_blank\">sports<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Workplace\" title=\"Workplace\" rel=\"external_link\" target=\"_blank\">workplace<\/a>. Numerous other methods with varying degrees of accuracy, sensitivity (detection threshold\/cutoff), and detection periods exist.\n<\/p><p>A drug test may also refer to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Illegal_drug_trade\" title=\"Illegal drug trade\" rel=\"external_link\" target=\"_blank\">a test<\/a> that provides quantitative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_analysis\" class=\"mw-redirect\" title=\"Chemical analysis\" rel=\"external_link\" target=\"_blank\">chemical analysis<\/a> of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Illegal_drug\" class=\"mw-redirect\" title=\"Illegal drug\" rel=\"external_link\" target=\"_blank\">illegal drug<\/a>, typically intended to help with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Responsible_drug_use\" title=\"Responsible drug use\" rel=\"external_link\" target=\"_blank\">responsible drug use<\/a>.<sup id=\"rdp-ebb-cite_ref-inde1_1-0\" class=\"reference\"><a href=\"#cite_note-inde1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Detection_periods\">Detection periods<\/span><\/h2>\n<p>The following chart gives approximate detection periods for each substance by test type.<sup id=\"rdp-ebb-cite_ref-reference_guide_2-0\" class=\"reference\"><a href=\"#cite_note-reference_guide-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The detection windows depend upon multiple factors: drug class, amount and frequency of use, metabolic rate, body mass, age, overall health, and urine pH. For ease of use, the detection times of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolite\" title=\"Metabolite\" rel=\"external_link\" target=\"_blank\">metabolites<\/a> have been incorporated into each parent drug. For example, heroin and cocaine can only be detected for a few hours after use, but their metabolites can be detected for several days in urine. The chart depicts the longer detection times of the metabolites.\n<\/p><p>Oral fluid or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saliva_testing\" title=\"Saliva testing\" rel=\"external_link\" target=\"_blank\">saliva testing<\/a> results for the most part mimic that of blood. The only exceptions are THC (tetrahydrocannabinol) and benzodiazepines. Oral fluid will likely detect THC from ingestion up to a maximum period of 6\u201312 hours. This continues to cause difficulty in oral fluid detection of THC and benzodiazepines.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Breath air for the most part mimics blood tests as well. Due to the very low levels of substances in the breath air, liquid chromatography\u2014mass spectrometry has to be used to analyze the sample according to a recent publication wherein 12 analytes were investigated.\n<\/p><p>Rapid oral fluid products are not approved for use in workplace drug testing programs and are not FDA cleared. Using rapid oral fluid drug tests in the workplace is prohibited in only:<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/California\" title=\"California\" rel=\"external_link\" target=\"_blank\">California<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kansas\" title=\"Kansas\" rel=\"external_link\" target=\"_blank\">Kansas<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Maine\" title=\"Maine\" rel=\"external_link\" target=\"_blank\">Maine<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Minnesota\" title=\"Minnesota\" rel=\"external_link\" target=\"_blank\">Minnesota<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_(state)\" title=\"New York (state)\" rel=\"external_link\" target=\"_blank\">New York<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vermont\" title=\"Vermont\" rel=\"external_link\" target=\"_blank\">Vermont<\/a><\/li><\/ul>\n<table class=\"wikitable\" style=\"\">\n<caption>Approximate values for detection periods<sup id=\"rdp-ebb-cite_ref-theg_Hero_5-0\" class=\"reference\"><a href=\"#cite_note-theg_Hero-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/caption>\n<tbody><tr>\n<th>Substance<\/th>\n<th>Urine<\/th>\n<th>Hair<\/th>\n<th>Blood \/ Oral Fluid\n<\/th><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethanol\" title=\"Ethanol\" rel=\"external_link\" target=\"_blank\">Alcohol<\/a>\n<\/th>\n<td>6\u201324 hours<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Note: Alcohol tests may measure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethyl_glucuronide\" title=\"Ethyl glucuronide\" rel=\"external_link\" target=\"_blank\">ethyl glucuronide<\/a>, which can stay in urine for up to 80 hours<\/td>\n<td>up to 90 days<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><\/td>\n<td>12 to 24 hours\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Amphetamines\" class=\"mw-redirect\" title=\"Amphetamines\" rel=\"external_link\" target=\"_blank\">Amphetamines<\/a> (except methamphetamine)\n<\/th>\n<td>1 to 3 days<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/td>\n<td>up to 90 days<\/td>\n<td>12 hours\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Methamphetamine\" title=\"Methamphetamine\" rel=\"external_link\" target=\"_blank\">Methamphetamine<\/a>\n<\/th>\n<td>3 to 5 days<sup id=\"rdp-ebb-cite_ref-erowid.org_9-0\" class=\"reference\"><a href=\"#cite_note-erowid.org-9\" rel=\"external_link\">[9]<\/a><\/sup><\/td>\n<td>up to 90 days<\/td>\n<td>1 to 3 days<sup id=\"rdp-ebb-cite_ref-erowid.org_9-1\" class=\"reference\"><a href=\"#cite_note-erowid.org-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/MDMA\" title=\"MDMA\" rel=\"external_link\" target=\"_blank\">MDMA<\/a> (Ecstasy)\n<\/th>\n<td>3 to 4 days<\/td>\n<td>up to 90 days<\/td>\n<td>3 to 4 days\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barbiturates\" class=\"mw-redirect\" title=\"Barbiturates\" rel=\"external_link\" target=\"_blank\">Barbiturates<\/a> (except phenobarbital)\n<\/th>\n<td>1 day<\/td>\n<td>up to 90 days<\/td>\n<td>1 to 2 days\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phenobarbital\" title=\"Phenobarbital\" rel=\"external_link\" target=\"_blank\">Phenobarbital<\/a>\n<\/th>\n<td>2 to 3 weeks<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><\/td>\n<td>up to 90 days<\/td>\n<td>4 to 7 days\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Benzodiazepines\" class=\"mw-redirect\" title=\"Benzodiazepines\" rel=\"external_link\" target=\"_blank\">Benzodiazepines<\/a>\n<\/th>\n<td>Therapeutic use: up to 7 days. Chronic use (over one year): 4 to 6 weeks<\/td>\n<td>up to 90 days<\/td>\n<td>6 to 48 hours\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannabis_(drug)\" title=\"Cannabis (drug)\" rel=\"external_link\" target=\"_blank\">Cannabis<\/a>\n<\/th>\n<td>Passive inhalation: up to 22 minutes** Infrequent users: 7-10 Days; Heavy users:30 to 100 days;<sup id=\"rdp-ebb-cite_ref-ReferenceA_11-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ReferenceA2_12-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA2-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-thec_Howl_13-0\" class=\"reference\"><a href=\"#cite_note-thec_Howl-13\" rel=\"external_link\">[13]<\/a><\/sup><\/td>\n<td>up to 90 days<sup id=\"rdp-ebb-cite_ref-ReferenceA_11-1\" class=\"reference\"><a href=\"#cite_note-ReferenceA-11\" rel=\"external_link\">[11]<\/a><\/sup><\/td>\n<td>2 to 3 days in blood, up to 2 weeks in blood of heavy users<sup id=\"rdp-ebb-cite_ref-ReferenceA_11-2\" class=\"reference\"><a href=\"#cite_note-ReferenceA-11\" rel=\"external_link\">[11]<\/a><\/sup> However, it depends on whether actual THC or THC metabolites are being tested for, the latter having a much longer detection time than the former. THC (found in marijuana) may only be detectable in saliva\/oral fluid for 2 to 24 hours in most cases.\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cocaine\" title=\"Cocaine\" rel=\"external_link\" target=\"_blank\">Cocaine<\/a>\n<\/th>\n<td>2 to 5 days (with exceptions for heavy users who can test positive up to 7\u201310 days, and individuals with certain kidney disorders)<\/td>\n<td>up to 90 days<\/td>\n<td>2 to 10 days\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Codeine\" title=\"Codeine\" rel=\"external_link\" target=\"_blank\">Codeine<\/a>\n<\/th>\n<td>2 to 3 days\n<\/td>\n<td>up to 90 days\n<\/td>\n<td>1 to 4 days\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cotinine\" title=\"Cotinine\" rel=\"external_link\" target=\"_blank\">Cotinine<\/a> (a breakdown product of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nicotine\" title=\"Nicotine\" rel=\"external_link\" target=\"_blank\">nicotine<\/a>)\n<\/th>\n<td>2 to 4 days<\/td>\n<td>up to 90 days<\/td>\n<td>2 to 4 days\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Morphine\" title=\"Morphine\" rel=\"external_link\" target=\"_blank\">Morphine<\/a>\n<\/th>\n<td>2 to 4 days<\/td>\n<td>up to 90 days<\/td>\n<td>1 to 3 days\n<\/td><\/tr>\n\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricyclic_antidepressants\" class=\"mw-redirect\" title=\"Tricyclic antidepressants\" rel=\"external_link\" target=\"_blank\">Tricyclic antidepressants<\/a> (TCA's)\n<\/th>\n<td>7 to 10 days<sup id=\"rdp-ebb-cite_ref-testcountry.com_14-0\" class=\"reference\"><a href=\"#cite_note-testcountry.com-14\" rel=\"external_link\">[14]<\/a><\/sup><\/td>\n<td>Undetectable<sup id=\"rdp-ebb-cite_ref-mayomedicallaboratories.com_15-0\" class=\"reference\"><a href=\"#cite_note-mayomedicallaboratories.com-15\" rel=\"external_link\">[15]<\/a><\/sup><\/td>\n<td>Detectable but dose relationship not established<sup id=\"rdp-ebb-cite_ref-www.omegalabs.net_16-0\" class=\"reference\"><a href=\"#cite_note-www.omegalabs.net-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/LSD\" class=\"mw-redirect\" title=\"LSD\" rel=\"external_link\" target=\"_blank\">LSD<\/a>\n<\/th>\n<td>2\u201324 hours<\/td>\n<td>up to 4 days<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2014)\">citation needed<\/span><\/a><\/i>]<\/sup><\/td>\n<td>2 to 4 days\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Methadone\" title=\"Methadone\" rel=\"external_link\" target=\"_blank\">Methadone<\/a>\n<\/th>\n<td>7 to 10 days<\/td>\n<td>up to 90 days<\/td>\n<td>24 hours\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Steroids\" class=\"mw-redirect\" title=\"Steroids\" rel=\"external_link\" target=\"_blank\">Steroids<\/a>\n<\/th>\n<td>3 to 30 days<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phencyclidine\" title=\"Phencyclidine\" rel=\"external_link\" target=\"_blank\">PCP<\/a>\n<\/th>\n<td>3 to 7 days for single use; up to 30 days in chronic users<sup id=\"rdp-ebb-cite_ref-ReferenceB_17-0\" class=\"reference\"><a href=\"#cite_note-ReferenceB-17\" rel=\"external_link\">[17]<\/a><\/sup><\/td>\n<td>up to 90 days<\/td>\n<td>1 to 3 days<sup id=\"rdp-ebb-cite_ref-ReferenceB_17-1\" class=\"reference\"><a href=\"#cite_note-ReferenceB-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Urine_drug_screen\">Urine drug screen<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinalysis\" class=\"mw-redirect\" title=\"Urinalysis\" rel=\"external_link\" target=\"_blank\">Urinalysis<\/a><\/div>\n<p>Urine analysis is primarily used because of its low cost. Urine drug testing is one of the most common testing methods used. The enzyme-multiplied immune test is the most frequently used urinalysis. Complaints have been made about the relatively high rates of false positives using this test.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>Urine drug tests screen the urine for the presence of a parent drug or its metabolites. The level of drug or its metabolites is not predictive of when the drug was taken or how much the patient used. Rather, it is simply a confirmatory report indicating the presence of the parent drug or its metabolites.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Urine drug testing is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immunoassay\" title=\"Immunoassay\" rel=\"external_link\" target=\"_blank\">immunoassay<\/a> based on the principle of competitive binding. Drugs which may be present in the urine specimen compete against their respective drug conjugate for binding sites on their specific antibody. During testing, a urine specimen migrates upward by capillary action. A drug, if present in the urine specimen below its cut-off concentration, will not saturate the binding sites of its specific antibody. The antibody will then react with the drug-protein conjugate and a visible colored line will show up in the test line region of the specific drug strip.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>When an employer requests a drug test from an employee, or a physician requests a drug test from a patient, the employee or patient is typically instructed to go to a collection site or their home. The urine sample goes through a specified 'chain of custody' to ensure that it is not tampered with or invalidated through lab or employee error. The patient or employee\u2019s urine is collected at a remote location in a specially designed secure cup, sealed with tamper-resistant tape, and sent to a testing laboratory to be screened for drugs (typically the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Substance_Abuse_and_Mental_Health_Services_Administration\" title=\"Substance Abuse and Mental Health Services Administration\" rel=\"external_link\" target=\"_blank\">Substance Abuse and Mental Health Services Administration<\/a> 5 panel). The first step at the testing site is to split the urine into two <a href=\"https:\/\/en.wiktionary.org\/wiki\/aliquot\" class=\"extiw\" title=\"wikt:aliquot\" rel=\"external_link\" target=\"_blank\">aliquots<\/a>. One aliquot is first screened for drugs using an analyzer that performs immunoassay as the initial screen. To ensure the specimen integrity and detecting possible adulterant, some other parameters such as, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creatinine\" title=\"Creatinine\" rel=\"external_link\" target=\"_blank\">urine creatinine<\/a>, pH, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Specific_gravity\" title=\"Specific gravity\" rel=\"external_link\" target=\"_blank\">specific gravity<\/a> are tested along in this initial test. If the urine screen is positive then another aliquot of the sample is used to confirm the findings by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_chromatography\" title=\"Gas chromatography\" rel=\"external_link\" target=\"_blank\">gas chromatography<\/a>\u2014<a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_spectrometry\" title=\"Mass spectrometry\" rel=\"external_link\" target=\"_blank\">mass spectrometry<\/a> (GC-MS) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/LC\/MS\" class=\"mw-redirect\" title=\"LC\/MS\" rel=\"external_link\" target=\"_blank\">liquid chromatography - mass spectrometry<\/a> methodology. If requested by the physician or employer, certain drugs are screened for individually; these are generally drugs part of a chemical class that are, for one of many reasons, considered more abuse-prone or of concern. For instance, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxycodone\" title=\"Oxycodone\" rel=\"external_link\" target=\"_blank\">oxycodone<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamorphine\" class=\"mw-redirect\" title=\"Diamorphine\" rel=\"external_link\" target=\"_blank\">diamorphine<\/a> may be tested, both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedative\" title=\"Sedative\" rel=\"external_link\" target=\"_blank\">sedative<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesics\" class=\"mw-redirect\" title=\"Analgesics\" rel=\"external_link\" target=\"_blank\">analgesics<\/a>. If such a test is not requested specifically, the more general test (in the preceding case, the test for opiates) will detect the drugs, but the employer or physician will not have the benefit of the identity of the drug.\n<\/p><p>Employment-related test results are relayed to a medical review office (MRO) where a medical physician reviews the results. If the result of the screen is negative, the MRO informs the employer that the employee has no detectable drug in the urine, typically within 24 hours. However, if the test result of the immunoassay and GC-MS are non-negative and show a concentration level of parent drug or metabolite above the established limit, the MRO contacts the employee to determine if there is any legitimate reason\u2014such as a medical treatment or prescription.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>On-site instant drug testing is a more cost-efficient method of effectively detecting drug abuse amongst employees, as well as in rehabilitation programs to monitor patient progress.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> These instant tests can be used for both urine and saliva testing. Although the accuracy of such tests varies with the manufacturer, some kits boast extremely high rates of accuracy, correlating closely with laboratory test results.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Breath_test\">Breath test<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breathalyzer\" title=\"Breathalyzer\" rel=\"external_link\" target=\"_blank\">Breathalyzer<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:206px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Breathalyzer_on_citizen.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f7\/Breathalyzer_on_citizen.jpg\/204px-Breathalyzer_on_citizen.jpg\" width=\"204\" height=\"124\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Breathalyzer_on_citizen.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Breath test being used on a volunteer.<\/div><\/div><\/div>\n<p>Breath test is a widespread method for quickly determining alcohol intoxication. A breath test measures the alcohol concentration in the body by a deep-lung breath. There are different instruments used for measuring the alcohol content of an individual though their breath. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breathalyzer\" title=\"Breathalyzer\" rel=\"external_link\" target=\"_blank\">Breathalyzer<\/a> is a widely known instrument which was developed in 1954 and contained chemicals unlike other breath-testing instruments.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> More modernly used instruments are the infrared <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spectrophotometry\" title=\"Spectrophotometry\" rel=\"external_link\" target=\"_blank\">light-absorption devices<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fuel_cell\" title=\"Fuel cell\" rel=\"external_link\" target=\"_blank\">fuel cell<\/a> detectors, these two testers are microprocessor controlled meaning the operator only has to press the start button.\n<\/p><p>To get accurate readings on a breath-testing device the individual must blow for approximately 6 seconds and need to contain roughly 1.1 to 1.5 liters of breath. For a breath-test to result accurately and truly an operator must take steps such as avoiding measuring \u201cmouth alcohol\u201d which is a result from regurgitation, belching, or recent intake of an alcoholic beverage.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> To avoid measuring \u201cmouth alcohol\u201d the operator must not allow the individual that\u2019s taking the test to consume any materials for at least fifteen minutes before the breath test. When pulled over for a driving violation if an individual in the United States refuses to take a breath test that individual's driver's license can be suspend for a 6 to 12 months time period.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hair_testing\">Hair testing<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hair_analysis\" title=\"Hair analysis\" rel=\"external_link\" target=\"_blank\">Hair analysis<\/a><\/div>\n<p>Hair analysis to detect drugs of abuse has been used by court systems in the United States, United Kingdom, Canada, and other countries worldwide. In the United States, hair testing has been accepted in court cases as forensic evidence following the Frye Rule, the Federal Rules of Evidence, and the Daubert Rule. As such, hair testing results are legally and scientifically recognized as admissible evidence.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Although some lower courts may have accepted hair test evidence, there is no controlling judicial ruling in either the federal or any state system declaring any type of hair test as reliable.\n<\/p><p>Hair testing is now recognized in both the UK and US judicial systems. There are guidelines for hair testing that have been published by the Society of Hair Testing (a private company in France) that specify the markers to be tested for and the cutoff concentrations that need to be tested. Drugs of abuse that can be detected include Cannabis, Cocaine, Amphetamines and drugs new to the UK such as Mephedrone.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Alcohol\">Alcohol<\/span><\/h4>\n<p>In contrast to other drugs consumed, alcohol is deposited directly in the hair. For this reason the investigation procedure looks for direct products of ethanol metabolism. The main part of alcohol is oxidized in the human body. This means it is released as water and carbon dioxide. One part of the alcohol reacts with fatty acids to produce esters. The sum of the concentrations of four of these fatty acid ethyl esters (FAEEs: ethyl myristate, ethyl palmitate, ethyl oleate and ethyl stearate) are used as indicators of the alcohol consumption. The amounts found in hair are measured in nanograms (one nanogram equals only one billionth of a gram), however with the benefit of modern technology, it is possible to detect such small amounts. In the detection of ethyl glucuronide, or EtG, testing can detect amounts in picograms (one picogram equals 0.001 nanograms).\n<\/p><p>However, there is one major difference between most drugs and alcohol metabolites in the way in which they enter into the hair: on the one hand like other drugs FAEEs enter into the hair via the keratinocytes, the cells responsible for hair growth. These cells form the hair in the root and then grow through the skin surface taking any substances with them. On the other hand, the sebaceous glands produce FAEEs in the scalp and these migrate together with the sebum along the hair shaft (Auw\u00e4rter et al., 2001, Pragst et al., 2004). So these glands lubricate not only the part of the hair that is just growing at 0.3 mm per day on the skin surface, but also the more mature hair growth, providing it with a protective layer of fat.\n<\/p><p>FAEEs (nanogram = one billionth of a gram) appear in hair in almost one order of magnitude lower than (the relevant order of magnitude of) EtG (picogram = one trillionth of a gram). It has been technically possible to measure FAEEs since 1993, and the first study reporting the detection of EtG in hair was done by Sachs in 1993.<sup id=\"rdp-ebb-cite_ref-Kintz_23-0\" class=\"reference\"><a href=\"#cite_note-Kintz-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>In practice, most hair which is sent for analysis has been cosmetically treated in some way (bleached, permed etc.). It has been proven that FAEEs are not significantly affected by such treatments (Hartwig et al., 2003a). FAEE concentrations in hair from other body sites can be interpreted in a similar fashion as scalp hair (Hartwig et al., 2003b).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Presumptive_substance_testing\">Presumptive substance testing<\/span><\/h3>\n<p>Presumptive substance tests identify a suspicious substance, material or surface where traces of drugs are thought to be, instead of testing individuals through biological methods such as urine or hair testing. The test involves mixing the suspicious material with a chemical in order to trigger a color change to indicate if a drug is present. Most are now available over-the-counter, and do not require a lab to read results.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:176px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Duquenois_Reagent.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Duquenois_Reagent.jpg\/174px-Duquenois_Reagent.jpg\" width=\"174\" height=\"116\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Duquenois_Reagent.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Duquenois reagent<\/div><\/div><\/div>\n<p>Benefits to this method include that the person who is suspected of drug use does not need to be confronted or aware of testing. Only a very small amount of material is needed to obtain results, and can be used to test powder, pills, capsules, crystals, or organic material. There is also the ability to detect illicit material when mixed with other non-illicit materials. The tests are used for general screening purposes, offering a generic result for the presence of a wide range of drugs, including Heroin, Cocaine, Methamphetamine, Amphetamine, Ecstasy\/MDMA, Methadone, Ketamine, PCP, PMA, DMT, MDPV, and may detect rapidly evolving synthetic designer drugs. Separate tests for Marijuana\/Hashish are also available.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>There are five primary color-tests reagents used for general screening purposes. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marquis_reagent\" title=\"Marquis reagent\" rel=\"external_link\" target=\"_blank\">Marquis reagent<\/a> turns into a variety of colors when in the presence of different substances. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dille%E2%80%93Koppanyi_reagent\" title=\"Dille\u2013Koppanyi reagent\" rel=\"external_link\" target=\"_blank\">Dille-Koppanyi reagent<\/a> uses two chemical solutions which turns a violet-blue color in the presence of barbiturates. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duquenois%E2%80%93Levine_reagent\" title=\"Duquenois\u2013Levine reagent\" rel=\"external_link\" target=\"_blank\">Duquenois-Levine reagent<\/a> is a series of chemical solutions that turn to the color of purple when the vegetation of marijuana is added. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ehrlich%27s_reagent\" title=\"Ehrlich's reagent\" rel=\"external_link\" target=\"_blank\">Van Urk reagent<\/a> turns blue-purple when in the presence of LSD. Scott Test's chemical solution shows up as a faint blue for cocaine base.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Saliva_drug_screen_.2F_Oral_fluid-based_drug_screen\"><\/span><span class=\"mw-headline\" id=\"Saliva_drug_screen_\/_Oral_fluid-based_drug_screen\">Saliva drug screen \/ Oral fluid-based drug screen<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Saliva\" title=\"Saliva\" rel=\"external_link\" target=\"_blank\">Saliva<\/a> \/ oral fluid-based drug tests can generally detect use during the previous few days. Is better at detecting very recent use of a substance. THC may only be detectable for 2\u201324 hours in most cases. On site drug tests are allowed per the Department of Labor.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Detection in saliva tests begins almost immediately upon use of the following substances, and lasts for approximately the following times:\n<\/p>\n<ul><li>Alcohol: 6-12 h<sup id=\"rdp-ebb-cite_ref-ReferenceC_26-0\" class=\"reference\"><a href=\"#cite_note-ReferenceC-26\" rel=\"external_link\">[26]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Marijuana\" class=\"mw-redirect\" title=\"Marijuana\" rel=\"external_link\" target=\"_blank\">Marijuana<\/a>: 1-24h<\/li><\/ul>\n<p>A disadvantage of saliva based drug testing is that it is not approved by FDA or SAMHSA for use with DOT \/ Federal Mandated Drug Testing. Oral fluid is not considered a bio-hazard unless there is visible blood; however, it should be treated with care.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sweat_drug_screen\">Sweat drug screen<\/span><\/h3>\n<p>Sweat patches are attached to the skin to collect sweat over a long period of time (up to 14 days).<sup id=\"rdp-ebb-cite_ref-Drug_Test_27-0\" class=\"reference\"><a href=\"#cite_note-Drug_Test-27\" rel=\"external_link\">[27]<\/a><\/sup> These are used by child protective services, parole departments, and other government institutions concerned with drug use over long periods, when urine testing is not practical.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> There are also surface drug tests that test for the metabolite of parent drug groups in the residue of drugs left in sweat.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Blood\">Blood<\/span><\/h3>\n<p>Drug-testing a blood sample measures whether or not a drug or a metabolite is in the body at a particular time. These types of tests are considered to be the most accurate way of telling if a person is intoxicated. Blood drug tests are not used very often because they need specialized equipment and medically trained administrators.\n<\/p><p>Depending on how much marijuana was consumed, it can usually be detected in blood tests within six hours of consumption. After six hours has passed, the concentration of marijuana in the blood decreases significantly. It generally disappears completely within 30 days.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Anabolic_steroids\">Anabolic steroids<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Anabolic_steroid\" title=\"Anabolic steroid\" rel=\"external_link\" target=\"_blank\">Anabolic steroids<\/a> are used to enhance performance in sports and as they are prohibited in most high-level competitions drug testing is used extensively in order to enforce this prohibition. This is particularly so in individual (rather than team) sports such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Athletics_(sport)\" class=\"mw-redirect\" title=\"Athletics (sport)\" rel=\"external_link\" target=\"_blank\">athletics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cycling\" title=\"Cycling\" rel=\"external_link\" target=\"_blank\">cycling<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Random_drug_testing\">Random drug testing<\/span><\/h3>\n<p>Can occur at any time, usually when the investigator has reason to believe that a substance is possibly being abused by the subject by behavior or immediately after an employee-related incident occurs during work hours. Testing protocol typically conforms to the national medical standard, candidates are given up to 120 minutes to reasonably produce a urine sample from the time of commencement (in some instances this time frame may be extended at the examiners discretion).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Diagnostic_screening\">Diagnostic screening<\/span><\/h3>\n<p>In the case of life-threatening symptoms, unconsciousness, or bizarre behavior in an emergency situation, screening for common drugs and toxins may help find the cause, called a <i>toxicology test<\/i> or <i>tox screen<\/i> to denote the broader area of possible substances beyond just self-administered drugs. These tests can also be done post-mortem during an autopsy in cases where a death was not expected. The test is usually done within 96 hours (4 days) after the desire for the test is realized. Both a urine sample and a blood sample may be tested.<sup id=\"rdp-ebb-cite_ref-webmd_29-0\" class=\"reference\"><a href=\"#cite_note-webmd-29\" rel=\"external_link\">[29]<\/a><\/sup> A blood sample is routinely used to detect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethanol\" title=\"Ethanol\" rel=\"external_link\" target=\"_blank\">ethanol<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">methanol<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetylsalicylic_acid\" class=\"mw-redirect\" title=\"Acetylsalicylic acid\" rel=\"external_link\" target=\"_blank\">ASA<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Paracetamol\" title=\"Paracetamol\" rel=\"external_link\" target=\"_blank\">paracetamol<\/a> intoxication. Various panels are used for screening urine samples for common substances, e.g. <i>triage 8<\/i> that detects <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amphetamines\" class=\"mw-redirect\" title=\"Amphetamines\" rel=\"external_link\" target=\"_blank\">amphetamines<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benzodiazepine\" title=\"Benzodiazepine\" rel=\"external_link\" target=\"_blank\">benzodiazepines<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cocaine\" title=\"Cocaine\" rel=\"external_link\" target=\"_blank\">cocaine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methadone\" title=\"Methadone\" rel=\"external_link\" target=\"_blank\">methadone<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Opiates\" class=\"mw-redirect\" title=\"Opiates\" rel=\"external_link\" target=\"_blank\">opiates<\/a>, cannabis, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Barbiturates\" class=\"mw-redirect\" title=\"Barbiturates\" rel=\"external_link\" target=\"_blank\">barbiturates<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricyclic_antidepressants\" class=\"mw-redirect\" title=\"Tricyclic antidepressants\" rel=\"external_link\" target=\"_blank\">tricyclic antidepressants<\/a>.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Results are given in 10\u201315 min.\n<\/p><p>Similar screenings may be used to evaluate the possible use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Date_rape_drug\" title=\"Date rape drug\" rel=\"external_link\" target=\"_blank\">date rape drugs<\/a>. This is usually done on a urine sample.<sup id=\"rdp-ebb-cite_ref-webmd_29-1\" class=\"reference\"><a href=\"#cite_note-webmd-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Methodologies\">Methodologies<\/span><\/h2>\n<p>Before testing samples, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tamper-evident\" class=\"mw-redirect\" title=\"Tamper-evident\" rel=\"external_link\" target=\"_blank\">tamper-evident<\/a> seal is checked for integrity. If it appears to have been tampered with or damaged, the laboratory rejects the sample and does not test it.\n<\/p><p>Next, the sample must be made testable. Urine and oral fluid can be used \"as is\" for some tests, but other tests require the drugs to be extracted from urine. Strands of hair, patches, and blood must be prepared before testing. Hair is washed in order to eliminate second-hand sources of drugs on the surface of the hair, then the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keratin\" title=\"Keratin\" rel=\"external_link\" target=\"_blank\">keratin<\/a> is broken down using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enzymes\" class=\"mw-redirect\" title=\"Enzymes\" rel=\"external_link\" target=\"_blank\">enzymes<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_plasma\" title=\"Blood plasma\" rel=\"external_link\" target=\"_blank\">Blood plasma<\/a> may need to be separated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centrifuge\" title=\"Centrifuge\" rel=\"external_link\" target=\"_blank\">centrifuge<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_cells\" class=\"mw-redirect\" title=\"Blood cells\" rel=\"external_link\" target=\"_blank\">blood cells<\/a> prior to testing. Sweat patches are opened and the sweat collection component is removed and soaked in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solvent\" title=\"Solvent\" rel=\"external_link\" target=\"_blank\">solvent<\/a> to dissolve any drugs present.\n<\/p><p>Laboratory-based drug testing is done in two steps. The first step is the <b>screening test<\/b>, which is an immunoassay based test applied to all samples. The second step, known as the confirmation test, is usually undertaken by a laboratory using highly specific chromatographic techniques and only applied to samples that test positive during the screening test.<sup id=\"rdp-ebb-cite_ref-principles_of_drug_testing_technology_31-0\" class=\"reference\"><a href=\"#cite_note-principles_of_drug_testing_technology-31\" rel=\"external_link\">[31]<\/a><\/sup> Screening tests are usually done by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immunoassay\" title=\"Immunoassay\" rel=\"external_link\" target=\"_blank\">immunoassay<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Enzyme_Multiplied_Immunoassay_Technique\" class=\"mw-redirect\" title=\"Enzyme Multiplied Immunoassay Technique\" rel=\"external_link\" target=\"_blank\">EMIT<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/ELISA\" title=\"ELISA\" rel=\"external_link\" target=\"_blank\">ELISA<\/a>, and RIA are the most common). A \"<a href=\"https:\/\/en.wiktionary.org\/wiki\/dipstick\" class=\"extiw\" title=\"wiktionary:dipstick\" rel=\"external_link\" target=\"_blank\">dipstick<\/a>\" drug testing method which could provide screening test capabilities to field investigators has been developed at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Illinois_at_Urbana-Champaign\" class=\"mw-redirect\" title=\"University of Illinois at Urbana-Champaign\" rel=\"external_link\" target=\"_blank\">University of Illinois<\/a>.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>After a suspected positive sample is detected during screening, the sample is tested using a <b>confirmation test<\/b>. Samples that are negative on the screening test are discarded and reported as negative. The confirmation test in most laboratories (and all <a href=\"https:\/\/en.wikipedia.org\/wiki\/SAMHSA\" class=\"mw-redirect\" title=\"SAMHSA\" rel=\"external_link\" target=\"_blank\">SAMHSA<\/a> certified labs) is performed using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_spectrometry\" title=\"Mass spectrometry\" rel=\"external_link\" target=\"_blank\">mass spectrometry<\/a>, and is precise but expensive. False positive samples from the screening test will almost always be negative on the confirmation test. Samples testing positive during both screening and confirmation tests are reported as positive to the entity that ordered the test. Most laboratories save positive samples for some period of months or years in the event of a disputed result or lawsuit. For workplace drug testing, a positive result is generally not confirmed without a review by a Medical Review Officer who will normally interview the subject of the drug test.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Urine_drug_testing\">Urine drug testing<\/span><\/h3>\n<p>Urine drug test kits are available as on-site tests, or laboratory analysis. Urinalysis is the most common test type and used by federally mandated drug testing programs and is considered the Gold Standard of drug testing. Urine based tests have been upheld in most courts for more than 30 years. However, urinalysis conducted by the Department of Defense has been challenged for reliability of testing the metabolite of cocaine. There are two associated metabolites of cocaine, benzoylecgonine (BZ) and ecgonine methyl ester (EME), the first (BZ) is created by the presence of cocaine in an aqeous solution with a pH greater than 7.0, while the second (EME) results from the actual human metabolic process. The presence of EME confirms actual ingestion of cocaine by a human being, while the presence of BZ is indicative only. BZ without EME is evidence of sample contamination, however, the US Department of Defense has chosen not to test for EME in its urinalysis program.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Writing_better_articles#Stay_on_topic\" title=\"Wikipedia:Writing better articles\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag may contain information that is not relevant to the article's main topic. (October 2016)\">relevant?<\/span><\/a> <span class=\"metadata\"> – <a href=\"https:\/\/en.wikipedia.org\/wiki\/Talk:Drug_test\" title=\"Talk:Drug test\" rel=\"external_link\" target=\"_blank\">discuss<\/a><\/span><\/i>]<\/sup>\n<\/p><p>A number of different analyses (defined as the unknown substance being tested for) are available on Urine Drug Screens.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Spray_drug_testing\">Spray drug testing<\/span><\/h3>\n<p>Spray (sweat) drug test kits are non-invasive. It is a simple process to collect the required specimen, no bathroom is needed, no laboratory is required for analysis, and the tests themselves are difficult to manipulate and relatively tamper-resistant. The detection window is long and can detect recent drug use within several hours.\n<\/p><p>There are also some disadvantages to spray or sweat testing. There is not much variety in these drug tests, only a limited number of drugs can be detected, prices tend to be higher, and inconclusive results can be produced by variations in sweat production rates in donors. They also have a relatively long specimen collection period and are more vulnerable to contamination than other common forms of testing.<sup id=\"rdp-ebb-cite_ref-Drug_Test_27-1\" class=\"reference\"><a href=\"#cite_note-Drug_Test-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hair_drug_testing\">Hair drug testing<\/span><\/h3>\n<p>Hair drug testing is a method that can detect drug use over a much longer period of time,<sup id=\"rdp-ebb-cite_ref-Your_hair_tells_all_34-0\" class=\"reference\"><a href=\"#cite_note-Your_hair_tells_all-34\" rel=\"external_link\">[34]<\/a><\/sup> and is often used for highly safety-critical positions where there is zero tolerance of illegal drug use.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> Standard hair follicle screen covers a period of 30 to 90 days. The growth of head hair is usually at the rate of 0.5 inches per month.<sup id=\"rdp-ebb-cite_ref-zme_36-0\" class=\"reference\"><a href=\"#cite_note-zme-36\" rel=\"external_link\">[36]<\/a><\/sup> The hair sample is cut close to the scalp and 80 to 120 strands of hair are needed for the test. In the absence of hair on the head, body hair can be used as an acceptable substitute.<sup id=\"rdp-ebb-cite_ref-Your_hair_tells_all_34-1\" class=\"reference\"><a href=\"#cite_note-Your_hair_tells_all-34\" rel=\"external_link\">[34]<\/a><\/sup> This includes facial hair, the underarms, arms, and legs or even pubic hair. Because body hair grows at a different rate than head hair, the timeframe changes, with scientists estimating that drug use can be detected in body hair for up to 12 months. Currently, most entities that use hair testing have prescribed consequences for individuals removing hair to avoid a hair drug test.\n<\/p><p>The claim that a hair test cannot be tampered with has been shown to be debatable. One study has shown that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetrahydrocannabinol\" title=\"Tetrahydrocannabinol\" rel=\"external_link\" target=\"_blank\">THC<\/a> does not readily deposit inside epithelial cells so it is possible for cosmetic and other forms of adulteration to reduce the amount of testable cannabinoids within a hair sample.<sup id=\"rdp-ebb-cite_ref-Kintz_23-1\" class=\"reference\"><a href=\"#cite_note-Kintz-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-Legality.2C_ethics_and_politics\"><\/span><span class=\"mw-headline\" id=\"Legality,_ethics_and_politics\">Legality, ethics and politics<\/span><\/h2>\n<p>The results of federally mandating drug testing were similar to the effects of simply extending to the trucking industry the right to perform drug tests, and it has been argued that the latter approach would have been as effective at lower cost.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup>\n<\/p><p>Psychologist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tony_Buon\" title=\"Tony Buon\" rel=\"external_link\" target=\"_blank\">Tony Buon<\/a> has criticized the use of workplace drug testing on a number of grounds, including:\n<\/p>\n<ol><li>Flawed Technology: The real world performance of testing is much lower than that claimed by its promoters. Buon suggest that tests are probably adequate for rehabilitation and treatment situations, possibly adequate for pre-employment situations, but not for dismissing employees.<\/li>\n<li>Ethical Issues: Because of the fairly simple ways that an employee can invalidate the test, drug testing must be strictly monitored. This means that the specimen must be observed leaving the body. Many legal objections currently being raised in the courts about drug testing are pointing to legal requirements of prior notice, consent, due process, and cause.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li>Wrong focus: As has been shown with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Employee_Assistance_Program\" class=\"mw-redirect\" title=\"Employee Assistance Program\" rel=\"external_link\" target=\"_blank\">Employee Assistance Programs<\/a>, the focus of management concern should be on work performance decline. Buon suggests effective management practices are an infinitely better approach to managing workplace alcohol and other drug issues.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li><\/ol>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tony_Buon\" title=\"Tony Buon\" rel=\"external_link\" target=\"_blank\">Tony Buon<\/a> has also reported by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/CIPD\" class=\"mw-redirect\" title=\"CIPD\" rel=\"external_link\" target=\"_blank\">CIPD<\/a> as stating that \"drug testing captures the stupid\u2014experienced drug users know how to beat the tests\".<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p><p>From a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penology\" title=\"Penology\" rel=\"external_link\" target=\"_blank\">penological<\/a> standpoint, one purpose of drug testing is to help classify the \n<p>people taking the drug test within risk groups so that those who pose more of a danger to the public can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incapacitation_(penology)\" title=\"Incapacitation (penology)\" rel=\"external_link\" target=\"_blank\">incapacitated<\/a> through incarceration or other restrictions on liberty. Thus, the drug testing serves a crime control purpose even if there is no expectation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rehabilitation_(penology)\" title=\"Rehabilitation (penology)\" rel=\"external_link\" target=\"_blank\">rehabilitating<\/a> the drug user through treatment, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deterrence_(penology)\" title=\"Deterrence (penology)\" rel=\"external_link\" target=\"_blank\">deterring<\/a> drug use through sanctions, or sending a message that drug use is a deviant behavior that will not be tolerated.<sup id=\"rdp-ebb-cite_ref-newpenology_42-0\" class=\"reference\"><a href=\"#cite_note-newpenology-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"United_Kingdom\">United Kingdom<\/span><\/h3>\n<p>A study in 2004 by the Independent Inquiry into Drug Testing at Work found that attempts by employers to force employees to take drug tests could potentially be challenged as a violation of privacy under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_Rights_Act_1998\" title=\"Human Rights Act 1998\" rel=\"external_link\" target=\"_blank\">Human Rights Act 1998<\/a> and Article 8 of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Convention_of_Human_Rights\" class=\"mw-redirect\" title=\"European Convention of Human Rights\" rel=\"external_link\" target=\"_blank\">European Convention of Human Rights<\/a>.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> However, this does not apply to industries where drug testing is a matter of personal and public safety or security rather than productivity.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"United_States\">United States<\/span><\/h3>\n<p>In consultation with Dr. Carlton Turner, President Ronald Reagan issued <a href=\"https:\/\/en.wikipedia.org\/wiki\/Executive_order_(United_States)\" class=\"mw-redirect\" title=\"Executive order (United States)\" rel=\"external_link\" target=\"_blank\">Executive Order<\/a> 12564. In doing so, he instituted mandatory drug-testing for all safety-sensitive executive-level and civil-service Federal employees. This was <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Treasury_Employees_Union_v._Von_Raab\" title=\"National Treasury Employees Union v. Von Raab\" rel=\"external_link\" target=\"_blank\">challenged in the courts<\/a> by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Treasury_Employees_Union\" title=\"National Treasury Employees Union\" rel=\"external_link\" target=\"_blank\">National Treasury Employees Union<\/a>. In 1988, this challenge was considered by the US Supreme Court.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> A similar challenge resulted in the Court extending the drug-free workplace concept to the private sector.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> These decisions were then incorporated into the White House Drug Control Strategy directive issued by President George H.W. Bush in 1989.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> All defendants serving on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_probation\" class=\"mw-redirect\" title=\"Federal probation\" rel=\"external_link\" target=\"_blank\">federal probation<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_supervised_release\" class=\"mw-redirect\" title=\"Federal supervised release\" rel=\"external_link\" target=\"_blank\">federal supervised release<\/a> are required to submit to at least three drug tests. Failing a drug test can be construed as possession of a controlled substance, resulting in mandatory revocation and imprisonment.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p><p>There have been inconsistent evaluation results as to whether continued pretrial drug testing has beneficial effects.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p><p>Testing positive can lead to bail not being granted, or if bail has already been granted, to bail revocation or other sanctions. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arizona\" title=\"Arizona\" rel=\"external_link\" target=\"_blank\">Arizona<\/a> also adopted a law in 1987 authorizing mandatory drug testing of felony arrestees for the purpose of informing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pretrial_release\" class=\"mw-redirect\" title=\"Pretrial release\" rel=\"external_link\" target=\"_blank\">pretrial release<\/a> decision, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/District_of_Columbia\" class=\"mw-redirect\" title=\"District of Columbia\" rel=\"external_link\" target=\"_blank\">District of Columbia<\/a> has had a similar law since the 1970s. It has been argued that one of the problems with such testing is that there is often not enough time between the arrest and the bail decision to confirm positive results using GC\/MS technology. It has also been argued that such testing potentially implicates the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fifth_Amendment_to_the_U.S._Constitution\" class=\"mw-redirect\" title=\"Fifth Amendment to the U.S. Constitution\" rel=\"external_link\" target=\"_blank\">Fifth Amendment<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Privilege_against_self-incrimination\" class=\"mw-redirect\" title=\"Privilege against self-incrimination\" rel=\"external_link\" target=\"_blank\">privilege against self-incrimination<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_to_due_process\" class=\"mw-redirect\" title=\"Right to due process\" rel=\"external_link\" target=\"_blank\">right to due process<\/a> (including the prohibition against gathering evidence in a manner that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shocks_the_conscience\" title=\"Shocks the conscience\" rel=\"external_link\" target=\"_blank\">shocks the conscience<\/a> or constitutes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Outrageous_government_conduct\" title=\"Outrageous government conduct\" rel=\"external_link\" target=\"_blank\">outrageous government conduct<\/a>), and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prohibition_against_unreasonable_searches_and_seizures\" class=\"mw-redirect\" title=\"Prohibition against unreasonable searches and seizures\" rel=\"external_link\" target=\"_blank\">prohibition against unreasonable searches and seizures<\/a> contained in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fourth_Amendment_to_the_U.S._Constitution\" class=\"mw-redirect\" title=\"Fourth Amendment to the U.S. Constitution\" rel=\"external_link\" target=\"_blank\">Fourth Amendment<\/a>.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p><p>According to Henriksson, the anti-drug appeals of the Reagan administration \"created an environment in which many employers felt compelled to implement drug testing programs because failure to do so might be perceived as condoning drug use. This fear was easily exploited by aggressive marketing and sales forces, who often overstated the value of testing and painted a bleak picture of the consequences of failing to use the drug testing product or service being offered.\"<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> On March 10, 1986, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Commission_on_Organized_Crime\" class=\"mw-redirect\" title=\"Commission on Organized Crime\" rel=\"external_link\" target=\"_blank\">Commission on Organized Crime<\/a> asked all U.S. companies to test employees for drug use. By 1987, nearly 25% of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fortune_500\" title=\"Fortune 500\" rel=\"external_link\" target=\"_blank\">Fortune 500<\/a> companies used drug tests.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p><p>According to an uncontrolled self-report study done by DATIA and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Society_for_Human_Resource_Management\" title=\"Society for Human Resource Management\" rel=\"external_link\" target=\"_blank\">Society for Human Resource Management<\/a> in 2012 (sample of 6,000 randomly selected human resource professionals), human resource professionals reported the following results after implementing a drug testing program: 19% of companies reported a subjective increase in employee productivity, 16% reported a decrease in employee turnover (8% reported an increase), and unspecified percentages reported decreases in absenteeism and improvement of workers' compensation incidence rates.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p><p>According to US Chamber of Commerce 70% of all illicit drug users are employed.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> Some industries have high rates of employee drug use such as construction (12.8%), repair (11.1%), and hospitality (7.9-16.3%).<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Australia\">Australia<\/span><\/h3>\n<p>A person conducting a business or undertaking (PCBU\u2014the new term that includes employers) has duties under the work health and safety (WHS) legislation to ensure a worker affected by alcohol or other drugs does not place themselves or other persons at risk of injury while at work. Workplace policies and prevention programs can help change the norms and culture around substance abuse.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>All organisations\u2014large and small\u2014can benefit from an agreed policy on alcohol and drug misuse that applies to all workers. Such a policy should form part of an organisations overall health and safety management system. PCBUs are encouraged to establish a policy and procedure, in consultation with workers, to constructively manage alcohol and other drug related hazards in their workplace. A comprehensive workplace alcohol and other drug policy should apply to everyone in the workplace and include prevention, education, counselling and rehabilitation arrangements. In addition, the roles and responsibilities of managers and supervisors should be clearly outlined.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>All Australian workplace drug testing must comply with Australian standard AS\/NZS4308:2008.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In Victoria, roadside saliva tests detect drugs that contain:<sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup>\n<\/p>\n<ul><li>THC (Delta-9 tetrahydrocannabinol), the active component in cannabis.<\/li>\n<li>methamphetamine, also known as \"ice\", \"crystal\" and \"crank\".<\/li>\n<li>MDMA (Methylenedioxymethamphetamine), which is known as ecstasy.<\/li><\/ul>\n<p>In February 2016 a New South Wales magistrate \"acquitted a man who tested positive for cannabis\". He had been arrested and charged after testing positive during a roadside drug test, despite not having smoked for nine days. He was relying on advice previously given to him by police.<sup id=\"rdp-ebb-cite_ref-abc.net.au2016-02-02-man-caught_56-0\" class=\"reference\"><a href=\"#cite_note-abc.net.au2016-02-02-man-caught-56\" rel=\"external_link\">[56]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Refusal\">Refusal<\/span><\/h2>\n<p>In the United States federal criminal system, refusing to take a drug test triggers an automatic revocation of probation or supervised release.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p><p>In Victoria, Australia the driver of the car has the option to refuse the drug test. Refusing to undergo a drug test or refusing to undergo a secondary drug test after the first one, triggers an automatic suspension and disqualification for a period of 2 years and a fine of AUD$1000. The second refusal triggers an automatic suspension and disqualification for a period of 4 years and an even larger fine.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Historical_cases\">Historical cases<\/span><\/h3>\n<ul><li>In 1993 Meritorious Marine Sergeant Steve Steinmetz refused to submit to further drug screening on the grounds that it violated his 4th and 5th Amendment Rights against unwarranted search and self-incrimination. He was court-martialed and given a Bad Conduct Discharge from the United States Marine Corps in 1994 for refusing to obey a \"lawful order\". He was threatened with forced medical procedures to obtain a sample if he was imprisoned. Said Marine stated, \"That won't happen\". He was discharged without being imprisoned.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2017)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li>In 2000, an Australian Mining Company South Blackwater Coal Ltd with 400 employees, imposed drug-testing procedures, and the trade unions advised their members to refuse to take the tests, partly because a positive result does not necessarily indicate present impairment; the workers were stood-down by the company without pay for a week.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup><\/li>\n<li>In 2003, sixteen members of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chicago_White_Sox\" title=\"Chicago White Sox\" rel=\"external_link\" target=\"_blank\">Chicago White Sox<\/a> considered refusing to take a drug test, in hopes of making <a href=\"https:\/\/en.wikipedia.org\/wiki\/Steroid\" title=\"Steroid\" rel=\"external_link\" target=\"_blank\">steroid<\/a> testing mandatory.<sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup><\/li>\n<li>In 2006, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Levy_County,_Florida\" title=\"Levy County, Florida\" rel=\"external_link\" target=\"_blank\">Levy County, Florida<\/a>, volunteer librarians resigned en masse rather than take drug tests.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup><\/li>\n<li>In 2010, Iranian super heavyweight class weightlifters refused to submit to a drug test authorized by the Iran Weightlifting League.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannabis_drug_tests\" class=\"mw-redirect\" title=\"Cannabis drug tests\" rel=\"external_link\" target=\"_blank\">Cannabis drug tests<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug-Free_Workplace_Act_of_1988\" title=\"Drug-Free Workplace Act of 1988\" rel=\"external_link\" target=\"_blank\">Drug-Free Workplace Act of 1988<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Equine_drug_testing\" title=\"Equine drug testing\" rel=\"external_link\" target=\"_blank\">Equine drug testing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Forensic_toxicology\" title=\"Forensic toxicology\" rel=\"external_link\" target=\"_blank\">Forensic toxicology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lacing_(drugs)\" title=\"Lacing (drugs)\" rel=\"external_link\" target=\"_blank\">Lacing (drugs)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Presumptive_and_confirmatory_tests\" title=\"Presumptive and confirmatory tests\" rel=\"external_link\" target=\"_blank\">Presumptive and confirmatory tests<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/School_district_drug_policies\" title=\"School district drug policies\" rel=\"external_link\" target=\"_blank\">School district drug policies<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinalysis\" class=\"mw-redirect\" title=\"Urinalysis\" rel=\"external_link\" target=\"_blank\">Urinalysis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_health_concerns_of_cannabis_use\" title=\"Occupational health concerns of cannabis use\" rel=\"external_link\" target=\"_blank\">Occupational health concerns of cannabis use<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-inde1-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-inde1_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.independent.co.uk\/voices\/secret-garden-party-drugs-service-i-tested-drugs-at-festival-service-for-everyone-a7155376.html\" target=\"_blank\">\"I spent my weekend testing drugs at a festival\"<\/a>. The Independent. 25 July 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 May<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=I+spent+my+weekend+testing+drugs+at+a+festival&rft.pub=The+Independent&rft.date=2016-07-25&rft_id=https%3A%2F%2Fwww.independent.co.uk%2Fvoices%2Fsecret-garden-party-drugs-service-i-tested-drugs-at-festival-service-for-everyone-a7155376.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-reference_guide-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-reference_guide_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/nebula.wsimg.com\/f9798210579e56d22dd4c3facc3cf7fa?AccessKeyId=020EF4172A625EEA5605&disposition=0&alloworigin=1\" target=\"_blank\">\"Drugs of Abuse Reference Guide,\"<\/a> <i>Pinnacle BioLabs<\/i>, Retrieved online April 11, 2007.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">U.S. Department of Transportation: National Highway Traffic Safety Administration (DOT HS 810 704). <i>Pilot Test of New Roadside Survey Methodology for Impaired Driving<\/i>. January, 2007.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140125024950\/http:\/\/www.singlesourceservices.com\/drug-test-kits\/Statebystatelaw_800059vA_0611.pdf\" target=\"_blank\">\"Archived copy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.singlesourceservices.com\/drug-test-kits\/Statebystatelaw_800059vA_0611.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on January 25, 2014<span class=\"reference-accessdate\">. 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US Supreme Court, 1989<\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Miller, NS; Giannini, AJ; Gold, MS; Philomena, JA (1990). \"Drug testing: medical, legal, and ethical issues\". <i>Journal of Substance Abuse Treatment<\/i>. <b>7<\/b> (4): 239\u201344. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0740-5472%2890%2990047-T\" target=\"_blank\">10.1016\/0740-5472(90)90047-T<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2290186\" target=\"_blank\">2290186<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Substance+Abuse+Treatment&rft.atitle=Drug+testing%3A+medical%2C+legal%2C+and+ethical+issues.&rft.volume=7&rft.issue=4&rft.pages=239-44&rft.date=1990&rft_id=info%3Adoi%2F10.1016%2F0740-5472%2890%2990047-T&rft_id=info%3Apmid%2F2290186&rft.aulast=Miller&rft.aufirst=NS&rft.au=Giannini%2C+AJ&rft.au=Gold%2C+MS&rft.au=Philomena%2C+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Title_18_of_the_United_States_Code\" title=\"Title 18 of the United States Code\" rel=\"external_link\" target=\"_blank\">18 U.S.C.<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.law.cornell.edu\/uscode\/text\/18\/3563\" target=\"_blank\">\u00a7 3563<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Title_18_of_the_United_States_Code\" title=\"Title 18 of the United States Code\" rel=\"external_link\" target=\"_blank\">18 U.S.C.<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.law.cornell.edu\/uscode\/text\/18\/3583\" target=\"_blank\">\u00a7 3583<\/a><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Christy A. 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USUHS.mil.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=EAP+Employee+and+Supervisor+Drug+Education&rft.pub=USUHS.mil&rft_id=http%3A%2F%2Fwww.usuhs.mil%2Fchr%2Fdoc%2FEAPDrugFree.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-54\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090216184651\/http:\/\/asbtdc.ualr.edu\/drugfree\/hospitly.htm\" target=\"_blank\">\"Substance Abuse in the hospitality industry\"<\/a>. Arkansas Small Business Development Center. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/asbtdc.ualr.edu\/drugfree\/hospitly.htm\" target=\"_blank\">the original<\/a> on February 16, 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Substance+Abuse+in+the+hospitality+industry&rft.pub=Arkansas+Small+Business+Development+Center&rft_id=http%3A%2F%2Fasbtdc.ualr.edu%2Fdrugfree%2Fhospitly.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/adf.org.au\/insights\/roadside-drug-testing\/\" target=\"_blank\">\"Roadside drug testing\"<\/a>. <i>www.adf.org.au<\/i>. Alcohol and Drug Foundation<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-07-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.adf.org.au&rft.atitle=Roadside+drug+testing&rft_id=https%3A%2F%2Fadf.org.au%2Finsights%2Froadside-drug-testing%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-abc.net.au2016-02-02-man-caught-56\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-abc.net.au2016-02-02-man-caught_56-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Knowles, Lorna; Branley (2 February 2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.abc.net.au\/news\/2016-02-02\/man-caught-drug-driving-days-after-smoking-cannabis-acquitted\/7133628\" target=\"_blank\">\"Acquittal of man caught drug-driving nine days after smoking cannabis throws NSW drug laws into doubt\"<\/a>. <i>abc.net.au<\/i>. Australian Broadcasting Corporation<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2 February<\/span> 2016<\/span>. <q>A spokeswoman for NSW Roads Minister Duncan Gay said roadside tests were followed up with lab tests and 97 per cent of tests matched. 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Associated Press. March 12, 2003.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Los+Angeles+Times&rft.atitle=White+Sox+Players+Almost+Refused+Drug+Test&rft.date=2003-03-12&rft_id=http%3A%2F%2Farticles.latimes.com%2F2003%2Fmar%2F12%2Fsports%2Fsp-bbnotes12&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Voyles, Karen (October 6, 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gainesville.com\/apps\/pbcs.dll\/article?AID=2006210070330\" target=\"_blank\">\"Library volunteers just say no to drug testing\"<\/a>. Gainesville Sun.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Library+volunteers+just+say+no+to+drug+testing&rft.date=2006-10-06&rft.au=Voyles%2C+Karen&rft_id=http%3A%2F%2Fwww.gainesville.com%2Fapps%2Fpbcs.dll%2Farticle%3FAID%3D2006210070330&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tehrantimes.com\/index_View.asp?code=214245\" target=\"_blank\">\"Iranian weightlifters refuse drug testing\"<\/a>. February 16, 2010<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Iranian+weightlifters+refuse+drug+testing&rft.date=2010-02-16&rft_id=http%3A%2F%2Fwww.tehrantimes.com%2Findex_View.asp%3Fcode%3D214245&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADrug+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.drugabuse.gov\/related-topics\/drug-testing\/\" target=\"_blank\">National Institute on Drug Abuse<\/a><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181129215452\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.860 seconds\nReal time usage: 1.053 seconds\nPreprocessor visited node count: 4405\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 206069\/2097152 bytes\nTemplate argument size: 5803\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 11\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 113838\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.415\/10.000 seconds\nLua memory usage: 5.83 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 784.639 1 -total\n<\/p>\n<pre>52.15% 409.172 1 Template:Reflist\n23.60% 185.211 21 Template:Cite_web\n17.54% 137.590 10 Template:Citation_needed\n17.06% 133.842 11 Template:Fix\n11.97% 93.945 9 Template:Cite_journal\n 8.91% 69.909 7 Template:Navbox\n 8.02% 62.912 11 Template:Delink\n 7.88% 61.860 21 Template:Category_handler\n 4.81% 37.708 1 Template:Drug_use\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:986871-1!canonical and timestamp 20181129215451 and revision id 871185274\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_test\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214635\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.039 seconds\nReal time usage: 0.196 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 183.141 1 - wikipedia:Drug_test\n100.00% 183.141 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8537-0!*!*!*!*!*!* and timestamp 20181217214635 and revision id 24962\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Drug_test\">https:\/\/www.limswiki.org\/index.php\/Drug_test<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a77e286e4af95b13abc7acf73113e96b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f7\/Breathalyzer_on_citizen.jpg\/408px-Breathalyzer_on_citizen.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Duquenois_Reagent.jpg\/348px-Duquenois_Reagent.jpg"],"a77e286e4af95b13abc7acf73113e96b_timestamp":1545083195,"9741cb9f721b9f0744efaf204ee7b0c8_type":"article","9741cb9f721b9f0744efaf204ee7b0c8_title":"Crutch","9741cb9f721b9f0744efaf204ee7b0c8_url":"https:\/\/www.limswiki.org\/index.php\/Crutch","9741cb9f721b9f0744efaf204ee7b0c8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCrutch\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Crutch (disambiguation).\nA crutch is a mobility aid that transfers weight from the legs to the upper body. It is often used by people who cannot use their legs to support their weight, for reasons ranging from short-term injuries to lifelong disabilities.\n\nContents \n\n1 History \n2 Types \n\n2.1 Underarm or axilla \n2.2 Forearm \n2.3 Platform \n2.4 Leg support \n\n\n3 Types of gaits \n\n3.1 One crutch \n3.2 Four-point gait \n3.3 Two-point gait \n3.4 Three-point gait \n3.5 Swing-to gait \n3.6 Stairs \n\n\n4 Alternative devices \n5 Materials \n6 See also \n7 References \n\n\nHistory \nCrutches were used in ancient Egypt.[1] In 1917, Emile Schlick patented the first commercially produced crutch; the design consisted of a walking stick with an upper arm support. Later, A.R. Lofstrand, Jr. developed the first crutches with a height-adjustable feature making the crutches customizable. Through time, the design of crutches haven't changed much such that the classic design still is most commonly used.[1]\n\nTypes \n Axillary (underarm) crutches\nThere are several types of crutches:\n\nUnderarm or axilla \nAxillary crutches are used by placing the pad against the ribcage beneath the armpit and holding the grip, which is below and parallel to the pad. They are usually used to provide support for patients who have temporary restriction on ambulation.[2]\nWith underarm crutches, sometimes a towel or some kind of soft cover is needed to prevent or reduce armpit injury. A condition known as crutch paralysis, or crutch palsy can arise from pressure on nerves in the armpit, or axilla.[3][4] Specifically, \"the brachial plexus in the axilla is often damaged from the pressure of a crutch...In these cases the radial is the nerve most frequently implicated; the ulnar nerve suffers next in frequency.\"[4]\nAn uncommon type of axillary crutches is the spring-loaded crutch. The underarm pad is a curved design that is open in the front with the grips for the hands shaped for maximum comfort and to reduce the prevalence of overuse injuries.[5] These crutches also contain a spring mechanism at the bottom. The idea behind this design is to allow the user to propel themselves further, resulting in quicker movement from place to place, though research has shown that the difference in speed is very small when comparing standard axillary crutches to spring-loaded crutches.[6] These crutches are most commonly used by young or athletic populations.\n\nForearm \nPlay media A typical forearm crutch\nA forearm crutch (also commonly known as an elbow crutch, Canadian crutch or \"Lofstrand\" crutch due to a brand by this name) has a cuff at the top that goes around the forearm.[1] It is used by inserting the arm into a cuff and holding the grip. The hinged cuff, most frequently made of plastic or metal, can be a half-circle or a full circle with a V-type opening in the front allowing the forearm to slip out in case of a fall.\nForearm crutches are the dominant type used in Europe, whether for short or long term use. Outside of Europe forearm crutches are more likely to be used by users with long term disabilities, with axillary crutches more common for short term use.[2]\n\nPlatform \n Top portion of a platform crutch showing platform and grip\nThese are less common and used by those with poor hand or grip strength due to arthritis, cerebral palsy, or other conditions. The forearm rests on a horizontal platform and is usually strapped in place with velcro-type straps that allow the platform or trough to release in case of a fall. The hand holds an angled grip which, in addition, should allow adjustment of length from trough to grip and side-to-side sway depending on the user's disability.\n\nLeg support \nThese non-traditional crutches are useful for users with an injury or disability affecting one lower leg only. They function by strapping the affected leg into a support frame that simultaneously holds the lower leg clear of the ground while transferring the load from the ground to the user's knee or thigh. This style of crutch has the advantage of not using the hands or arms while walking. A claimed benefit is that upper thigh atrophy is also reduced because the affected leg remains in use. Unlike other crutch designs these designs are unusable for pelvic, hip or thigh injuries and in some cases for knee injuries also.\nWalking sticks or canes serve an identical purpose to crutches, but are held only in the hand and have a limited load bearing capability because of this.\n\nTypes of gaits \n Small boy learns to use his crutches (1942)\nOne crutch \nWhen using one crutch, the crutch is placed on the side of the unaffected leg.\n\nFour-point gait \nThose who can tolerate partial weight bearing on both legs usually use the four point gait. The sequence is right crutch, left leg, left crutch, right leg. This is the slowest of all gaits but also the safest in that three of the four points are in contact with the ground at any given time. [7]\n\nTwo-point gait \nThose who can tolerate partial weight bearing on both legs but require less support than a four-point gait usually use the two-point gait. The sequence is right crutch with left leg and then left crutch with right leg.\n\nThree-point gait \nThe three point gait is usually used by those who cannot bear weight on one leg. Both crutches are advanced while bearing weight on the unaffected leg. Then the unaffected leg is advanced while bearing weight on the crutches.\n\nSwing-to gait \nA person with a non-weight bearing injury generally performs a \"swing-to\" gait: lifting the affected leg, the user places both crutches in front of himself, and then swings his uninjured leg to meet the crutches. A similar \"swing-through\" gait is when both legs are advanced in front of the crutches rather than beside them.\n\nStairs \nWhen climbing up stairs, the unaffected leg is advanced first, then the affected leg and the crutches are advanced. When descending stairs, the crutches are advanced first and then the affected leg and the unaffected leg.[2]\n\nAlternative devices \nThe knee scooter and the wheelchair are possible alternatives for patients who cannot use or do not like crutches. These wheeled devices introduce an additional limitation, however, since they cannot negotiate stairs.\n\nMaterials \nWood\nMetal alloys (most often steel, aluminium alloys, titanium alloys)\nCarbon or glass fiber reinforced composites\nThermoplastic\nCarbon fiber reinforced polymer[8]\nSee also \nAssistive technology\nWalker\nReferences \n\n\n\nWikimedia Commons has media related to Crutches.\n\n\n^ a b c Fairley, Miki (April 2008). \"Innovative Crutch Designs: More Gain, Much Less Pain\". The O&P Edge. \n\n^ a b c Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1042-1043. \n\n^ Glanze, W.D., Anderson, K.N., & Anderson, L.E, eds. (1990). Mosby's Medical, Nursing & Allied Health Dictionary (3rd ed.). St. Louis, Missouri: The C.V. Mosby Co. ISBN 0-8016-3227-7. CS1 maint: Uses editors parameter (link) p.324 \n\n^ a b Warwick, R.; Williams, P.L, eds. (1973). Gray\u2019s Anatomy (35th ed.). London: Longman. p.1046 \n\n^ Segura, A; Piazza, SJ (2007). \"Mechanics of Ambulation With Standard and Spring-Loaded Crutches\". Archives of Physical Medicine and Rehabilitation. 88 (9): 1159\u20131163. doi:10.1016\/j.apmr.2007.05.026. PMID 17826462. \n\n^ Seeley, M K; Hunter, I; Bateman, T; Roggia, A; Larson, B J; Draper, DO (2011). \"A Kinematic Comparison of Spring-Loaded and Traditional Crutches\". Journal of Sport Rehabilitation. 20 (2): 198\u2013206. doi:10.1123\/jsr.20.2.198. PMID 21576711. \n\n^ Walk Easy > Explore > Crutch Gaits. Retrieved on May 19, 2018. \n\n^ \"Health Resources: Using crutches\". PinnacleHealth. Retrieved 30 May 2017 . \n\n\nvteHealth care\nEconomics\nEquipment\nGuidelines\nIndustry\nPhilosophy\nPolicy\nProviders\nRanking\nReform\nSystem\nProfessions\nMedicine\nNursing\nHealthcare science\nDentistry\nAllied health professions\nPharmacy\nHealth information management\nSettings\nAssisted living\nClinic\nHospital\nNursing home\nMedical school (Academic health science centre, Teaching hospital)\nCare\nAcute\nChronic\nEnd-of-life\nHospice\nOverutilization\nPalliative\nPrimary\nSelf\nTotal\nSkills \/ Training\nBedside manner\nCultural competence\nDiagnosis\nEducation\nUniversal precautions\nBy country\nUnited States\nreform debate in the United States\nUnited Kingdom\nCanada\nAustralia\nNew Zealand\n(Category Healthcare by country)\n\n Category\n\nvteDisabilityMain topics\nDisability\nDisability studies\nMedical model\nSocial model\nSociety for Disability Studies\nApproaches\nFreak show\nIEP\nInclusion\nLearning disability\nMainstreaming\nPhysical therapy\ndriver 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disorder\nDown syndrome\nFragile X syndrome\nSchizophrenia\nArts, media, culture, sport\nDisability culture\nDisability art\nDisability in the arts\nDisability in the media\nDisabled sports\nDeaflympics\nParalympics\nSpecial Olympics\nPortal\nPortal\ncategories\nlists\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Crutch\">https:\/\/www.limswiki.org\/index.php\/Crutch<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog 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version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:33.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 601 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9741cb9f721b9f0744efaf204ee7b0c8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Crutch skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Crutch<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crutch_(disambiguation)\" class=\"mw-disambig\" title=\"Crutch (disambiguation)\" rel=\"external_link\" target=\"_blank\">Crutch (disambiguation)<\/a>.<\/div>\n<p>A <b>crutch<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mobility_aid\" title=\"Mobility aid\" rel=\"external_link\" target=\"_blank\">mobility aid<\/a> that transfers weight from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_leg\" title=\"Human leg\" rel=\"external_link\" target=\"_blank\">legs<\/a> to the upper body. It is often used by people who cannot use their legs to support their weight, for reasons ranging from short-term injuries to lifelong disabilities.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Crutches were used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Egypt\" title=\"Ancient Egypt\" rel=\"external_link\" target=\"_blank\">ancient Egypt<\/a>.<sup id=\"rdp-ebb-cite_ref-Fairley_1-0\" class=\"reference\"><a href=\"#cite_note-Fairley-1\" rel=\"external_link\">[1]<\/a><\/sup> In 1917, Emile Schlick patented the first commercially produced crutch; the design consisted of a walking stick with an upper arm support. Later, A.R. Lofstrand, Jr. developed the first crutches with a height-adjustable feature making the crutches customizable. Through time, the design of crutches haven't changed much such that the classic design still is most commonly used.<sup id=\"rdp-ebb-cite_ref-Fairley_1-1\" class=\"reference\"><a href=\"#cite_note-Fairley-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:102px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Axillary_(underarm)_crutches.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Axillary_%28underarm%29_crutches.JPG\/100px-Axillary_%28underarm%29_crutches.JPG\" width=\"100\" height=\"218\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Axillary_(underarm)_crutches.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Axillary (underarm) crutches<\/div><\/div><\/div>\n<p>There are several types of crutches:\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Underarm_or_axilla\">Underarm or axilla<\/span><\/h3>\n<p>Axillary crutches are used by placing the pad against the ribcage beneath the armpit and holding the grip, which is below and parallel to the pad. They are usually used to provide support for patients who have temporary restriction on ambulation.<sup id=\"rdp-ebb-cite_ref-Taylor_2-0\" class=\"reference\"><a href=\"#cite_note-Taylor-2\" rel=\"external_link\">[2]<\/a><\/sup>\nWith underarm crutches, sometimes a towel or some kind of soft cover is needed to prevent or reduce armpit injury. A condition known as <i>crutch paralysis,<\/i> or <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Crutch_palsy\" class=\"mw-redirect\" title=\"Crutch palsy\" rel=\"external_link\" target=\"_blank\">crutch palsy<\/a><\/i> can arise from pressure on nerves in the armpit, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axilla\" title=\"Axilla\" rel=\"external_link\" target=\"_blank\">axilla<\/a>.<sup id=\"rdp-ebb-cite_ref-MosbysDictionary3rded_3-0\" class=\"reference\"><a href=\"#cite_note-MosbysDictionary3rded-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-GraysAnatomy35th1046_4-0\" class=\"reference\"><a href=\"#cite_note-GraysAnatomy35th1046-4\" rel=\"external_link\">[4]<\/a><\/sup> Specifically, \"the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brachial_plexus\" title=\"Brachial plexus\" rel=\"external_link\" target=\"_blank\">brachial plexus<\/a> in the axilla is often damaged from the pressure of a crutch...In these cases the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radial_nerve\" title=\"Radial nerve\" rel=\"external_link\" target=\"_blank\">radial<\/a> is the nerve most frequently implicated; the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ulnar_nerve\" title=\"Ulnar nerve\" rel=\"external_link\" target=\"_blank\">ulnar nerve<\/a> suffers next in frequency.\"<sup id=\"rdp-ebb-cite_ref-GraysAnatomy35th1046_4-1\" class=\"reference\"><a href=\"#cite_note-GraysAnatomy35th1046-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>An uncommon type of axillary crutches is the spring-loaded crutch. The underarm pad is a curved design that is open in the front with the grips for the hands shaped for maximum comfort and to reduce the prevalence of overuse injuries.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> These crutches also contain a spring mechanism at the bottom. The idea behind this design is to allow the user to propel themselves further, resulting in quicker movement from place to place, though research has shown that the difference in speed is very small when comparing standard axillary crutches to spring-loaded crutches.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> These crutches are most commonly used by young or athletic populations.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Forearm\">Forearm<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_0\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:854px"><video id="mwe_player_1" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6a\/El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv\/854px--El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv.jpg" controls="" preload="none" autoplay="" style="width:854px;height:480px" class="kskin" data-durationhint="49.208333333333" data-startoffset="0" data-mwtitle="El_uso_correcto_del_bast\u00f3n_ingl\u00e9s.ogv" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/6\/6a\/El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv\/El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv.480p.vp9.webm" type="video\/webm; 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codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="640" data-height="360" data-bandwidth="150288" data-framerate="24"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/6\/6a\/El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv\/El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="640" data-height="360" data-bandwidth="439448" data-framerate="24"\/><\/video><\/div>\"><img alt=\"File:El uso correcto del bast\u00f3n ingl\u00e9s.ogv\" style=\"width:220px;height:124px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6a\/El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv\/220px--El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/6\/6a\/El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:El_uso_correcto_del_bast%C3%B3n_ingl%C3%A9s.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A typical forearm crutch<\/div><\/div><\/div>\n<p>A forearm crutch (also commonly known as an elbow crutch, Canadian crutch or \"Lofstrand\" crutch due to a brand by this name) has a cuff at the top that goes around the forearm.<sup id=\"rdp-ebb-cite_ref-Fairley_1-2\" class=\"reference\"><a href=\"#cite_note-Fairley-1\" rel=\"external_link\">[1]<\/a><\/sup> It is used by inserting the arm into a cuff and holding the grip. The hinged cuff, most frequently made of plastic or metal, can be a half-circle or a full circle with a V-type opening in the front allowing the forearm to slip out in case of a fall.\n<\/p><p>Forearm crutches are the dominant type used in Europe, whether for short or long term use. Outside of Europe forearm crutches are more likely to be used by users with long term disabilities, with axillary crutches more common for short term use.<sup id=\"rdp-ebb-cite_ref-Taylor_2-1\" class=\"reference\"><a href=\"#cite_note-Taylor-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Platform\">Platform<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Platform-crutch.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Platform-crutch.jpg\/220px-Platform-crutch.jpg\" width=\"220\" height=\"308\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Platform-crutch.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Top portion of a platform crutch showing platform and grip<\/div><\/div><\/div>\n<p>These are less common and used by those with poor hand or grip strength due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\" title=\"Arthritis\" rel=\"external_link\" target=\"_blank\">arthritis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_palsy\" title=\"Cerebral palsy\" rel=\"external_link\" target=\"_blank\">cerebral palsy<\/a>, or other conditions. The forearm rests on a horizontal platform and is usually strapped in place with velcro-type straps that allow the platform or trough to release in case of a fall. The hand holds an angled grip which, in addition, should allow adjustment of length from trough to grip and side-to-side sway depending on the user's disability.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Leg_support\">Leg support<\/span><\/h3>\n<p>These non-traditional crutches are useful for users with an injury or disability affecting one lower leg only. They function by strapping the affected leg into a support frame that simultaneously holds the lower leg clear of the ground while transferring the load from the ground to the user's knee or thigh. This style of crutch has the advantage of not using the hands or arms while walking. A claimed benefit is that upper thigh <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrophy\" title=\"Atrophy\" rel=\"external_link\" target=\"_blank\">atrophy<\/a> is also reduced because the affected leg remains in use. Unlike other crutch designs these designs are unusable for pelvic, hip or thigh injuries and in some cases for knee injuries also.\n<\/p><p>Walking sticks or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cane_(walking_stick)\" class=\"mw-redirect\" title=\"Cane (walking stick)\" rel=\"external_link\" target=\"_blank\">canes<\/a> serve an identical purpose to crutches, but are held only in the hand and have a limited load bearing capability because of this.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_gaits\">Types of gaits<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_student_nurse,_acting_as_physical_therapist_8b07715v.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/A_student_nurse%2C_acting_as_physical_therapist_8b07715v.jpg\/220px-A_student_nurse%2C_acting_as_physical_therapist_8b07715v.jpg\" width=\"220\" height=\"230\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_student_nurse,_acting_as_physical_therapist_8b07715v.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Small boy learns to use his crutches (1942)<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"One_crutch\">One crutch<\/span><\/h3>\n<p>When using one crutch, the crutch is placed on the side of the unaffected leg.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Four-point_gait\">Four-point gait<\/span><\/h3>\n<p>Those who can tolerate partial weight bearing on both legs usually use the four point gait. The sequence is right crutch, left leg, left crutch, right leg. This is the slowest of all gaits but also the safest in that three of the four points are in contact with the ground at any given time. <sup id=\"rdp-ebb-cite_ref-walkeasy-gaits_7-0\" class=\"reference\"><a href=\"#cite_note-walkeasy-gaits-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Two-point_gait\">Two-point gait<\/span><\/h3>\n<p>Those who can tolerate partial weight bearing on both legs but require less support than a four-point gait usually use the two-point gait. The sequence is right crutch with left leg and then left crutch with right leg.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Three-point_gait\">Three-point gait<\/span><\/h3>\n<p>The three point gait is usually used by those who cannot bear weight on one leg. Both crutches are advanced while bearing weight on the unaffected leg. Then the unaffected leg is advanced while bearing weight on the crutches.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Swing-to_gait\">Swing-to gait<\/span><\/h3>\n<p>A person with a non-weight bearing injury generally performs a \"swing-to\" gait: lifting the affected leg, the user places both crutches in front of himself, and then swings his uninjured leg to meet the crutches. A similar \"swing-through\" gait is when both legs are advanced in front of the crutches rather than beside them.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Stairs\">Stairs<\/span><\/h3>\n<p>When climbing up stairs, the unaffected leg is advanced first, then the affected leg and the crutches are advanced. When descending stairs, the crutches are advanced first and then the affected leg and the unaffected leg.<sup id=\"rdp-ebb-cite_ref-Taylor_2-2\" class=\"reference\"><a href=\"#cite_note-Taylor-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternative_devices\">Alternative devices<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_scooter\" title=\"Knee scooter\" rel=\"external_link\" target=\"_blank\">knee scooter<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wheelchair\" title=\"Wheelchair\" rel=\"external_link\" target=\"_blank\">wheelchair<\/a> are possible alternatives for patients who cannot use or do not like crutches. These wheeled devices introduce an additional limitation, however, since they cannot negotiate stairs.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h2>\n<ol><li>Wood<\/li>\n<li>Metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloys<\/a> (most often steel, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_alloy\" title=\"Aluminium alloy\" rel=\"external_link\" target=\"_blank\">aluminium alloys<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_alloy\" title=\"Titanium alloy\" rel=\"external_link\" target=\"_blank\">titanium alloys<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">Carbon or glass fiber reinforced composites<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">Thermoplastic<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_fiber_reinforced_polymer\" title=\"Carbon fiber reinforced polymer\" rel=\"external_link\" target=\"_blank\">Carbon fiber reinforced polymer<\/a><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_technology\" title=\"Assistive technology\" rel=\"external_link\" target=\"_blank\">Assistive technology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Walker_(mobility)\" title=\"Walker (mobility)\" rel=\"external_link\" target=\"_blank\">Walker<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Fairley-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Fairley_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fairley_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fairley_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Fairley, Miki (April 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/opedge.com\/Articles\/ViewArticle\/2008-04_06\" target=\"_blank\">\"Innovative Crutch Designs: More Gain, Much Less Pain\"<\/a>. <i>The O&P Edge<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+O%26P+Edge&rft.atitle=Innovative+Crutch+Designs%3A+More+Gain%2C+Much+Less+Pain&rft.date=2008-04&rft.aulast=Fairley&rft.aufirst=Miki&rft_id=https%3A%2F%2Fopedge.com%2FArticles%2FViewArticle%2F2008-04_06&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACrutch\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Taylor-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Taylor_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Taylor_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Taylor_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1042-1043.<\/span>\n<\/li>\n<li id=\"cite_note-MosbysDictionary3rded-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MosbysDictionary3rded_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Glanze, W.D., Anderson, K.N., & Anderson, L.E, eds. (1990). <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mosby%27s_Medical,_Nursing_%26_Allied_Health_Dictionary\" class=\"mw-redirect\" title=\"Mosby's Medical, Nursing & Allied Health Dictionary\" rel=\"external_link\" target=\"_blank\">Mosby's Medical, Nursing & Allied Health Dictionary<\/a><\/i> (3rd ed.). St. Louis, Missouri: The C.V. Mosby Co. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8016-3227-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mosby%27s+Medical%2C+Nursing+%26+Allied+Health+Dictionary&rft.place=St.+Louis%2C+Missouri&rft.edition=3rd&rft.pub=The+C.V.+Mosby+Co.&rft.date=1990&rft.isbn=0-8016-3227-7&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACrutch\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses editors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_editors_parameter\" title=\"Category:CS1 maint: Uses editors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> p.324<\/span>\n<\/li>\n<li id=\"cite_note-GraysAnatomy35th1046-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-GraysAnatomy35th1046_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GraysAnatomy35th1046_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Warwick, R.; Williams, P.L, eds. (1973). <i>Gray\u2019s Anatomy<\/i> (35th ed.). London: Longman.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Gray%E2%80%99s+Anatomy&rft.place=London&rft.edition=35th&rft.pub=Longman&rft.date=1973&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACrutch\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> p.1046<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Segura, A; Piazza, SJ (2007). \"Mechanics of Ambulation With Standard and Spring-Loaded Crutches\". <i>Archives of Physical Medicine and Rehabilitation<\/i>. <b>88<\/b> (9): 1159\u20131163. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.apmr.2007.05.026\" target=\"_blank\">10.1016\/j.apmr.2007.05.026<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17826462\" target=\"_blank\">17826462<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Physical+Medicine+and+Rehabilitation&rft.atitle=Mechanics+of+Ambulation+With+Standard+and+Spring-Loaded+Crutches&rft.volume=88&rft.issue=9&rft.pages=1159-1163&rft.date=2007&rft_id=info%3Adoi%2F10.1016%2Fj.apmr.2007.05.026&rft_id=info%3Apmid%2F17826462&rft.aulast=Segura&rft.aufirst=A&rft.au=Piazza%2C+SJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACrutch\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Seeley, M K; Hunter, I; Bateman, T; Roggia, A; Larson, B J; Draper, DO (2011). \"A Kinematic Comparison of Spring-Loaded and Traditional Crutches\". <i>Journal of Sport Rehabilitation<\/i>. <b>20<\/b> (2): 198\u2013206. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1123%2Fjsr.20.2.198\" target=\"_blank\">10.1123\/jsr.20.2.198<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21576711\" target=\"_blank\">21576711<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Sport+Rehabilitation&rft.atitle=A+Kinematic+Comparison+of+Spring-Loaded+and+Traditional+Crutches&rft.volume=20&rft.issue=2&rft.pages=198-206&rft.date=2011&rft_id=info%3Adoi%2F10.1123%2Fjsr.20.2.198&rft_id=info%3Apmid%2F21576711&rft.aulast=Seeley&rft.aufirst=M+K&rft.au=Hunter%2C+I&rft.au=Bateman%2C+T&rft.au=Roggia%2C+A&rft.au=Larson%2C+B+J&rft.au=Draper%2C+DO&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACrutch\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-walkeasy-gaits-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-walkeasy-gaits_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/walkeasy.com\/explore\/crutch-gaits.php\" target=\"_blank\">Walk Easy > Explore > Crutch Gaits<\/a>. Retrieved on May 19, 2018.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pinnaclehealth.org\/wellness-library\/blog-and-staywell\/health-resources\/article\/40347\" target=\"_blank\">\"Health Resources: Using crutches\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PinnacleHealth_System\" class=\"mw-redirect\" title=\"PinnacleHealth System\" rel=\"external_link\" target=\"_blank\">PinnacleHealth<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 May<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Health+Resources%3A+Using+crutches&rft.pub=PinnacleHealth&rft_id=http%3A%2F%2Fwww.pinnaclehealth.org%2Fwellness-library%2Fblog-and-staywell%2Fhealth-resources%2Farticle%2F40347&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACrutch\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181207105637\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.280 seconds\nReal time usage: 0.377 seconds\nPreprocessor visited node count: 753\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 52617\/2097152 bytes\nTemplate argument size: 238\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 17751\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.136\/10.000 seconds\nLua memory usage: 3.78 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 293.651 1 -total\n<\/p>\n<pre>48.02% 141.003 1 Template:Reflist\n25.18% 73.937 1 Template:Cite_news\n24.33% 71.457 1 Template:Commons_category\n11.75% 34.518 1 Template:Other_uses\n10.50% 30.848 3 Template:Navbox\n10.13% 29.746 2 Template:Cite_journal\n 8.46% 24.835 1 Template:Health_care\n 6.22% 18.254 1 Template:Commons\n 5.23% 15.367 1 Template:Sister_project\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1471182-1!canonical and timestamp 20181207105636 and revision id 872055773\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Crutch\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214635\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.027 seconds\nReal time usage: 0.170 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 162.497 1 - wikipedia:Crutch\n100.00% 162.497 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8536-0!*!*!*!*!*!* and timestamp 20181217214635 and revision id 24961\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Crutch\">https:\/\/www.limswiki.org\/index.php\/Crutch<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9741cb9f721b9f0744efaf204ee7b0c8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Axillary_%28underarm%29_crutches.JPG\/200px-Axillary_%28underarm%29_crutches.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Platform-crutch.jpg\/440px-Platform-crutch.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/A_student_nurse%2C_acting_as_physical_therapist_8b07715v.jpg\/440px-A_student_nurse%2C_acting_as_physical_therapist_8b07715v.jpg"],"9741cb9f721b9f0744efaf204ee7b0c8_timestamp":1545083195,"ac4d8ae8228612869ab0e05d3778b2ba_type":"article","ac4d8ae8228612869ab0e05d3778b2ba_title":"Colostomy bag","ac4d8ae8228612869ab0e05d3778b2ba_url":"https:\/\/www.limswiki.org\/index.php\/Ostomy_pouching_system","ac4d8ae8228612869ab0e05d3778b2ba_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOstomy pouching system\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Ostomy pouching system\nAn ostomy pouching system\n[1] is a prosthetic medical device that provides a means for the collection of waste from a surgically diverted biological system (colon, ileum, bladder) and the creation of a stoma. Pouching systems are most commonly associated with colostomies, ileostomies, and urostomies.[2]\nPouching systems usually consist of a collection pouch plastic bag,[3] known as a one-piece system or, in some instances involves a mounting plate, commonly called a flange, wafer or a baseplate, and a collection pouch that is attached mechanically or with an adhesive in\nan airtight seal, known as a two-piece system. The selection of systems varies greatly between individuals and is often based on personal preference and lifestyle. Ostomy pouching systems collect waste that is output from a stoma. The pouching system allows the stoma to drain into a sealed collection pouch, while protecting the surrounding skin from contamination.[4]\n\n<\/p>Ostomy pouching systems are air- and water-tight and allow the wearer to lead an active lifestyle that can include all forms of sports and recreation.[citation needed ]\nOstomy pouching systems are also sometimes referred to as an appliance, where the term appliance refers to a prosthesis, as a mechanical replacement for a biological function.\n\nContents \n\n1 Wafers\/baseplates\/flange \n2 Pouches \n3 See also \n4 References \n5 External links \n\n\n Wafers\/baseplates\/flange \n A typical ostomy wafer\/baseplate\nMost wafers\/baseplates, also called ostomy barriers, are manufactured using pectin or similar organic material and are available in a wide variety of sizes to accommodate a person's particular anatomy.\nThe internal opening must be the correct size to accommodate the individual's stoma while protecting the skin from contact with waste. The methods for sizing this opening vary depending on the type of wafer\/baseplate; some pre-cut sizes are available, some users customize the opening using scissors. Manufacturers have recently introduced moldable wafers than can be shaped by hand without the need for scissors.[2]\nSkin adhesion for modern wafers\/baseplates\/flanges are optimized on all the five parameters required in an adhesive:\n\nabsorption\ntack and adhesion\nflexibility\nerosion resistance\nease of removal.\nIn addition, modern wafers\/baseplates\/flanges with adhesive border can provide additional security that the system stays in place. Using a barrier film spray before applying a new flange will improve adhesion, soothe irritated skin and protect the skin from irritation.\nA wafer\/baseplate\/flange may last between one and many days before it needs to be replaced; this is highly dependent on the individual's lifestyle, ostomy type, and anatomy.\n\nPouches \n A typical ostomy pouch, in this case a closed-end or \"disposable\". Note the flange ring, which uses a \"Tupperware\" type of seal\n One-piece (open-end) bags\nThe method of attachment to the wafer varies between manufactures and includes permanent (one-piece), press-on\/click (\"Tupperware\" type), turning locking rings and \"sticky\" adhesive mounts. The two-piece arrangement allows pouches to be exchanged without removing the wafer; for example, some people prefer to temporarily switch to a \"mini-pouch\" for swimming, intimate and other short-term activities. Mini-pouches are suitable for minimum usage only.\nPouches can be divided into two basic types: open-end (drainable) and closed-end (disposable).\n\nOpen-end pouches have a resealable end that can be opened to drain the contents of the pouch into a toilet. The end is sealed with either a Velcro-type closure or a simple clip.\nClosed-end pouches can be removed and replaced with a new pouch once the bag is full or the pouch can be emptied and rinsed. The flange or wafer does not need to be replaced.\nThe use of open-end vs. closed-end pouches is dependent on the frequency in which an individual needs to empty the contents, as well as economics.[4]\nGas is created during digestion, and an airtight pouch will collect this and inflate. To prevent this some pouches are available with special charcoal filtered vents that will allow the gas to escape, and prevent ballooning at night. Some odor can be expelled through the charcoal filter especially if sufficient deodorant is not used in the pouch.\nPouch covers are helpful to disguise the plastic pouch when it is exposed when reaching or other physical activity. These are usually made of cloth and can be decorative or plain to blend in with clothing. Various sources stock sizes for most manufacturers pouches. There are flexible elastic pouch belts available for extreme physical activity but some of these require the pouch to be worn sideways so it does not fill properly and the tight fit causes pancaking of the effluent.\n\nSee also \nColostomy\nIleostomy\nUrostomy\nElise S\u00f8rensen\nReferences \n\n\n^ Stedman's Medical Dictionary, Houghton Mifflin Company, 2002, colostomy bag n. A receptacle worn over the stoma to collect feces following a colostomy. \n\n^ a b \"Ostomy Information\". United Ostomy Associations of America. Retrieved September 3, 2010 . \n\n^ \"Ostomy\". Mayo Clinic. \n\n^ a b Lueder, Wendy. \"Ostomates' Choices\". Broward Ostomy Association. Archived from the original on 2008-11-21. Retrieved September 3, 2010 . \n\n\nExternal links \nUnited Ostomy Associations of America\nInternational ostomy association\nEuropean ostomy association\nColoplast educational material\nAnimated instruction guides\nHollister Ostomy Educational Theatre\nOstomy Wound Management\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ostomy_pouching_system\">https:\/\/www.limswiki.org\/index.php\/Ostomy_pouching_system<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal 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id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ostomy pouching system<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ileostomy_2016-09-09_4158.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/56\/Ileostomy_2016-09-09_4158.jpg\/220px-Ileostomy_2016-09-09_4158.jpg\" width=\"220\" height=\"157\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ileostomy_2016-09-09_4158.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Ostomy pouching system<\/div><\/div><\/div>\n<p>An <b>ostomy pouching system<\/b>\n<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthetic\" class=\"mw-redirect\" title=\"Prosthetic\" rel=\"external_link\" target=\"_blank\">prosthetic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> that provides a means for the collection of waste from a surgically diverted biological system (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colon_(anatomy)\" class=\"mw-redirect\" title=\"Colon (anatomy)\" rel=\"external_link\" target=\"_blank\">colon<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ileum\" title=\"Ileum\" rel=\"external_link\" target=\"_blank\">ileum<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_bladder\" title=\"Urinary bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a>) and the creation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stoma_(medicine)\" title=\"Stoma (medicine)\" rel=\"external_link\" target=\"_blank\">stoma<\/a>. Pouching systems are most commonly associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colostomy\" title=\"Colostomy\" rel=\"external_link\" target=\"_blank\">colostomies<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ileostomy\" title=\"Ileostomy\" rel=\"external_link\" target=\"_blank\">ileostomies<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urostomy\" title=\"Urostomy\" rel=\"external_link\" target=\"_blank\">urostomies<\/a>.<sup id=\"rdp-ebb-cite_ref-ostomy1_2-0\" class=\"reference\"><a href=\"#cite_note-ostomy1-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Pouching systems usually consist of a collection pouch <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_bag\" title=\"Plastic bag\" rel=\"external_link\" target=\"_blank\">plastic bag<\/a>,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> known as a one-piece system or, in some instances involves a mounting plate, commonly called a flange, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wafer\" title=\"Wafer\" rel=\"external_link\" target=\"_blank\">wafer<\/a> or a baseplate, and a collection <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bag\" title=\"Bag\" rel=\"external_link\" target=\"_blank\">pouch<\/a> that is attached mechanically or with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesive\" title=\"Adhesive\" rel=\"external_link\" target=\"_blank\">adhesive<\/a> in\n<p>an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airtight\" class=\"mw-redirect\" title=\"Airtight\" rel=\"external_link\" target=\"_blank\">airtight<\/a> seal, known as a two-piece system. The selection of systems varies greatly between individuals and is often based on personal preference and lifestyle. Ostomy pouching systems collect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Waste\" title=\"Waste\" rel=\"external_link\" target=\"_blank\">waste<\/a> that is output from a stoma. The pouching system allows the stoma to drain into a sealed collection pouch, while protecting the surrounding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contamination\" title=\"Contamination\" rel=\"external_link\" target=\"_blank\">contamination<\/a>.<sup id=\"rdp-ebb-cite_ref-Lueder_4-0\" class=\"reference\"><a href=\"#cite_note-Lueder-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<\/p><p>Ostomy pouching systems are air- and water-tight and allow the wearer to lead an active lifestyle that can include all forms of sports and recreation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Ostomy pouching systems are also sometimes referred to as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">appliance<\/a>, where the term appliance refers to a prosthesis, as a mechanical replacement for a biological function.\n<\/p>\n\n<h2><span id=\"rdp-ebb-Wafers.2Fbaseplates.2Fflange\"><\/span><span class=\"mw-headline\" id=\"Wafers\/baseplates\/flange\">Wafers\/baseplates\/flange<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OstomyWafer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cf\/OstomyWafer.jpg\/200px-OstomyWafer.jpg\" width=\"200\" height=\"170\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OstomyWafer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A typical ostomy wafer\/baseplate<\/div><\/div><\/div>\n<p>Most wafers\/baseplates, also called ostomy barriers, are manufactured using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectin\" title=\"Pectin\" rel=\"external_link\" target=\"_blank\">pectin<\/a> or similar organic material and are available in a wide variety of sizes to accommodate a person's particular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomy\" title=\"Anatomy\" rel=\"external_link\" target=\"_blank\">anatomy<\/a>.\n<\/p><p>The internal opening must be the correct size to accommodate the individual's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stoma_(medicine)\" title=\"Stoma (medicine)\" rel=\"external_link\" target=\"_blank\">stoma<\/a> while protecting the skin from contact with waste. The methods for sizing this opening vary depending on the type of wafer\/baseplate; some pre-cut sizes are available, some users customize the opening using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>. Manufacturers have recently introduced moldable wafers than can be shaped by hand without the need for scissors.<sup id=\"rdp-ebb-cite_ref-ostomy1_2-1\" class=\"reference\"><a href=\"#cite_note-ostomy1-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Skin adhesion for modern wafers\/baseplates\/flanges are optimized on all the five parameters required in an adhesive:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Absorption_(skin)\" title=\"Absorption (skin)\" rel=\"external_link\" target=\"_blank\">absorption<\/a><\/li>\n<li>tack and adhesion<\/li>\n<li>flexibility<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Erosion\" title=\"Erosion\" rel=\"external_link\" target=\"_blank\">erosion<\/a> resistance<\/li>\n<li>ease of removal.<\/li><\/ul>\n<p>In addition, modern wafers\/baseplates\/flanges with adhesive border can provide additional security that the system stays in place. Using a barrier film spray before applying a new flange will improve adhesion, soothe irritated skin and protect the skin from irritation.\n<\/p><p>A wafer\/baseplate\/flange may last between one and many days before it needs to be replaced; this is highly dependent on the individual's lifestyle, ostomy type, and anatomy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Pouches\">Pouches<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OstomyPouch.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7b\/OstomyPouch.jpg\/200px-OstomyPouch.jpg\" width=\"200\" height=\"125\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OstomyPouch.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A typical ostomy pouch, in this case a closed-end or \"disposable\". Note the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flange\" title=\"Flange\" rel=\"external_link\" target=\"_blank\">flange<\/a> ring, which uses a \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tupperware\" title=\"Tupperware\" rel=\"external_link\" target=\"_blank\">Tupperware<\/a>\" type of seal<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ileostomy_bag.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/Ileostomy_bag.jpg\/220px-Ileostomy_bag.jpg\" width=\"220\" height=\"269\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ileostomy_bag.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>One-piece (open-end) bags<\/div><\/div><\/div>\n<p>The method of attachment to the wafer varies between manufactures and includes permanent (one-piece), press-on\/click (\"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tupperware\" title=\"Tupperware\" rel=\"external_link\" target=\"_blank\">Tupperware<\/a>\" type), turning locking rings and \"sticky\" adhesive mounts. The two-piece arrangement allows pouches to be exchanged without removing the wafer; for example, some people prefer to temporarily switch to a \"mini-pouch\" for swimming, intimate and other short-term activities. Mini-pouches are suitable for minimum usage only.\n<\/p><p>Pouches can be divided into two basic types: open-end (drainable) and closed-end (disposable).\n<\/p>\n<ul><li>Open-end pouches have a resealable end that can be opened to drain the contents of the pouch into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toilet\" title=\"Toilet\" rel=\"external_link\" target=\"_blank\">toilet<\/a>. The end is sealed with either a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Velcro\" title=\"Velcro\" rel=\"external_link\" target=\"_blank\">Velcro<\/a>-type closure or a simple clip.<\/li>\n<li>Closed-end pouches can be removed and replaced with a new pouch once the bag is full or the pouch can be emptied and rinsed. The flange or wafer does not need to be replaced.<\/li><\/ul>\n<p>The use of open-end vs. closed-end pouches is dependent on the frequency in which an individual needs to empty the contents, as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Economics\" title=\"Economics\" rel=\"external_link\" target=\"_blank\">economics<\/a>.<sup id=\"rdp-ebb-cite_ref-Lueder_4-1\" class=\"reference\"><a href=\"#cite_note-Lueder-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Flatulence\" title=\"Flatulence\" rel=\"external_link\" target=\"_blank\">Gas<\/a> is created during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digestion\" title=\"Digestion\" rel=\"external_link\" target=\"_blank\">digestion<\/a>, and an airtight pouch will collect this and inflate. To prevent this some pouches are available with special <a href=\"https:\/\/en.wikipedia.org\/wiki\/Activated_carbon\" title=\"Activated carbon\" rel=\"external_link\" target=\"_blank\">charcoal filtered<\/a> vents that will allow the gas to escape, and prevent ballooning at night. Some odor can be expelled through the charcoal filter especially if sufficient deodorant is not used in the pouch.\n<\/p><p>Pouch covers are helpful to disguise the plastic pouch when it is exposed when reaching or other physical activity. These are usually made of cloth and can be decorative or plain to blend in with clothing. Various sources stock sizes for most manufacturers pouches. There are flexible elastic pouch belts available for extreme physical activity but some of these require the pouch to be worn sideways so it does not fill properly and the tight fit causes pancaking of the effluent.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Colostomy\" title=\"Colostomy\" rel=\"external_link\" target=\"_blank\">Colostomy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ileostomy\" title=\"Ileostomy\" rel=\"external_link\" target=\"_blank\">Ileostomy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Urostomy\" title=\"Urostomy\" rel=\"external_link\" target=\"_blank\">Urostomy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Elise_S%C3%B8rensen\" title=\"Elise S\u00f8rensen\" rel=\"external_link\" target=\"_blank\">Elise S\u00f8rensen<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dictionary.reference.com\/browse\/colostomy+bag\" target=\"_blank\"><i>Stedman's Medical Dictionary<\/i><\/a>, Houghton Mifflin Company, 2002, <q>colostomy bag n. A receptacle worn over the stoma to collect feces following a colostomy.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Stedman%27s+Medical+Dictionary&rft.pub=Houghton+Mifflin+Company&rft.date=2002&rft_id=http%3A%2F%2Fdictionary.reference.com%2Fbrowse%2Fcolostomy%2Bbag&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOstomy+pouching+system\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-ostomy1-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ostomy1_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ostomy1_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ostomy.org\/ostomy_info\/whatis.shtml\" target=\"_blank\">\"Ostomy Information\"<\/a>. United Ostomy Associations of America<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 3,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Ostomy+Information&rft.pub=United+Ostomy+Associations+of+America&rft_id=http%3A%2F%2Fwww.ostomy.org%2Fostomy_info%2Fwhatis.shtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOstomy+pouching+system\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayoclinic.com\/health\/ostomy\/SA00072\" target=\"_blank\">\"Ostomy\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_Clinic\" title=\"Mayo Clinic\" rel=\"external_link\" target=\"_blank\">Mayo Clinic<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Mayo+Clinic&rft.atitle=Ostomy&rft_id=http%3A%2F%2Fwww.mayoclinic.com%2Fhealth%2Fostomy%2FSA00072&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOstomy+pouching+system\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lueder-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Lueder_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Lueder_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Lueder, Wendy. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081121081858\/http:\/\/www.browardostomy.org\/newsletter-articles\/ostomate-choices.html\" target=\"_blank\">\"Ostomates' Choices\"<\/a>. Broward Ostomy Association. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.browardostomy.org\/newsletter-articles\/ostomate-choices.html\" target=\"_blank\">the original<\/a> on 2008-11-21<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 3,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Ostomates%27+Choices&rft.pub=Broward+Ostomy+Association&rft.au=Lueder%2C+Wendy&rft_id=http%3A%2F%2Fwww.browardostomy.org%2Fnewsletter-articles%2Fostomate-choices.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOstomy+pouching+system\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ostomy.org\/\" target=\"_blank\">United Ostomy Associations of America<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ostomyinternational.org\/\" target=\"_blank\">International ostomy association<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ostomyeurope.org\/\" target=\"_blank\">European ostomy association<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.coloplast.us\/Ostomy\/People-with-an-ostomy\/Before-ostomy-surgery\/\" target=\"_blank\">Coloplast educational material<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.coloplast.us\/Ostomy\/People-with-an-ostomy\/After-ostomy-surgery\/#section4\" target=\"_blank\">Animated instruction guides<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hollister.com\/us\/ostomy\/learning\/theatre.asp\" target=\"_blank\">Hollister Ostomy Educational Theatre<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.o-wm.com\/\" target=\"_blank\">Ostomy Wound Management<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1329\nCached time: 20181203212145\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.180 seconds\nReal time usage: 0.244 seconds\nPreprocessor visited node count: 395\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7861\/2097152 bytes\nTemplate argument size: 556\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 10451\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.093\/10.000 seconds\nLua memory usage: 2.45 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 195.295 1 -total\n<\/p>\n<pre>63.98% 124.951 1 Template:Reflist\n45.69% 89.236 1 Template:Citation\n35.27% 68.872 1 Template:Citation_needed\n26.42% 51.598 1 Template:Fix\n18.43% 35.993 2 Template:Category_handler\n 7.85% 15.332 3 Template:Cite_web\n 5.69% 11.119 1 Template:Delink\n 2.40% 4.684 1 Template:Fix\/category\n 1.59% 3.102 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:10853262-1!canonical and timestamp 20181203212144 and revision id 864881564\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ostomy_pouching_system\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214634\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.175 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 169.308 1 - wikipedia:Ostomy_pouching_system\n100.00% 169.308 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8535-0!*!*!*!*!*!* and timestamp 20181217214634 and revision id 24960\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ostomy_pouching_system\">https:\/\/www.limswiki.org\/index.php\/Ostomy_pouching_system<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ac4d8ae8228612869ab0e05d3778b2ba_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/56\/Ileostomy_2016-09-09_4158.jpg\/440px-Ileostomy_2016-09-09_4158.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cf\/OstomyWafer.jpg\/400px-OstomyWafer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7b\/OstomyPouch.jpg\/400px-OstomyPouch.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/Ileostomy_bag.jpg\/440px-Ileostomy_bag.jpg"],"ac4d8ae8228612869ab0e05d3778b2ba_timestamp":1545083194,"d4fe133590044b604f796f00eb864614_type":"article","d4fe133590044b604f796f00eb864614_title":"Bedpan","d4fe133590044b604f796f00eb864614_url":"https:\/\/www.limswiki.org\/index.php\/Bedpan","d4fe133590044b604f796f00eb864614_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBedpan\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (July 2016) (Learn how and when to remove this template message)\nThis article is about an item of medical equipment. For the Bedford to London St Pancras railway line known colloquially as the \"Bedpan service\", see Thameslink.\nA bedpan or bed pan is a receptacle used for the toileting of a bedridden patient in a health care facility, and is usually made of metal, glass, ceramic, or plastic. A bedpan can be used for both urinary and fecal discharge. Many diseases can confine a patient to bed, necessitating the use of bedpans, including Alzheimer's disease, Parkinson's disease, stroke, and dementia. Additionally, many patients may be confined to a bed temporarily as a result of a temporary illness, injury, or surgery, thereby necessitating the use of a bedpan.\nBedpans are usually constructed of stainless steel, which is easy to clean and durable, but may be cold, hard, and uncomfortable to use. Also, the supporting area of some products is very small, and prolonged use can cause pressure ulcers. To solve these problems, new ergonomic bedpans have been developed, which support the patient with a larger area of warm plastic. Some designs completely cover the genitalia during use, offering protection and an extra measure of privacy. On the other hand, the material is more difficult to sterilize, and may become a reservoir for microorganisms.\nFracture bedpans are smaller than standard size bedpans, and have one flat end. These bedpans are designed specifically for patients who have had a hip fracture or are recovering from hip replacement. This type of bedpan may be used for those patients who cannot raise their hips high enough or roll over onto a regular size bedpan.[1]\nIn recent years, a bedpan liner made of recycled wood pulp (molded pulp) is more popular in UK hospitals; it is for single use, decreasing the risk of cross-contamination diseases. An alternative to the recycled pulp liner is the plastic bedpan liner, which also creates a barrier between the waste and the bedpan. Some liners are made of biodegradable plastic and contain absorbent powder to eliminate splashing and spills. Liners are used in hospitals to decrease infection, and can also be purchased and used for home health care.\n\nGallery \n\n\t\t\n\t\t\t\n\t\t\t\nOval stainless steel pan\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nErgonomic plastic bedpan in use\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nErgonomic design can be used regardless of patient's genitalia\n\n\t\t\t\n\t\t\n\nSee also \nChamber pot\nReferences \n\n\n^ Bunker Rosdahl, Caroline; Kowalski, Mary T. (2008). Textbook of basic nursing (9th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 648. ISBN 0781765218. Retrieved March 29, 2012 . \n\n\n Media related to Bedpans at Wikimedia Commons\n\nvteHealth care\nEconomics\nEquipment\nGuidelines\nIndustry\nPhilosophy\nPolicy\nProviders\nRanking\nReform\nSystem\nProfessions\nMedicine\nNursing\nHealthcare science\nDentistry\nAllied health professions\nPharmacy\nHealth information management\nSettings\nAssisted living\nClinic\nHospital\nNursing home\nMedical school (Academic health science centre, Teaching hospital)\nCare\nAcute\nChronic\nEnd-of-life\nHospice\nOverutilization\nPalliative\nPrimary\nSelf\nTotal\nSkills \/ Training\nBedside manner\nCultural competence\nDiagnosis\nEducation\nUniversal precautions\nBy country\nUnited States\nreform debate in the United States\nUnited Kingdom\nCanada\nAustralia\nNew Zealand\n(Category Healthcare by country)\n\n Category\n\nvteToiletsEquipment\nAutomatic toilet paper dispenser\nBallcock\nBedpan\nBidet\nBidet shower\nBrush\nCistern\nCommode\nElectronic bidet\nFlushometer\nRoll holder\nSeat\nSeat cover\nSelf-cleaning toilet seat\nToilet\nToilet paper\nTrap (U-bend)\nTypes\nAircraft\nArborloo\nBlair\nBucket\nCathole\nChemical\nComposting\nContainer-based\nDry\nDual flush\nFlush\nFreezing\nHead (boat)\nHudo (Scouting)\nIncinerating\nIntelligent\nLatrine\nLow-flush\nOn-board\nPassenger train\nPay\nPit\nPig\nPortable\nPotty\nPublic\nSanisette (self-cleaning)\nSpace\nSquat\nTree bog\nUrine-diverting dry\nVacuum\nWashlet (combined toilet and bidet)\nCultural aspects\nAccessible\nAdult diaper\nBathroom privileges\nFeminine hygiene\nHoneywagon (vehicle)\nIncontinence pad\nIslamic toilet etiquette\nIstinja\nLatrinalia\nPrivatization of public toilets\nSex segregation in public restrooms\nToilet god\nToilet humour\nToilet paper orientation\nToilet-related injuries and deaths\nToilet Twinning\nUnisex public\nVacuum truck\nJobs and activities\nManual scavenging\nSlopping out\nToileting\nToilet training\nRestroom attendant\nUrine-related aspects\nFemale urination device\nInteractive urinal\nPissoir\nPollee\nUrination\nUrinal\nUrinal (health care)\nUrine collection device\nUrine diversion\nFeces-related aspects\nAnal hygiene\nDefecation\nDefecation postures\nFecal sludge management\nFlying toilet\nOpen defecation\nScatology\nPlaces\nOuthouse\nRest area\nShit Museum\nSulabh International Museum of Toilets\nToilet (room)\nToilets in Japan\nHistorical terms\nAphedron\nChamber pot\nClose stool\nGarderobe\nGong farmer\nGroom of the Stool\nNight soil\nPail closet\nPrivy midden\nReredorter\nSee also\nHistory of water supply and sanitation\nSanitation\nSewage treatment\nWorld Toilet Day\n\nThis medical treatment\u2013related article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bedpan\">https:\/\/www.limswiki.org\/index.php\/Bedpan<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:31.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 529 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d4fe133590044b604f796f00eb864614_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Bedpan skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Bedpan<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about an item of medical equipment. For the Bedford to London St Pancras railway line known colloquially as the \"Bedpan service\", see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thameslink\" title=\"Thameslink\" rel=\"external_link\" target=\"_blank\">Thameslink<\/a>.<\/div>\n<p>A <b>bedpan<\/b> or <b>bed pan<\/b> is a receptacle used for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toileting\" title=\"Toileting\" rel=\"external_link\" target=\"_blank\">toileting<\/a> of a bedridden <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient\" title=\"Patient\" rel=\"external_link\" target=\"_blank\">patient<\/a> in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">health care<\/a> facility, and is usually made of metal, glass, ceramic, or plastic. A bedpan can be used for both urinary and fecal discharge. Many diseases can confine a patient to bed, necessitating the use of bedpans, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alzheimer%27s_disease\" title=\"Alzheimer's disease\" rel=\"external_link\" target=\"_blank\">Alzheimer's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a>. Additionally, many patients may be confined to a bed temporarily as a result of a temporary illness, injury, or surgery, thereby necessitating the use of a bedpan.\n<\/p><p>Bedpans are usually constructed of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, which is easy to clean and durable, but may be cold, hard, and uncomfortable to use. Also, the supporting area of some products is very small, and prolonged use can cause <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_ulcer\" title=\"Pressure ulcer\" rel=\"external_link\" target=\"_blank\">pressure ulcers<\/a>. To solve these problems, new ergonomic bedpans have been developed, which support the patient with a larger area of warm plastic. Some designs completely cover the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sex_organ\" title=\"Sex organ\" rel=\"external_link\" target=\"_blank\">genitalia<\/a> during use, offering protection and an extra measure of privacy. On the other hand, the material is more difficult to sterilize, and may become a reservoir for microorganisms.\n<\/p><p><b>Fracture bedpans<\/b> are smaller than standard size bedpans, and have one flat end. These bedpans are designed specifically for patients who have had a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvic_fracture\" title=\"Pelvic fracture\" rel=\"external_link\" target=\"_blank\">hip fracture<\/a> or are recovering from hip replacement. This type of bedpan may be used for those patients who cannot raise their hips high enough or roll over onto a regular size bedpan.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>In recent years, a bedpan liner made of recycled wood pulp (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Molded_pulp\" title=\"Molded pulp\" rel=\"external_link\" target=\"_blank\">molded pulp<\/a>) is more popular in UK hospitals; it is for single use, decreasing the risk of cross-contamination diseases. An alternative to the recycled pulp liner is the plastic bedpan liner, which also creates a barrier between the waste and the bedpan. Some liners are made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable_plastic\" title=\"Biodegradable plastic\" rel=\"external_link\" target=\"_blank\">biodegradable plastic<\/a> and contain absorbent powder to eliminate splashing and spills. Liners are used in hospitals to decrease infection, and can also be purchased and used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Home_health_care\" class=\"mw-redirect\" title=\"Home health care\" rel=\"external_link\" target=\"_blank\">home health care<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Gallery\">Gallery<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional center\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Image-Oval-steel.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9c\/Image-Oval-steel.jpg\/120px-Image-Oval-steel.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Oval stainless steel pan\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cleanius.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c5\/Cleanius.jpg\/120px-Cleanius.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Ergonomic plastic bedpan in use\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:27px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Woman-man1.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Woman-man1.gif\/120px-Woman-man1.gif\" width=\"120\" height=\"96\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Ergonomic design can be used regardless of patient's genitalia\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chamber_pot\" title=\"Chamber pot\" rel=\"external_link\" target=\"_blank\">Chamber pot<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bunker Rosdahl, Caroline; Kowalski, Mary T. (2008). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=bedpan%20fracture%20how%20to%20use&f=false\"><i>Textbook of basic nursing<\/i><\/a> (9th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 648. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0781765218<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">March 29,<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Textbook+of+basic+nursing&rft.place=Philadelphia&rft.pages=648&rft.edition=9th&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2008&rft.isbn=0781765218&rft.aulast=Bunker+Rosdahl&rft.aufirst=Caroline&rft.au=Kowalski%2C+Mary+T.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DtB1YiYj_kdkC%26pg%3DPA648%26lpg%3DPA648%26dq%3Dbedpan%2Bfracture%2Bhow%2Bto%2Buse%26source%3Dbl%26ots%3DxCKKxA4NMv%26sig%3DmPBQCyPc29zcZJnFM_TZa8ias-E%26hl%3Den%23v%3Donepage%26q%3Dbedpan%2520fracture%2520how%2520to%2520use%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABedpan\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Bedpans\" class=\"extiw\" title=\"commons:Category:Bedpans\" rel=\"external_link\" target=\"_blank\">Bedpans <\/a> at Wikimedia Commons\n<\/p>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1263\nCached time: 20181213012013\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.280 seconds\nReal time usage: 0.400 seconds\nPreprocessor visited node count: 486\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 42358\/2097152 bytes\nTemplate argument size: 178\/2097152 bytes\nHighest expansion depth: 8\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 5528\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.128\/10.000 seconds\nLua memory usage: 3.54 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 320.337 1 -total\n<\/p>\n<pre>29.89% 95.736 1 Template:Reflist\n25.46% 81.563 1 Template:Cite_book\n23.44% 75.073 1 Template:Commons_category-inline\n21.82% 69.913 1 Template:More_references\n13.68% 43.808 1 Template:Ambox\n 9.78% 31.331 2 Template:Navbox\n 9.12% 29.224 1 Template:Health_care\n 5.74% 18.376 1 Template:Treatment-stub\n 4.60% 14.720 1 Template:Asbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2524673-1!canonical and timestamp 20181213012012 and revision id 858065632\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bedpan\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214634\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.162 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 155.588 1 - wikipedia:Bedpan\n100.00% 155.588 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8534-0!*!*!*!*!*!* and timestamp 20181217214634 and revision id 24959\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bedpan\">https:\/\/www.limswiki.org\/index.php\/Bedpan<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d4fe133590044b604f796f00eb864614_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9c\/Image-Oval-steel.jpg\/240px-Image-Oval-steel.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c5\/Cleanius.jpg\/240px-Cleanius.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Woman-man1.gif\/240px-Woman-man1.gif","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/AdhesiveBandage.png\/80px-AdhesiveBandage.png"],"d4fe133590044b604f796f00eb864614_timestamp":1545083194,"875e0919078d731018cd9e8e0096bf77_type":"article","875e0919078d731018cd9e8e0096bf77_title":"Tweezers","875e0919078d731018cd9e8e0096bf77_url":"https:\/\/www.limswiki.org\/index.php\/Tweezers","875e0919078d731018cd9e8e0096bf77_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTweezers\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2008) (Learn how and when to remove this template message)\nTweezers are small tools used for picking up objects too small to be easily handled with the human fingers. The word is most likely derived from tongs, pincers, or scissors-like pliers used to grab or hold hot objects since the dawn of recorded history. In a scientific or medical context they are normally referred to as forceps.\nTweezers make use of two third-class levers connected at one fixed end (the fulcrum point of each lever), with the pincers at the others.\nPeople commonly use tweezers mainly for tasks such as plucking hair from the face or eyebrows, often using the term eyebrow tweezers. Other common uses for tweezers are as a tool to manipulate small objects, including for example small, particularly surface-mount, electronic parts, and small mechanical parts for models and precision mechanisms. Stamp collectors use tweezers (stamp tongs) to handle postage stamps which, while large enough to pick up by hand, could be damaged by handling; the jaws of stamp tongs are smooth. One example of a specialised use is picking out flakes of gold in gold panning. Tweezers are also used in kitchens for food presentation[1] to remove bones from fillets of fish in a process known as pin boning.\n\nContents \n\n1 History \n2 Types \n3 Classification by usage \n\n3.1 Culture-associated uses \n\n\n4 See also \n5 References \n\n\nHistory \n A pair of bronze tweezers attributed to the Minoan civilization, circa 2900\u20131050 B.C.\nTweezers are known to have been used in predynastic Egypt. There are drawings of Egyptian craftsmen holding hot pots over ovens with a double-bow shaped tool. Asiatic tweezers, consisting of two strips of metal brazed together, were commonly used in Mesopotamia and India from about 3000 BC, perhaps for purposes such as catching lice.[2]\nThe word tweezer comes from etwee which describes a small case that people would use to carry small objects (such as toothpicks) with them. Etwee takes its origin from French \u00e9tui \"small case\" from the Old French verb estuier, \"to hold or keep safe.\" Over time, the object now known as \"tweezers\" took on this name because the tool was commonly found in these tiny carrying cases. Eventually, the word \"tweeze\" was accepted as a verb in the English language.\nThere is evidence of Roman shipbuilders pulling nails out of construction with plier-type pincers.\n\nTypes \n Flat tip conventional tweezers\nTweezers come in a variety of tip shapes and sizes. Blunt tip tweezers have a rounded end which can be used when a pointed object may get entangled, when manipulating cotton swabs, for example. Flat tip tweezers, pictured at right, have an angled tip which may be used for removing splinters. Some tweezers have a long needle-like tip which may be useful for reaching into small crevices. Triangular tip tweezers have larger, wider tips useful for gripping larger objects. Tweezers with curved tips also exist, sometimes called bent forceps. Microtweezers have an extremely small, pointed tip used for manipulating tiny electronic components and the like.\nThere are two common forms of construction for tweezers: two fused, angled pieces of metal, or one piece of metal bent in half. The bent tweezer is cheaper to manufacture, but gives weaker grip. The fused tweezer is more expensive, but allows for a stronger grip. The width between the tips of the tweezers when no force is applied also affects how powerful the grip is.\nCross-locking tweezers (aka reverse-action tweezers or self-closing tweezers) work in the opposite way to normal tweezers. Cross-locking tweezers open when squeezed and close when released, gripping the item without any exertion of the user's fingers.\n\nClassification by usage \nApplications:\n\nin lead type\nin dealing with stamps (see Philately)\nin dealing with smaller coins (see Numismatics), to protect the coins these are wrapped at the tips with plastic\nin electronics\nfor hair removal (eyebrow tweezers)\nin semiconductor technology in the form of wafer tweezers\nin cosmetics\nin medicine (Forceps and Tissue Forceps)\nin the household\nin jewelery\nIn the textile industry as iron nubs\nin soldering\nin science, laboratory\nin aquatics at planting e.g. Aquascaping\nin watchmaker usage\nThere are also other tweezers, for example, so-called optical tweezers and vacuum tweezers to the tweezers.\nThe original tweezers for mechanical gripping have given rise to a number of tools with similar action or purpose but not dependent upon mechanical pressure, including\n\nOptical tweezers use light to manipulate microscopic objects as small as a single atom. The momentum transfer from a focused laser beam is able to trap small particles.[3] In the biological sciences, these instruments have been used to apply forces in the pico Newton range and to measure displacements in the nm range of objects ranging in size from 10 nm to over 100 mm.\nMagnetic tweezers use magnetic forces to manipulate single molecules (such as DNA) via paramagnetic interactions. In practice it is an array of magnetic traps designed for manipulating individual biomolecules and measuring the ultra-small forces that affect their behavior.\n Plastic tweezers used in first aid kit\nElectric tweezers deliver an electrical signal through the tip, intended for depilation by damaging hair roots to prevent new hair from growing from the same root.\nVacuum tweezers use differences in atmospheric pressure to grasp items from 100 micrometres in size up to parts weighing several pounds. Special vacuum tweezer tips are manufactured to handle a wide variety of items such as surface-mount electronics, optics, biological material, stamps and coins. They may be used to handle parts that are so small that conventional mechanical tweezers may cause parts to be damaged or dropped and lost.\nMolecular tweezers are noncyclic host molecules that have two arms capable of binding guests molecules through non-covalent bonding.\nHot, or soldering, tweezers combine the squeezing action of mechanical tweezers with heating, to grip small surface-mount electronic devices while simultaneously heating them, for soldering or desoldering.\nTweezer probes are a pair of electrical test probes fixed to a tweezer mechanism to measure voltages or other electronic circuit parameters between closely spaced pins.\nTweezers integrated with an electronic measuring device for evaluation of electrical parameters of small-size electronic components.[4]\nCarbon nano-tweezers have been fabricated by deposition of MWNT bundles on isolated electrodes deposited on tempered glass micropipettes.Those nanotube bundles can be mechanically manipulated by electricity and can be used to manipulate and transfer micro- and nano-structures. The nanotube bundles used for tweezers are about 50 nm in diameter and 2 \u00b5m in lengths. Under electric bias, two close sets of bundles are attracted and can be used as nanoscale tweezers.\nOther uses of the same principle are named tweezers; although such terms are not necessarily widely used their meaning is clear to people in the relevant field. E.g., Raman tweezers, which combine Raman spectroscopy with optical tweezers.[5]\n\nCulture-associated uses \nThe main objective of the Hasbro board game Operation is to use tweezers attached to the board to remove plastic ailments from their respective cavity openings without them coming in contact with the metal edges, which will let out a buzzing vibration and light up the patient's red lightbulb nose.[6]\n\nSee also \nEyelash curler\nInstruments used in general surgery\nOptical tweezers, which use highly focused small lasers and a lens to stabilize atom or cell-sized small objects; the chief inventor won half the 2018 Nobel Prize in Physics\nReferences \n\n\n\nLook up tweezers in Wiktionary, the free dictionary.\n\n\n\nWikimedia Commons has media related to Tweezers.\n\n\n^ Archived article about food decoration with tweezers in high-end restaurants Source (Multilanguage): Developers Tocan-Tweezer.org Sourceforge project. (CC-BY-SA) \n\n^ Childe, Vere (1963). The Bronze Age. Biblo & Tannen. ISBN 0-8196-0123-3. \n\n^ Ashkin, Arthur, et al. \"Observation of a single-beam gradient force optical trap for dielectric particles.\" Optics letters 11.5 (1986): 288-290. [1] \n\n^ Multimeter\/LCR Meter tweezers \n\n^ Optics.org: Raman tweezers \n\n^ Wilson, Jacque (29 October 2014). \"' Operation' Creator Needs Operation\". CNN. Retrieved 9 April 2018 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tweezers\">https:\/\/www.limswiki.org\/index.php\/Tweezers<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:30.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 367 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","875e0919078d731018cd9e8e0096bf77_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Tweezers skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Tweezers<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Tweezers<\/b> are small tools used for picking up objects too small to be easily handled with the human <a href=\"https:\/\/en.wikipedia.org\/wiki\/Finger\" title=\"Finger\" rel=\"external_link\" target=\"_blank\">fingers<\/a>. The word is most likely derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongs\" title=\"Tongs\" rel=\"external_link\" target=\"_blank\">tongs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pincer_(tool)\" class=\"mw-redirect\" title=\"Pincer (tool)\" rel=\"external_link\" target=\"_blank\">pincers<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>-like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pliers\" title=\"Pliers\" rel=\"external_link\" target=\"_blank\">pliers<\/a> used to grab or hold hot objects since the dawn of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recorded_history\" title=\"Recorded history\" rel=\"external_link\" target=\"_blank\">recorded history<\/a>. In a scientific or medical context they are normally referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps\" title=\"Forceps\" rel=\"external_link\" target=\"_blank\">forceps<\/a>.\n<\/p><p>Tweezers make use of two third-class <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lever\" title=\"Lever\" rel=\"external_link\" target=\"_blank\">levers<\/a> connected at one fixed end (the fulcrum point of each lever), with the pincers at the others.\n<\/p><p>People commonly use tweezers mainly for tasks such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plucking_(hair_removal)\" title=\"Plucking (hair removal)\" rel=\"external_link\" target=\"_blank\">plucking hair<\/a> from the face or eyebrows, often using the term . Other common uses for tweezers are as a tool to manipulate small objects, including for example small, particularly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface-mount\" class=\"mw-redirect\" title=\"Surface-mount\" rel=\"external_link\" target=\"_blank\">surface-mount<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronics\" title=\"Electronics\" rel=\"external_link\" target=\"_blank\">electronic parts<\/a>, and small mechanical parts for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scale_model\" title=\"Scale model\" rel=\"external_link\" target=\"_blank\">models<\/a> and precision mechanisms. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stamp_collecting\" title=\"Stamp collecting\" rel=\"external_link\" target=\"_blank\">Stamp collectors<\/a> use tweezers (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Stamp_tongs\" title=\"Stamp tongs\" rel=\"external_link\" target=\"_blank\">stamp tongs<\/a>) to handle <a href=\"https:\/\/en.wikipedia.org\/wiki\/Postage_stamp\" title=\"Postage stamp\" rel=\"external_link\" target=\"_blank\">postage stamps<\/a> which, while large enough to pick up by hand, could be damaged by handling; the jaws of stamp tongs are smooth. One example of a specialised use is picking out flakes of gold in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gold_panning\" title=\"Gold panning\" rel=\"external_link\" target=\"_blank\">gold panning<\/a>. Tweezers are also used in kitchens for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_presentation\" title=\"Food presentation\" rel=\"external_link\" target=\"_blank\">food presentation<\/a><sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> to remove bones from fillets of fish in a process known as .\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bronze_Minoan_Tweezers_(MET).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Bronze_Minoan_Tweezers_%28MET%29.jpg\/220px-Bronze_Minoan_Tweezers_%28MET%29.jpg\" width=\"220\" height=\"138\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bronze_Minoan_Tweezers_(MET).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A pair of bronze tweezers attributed to the Minoan civilization, circa 2900\u20131050 B.C.<\/div><\/div><\/div>\n<p>Tweezers are known to have been used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prehistoric_Egypt\" title=\"Prehistoric Egypt\" rel=\"external_link\" target=\"_blank\">predynastic Egypt<\/a>. There are drawings of Egyptian <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artisan\" title=\"Artisan\" rel=\"external_link\" target=\"_blank\">craftsmen<\/a> holding hot pots over <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oven\" title=\"Oven\" rel=\"external_link\" target=\"_blank\">ovens<\/a> with a double-bow shaped tool. Asiatic tweezers, consisting of two strips of metal brazed together, were commonly used in Mesopotamia and India from about 3000 BC, perhaps for purposes such as catching lice.<sup id=\"rdp-ebb-cite_ref-Childe000_2-0\" class=\"reference\"><a href=\"#cite_note-Childe000-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The word tweezer comes from etwee which describes a small case that people would use to carry small objects (such as toothpicks) with them. Etwee takes its origin from French <i>\u00e9tui<\/i> \"small case\" from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Old_French\" title=\"Old French\" rel=\"external_link\" target=\"_blank\">Old French<\/a> verb <i>estuier<\/i>, \"to hold or keep safe.\" Over time, the object now known as \"tweezers\" took on this name because the tool was commonly found in these tiny carrying cases. Eventually, the word \"tweeze\" was accepted as a verb in the English language.\n<\/p><p>There is evidence of Roman shipbuilders pulling nails out of construction with plier-type pincers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tweezers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e4\/Tweezers.jpg\/220px-Tweezers.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tweezers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Flat tip conventional tweezers<\/div><\/div><\/div>\n<p>Tweezers come in a variety of tip shapes and sizes. Blunt tip tweezers have a rounded end which can be used when a pointed object may get entangled, when manipulating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cotton_swabs\" class=\"mw-redirect\" title=\"Cotton swabs\" rel=\"external_link\" target=\"_blank\">cotton swabs<\/a>, for example. Flat tip tweezers, pictured at right, have an angled tip which may be used for removing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Splinter\" title=\"Splinter\" rel=\"external_link\" target=\"_blank\">splinters<\/a>. Some tweezers have a long needle-like tip which may be useful for reaching into small crevices. Triangular tip tweezers have larger, wider tips useful for gripping larger objects. Tweezers with curved tips also exist, sometimes called bent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps\" title=\"Forceps\" rel=\"external_link\" target=\"_blank\">forceps<\/a>. Microtweezers have an extremely small, pointed tip used for manipulating tiny electronic components and the like.\n<\/p><p>There are two common forms of construction for tweezers: two fused, angled pieces of metal, or one piece of metal bent in half. The bent tweezer is cheaper to manufacture, but gives weaker grip. The fused tweezer is more expensive, but allows for a stronger grip. The width between the tips of the tweezers when no force is applied also affects how powerful the grip is.\n<\/p><p><b>Cross-locking tweezers<\/b> (aka reverse-action tweezers or self-closing tweezers) work in the opposite way to normal tweezers. Cross-locking tweezers open when squeezed and close when released, gripping the item without any exertion of the user's fingers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Classification_by_usage\">Classification by usage<\/span><\/h2>\n<p>Applications:\n<\/p>\n<ul><li>in lead type<\/li>\n<li>in dealing with stamps (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Philately\" title=\"Philately\" rel=\"external_link\" target=\"_blank\">Philately<\/a>)<\/li>\n<li>in dealing with smaller coins (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Numismatics\" title=\"Numismatics\" rel=\"external_link\" target=\"_blank\">Numismatics<\/a>), to protect the coins these are wrapped at the tips with plastic<\/li>\n<li>in electronics<\/li>\n<li>for hair removal (eyebrow tweezers)<\/li>\n<li>in semiconductor technology in the form of wafer tweezers<\/li>\n<li>in cosmetics<\/li>\n<li>in medicine (Forceps and Tissue Forceps)<\/li>\n<li>in the household<\/li>\n<li>in jewelery<\/li>\n<li>In the textile industry as iron nubs<\/li>\n<li>in soldering<\/li>\n<li>in science, laboratory<\/li>\n<li>in aquatics at planting e.g. Aquascaping<\/li>\n<li>in watchmaker usage<\/li>\n<li>There are also other tweezers, for example, so-called optical tweezers and vacuum tweezers to the tweezers.<\/li><\/ul>\n<p>The original tweezers for mechanical gripping have given rise to a number of tools with similar action or purpose but not dependent upon mechanical pressure, including\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_tweezers\" title=\"Optical tweezers\" rel=\"external_link\" target=\"_blank\">Optical tweezers<\/a> use light to manipulate microscopic objects as small as a single <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atom\" title=\"Atom\" rel=\"external_link\" target=\"_blank\">atom<\/a>. The momentum transfer from a focused laser beam is able to trap small particles.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_science\" class=\"mw-redirect\" title=\"Biological science\" rel=\"external_link\" target=\"_blank\">biological sciences<\/a>, these instruments have been used to apply forces in the pico Newton range and to measure displacements in the nm range of objects ranging in size from 10 nm to over 100 mm.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_tweezers\" title=\"Magnetic tweezers\" rel=\"external_link\" target=\"_blank\">Magnetic tweezers<\/a> use magnetic forces to manipulate single molecules (such as DNA) via paramagnetic interactions. In practice it is an array of magnetic traps designed for manipulating individual biomolecules and measuring the ultra-small forces that affect their behavior.<\/li><\/ul>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tweezer-plastic.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Tweezer-plastic.JPG\/220px-Tweezer-plastic.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tweezer-plastic.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Plastic tweezers used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/First_aid_kit\" title=\"First aid kit\" rel=\"external_link\" target=\"_blank\">first aid kit<\/a><\/div><\/div><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_tweezers\" title=\"Electric tweezers\" rel=\"external_link\" target=\"_blank\">Electric tweezers<\/a> deliver an electrical signal through the tip, intended for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Depilation\" class=\"mw-redirect\" title=\"Depilation\" rel=\"external_link\" target=\"_blank\">depilation<\/a> by damaging hair roots to prevent new hair from growing from the same root.<\/li>\n<li> use differences in atmospheric pressure to grasp items from 100 micrometres in size up to parts weighing several pounds. Special vacuum tweezer tips are manufactured to handle a wide variety of items such as surface-mount electronics, optics, biological material, stamps and coins. They may be used to handle parts that are so small that conventional mechanical tweezers may cause parts to be damaged or dropped and lost.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_tweezers\" title=\"Molecular tweezers\" rel=\"external_link\" target=\"_blank\">Molecular tweezers<\/a> are noncyclic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Host-guest_chemistry\" class=\"mw-redirect\" title=\"Host-guest chemistry\" rel=\"external_link\" target=\"_blank\">host molecules<\/a> that have two arms capable of binding guests molecules through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-covalent\" class=\"mw-redirect\" title=\"Non-covalent\" rel=\"external_link\" target=\"_blank\">non-covalent<\/a> bonding.<\/li>\n<li>Hot, or soldering, tweezers combine the squeezing action of mechanical tweezers with heating, to grip small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface-mount\" class=\"mw-redirect\" title=\"Surface-mount\" rel=\"external_link\" target=\"_blank\">surface-mount<\/a> electronic devices while simultaneously heating them, for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soldering\" title=\"Soldering\" rel=\"external_link\" target=\"_blank\">soldering<\/a> or desoldering.<\/li>\n<li>Tweezer probes are a pair of electrical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Test_probe\" title=\"Test probe\" rel=\"external_link\" target=\"_blank\">test probes<\/a> fixed to a tweezer mechanism to measure voltages or other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronic_circuit\" title=\"Electronic circuit\" rel=\"external_link\" target=\"_blank\">electronic circuit<\/a> parameters between closely spaced pins.<\/li>\n<li>Tweezers integrated with an electronic measuring device for evaluation of electrical parameters of small-size electronic components.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li>Carbon nano-tweezers have been fabricated by deposition of MWNT bundles on isolated electrodes deposited on tempered glass micropipettes.Those nanotube bundles can be mechanically manipulated by electricity and can be used to manipulate and transfer micro- and nano-structures. The nanotube bundles used for tweezers are about 50 nm in diameter and 2 \u00b5m in lengths. Under electric bias, two close sets of bundles are attracted and can be used as nanoscale tweezers.<\/li><\/ul>\n<p>Other uses of the same principle are named tweezers; although such terms are not necessarily widely used their meaning is clear to people in the relevant field. E.g., Raman tweezers, which combine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Raman_spectroscopy\" title=\"Raman spectroscopy\" rel=\"external_link\" target=\"_blank\">Raman spectroscopy<\/a> with optical tweezers.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Culture-associated_uses\">Culture-associated uses<\/span><\/h3>\n<p>The main objective of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hasbro\" title=\"Hasbro\" rel=\"external_link\" target=\"_blank\">Hasbro<\/a> board game <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Operation_(game)\" title=\"Operation (game)\" rel=\"external_link\" target=\"_blank\">Operation<\/a><\/i> is to use tweezers attached to the board to remove plastic ailments from their respective cavity openings without them coming in contact with the metal edges, which will let out a buzzing vibration and light up the patient's red <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lightbulb\" class=\"mw-redirect\" title=\"Lightbulb\" rel=\"external_link\" target=\"_blank\">lightbulb<\/a> nose.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Eyelash_curler\" title=\"Eyelash curler\" rel=\"external_link\" target=\"_blank\">Eyelash curler<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_tweezers\" title=\"Optical tweezers\" rel=\"external_link\" target=\"_blank\">Optical tweezers<\/a>, which use highly focused small lasers and a lens to stabilize atom or cell-sized small objects; the chief inventor won half the 2018 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nobel_Prize_in_Physics\" title=\"Nobel Prize in Physics\" rel=\"external_link\" target=\"_blank\">Nobel Prize in Physics<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n\n\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151222123500\/http:\/\/tocan-tweezer.org\/2015\/12\/07\/christmas-bakery-santa-claus-cake-made-with-gerald-tweezers\/\" target=\"_blank\">Archived article about food decoration with tweezers in high-end restaurants<\/a> Source (Multilanguage): Developers Tocan-Tweezer.org Sourceforge project. (CC-BY-SA)<\/span>\n<\/li>\n<li id=\"cite_note-Childe000-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Childe000_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Childe, Vere (1963). <i>The Bronze Age<\/i>. Biblo & Tannen. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8196-0123-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Bronze+Age&rft.pub=Biblo+%26+Tannen&rft.date=1963&rft.isbn=0-8196-0123-3&rft.aulast=Childe&rft.aufirst=Vere&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATweezers\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ashkin, Arthur, et al. \"Observation of a single-beam gradient force optical trap for dielectric particles.\" Optics letters 11.5 (1986): 288-290. <a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/www.osapublishing.org\/ol\/abstract.cfm?uri=ol-11-5-288\" target=\"_blank\">[1]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.advancedevices.com\/Smart_Tweezers_LCR_Meter.htm\" target=\"_blank\">Multimeter\/LCR Meter tweezers<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/optics.org\/cws\/article\/research\/9041\" target=\"_blank\">Optics.org: Raman tweezers<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Wilson, Jacque (29 October 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cnn.com\/2014\/10\/29\/living\/operation-creator-needs-operation\/index.html\" target=\"_blank\">\"<span class=\"cs1-kern-left\">'<\/span>Operation' Creator Needs Operation\"<\/a>. CNN<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">9 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=%27Operation%27+Creator+Needs+Operation&rft.pub=CNN&rft.date=2014-10-29&rft.au=Wilson%2C+Jacque&rft_id=http%3A%2F%2Fwww.cnn.com%2F2014%2F10%2F29%2Fliving%2Foperation-creator-needs-operation%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATweezers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181207144616\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.212 seconds\nReal time usage: 0.289 seconds\nPreprocessor visited node count: 525\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 10699\/2097152 bytes\nTemplate argument size: 366\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 6851\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.114\/10.000 seconds\nLua memory usage: 2.98 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 244.379 1 -total\n<\/p>\n<pre>41.82% 102.196 1 Template:Reflist\n32.26% 78.828 1 Template:Cite_book\n25.83% 63.130 1 Template:Commons_category\n25.25% 61.704 2 Template:Sister_project\n23.99% 58.622 1 Template:Refimprove\n23.52% 57.466 2 Template:Side_box\n21.44% 52.385 1 Template:Commons\n19.72% 48.188 2 Template:If_then_show\n14.66% 35.818 1 Template:Ambox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:645586-1!canonical and timestamp 20181207144616 and revision id 867887453\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tweezers\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214634\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.152 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 146.488 1 - wikipedia:Tweezers\n100.00% 146.488 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8533-0!*!*!*!*!*!* and timestamp 20181217214634 and revision id 24958\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tweezers\">https:\/\/www.limswiki.org\/index.php\/Tweezers<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","875e0919078d731018cd9e8e0096bf77_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Bronze_Minoan_Tweezers_%28MET%29.jpg\/440px-Bronze_Minoan_Tweezers_%28MET%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e4\/Tweezers.jpg\/440px-Tweezers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Tweezer-plastic.JPG\/440px-Tweezer-plastic.JPG"],"875e0919078d731018cd9e8e0096bf77_timestamp":1545083194,"a214b62cc7c091059a9e96bc7ab631a7_type":"article","a214b62cc7c091059a9e96bc7ab631a7_title":"Tongue depressor","a214b62cc7c091059a9e96bc7ab631a7_url":"https:\/\/www.limswiki.org\/index.php\/Tongue_depressor","a214b62cc7c091059a9e96bc7ab631a7_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTongue depressor\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Tongue depressor\nA tongue depressor (somewtimes called spatula[1]) is a tool used in medical practice to depress the tongue to allow for examination of the mouth and throat. The most common modern tongue depressors are flat, thin, wooden blades, smoothed and rounded at both ends,[2] but, historically, tongue depressors have been made of a variety of materials.[3] Since they are inexpensive and difficult to clean, wooden tongue depressors are labeled for disposal after a single use.[4]\nHobbyists and teachers have found a multitude of uses for tongue depressors (sometimes called \"craft sticks\" or \"popsicle sticks\") in their projects.[5][6] Tongue depressors may be used to form so-called \"stick bombs\".\nEarlier versions of depressors were made from balsa, pine, or redwood woods. Tongue depressors made from wood and metal exist from the American Civil War.[7]\n\nReferences \n\n\n^ \"Spatula\", Collins Dictionary of Medicine, Robert M. Youngson 2004, 2005 \n\n^ Mirriam-Webster's Medical Dictionary \n\n^ Cohen, J Solis. Diseases of the Throat and Nasal Passages: A Guide to the Diagnosis and Treatment of Affections of the Pharynx, Oesophagus, Trachea, Larynx, and Nares. Chapter II, Examination of the Throat and Nasal Passages. Published by W. Wood, 1884, 742 pp. \n\n^ Landro, L. Hospitals Reuse Medical Devices To Lower Costs Wall Street Journal March 19, 2008. \n\n^ Kent Wood, Ric LaBan. N Scale Model Railroad That Grows Kalmbach Publishing, Co., 1996. \n\n^ LaBritta Gilbert, Linda Greigg. Do touch: instant, easy hands-on learning experiences for young children Published by Gryphon House, Inc., 1989. \n\n^ Echols, M. Items on the 1865 inventory list of the Conesus, N.Y. Military Hospital, June 2010. \n\n\nExternal links \nVCU Libraries Medical Artifacts Collection: Tongue Depressors\n\r\n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tongue_depressor\">https:\/\/www.limswiki.org\/index.php\/Tongue_depressor<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:27.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 373 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a214b62cc7c091059a9e96bc7ab631a7_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Tongue_depressor skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Tongue depressor<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mundspatel.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Mundspatel.jpg\/220px-Mundspatel.jpg\" width=\"220\" height=\"134\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mundspatel.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tongue depressor<\/div><\/div><\/div>\n<p>A <b>tongue depressor<\/b> (somewtimes called <b>spatula<\/b><sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tool\" title=\"Tool\" rel=\"external_link\" target=\"_blank\">tool<\/a> used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_practice\" class=\"mw-redirect\" title=\"Medical practice\" rel=\"external_link\" target=\"_blank\">medical practice<\/a> to depress the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongue\" title=\"Tongue\" rel=\"external_link\" target=\"_blank\">tongue<\/a> to allow for examination of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mouth\" title=\"Mouth\" rel=\"external_link\" target=\"_blank\">mouth<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Throat\" title=\"Throat\" rel=\"external_link\" target=\"_blank\">throat<\/a>. The most common modern tongue depressors are flat, thin, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wood\" title=\"Wood\" rel=\"external_link\" target=\"_blank\">wooden<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blade\" title=\"Blade\" rel=\"external_link\" target=\"_blank\">blades<\/a>, smoothed and rounded at both ends,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> but, historically, tongue depressors have been made of a variety of materials.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Since they are inexpensive and difficult to clean, wooden tongue depressors are labeled for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disposable\" class=\"mw-redirect\" title=\"Disposable\" rel=\"external_link\" target=\"_blank\">disposal<\/a> after a single use.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hobbyist\" class=\"mw-redirect\" title=\"Hobbyist\" rel=\"external_link\" target=\"_blank\">Hobbyists<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teacher\" title=\"Teacher\" rel=\"external_link\" target=\"_blank\">teachers<\/a> have found a multitude of uses for tongue depressors (sometimes called \"craft sticks\" or \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ice_pop\" title=\"Ice pop\" rel=\"external_link\" target=\"_blank\">popsicle<\/a> sticks\") in their projects.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Tongue depressors may be used to form so-called \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Stick_bomb\" title=\"Stick bomb\" rel=\"external_link\" target=\"_blank\">stick bombs<\/a>\".\n<\/p><p>Earlier versions of depressors were made from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Balsa\" class=\"mw-redirect\" title=\"Balsa\" rel=\"external_link\" target=\"_blank\">balsa<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pine\" title=\"Pine\" rel=\"external_link\" target=\"_blank\">pine<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Redwood\" class=\"mw-redirect\" title=\"Redwood\" rel=\"external_link\" target=\"_blank\">redwood<\/a> woods. Tongue depressors made from wood and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> exist from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Civil_War\" title=\"American Civil War\" rel=\"external_link\" target=\"_blank\">American Civil War<\/a>.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/medical-dictionary.thefreedictionary.com\/spatula\" target=\"_blank\">\"Spatula\"<\/a>, Collins Dictionary of Medicine, Robert M. Youngson 2004, 2005<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.merriam-webster.com\/medical\/tongue_depressor\" target=\"_blank\">Mirriam-Webster's Medical Dictionary<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Cohen, J Solis. <i>Diseases of the Throat and Nasal Passages: A Guide to the Diagnosis and Treatment of Affections of the Pharynx, Oesophagus, Trachea, Larynx, and Nares. Chapter II, Examination of the Throat and Nasal Passages.<\/i> Published by W. Wood, 1884, 742 pp.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wsj.com\/articles\/SB120588469924246975\" target=\"_blank\">Landro, L. Hospitals Reuse Medical Devices To Lower Costs Wall Street Journal March 19, 2008.<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kent Wood, Ric LaBan. <i>N Scale Model Railroad That Grows<\/i> Kalmbach Publishing, Co., 1996.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">LaBritta Gilbert, Linda Greigg. <i>Do touch: instant, easy hands-on learning experiences for young children<\/i> Published by Gryphon House, Inc., 1989.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20091119050950\/http:\/\/www.braceface.com\/medical\/Civil_War_Articles\/Civil_War_Hospital_inventory_1865.htm\" target=\"_blank\">Echols, M. Items on the 1865 inventory list of the Conesus, N.Y. Military Hospital, June 2010.<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dig.library.vcu.edu\/cdm\/search\/collection\/mar\/searchterm\/depressor%2C_tongue\/field\/descri\/mode\/all\/conn\/and\/order\/title\/ad\/asc\" target=\"_blank\">VCU Libraries Medical Artifacts Collection: Tongue Depressors<\/a><\/li><\/ul>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181207225621\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.056 seconds\nReal time usage: 0.080 seconds\nPreprocessor visited node count: 180\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 3059\/2097152 bytes\nTemplate argument size: 80\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 2916\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.013\/10.000 seconds\nLua memory usage: 796 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 49.805 1 -total\n<\/p>\n<pre>52.47% 26.133 1 Template:Reflist\n47.33% 23.573 1 Template:Medical-equipment-stub\n41.79% 20.813 1 Template:Asbox\n 5.25% 2.613 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:22257493-1!canonical and timestamp 20181207225621 and revision id 872568918\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tongue_depressor\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214633\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.023 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 159.004 1 - wikipedia:Tongue_depressor\n100.00% 159.004 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8532-0!*!*!*!*!*!* and timestamp 20181217214633 and revision id 24957\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tongue_depressor\">https:\/\/www.limswiki.org\/index.php\/Tongue_depressor<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a214b62cc7c091059a9e96bc7ab631a7_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Mundspatel.jpg\/440px-Mundspatel.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png"],"a214b62cc7c091059a9e96bc7ab631a7_timestamp":1545083193,"ec9f11e03c504147cf9b12f3a830c694_type":"article","ec9f11e03c504147cf9b12f3a830c694_title":"Stethoscope","ec9f11e03c504147cf9b12f3a830c694_url":"https:\/\/www.limswiki.org\/index.php\/Stethoscope","ec9f11e03c504147cf9b12f3a830c694_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tStethoscope\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Modern stethoscope\nThe stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the chest, and two tubes connected to earpieces. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins. In combination with a sphygmomanometer, it is commonly used for measurements of blood pressure. Less commonly, \"mechanic's stethoscopes\", equipped with rod shaped chestpieces, are used to listen to internal sounds made by machines (for example, sounds and vibrations emitted by worn ball bearings), such as diagnosing a malfunctioning automobile engine by listening to the sounds of its internal parts. Stethoscopes can also be used to check scientific vacuum chambers for leaks, and for various other small-scale acoustic monitoring tasks. A stethoscope that intensifies auscultatory sounds is called phonendoscope.\n\nContents \n\n1 History \n2 Current practice \n3 Types \n\n3.1 Acoustic \n3.2 Electronic \n\n3.2.1 Recording \n\n\n3.3 Fetal \n3.4 Doppler \n3.5 3D-printed \n\n\n4 Earpieces \n5 See also \n6 References \n7 External links \n\n\nHistory \n \n\n This early stethoscope belonged to Laennec. (Science Museum, London)\n Early stethoscopes\n A Traube-type stethoscope in ivory\nThe stethoscope was invented in France in 1816 by Ren\u00e9 Laennec at the Necker-Enfants Malades Hospital in Paris.[1][2][3] It consisted of a wooden tube and was monaural. Laennec invented the stethoscope because he was uncomfortable placing his ear on women's chests to hear heart sounds.[4][5]:186 He observed that a rolled piece of paper, placed between the patient's chest and his ear, could amplify heart sounds without requiring physical contact.[6] Laennec's device was similar to the common ear trumpet, a historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which was commonly called a \"microphone\". Laennec called his device the \"stethoscope\"[7] (stetho- + -scope, \"chest scope\"), and he called its use \"mediate auscultation\", because it was auscultation with a tool intermediate between the patient's body and the physician's ear. (Today the word auscultation denotes all such listening, mediate or not.) The first flexible stethoscope of any sort may have been a binaural instrument with articulated joints not very clearly described in 1829.[8] In 1840, Golding Bird described a stethoscope he had been using with a flexible tube. Bird was the first to publish a description of such a stethoscope but he noted in his paper the prior existence of an earlier design (which he thought was of little utility) which he described as the snake ear trumpet. Bird's stethoscope had a single earpiece.[9]\nIn 1851, Irish physician Arthur Leared invented a binaural stethoscope and, in 1852, George Philip Cammann perfected the design of the stethoscope instrument (that used both ears) for commercial production, which has become the standard ever since. Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible. By 1873, there were descriptions of a differential stethoscope that could connect to slightly different locations to create a slight stereo effect, though this did not become a standard tool in clinical practice.\nSomerville Scott Alison described his invention of the stethophone at the Royal Society in 1858; the stethophone had two separate bells, allowing the user to hear and compare sounds derived from two discrete locations. This was used to do definitive studies on binaural hearing and auditory processing that advanced knowledge of sound localization and eventually lead to an understanding of binaural fusion.[1]\nThe medical historian Jacalyn Duffin has argued that the invention of the stethoscope marked a major step in the redefinition of disease from being a bundle of symptoms, to the current sense of a disease as a problem with an anatomical system even if there are no noticeable symptoms. This re-conceptualization occurred in part, Duffin argues, because prior to stethoscopes, there were no non-lethal instruments for exploring internal anatomy.[10]\nRappaport and Sprague designed a new stethoscope in the 1940s, which became the standard by which other stethoscopes are measured, consisting of two sides, one of which is used for the respiratory system, the other for the cardiovascular system. The Rappaport-Sprague was later made by Hewlett-Packard. HP's medical products division was spun off as part of Agilent Technologies, Inc., where it became Agilent Healthcare. Agilent Healthcare was purchased by Philips which became Philips Medical Systems, before the walnut-boxed, $300, original Rappaport-Sprague stethoscope was finally abandoned ca. 2004, along with Philips' brand (manufactured by Andromed, of Montreal, Canada) electronic stethoscope model. The Rappaport-Sprague model stethoscope was heavy and short (18\u201324 in (46\u201361 cm)) with an antiquated appearance recognizable by their two large independent latex rubber tubes connecting an exposed leaf-spring-joined pair of opposing F-shaped chrome-plated brass binaural ear tubes with a dual-head chest piece.\n\n Early flexible tube stethoscopes. Golding Bird's instrument is on the left. The instrument on the right is the stethophone.[1]\nSeveral other minor refinements were made to stethoscopes until, in the early 1960s, David Littmann, a Harvard Medical School professor, created a new stethoscope that was lighter than previous models and had improved acoustics.[11] In the late 1970s, 3M-Littmann introduced the tunable diaphragm: a very hard (G-10) glass-epoxy resin diaphragm member with an overmolded silicone flexible acoustic surround which permitted increased excursion of the diaphragm member in a Z-axis with respect to the plane of the sound collecting area. The left shift to a lower resonant frequency increases the volume of some low frequency sounds due to the longer waves propagated by the increased excursion of the hard diaphragm member suspended in the concentric accountic surround. Conversely, restricting excursion of the diaphragm by pressing the stethoscope diaphragm surface firmly against the anatomical area overlying the physiological sounds of interest, the acoustic surround could also be used to dampen excursion of the diaphragm in response to \"z\"-axis pressure against a concentric fret. This raises the frequency bias by shortening the wavelength to auscultate a higher range of physiological sounds.\nIn 1999, Richard Deslauriers patented the first external noise reducing stethoscope, the DRG Puretone. It featured two parallel lumens containing two steel coils which dissipated infiltrating noise as inaudible heat energy. The steel coil \"insulation\" added .30 lb to each stethoscope. In 2005, DRG's diagnostics division was acquired by TRIMLINE Medical Products.[12]\n\nCurrent practice \n A doctor using a stethoscope to listen to a patient's abdomen\nStethoscopes are often considered as a symbol of healthcare professionals, as various healthcare providers are often seen or depicted with stethoscopes hanging around their necks. A 2012 research paper claimed that the stethoscope, when compared to other medical equipment, had the highest positive impact on the perceived trustworthiness of the practitioner seen with it.[13]\nThe advent of practical, widespread portable ultrasonography (point-of-care ultrasonography) in the late 1990s to early 2000s led some physicians to ask how soon it would be before stethoscopes would become obsolete.[14] Others answered that they thought the relationship of the various tools (stethoscopes and digital devices) would change but that it would be a long time before stethoscopes were obsolete.[15] A decade later, in 2016, the same two sides of the coin were still recognized.[16] One cardiologist said, \"the stethoscope is dead\", but a pediatrician said, \"We are not at the place, and probably won't be for a very long time\", where stethoscopes were obsolete. One consideration is that it depends on the segment of health care (emergency medical services, nursing, medicine) and the specialty. \"Stethoscopes retain their value for listening to lungs and bowels for clues of disease, experts agree.\"[16] But for the cardiovascular system, \"auscultation is superfluous\", one cardiologist said.[16] Thus, it could be that cardiology in the secondary and tertiary care settings may abandon the stethoscope many years before primary care, pediatrics, and physical therapy do.\n\nTypes \nAcoustic \n Parts of a binaural stethoscope\n Acoustic stethoscope, with the bell upwards\nAcoustic stethoscopes are familiar to most people, and operate on the transmission of sound from the chest piece, via air-filled hollow tubes, to the listener's ears. The chestpiece usually consists of two sides that can be placed against the patient for sensing sound: a diaphragm (plastic disc) or bell (hollow cup). If the diaphragm is placed on the patient, body sounds vibrate the diaphragm, creating acoustic pressure waves which travel up the tubing to the listener's ears. If the bell is placed on the patient, the vibrations of the skin directly produce acoustic pressure waves traveling up to the listener's ears. The bell transmits low frequency sounds, while the diaphragm transmits higher frequency sounds. This two-sided stethoscope was invented by Rappaport and Sprague in the early part of the 20th century.\nOne problem with acoustic stethoscopes was that the sound level was extremely low. This problem was surmounted in 1999 with the invention of the stratified continuous (inner) lumen, and the kinetic acoustic mechanism in 2002.\n\nElectronic \nAn electronic stethoscope (or stethophone) overcomes the low sound levels by electronically amplifying body sounds. However, amplification of stethoscope contact artifacts, and component cutoffs (frequency response thresholds of electronic stethoscope microphones, pre-amps, amps, and speakers) limit electronically amplified stethoscopes' overall utility by amplifying mid-range sounds, while simultaneously attenuating high- and low- frequency range sounds. Currently, a number of companies offer electronic stethoscopes.\nElectronic stethoscopes require conversion of acoustic sound waves to electrical signals which can then be amplified and processed for optimal listening. Unlike acoustic stethoscopes, which are all based on the same physics, transducers in electronic stethoscopes vary widely. The simplest and least effective method of sound detection is achieved by placing a microphone in the chestpiece. This method suffers from ambient noise interference and has fallen out of favor. Another method, used in Welch-Allyn's Meditron stethoscope, comprises placement of a piezoelectric crystal at the head of a metal shaft, the bottom of the shaft making contact with a diaphragm. 3M also uses a piezo-electric crystal placed within foam behind a thick rubber-like diaphragm. The Thinklabs' Rhythm 32 uses an electromagnetic diaphragm with a conductive inner surface to form a capacitive sensor. This diaphragm responds to sound waves, with changes in an electric field replacing changes in air pressure. The Eko Core enables wireless transmission of heart sounds to a smartphone or tablet.\nBecause the sounds are transmitted electronically, an electronic stethoscope can be a wireless device, can be a recording device, and can provide noise reduction, signal enhancement, and both visual and audio output. Around 2001, Stethographics introduced PC-based software which enabled a phonocardiograph, graphic representation of cardiologic and pulmonologic sounds to be generated, and interpreted according to related algorithms. All of these features are helpful for purposes of telemedicine (remote diagnosis) and teaching.\nElectronic stethoscopes are also used with computer-aided auscultation programs to analyze the recorded heart sounds pathological or innocent heart murmurs.\n\nRecording \nSome electronic stethoscopes feature direct audio output that can be used with an external recording device, such as a laptop or MP3 recorder. The same connection can be used to listen to the previously recorded auscultation through the stethoscope headphones, allowing for more detailed study for general research as well as evaluation and consultation regarding a particular patient's condition and telemedicine, or remote diagnosis.[17]\nThere are some smartphone apps that can use the phone as a stethoscope.[18] At least one uses the phone's own microphone to amplify sound, produce a visualization, and e-mail the results. These apps may be used for training purposes or as novelties, but have not yet gained acceptance for professional medical use.[19]\nThe first stethoscope that could work with a smartphone application was introduced in 2015 [20]\n\nFetal \nMain article: Pinard horn\n A Pinard horn used by a U.S. Army Reserve nurse in Uganda\nA fetal stethoscope or fetoscope is an acoustic stethoscope shaped like a listening trumpet. It is placed against the abdomen of a pregnant woman to listen to the heart sounds of the fetus.[21] The fetal stethoscope is also known as a Pinard horn after French obstetrician Adolphe Pinard (1844\u20131934).\n\nDoppler \nA Doppler stethoscope is an electronic device that measures the Doppler effect of ultrasound waves reflected from organs within the body. Motion is detected by the change in frequency, due to the Doppler effect, of the reflected waves. Hence the Doppler stethoscope is particularly suited to deal with moving objects such as a beating heart.[22]\nIt was recently demonstrated that continuous Doppler enables the auscultation of valvular movements and blood flow sounds that are undetected during cardiac examination with a stethoscope in adults. The Doppler auscultation presented a sensitivity of 84% for the detection of aortic regurgitations while classic stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was superior in the detection of impaired ventricular relaxation. Since the physics of Doppler auscultation and classic auscultation are different, it has been suggested that both methods could complement each other.[23][24]\nA military noise-immune Doppler based stethoscope has recently been developed for auscultation of patients in loud sound environments (up to 110 dB).\n\n3D-printed \nA 3D-printed stethoscope is an open-source medical device meant for auscultation and manufactured via means of 3D printing.[25] The 3D stethoscope was developed by Dr. Tarek Loubani and a team of medical and technology specialists. The 3D-stethoscope was developed as part of the Glia project, and its design is open source from the outset. The stethoscope gained widespread media coverage in Summer 2015.\nThe need for a 3D-stethoscope was borne out of a lack of stethoscopes and other vital medical equipment because of the blockade of the Gaza Strip, where Loubani, a Palestinian-Canadian, worked as an emergency physician during the 2012 conflict in Gaza. The 1960s-era Littmann Cardiology 3 stethoscope became the basis for the 3D-printed stethoscope developed by Loubani.[26]\n\nEarpieces \nStethoscopes usually have rubber earpieces, which aid comfort and create a seal with the ear, improving the acoustic function of the device. Stethoscopes can be modified by replacing the standard earpieces with moulded versions, which improve comfort and transmission of sound. Moulded earpieces can be cast by an audiologist or made by the stethoscope user from a kit.\n\nSee also \n\n\n Health portal \n Medicine portal \nDoppler fetal monitor\nSpeaking tube\nReferences \n\n\n^ a b c Wade, Nicholas J.; Deutsch, Diana (July 2008). \"Binaural Hearing \u2013 Before and After the Stethophone\" (PDF) . Acoustics Today: 16\u201327. \n\n^ Laennec, Ren\u00e9 (1819). De l'auscultation m\u00e9diate ou trait\u00e9 du diagnostic des maladies des poumon et du coeur. Paris: Brosson & Chaud\u00e9. \n\n^ 'Laennec, R. T. H.; Forbes, John, Sir, A Treatise on the Diseases of the Chest and on Mediate Auscultation (1835). New York : Samuel Wood & Sons ; Philadelphia : Desilver, Thomas & Co. . \n\n^ Roguin A (September 2006). \"Rene Theophile Hyacinthe La\u00ebnnec (1781\u20131826): The Man Behind the Stethoscope\". Clin Med Res. 4 (3): 230\u20135. doi:10.3121\/cmr.4.3.230. PMC 1570491 . PMID 17048358. \n\n^ Picard, Liza (2005). Victorian London: the life of a city, 1840\u20131870. London: Weidenfeld & Nicolson. ISBN 978-0297847335. \n\n^ Risse, Guenter (1999). Mending Bodies, Saving Souls. Oxford: Oxford University Press. p. 316. ISBN 978-0-19-505523-8. \n\n^ \"Laennec's new system of diagnosis\", The Quarterly Journal of Foreign Medicine and Surgery and of the Sciences Connected with Them, 2: 51\u201368, 1820. \n\n^ Wilks, p. 490, cites Comins, \"A flexible stethoscope\", Lancet 29 August 1829. \n\n^ Samuel Wilks, \"Evolution of the stethoscope\", Popular Science, vol. 22, no. 28, pp. 488\u201391, Feb 1883 ISSN 0161-7370.\r\nGolding Bird, \"Advantages presented by the employment of a stethoscope with a flexible tube\", London Medical Gazette, vol. 1, pp. 440\u201312, 11 December 1840. \n\n^ Duffin, Jacalyn. \"Big Ideas: Jacalyn Duffin on the History of the Stethoscope\". TVO. Retrieved 28 November 2012 . \n\n^ \"History of Littmann Stethoscopes at a glance\". 3M.com. Retrieved 2010-01-25 . \n\n^ \"TRIMLINE Medical Products\". Retrieved 2010-01-25 . \n\n^ \"Impact of the Presence of Medical Equipment in Images on Viewers' Perceptions of the Trustworthiness of an Individual On-Screen\". Journal of Medical Internet Research (JMIR). Retrieved 24 September 2015 . \n\n^ Wilkins, RL (2004), \"Is the stethoscope on the verge of becoming obsolete?\", Respir Care, 49 (12): 1488\u20131489, PMID 15571638. \n\n^ Murphy, R (2005), \"The stethoscope \u2013 obsolescence or marriage?\", Respir Care, 50 (5): 660\u2013661. \n\n^ a b c Bernstein, Lenny (2016-01-02), \"Heart doctors are listening for clues to the future of their stethoscopes\", Washington Post. \n\n^ Palaniappan R, Sundaraj K, Ahamed NU, Arjunan A, Sundaraj S. Computer-based Respiratory Sound Analysis: A Systematic Review. IETE Tech Rev 2013;30:248\u201356 \n\n^ Bianca K. Chung, Brad Tritle, \"The power of mobile devices and patient engagement\", p. 93, chapter 8 in Jan Oldenburg (ed), Engage! Transforming Healthcare Through Digital Patient Engagement, Himss Books, 2012 ISBN 1938904397. \n\n^ William Hanson, Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health Care, pp. 20\u201322, Macmillan, 2011 ISBN 0230120938. \n\n^ Matt McFarland, \"Eko\u2019s stethoscope shows the potential of digital technology to reinvent health care\", [1], Washington Post \n\n^ Arup Kumar Majhi (2016-08-16). Bedside Clinics In Obstetrics. Academic Publishers. pp. 47\u2013. ISBN 978-93-83420-87-2. \n\n^ S. Ananthi, A Textbook of Medical Instruments, pp. 290\u201396, New Age International, 2006 ISBN 8122415725. \n\n^ Mc Loughlin MJ and Mc Loughlin S. Cardiac auscultation: Preliminary findings of a pilot study using continuous Wave Doppler and comparison with classic auscultation Int J Cardiol. 2013 Jul 31; 167(2):5 90\u201391 \n\n^ \"Amazon.com: Cardiac Auscultation With Continuous Wave Doppler Stethoscope: A new method 200 years after Laennec's invention eBook: Mario Jorge Mc Loughlin, Santiago Mc Loughlin: Kindle Store\". amazon.com. Retrieved 24 September 2015 . \n\n^ Official project site at GitHub \n\n^ Pauli, Darren (2015-08-14). \"Gazan medico team 3D-prints world-leading stethoscope for 30c\". United Kingdom: The Register. Retrieved 2015-08-17 . \n\n\nExternal links \n\n Stethoscopeat Wikipedia's sister projects \n \n \n Definitions from Wiktionary \n Media from Wikimedia Commons \n News from Wikinews \n Quotations from Wikiquote \n Texts from Wikisource \n Textbooks from Wikibooks \n Resources from Wikiversity \n \n \n\nThe Auscultation Assistant, provides heart sounds, heart murmurs, and breath sounds in order to help medical students and others improve their physical diagnosis skills\nDemonstrations: Heart Sounds & Murmurs University of Washington School of Medicine\nVCU Libraries Medical Artifacts Collection: Stethoscopes\n\"The invention of the stethoscope: A milestone in cardiology\", analysis of Laennec's text (1819) on BibNum [click '\u00e0 t\u00e9l\u00e9charger' for English version].\nvteHealth care\nEconomics\nEquipment\nGuidelines\nIndustry\nPhilosophy\nPolicy\nProviders\nRanking\nReform\nSystem\nProfessions\nMedicine\nNursing\nHealthcare science\nDentistry\nAllied health professions\nPharmacy\nHealth information management\nSettings\nAssisted living\nClinic\nHospital\nNursing home\nMedical school (Academic health science centre, Teaching hospital)\nCare\nAcute\nChronic\nEnd-of-life\nHospice\nOverutilization\nPalliative\nPrimary\nSelf\nTotal\nSkills \/ Training\nBedside manner\nCultural competence\nDiagnosis\nEducation\nUniversal precautions\nBy country\nUnited States\nreform debate in the United States\nUnited Kingdom\nCanada\nAustralia\nNew Zealand\n(Category Healthcare by country)\n\n Category\n\nvteSymptoms and signs relating to the respiratory system (R04\u2013R07, 786)Medical examination and history takingAuscultation\nStethoscope\nRespiratory sounds\nStridor\nWheeze\nCrackles\nRhonchi\nStertor\nSquawk\nPleural friction rub\nFremitus\nBronchophony\nTerminal secretions\nElicited findings\nPercussion\nPectoriloquy\nWhispered pectoriloquy\nEgophony\nBreathingRate\nApnea\nPrematurity\nDyspnea\nHyperventilation\nHypoventilation\nHyperpnea\nTachypnea\nHypopnea\nBradypnea\nPattern\nAgonal respiration\nBiot's respiration\nCheyne\u2013Stokes respiration\nKussmaul breathing\nAtaxic respiration\nOther\nRespiratory distress\nRespiratory arrest\nOrthopnea\/Platypnea\nTrepopnea\nAerophagia\nAsphyxia\nBreath holding\nMouth breathing\nSnoring\nOther\nChest pain\nIn children\nPrecordial catch syndrome\nPleurisy\nNail clubbing\nCyanosis\nCough\nSputum\nHemoptysis\nEpistaxis\nSilhouette sign\nPost-nasal drip\nHiccup\nCOPD\nHoover's sign\nasthma\nCurschmann's spirals\nCharcot\u2013Leyden crystals\nchronic bronchitis\nReid index\nsarcoidosis\nKveim test\npulmonary embolism\nHampton hump\nWestermark sign\npulmonary edema\nKerley lines\nHamman's sign\nGolden S sign\n\nvteMedical instruments and implantsDiagnostics and research\nLaboratory diagnosis & research\nMicrobiology\nPathology\nRadiology\nToxicology\nSterilizationMicrobiological sterilization, disinfection, quarantine & biological waste managementFundamental clinical specializations\nDentistry\nGeneral medicine\nGeneral surgery\nSystem non-specific clinical specializations\nAnesthesiology\nOncology\nPhysical medicine & Rehabilitation\nPlastic surgery\nPreventive medicine\nSystem specific clinical specialties\nCardiology\nDermatology\nEndocrinology\nGastroenterology\nNephrology\nNeurology\nObstetrics & Gynecology\nOphthalmology\nOrthopedics\nOtorhinolaryngology (ENT)\nPulmonology\nPsychiatry\nUrology\nVascular surgery\nPost-mortem examinations\nAnatomy\nForensic sciences\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Stethoscope\">https:\/\/www.limswiki.org\/index.php\/Stethoscope<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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class=\"firstHeading\" lang=\"en\">Stethoscope<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stethoscope-2.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d2\/Stethoscope-2.png\/220px-Stethoscope-2.png\" width=\"220\" height=\"190\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stethoscope-2.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Modern stethoscope<\/div><\/div><\/div>\n<p>The <b>stethoscope<\/b> is an acoustic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medical<\/a> device for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auscultation\" title=\"Auscultation\" rel=\"external_link\" target=\"_blank\">auscultation<\/a>, or listening to the internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the chest, and two tubes connected to earpieces. It is often used to listen to lung and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_sounds\" title=\"Heart sounds\" rel=\"external_link\" target=\"_blank\">heart sounds<\/a>. It is also used to listen to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intestines\" class=\"mw-redirect\" title=\"Intestines\" rel=\"external_link\" target=\"_blank\">intestines<\/a> and blood flow in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">arteries<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">veins<\/a>. In combination with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sphygmomanometer\" title=\"Sphygmomanometer\" rel=\"external_link\" target=\"_blank\">sphygmomanometer<\/a>, it is commonly used for measurements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a>. Less commonly, \"mechanic's stethoscopes\", equipped with rod shaped chestpieces, are used to listen to internal sounds made by machines (for example, sounds and vibrations emitted by worn ball bearings), such as diagnosing a malfunctioning automobile engine by listening to the sounds of its internal parts. Stethoscopes can also be used to check scientific vacuum chambers for leaks, and for various other small-scale acoustic monitoring tasks. A stethoscope that intensifies <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auscultation\" title=\"Auscultation\" rel=\"external_link\" target=\"_blank\">auscultatory<\/a> sounds is called <b>phonendoscope<\/b>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p><span id=\"rdp-ebb-history\"><\/span>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laennecs_stethoscope,_c_1820._(9660576833).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Laennecs_stethoscope%2C_c_1820._%289660576833%29.jpg\/220px-Laennecs_stethoscope%2C_c_1820._%289660576833%29.jpg\" width=\"220\" height=\"177\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laennecs_stethoscope,_c_1820._(9660576833).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>This early stethoscope belonged to Laennec. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Science_Museum,_London\" title=\"Science Museum, London\" rel=\"external_link\" target=\"_blank\">Science Museum, London<\/a>)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:H%C3%B6rrohr_Stethoskop_Meyers_1890.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f0\/H%C3%B6rrohr_Stethoskop_Meyers_1890.jpg\/220px-H%C3%B6rrohr_Stethoskop_Meyers_1890.jpg\" width=\"220\" height=\"327\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:H%C3%B6rrohr_Stethoskop_Meyers_1890.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Early stethoscopes<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:182px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Toraube2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Toraube2.jpg\/180px-Toraube2.jpg\" width=\"180\" height=\"136\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Toraube2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ludwig_Traube_(physician)\" title=\"Ludwig Traube (physician)\" rel=\"external_link\" target=\"_blank\">Traube<\/a>-type stethoscope in ivory<\/div><\/div><\/div>\n<p>The stethoscope was invented in <a href=\"https:\/\/en.wikipedia.org\/wiki\/France\" title=\"France\" rel=\"external_link\" target=\"_blank\">France<\/a> in 1816 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ren%C3%A9_Laennec\" title=\"Ren\u00e9 Laennec\" rel=\"external_link\" target=\"_blank\">Ren\u00e9 Laennec<\/a> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Necker-Enfants_Malades_Hospital\" title=\"Necker-Enfants Malades Hospital\" rel=\"external_link\" target=\"_blank\">Necker-Enfants Malades Hospital<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paris\" title=\"Paris\" rel=\"external_link\" target=\"_blank\">Paris<\/a>.<sup id=\"rdp-ebb-cite_ref-Wade2008_1-0\" class=\"reference\"><a href=\"#cite_note-Wade2008-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Laennec_Forbes_translation_3-0\" class=\"reference\"><a href=\"#cite_note-Laennec_Forbes_translation-3\" rel=\"external_link\">[3]<\/a><\/sup> It consisted of a wooden tube and was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monaural\" title=\"Monaural\" rel=\"external_link\" target=\"_blank\">monaural<\/a>. Laennec invented the stethoscope because he was uncomfortable placing his ear on women's chests to hear heart sounds.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-picard-victorian-london_5-0\" class=\"reference\"><a href=\"#cite_note-picard-victorian-london-5\" rel=\"external_link\">[5]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>186<\/span><\/sup> He observed that a rolled piece of paper, placed between the patient's chest and his ear, could amplify heart sounds without requiring physical contact.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Laennec's device was similar to the common <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear_trumpet\" title=\"Ear trumpet\" rel=\"external_link\" target=\"_blank\">ear trumpet<\/a>, a historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which was commonly called a \"microphone\". Laennec called his device the \"stethoscope\"<sup id=\"rdp-ebb-cite_ref-Foreign_Medicine_and_Surgery_1820_7-0\" class=\"reference\"><a href=\"#cite_note-Foreign_Medicine_and_Surgery_1820-7\" rel=\"external_link\">[7]<\/a><\/sup> (<i><a href=\"https:\/\/en.wiktionary.org\/wiki\/stetho-#Prefix\" class=\"extiw\" title=\"wikt:stetho-\" rel=\"external_link\" target=\"_blank\">stetho-<\/a><\/i> + <i><a href=\"https:\/\/en.wiktionary.org\/wiki\/-scope#Suffix\" class=\"extiw\" title=\"wikt:-scope\" rel=\"external_link\" target=\"_blank\">-scope<\/a><\/i>, \"chest scope\"), and he called its use \"<a href=\"https:\/\/en.wiktionary.org\/wiki\/mediate#Adjective\" class=\"extiw\" title=\"wikt:mediate\" rel=\"external_link\" target=\"_blank\">mediate<\/a> auscultation\", because it was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auscultation\" title=\"Auscultation\" rel=\"external_link\" target=\"_blank\">auscultation<\/a> with a tool intermediate between the patient's body and the physician's ear. (Today the word <i>auscultation<\/i> denotes all such listening, mediate or not.) The first flexible stethoscope of any sort may have been a binaural instrument with articulated joints not very clearly described in 1829.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> In 1840, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Golding_Bird\" title=\"Golding Bird\" rel=\"external_link\" target=\"_blank\">Golding Bird<\/a> described a stethoscope he had been using with a flexible tube. Bird was the first to publish a description of such a stethoscope but he noted in his paper the prior existence of an earlier design (which he thought was of little utility) which he described as the snake ear trumpet. Bird's stethoscope had a single earpiece.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>In 1851, Irish physician Arthur Leared invented a binaural stethoscope and, in 1852, George Philip Cammann perfected the design of the stethoscope instrument (that used both ears) for commercial production, which has become the standard ever since. Cammann also wrote a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible. By 1873, there were descriptions of a differential stethoscope that could connect to slightly different locations to create a slight stereo effect, though this did not become a standard tool in clinical practice.\n<\/p><p> described his invention of the <b>stethophone<\/b> at the Royal Society in 1858; the stethophone had two separate bells, allowing the user to hear and compare sounds derived from two discrete locations. This was used to do definitive studies on binaural hearing and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_processing\" class=\"mw-redirect\" title=\"Auditory processing\" rel=\"external_link\" target=\"_blank\">auditory processing<\/a> that advanced knowledge of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sound_localization\" title=\"Sound localization\" rel=\"external_link\" target=\"_blank\">sound localization<\/a> and eventually lead to an understanding of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Binaural_fusion\" title=\"Binaural fusion\" rel=\"external_link\" target=\"_blank\">binaural fusion<\/a>.<sup id=\"rdp-ebb-cite_ref-Wade2008_1-1\" class=\"reference\"><a href=\"#cite_note-Wade2008-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The medical historian <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jackie_Duffin\" class=\"mw-redirect\" title=\"Jackie Duffin\" rel=\"external_link\" target=\"_blank\">Jacalyn Duffin<\/a> has argued that the invention of the stethoscope marked a major step in the redefinition of disease from being a bundle of symptoms, to the current sense of a disease as a problem with an anatomical system even if there are no noticeable symptoms. This re-conceptualization occurred in part, Duffin argues, because prior to stethoscopes, there were no non-lethal instruments for exploring internal anatomy.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Rappaport and Sprague designed a new stethoscope in the 1940s, which became the standard by which other stethoscopes are measured, consisting of two sides, one of which is used for the respiratory system, the other for the cardiovascular system. The Rappaport-Sprague was later made by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hewlett-Packard\" title=\"Hewlett-Packard\" rel=\"external_link\" target=\"_blank\">Hewlett-Packard<\/a>. HP's medical products division was spun off as part of Agilent Technologies, Inc., where it became Agilent Healthcare. Agilent Healthcare was purchased by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Philips\" title=\"Philips\" rel=\"external_link\" target=\"_blank\">Philips<\/a> which became Philips Medical Systems, before the walnut-boxed, $300, original Rappaport-Sprague stethoscope was finally abandoned ca. 2004, along with Philips' brand (manufactured by Andromed, of Montreal, Canada) electronic stethoscope model. The Rappaport-Sprague model stethoscope was heavy and short (18\u201324 in (46\u201361 cm)) with an antiquated appearance recognizable by their two large independent latex rubber tubes connecting an exposed leaf-spring-joined pair of opposing F-shaped chrome-plated brass binaural ear tubes with a dual-head chest piece.\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Early_flexible_stethoscopes.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/1\/1d\/Early_flexible_stethoscopes.jpg\/220px-Early_flexible_stethoscopes.jpg\" width=\"220\" height=\"166\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Early_flexible_stethoscopes.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Early flexible tube stethoscopes. Golding Bird's instrument is on the left. The instrument on the right is the stethophone.<sup id=\"rdp-ebb-cite_ref-Wade2008_1-2\" class=\"reference\"><a href=\"#cite_note-Wade2008-1\" rel=\"external_link\">[1]<\/a><\/sup><\/div><\/div><\/div>\n<p>Several other minor refinements were made to stethoscopes until, in the early 1960s, <a href=\"https:\/\/en.wikipedia.org\/wiki\/David_Littmann\" title=\"David Littmann\" rel=\"external_link\" target=\"_blank\">David Littmann<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvard_Medical_School\" title=\"Harvard Medical School\" rel=\"external_link\" target=\"_blank\">Harvard Medical School<\/a> professor, created a new stethoscope that was lighter than previous models and had improved acoustics.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> In the late 1970s, 3M-Littmann introduced the tunable diaphragm: a very hard (G-10) glass-epoxy resin diaphragm member with an overmolded silicone flexible acoustic surround which permitted increased excursion of the diaphragm member in a Z-axis with respect to the plane of the sound collecting area. The left shift to a lower resonant frequency increases the volume of some low frequency sounds due to the longer waves propagated by the increased excursion of the hard diaphragm member suspended in the concentric accountic surround. Conversely, restricting excursion of the diaphragm by pressing the stethoscope diaphragm surface firmly against the anatomical area overlying the physiological sounds of interest, the acoustic surround could also be used to dampen excursion of the diaphragm in response to \"z\"-axis pressure against a concentric fret. This raises the frequency bias by shortening the wavelength to auscultate a higher range of physiological sounds.\n<\/p><p>In 1999, Richard Deslauriers patented the first external noise reducing stethoscope, the DRG Puretone. It featured two parallel lumens containing two steel coils which dissipated infiltrating noise as inaudible heat energy. The steel coil \"insulation\" added .30 lb to each stethoscope. In 2005, DRG's diagnostics division was acquired by TRIMLINE Medical Products.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Current_practice\">Current practice<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Standardized-Patient-Program-examining-t_he-abdomen.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6d\/Standardized-Patient-Program-examining-t_he-abdomen.jpg\/220px-Standardized-Patient-Program-examining-t_he-abdomen.jpg\" width=\"220\" height=\"178\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Standardized-Patient-Program-examining-t_he-abdomen.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A doctor using a stethoscope to listen to a patient's abdomen<\/div><\/div><\/div>\n<p>Stethoscopes are often considered as a symbol of healthcare professionals, as various healthcare providers are often seen or depicted with stethoscopes hanging around their necks. A 2012 research paper claimed that the stethoscope, when compared to other medical equipment, had the highest positive impact on the perceived trustworthiness of the practitioner seen with it.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>The advent of practical, widespread <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portable_ultrasound\" title=\"Portable ultrasound\" rel=\"external_link\" target=\"_blank\">portable ultrasonography<\/a> (point-of-care ultrasonography) in the late 1990s to early 2000s led some physicians to ask how soon it would be before stethoscopes would become <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obsolescence\" title=\"Obsolescence\" rel=\"external_link\" target=\"_blank\">obsolete<\/a>.<sup id=\"rdp-ebb-cite_ref-pmid_15571638_14-0\" class=\"reference\"><a href=\"#cite_note-pmid_15571638-14\" rel=\"external_link\">[14]<\/a><\/sup> Others answered that they thought the relationship of the various tools (stethoscopes and digital devices) would change but that it would be a long time before stethoscopes were obsolete.<sup id=\"rdp-ebb-cite_ref-Respir_Care_2005_50_5_660_15-0\" class=\"reference\"><a href=\"#cite_note-Respir_Care_2005_50_5_660-15\" rel=\"external_link\">[15]<\/a><\/sup> A decade later, in 2016, the same two sides of the coin were still recognized.<sup id=\"rdp-ebb-cite_ref-Bernstein_2016-01-02_16-0\" class=\"reference\"><a href=\"#cite_note-Bernstein_2016-01-02-16\" rel=\"external_link\">[16]<\/a><\/sup> One <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiology\" title=\"Cardiology\" rel=\"external_link\" target=\"_blank\">cardiologist<\/a> said, \"the stethoscope is dead\", but a pediatrician said, \"We are not at the place, and probably won't be for a very long time\", where stethoscopes were obsolete. One consideration is that it depends on the segment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">health care<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_medical_services\" title=\"Emergency medical services\" rel=\"external_link\" target=\"_blank\">emergency medical services<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nursing\" title=\"Nursing\" rel=\"external_link\" target=\"_blank\">nursing<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>) and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Specialty_(medicine)\" title=\"Specialty (medicine)\" rel=\"external_link\" target=\"_blank\">specialty<\/a>. \"Stethoscopes retain their value for listening to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lungs<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_tract\" title=\"Gastrointestinal tract\" rel=\"external_link\" target=\"_blank\">bowels<\/a> for clues of disease, experts agree.\"<sup id=\"rdp-ebb-cite_ref-Bernstein_2016-01-02_16-1\" class=\"reference\"><a href=\"#cite_note-Bernstein_2016-01-02-16\" rel=\"external_link\">[16]<\/a><\/sup> But for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system#Human_cardiovascular_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">cardiovascular system<\/a>, \"auscultation is superfluous\", one cardiologist said.<sup id=\"rdp-ebb-cite_ref-Bernstein_2016-01-02_16-2\" class=\"reference\"><a href=\"#cite_note-Bernstein_2016-01-02-16\" rel=\"external_link\">[16]<\/a><\/sup> Thus, it could be that cardiology in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care#Secondary_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">secondary<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care#Tertiary_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">tertiary care<\/a> settings may abandon the stethoscope many years before <a href=\"https:\/\/en.wikipedia.org\/wiki\/Primary_care\" title=\"Primary care\" rel=\"external_link\" target=\"_blank\">primary care<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pediatrics\" title=\"Pediatrics\" rel=\"external_link\" target=\"_blank\">pediatrics<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a> do.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Acoustic\">Acoustic<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stethoscope.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Stethoscope.svg\/220px-Stethoscope.svg.png\" width=\"220\" height=\"158\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stethoscope.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Parts of a binaural stethoscope<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stethoscope_pink.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ef\/Stethoscope_pink.JPG\/150px-Stethoscope_pink.JPG\" width=\"150\" height=\"125\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stethoscope_pink.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Acoustic stethoscope, with the <i>bell<\/i> upwards<\/div><\/div><\/div>\n<p>Acoustic stethoscopes are familiar to most people, and operate on the transmission of sound from the chest piece, via air-filled hollow tubes, to the listener's ears. The chestpiece usually consists of two sides that can be placed against the patient for sensing sound: a diaphragm (plastic disc) or bell (hollow cup). If the diaphragm is placed on the patient, body sounds vibrate the diaphragm, creating acoustic pressure waves which travel up the tubing to the listener's ears. If the bell is placed on the patient, the vibrations of the skin directly produce acoustic pressure waves traveling up to the listener's ears. The bell transmits low frequency sounds, while the diaphragm transmits higher frequency sounds. This two-sided stethoscope was invented by Rappaport and Sprague in the early part of the 20th century.\n<\/p><p>One problem with acoustic stethoscopes was that the sound level was extremely low. This problem was surmounted in 1999 with the invention of the stratified continuous (inner) lumen, and the kinetic acoustic mechanism in 2002.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Electronic\">Electronic<span id=\"rdp-ebb-Digital_Stethoscope\"><\/span><span id=\"rdp-ebb-Electronic_Stethoschope\"><\/span><\/span><\/h3>\n<p>An electronic stethoscope (or <b>stethophone<\/b>) overcomes the low sound levels by electronically amplifying body sounds. However, amplification of stethoscope contact artifacts, and component cutoffs (frequency response thresholds of electronic stethoscope microphones, pre-amps, amps, and speakers) limit electronically amplified stethoscopes' overall utility by amplifying mid-range sounds, while simultaneously attenuating high- and low- frequency range sounds. Currently, a number of companies offer electronic stethoscopes.\nElectronic stethoscopes require conversion of acoustic sound waves to electrical signals which can then be amplified and processed for optimal listening. Unlike acoustic stethoscopes, which are all based on the same physics, transducers in electronic stethoscopes vary widely. The simplest and least effective method of sound detection is achieved by placing a microphone in the chestpiece. This method suffers from ambient noise interference and has fallen out of favor. Another method, used in Welch-Allyn's Meditron stethoscope, comprises placement of a piezoelectric crystal at the head of a metal shaft, the bottom of the shaft making contact with a diaphragm. 3M also uses a piezo-electric crystal placed within foam behind a thick rubber-like diaphragm. The Thinklabs' Rhythm 32 uses an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetic_diaphragm\" title=\"Electromagnetic diaphragm\" rel=\"external_link\" target=\"_blank\">electromagnetic diaphragm<\/a> with a conductive inner surface to form a capacitive sensor. This diaphragm responds to sound waves, with changes in an electric field replacing changes in air pressure. The Eko Core enables wireless transmission of heart sounds to a smartphone or tablet.\n<\/p><p>Because the sounds are transmitted electronically, an electronic stethoscope can be a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wireless\" title=\"Wireless\" rel=\"external_link\" target=\"_blank\">wireless<\/a> device, can be a recording device, and can provide noise reduction, signal enhancement, and both visual and audio output. Around 2001, Stethographics introduced PC-based software which enabled a phonocardiograph, graphic representation of cardiologic and pulmonologic sounds to be generated, and interpreted according to related algorithms. All of these features are helpful for purposes of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telemedicine\" title=\"Telemedicine\" rel=\"external_link\" target=\"_blank\">telemedicine<\/a> (remote diagnosis) and teaching.\n<\/p><p>Electronic stethoscopes are also used with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-aided_Auscultation\" class=\"mw-redirect\" title=\"Computer-aided Auscultation\" rel=\"external_link\" target=\"_blank\">computer-aided auscultation<\/a> programs to analyze the recorded heart sounds pathological or innocent heart murmurs.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Recording\">Recording<\/span><\/h4>\n<p>Some electronic stethoscopes feature direct audio output that can be used with an external recording device, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Notebook_computer\" class=\"mw-redirect\" title=\"Notebook computer\" rel=\"external_link\" target=\"_blank\">laptop<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MP3\" title=\"MP3\" rel=\"external_link\" target=\"_blank\">MP3<\/a> recorder. The same connection can be used to listen to the previously recorded <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auscultation\" title=\"Auscultation\" rel=\"external_link\" target=\"_blank\">auscultation<\/a> through the stethoscope headphones, allowing for more detailed study for general research as well as evaluation and consultation regarding a particular patient's condition and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telemedicine\" title=\"Telemedicine\" rel=\"external_link\" target=\"_blank\">telemedicine<\/a>, or remote diagnosis.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>There are some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smartphone\" title=\"Smartphone\" rel=\"external_link\" target=\"_blank\">smartphone<\/a> apps that can use the phone as a stethoscope.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> At least one uses the phone's own microphone to amplify sound, produce a visualization, and e-mail the results. These apps may be used for training purposes or as novelties, but have not yet gained acceptance for professional medical use.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>The first stethoscope that could work with a smartphone application was introduced in 2015 <sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fetal\">Fetal<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pinard_horn\" title=\"Pinard horn\" rel=\"external_link\" target=\"_blank\">Pinard horn<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pinard_horn_Uganda_US_Army_nurse.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b0\/Pinard_horn_Uganda_US_Army_nurse.jpg\/150px-Pinard_horn_Uganda_US_Army_nurse.jpg\" width=\"150\" height=\"225\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pinard_horn_Uganda_US_Army_nurse.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pinard_horn\" title=\"Pinard horn\" rel=\"external_link\" target=\"_blank\">Pinard horn<\/a> used by a U.S. Army Reserve nurse in Uganda<\/div><\/div><\/div>\n<p>A <i>fetal stethoscope<\/i> or <i>fetoscope<\/i> is an acoustic stethoscope shaped like a listening trumpet. It is placed against the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pregnancy\" title=\"Pregnancy\" rel=\"external_link\" target=\"_blank\">pregnant<\/a> woman to listen to the heart sounds of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fetus\" title=\"Fetus\" rel=\"external_link\" target=\"_blank\">fetus<\/a>.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> The fetal stethoscope is also known as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pinard_horn\" title=\"Pinard horn\" rel=\"external_link\" target=\"_blank\">Pinard horn<\/a> after French <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obstetrician\" class=\"mw-redirect\" title=\"Obstetrician\" rel=\"external_link\" target=\"_blank\">obstetrician<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adolphe_Pinard\" title=\"Adolphe Pinard\" rel=\"external_link\" target=\"_blank\">Adolphe Pinard<\/a> (1844\u20131934).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Doppler\">Doppler<\/span><\/h3>\n<p>A Doppler stethoscope is an electronic device that measures the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Doppler_effect\" title=\"Doppler effect\" rel=\"external_link\" target=\"_blank\">Doppler effect<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasound<\/a> waves reflected from organs within the body. Motion is detected by the change in frequency, due to the Doppler effect, of the reflected waves. Hence the Doppler stethoscope is particularly suited to deal with moving objects such as a beating heart.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\nIt was recently demonstrated that continuous Doppler enables the auscultation of valvular movements and blood flow sounds that are undetected during cardiac examination with a stethoscope in adults. The Doppler auscultation presented a sensitivity of 84% for the detection of aortic regurgitations while classic stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was superior in the detection of impaired ventricular relaxation. Since the physics of Doppler auscultation and classic auscultation are different, it has been suggested that both methods could complement each other.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\nA military noise-immune Doppler based stethoscope has recently been developed for auscultation of patients in loud sound environments (up to 110 dB).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"3D-printed\">3D-printed<\/span><\/h3>\n<p>A <b>3D-printed stethoscope<\/b> is an open-source medical device meant for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auscultation\" title=\"Auscultation\" rel=\"external_link\" target=\"_blank\">auscultation<\/a> and manufactured via means of <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a>.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> The 3D stethoscope was developed by Dr. Tarek Loubani and a team of medical and technology specialists. The 3D-stethoscope was developed as part of the Glia project, and its design is open source from the outset. The stethoscope gained widespread media coverage in Summer 2015.\n<\/p><p>The need for a 3D-stethoscope was borne out of a lack of stethoscopes and other vital medical equipment because of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blockade_of_the_Gaza_Strip\" title=\"Blockade of the Gaza Strip\" rel=\"external_link\" target=\"_blank\">blockade of the Gaza Strip<\/a>, where Loubani, a Palestinian-Canadian, worked as an emergency physician during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operation_Pillar_of_Defense\" title=\"Operation Pillar of Defense\" rel=\"external_link\" target=\"_blank\">the 2012 conflict in Gaza<\/a>. The 1960s-era <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/David_Littmann\" title=\"David Littmann\" rel=\"external_link\" target=\"_blank\">Littmann Cardiology 3<\/a><\/i> stethoscope became the basis for the 3D-printed stethoscope developed by Loubani.<sup id=\"rdp-ebb-cite_ref-TheRegister_26-0\" class=\"reference\"><a href=\"#cite_note-TheRegister-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Earpieces\">Earpieces<\/span><\/h2>\n<p>Stethoscopes usually have rubber earpieces, which aid comfort and create a seal with the ear, improving the acoustic function of the device. Stethoscopes can be modified by replacing the standard earpieces with moulded versions, which improve comfort and transmission of sound. Moulded earpieces can be cast by an audiologist or made by the stethoscope user from a kit.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nuvola_apps_package_favorite.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d8\/Nuvola_apps_package_favorite.svg\/28px-Nuvola_apps_package_favorite.svg.png\" width=\"28\" height=\"28\" class=\"noviewer\" \/><\/a><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Health\" class=\"mw-redirect\" title=\"Portal:Health\" rel=\"external_link\" target=\"_blank\">Health portal<\/a><\/span><\/li>\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/12px-WHO_Rod.svg.png\" width=\"12\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine\" title=\"Portal:Medicine\" rel=\"external_link\" target=\"_blank\">Medicine portal<\/a><\/span><\/li><\/ul><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Doppler_fetal_monitor\" title=\"Doppler fetal monitor\" rel=\"external_link\" target=\"_blank\">Doppler fetal monitor<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Speaking_tube\" title=\"Speaking tube\" rel=\"external_link\" target=\"_blank\">Speaking tube<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Wade2008-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Wade2008_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Wade2008_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Wade2008_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wade, Nicholas J.; Deutsch, Diana (July 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/acousticstoday.org\/wp-content\/uploads\/2017\/07\/Article_2of3_from_ATCODK_4_3.pdf\" target=\"_blank\">\"Binaural Hearing \u2013 Before and After the Stethophone\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Acoustics Today<\/i>: 16\u201327.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acoustics+Today&rft.atitle=Binaural+Hearing+%E2%80%93+Before+and+After+the+Stethophone&rft.pages=16-27&rft.date=2008-07&rft.aulast=Wade&rft.aufirst=Nicholas+J.&rft.au=Deutsch%2C+Diana&rft_id=http%3A%2F%2Facousticstoday.org%2Fwp-content%2Fuploads%2F2017%2F07%2FArticle_2of3_from_ATCODK_4_3.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Laennec, Ren\u00e9 (1819). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&f=false\"><i>De l'auscultation m\u00e9diate ou trait\u00e9 du diagnostic des maladies des poumon et du coeur<\/i><\/a>. Paris: Brosson & Chaud\u00e9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=De+l%27auscultation+m%C3%A9diate+ou+trait%C3%A9+du+diagnostic+des+maladies+des+poumon+et+du+coeur&rft.place=Paris&rft.pub=Brosson+%26+Chaud%C3%A9&rft.date=1819&rft.aulast=Laennec&rft.aufirst=Ren%C3%A9&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DTtTTeKls2bUC%26pg%3DPR5%23v%3Donepage%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Laennec_Forbes_translation-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Laennec_Forbes_translation_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">'Laennec, R. T. H.; Forbes, John, Sir, <i><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\">A Treatise on the Diseases of the Chest and on Mediate Auscultation<\/a><\/i> (1835). New York : Samuel Wood & Sons ; Philadelphia : Desilver, Thomas & Co. .<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Roguin A (September 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1570491\" target=\"_blank\">\"Rene Theophile Hyacinthe La\u00ebnnec (1781\u20131826): The Man Behind the Stethoscope\"<\/a>. <i>Clin Med Res<\/i>. <b>4<\/b> (3): 230\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3121%2Fcmr.4.3.230\" target=\"_blank\">10.3121\/cmr.4.3.230<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1570491\" target=\"_blank\">1570491<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17048358\" target=\"_blank\">17048358<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin+Med+Res&rft.atitle=Rene+Theophile+Hyacinthe+La%C3%ABnnec+%281781%E2%80%931826%29%3A+The+Man+Behind+the+Stethoscope&rft.volume=4&rft.issue=3&rft.pages=230-5&rft.date=2006-09&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1570491&rft_id=info%3Apmid%2F17048358&rft_id=info%3Adoi%2F10.3121%2Fcmr.4.3.230&rft.au=Roguin+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1570491&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-picard-victorian-london-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-picard-victorian-london_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Liza_Picard\" title=\"Liza Picard\" rel=\"external_link\" target=\"_blank\">Picard, Liza<\/a> (2005). <i>Victorian London: the life of a city, 1840\u20131870<\/i>. London: Weidenfeld & Nicolson. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0297847335.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Victorian+London%3A+the+life+of+a+city%2C+1840%E2%80%931870&rft.place=London&rft.pub=Weidenfeld+%26+Nicolson&rft.date=2005&rft.isbn=978-0297847335&rft.aulast=Picard&rft.aufirst=Liza&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Risse, Guenter (1999). <i>Mending Bodies, Saving Souls<\/i>. Oxford: Oxford University Press. p. 316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-19-505523-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mending+Bodies%2C+Saving+Souls&rft.place=Oxford&rft.pages=316&rft.pub=Oxford+University+Press&rft.date=1999&rft.isbn=978-0-19-505523-8&rft.aulast=Risse&rft.aufirst=Guenter&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Foreign_Medicine_and_Surgery_1820-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Foreign_Medicine_and_Surgery_1820_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\">\"Laennec's new system of diagnosis\"<\/a>, <i>The Quarterly Journal of Foreign Medicine and Surgery and of the Sciences Connected with Them<\/i>, <b>2<\/b>: 51\u201368, 1820.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Quarterly+Journal+of+Foreign+Medicine+and+Surgery+and+of+the+Sciences+Connected+with+Them&rft.atitle=Laennec%27s+new+system+of+diagnosis&rft.volume=2&rft.pages=51-68&rft.date=1820&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DLNVLAAAAYAAJ%26dq%3Dstethoscope%26pg%3DPA58%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Wilks, p. 490, cites Comins, \"A flexible stethoscope\", <i>Lancet<\/i> 29 August 1829.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Samuel Wilks, \"Evolution of the stethoscope\", <i>Popular Science<\/i>, <b>vol. 22<\/b>, no. 28, pp. 488\u201391, Feb 1883 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/search?fq=x0:jrnl&q=n2:0161-7370\" target=\"_blank\">0161-7370<\/a>.<br \/>Golding Bird, <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=true\">\"Advantages presented by the employment of a stethoscope with a flexible tube\"<\/a>, <i>London Medical Gazette<\/i>, <b>vol. 1<\/b>, pp. 440\u201312, 11 December 1840.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Duffin, Jacalyn. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ww3.tvo.org\/video\/182217\/jacalyn-duffin-history-stethoscope\" target=\"_blank\">\"Big Ideas: Jacalyn Duffin on the History of the Stethoscope\"<\/a>. TVO<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Big+Ideas%3A+Jacalyn+Duffin+on+the+History+of+the+Stethoscope&rft.pub=TVO&rft.aulast=Duffin&rft.aufirst=Jacalyn&rft_id=http%3A%2F%2Fww3.tvo.org%2Fvideo%2F182217%2Fjacalyn-duffin-history-stethoscope&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/solutions.3m.com\/wps\/portal\/3M\/en_US\/Littmann\/stethoscope\/products\/history\/\" target=\"_blank\">\"History of Littmann Stethoscopes at a glance\"<\/a>. 3M.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-01-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=History+of+Littmann+Stethoscopes+at+a+glance&rft.pub=3M.com&rft_id=http%3A%2F%2Fsolutions.3m.com%2Fwps%2Fportal%2F3M%2Fen_US%2FLittmann%2Fstethoscope%2Fproducts%2Fhistory%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.trimline.us\" target=\"_blank\">\"TRIMLINE Medical Products\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-01-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=TRIMLINE+Medical+Products&rft_id=http%3A%2F%2Fwww.trimline.us&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jmir.org\/2012\/4\/e100\/\" target=\"_blank\">\"Impact of the Presence of Medical Equipment in Images on Viewers' Perceptions of the Trustworthiness of an Individual On-Screen\"<\/a>. <i>Journal of Medical Internet Research (JMIR)<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 September<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Journal+of+Medical+Internet+Research+%28JMIR%29&rft.atitle=Impact+of+the+Presence+of+Medical+Equipment+in+Images+on+Viewers%E2%80%99+Perceptions+of+the+Trustworthiness+of+an+Individual+On-Screen&rft_id=http%3A%2F%2Fwww.jmir.org%2F2012%2F4%2Fe100%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid_15571638-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid_15571638_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFWilkins2004\" class=\"citation\">Wilkins, RL (2004), \"Is the stethoscope on the verge of becoming obsolete?\", <i>Respir Care<\/i>, <b>49<\/b> (12): 1488\u20131489, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15571638\" target=\"_blank\">15571638<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Respir+Care&rft.atitle=Is+the+stethoscope+on+the+verge+of+becoming+obsolete%3F&rft.volume=49&rft.issue=12&rft.pages=1488-1489&rft.date=2004&rft_id=info%3Apmid%2F15571638&rft.aulast=Wilkins&rft.aufirst=RL&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Respir_Care_2005_50_5_660-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Respir_Care_2005_50_5_660_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFMurphy2005\" class=\"citation\">Murphy, R (2005), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/rc.rcjournal.com\/content\/50\/5\/660.full.pdf+html\" target=\"_blank\">\"The stethoscope \u2013 obsolescence or marriage?\"<\/a>, <i>Respir Care<\/i>, <b>50<\/b> (5): 660\u2013661.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Respir+Care&rft.atitle=The+stethoscope+%E2%80%93+obsolescence+or+marriage%3F&rft.volume=50&rft.issue=5&rft.pages=660-661&rft.date=2005&rft.aulast=Murphy&rft.aufirst=R&rft_id=http%3A%2F%2Frc.rcjournal.com%2Fcontent%2F50%2F5%2F660.full.pdf%2Bhtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Bernstein_2016-01-02-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Bernstein_2016-01-02_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bernstein_2016-01-02_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bernstein_2016-01-02_16-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFBernstein2016\" class=\"citation\">Bernstein, Lenny (2016-01-02), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.washingtonpost.com\/national\/health-science\/heart-doctors-are-listening-for-clues-to-the-future-of-their-stethoscopes\/2016\/01\/02\/bd73b000-a98d-11e5-8058-480b572b4aae_story.html\" target=\"_blank\">\"Heart doctors are listening for clues to the future of their stethoscopes\"<\/a>, <i>Washington Post<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Washington+Post&rft.atitle=Heart+doctors+are+listening+for+clues+to+the+future+of+their+stethoscopes&rft.date=2016-01-02&rft.aulast=Bernstein&rft.aufirst=Lenny&rft_id=https%3A%2F%2Fwww.washingtonpost.com%2Fnational%2Fhealth-science%2Fheart-doctors-are-listening-for-clues-to-the-future-of-their-stethoscopes%2F2016%2F01%2F02%2Fbd73b000-a98d-11e5-8058-480b572b4aae_story.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Palaniappan R, Sundaraj K, Ahamed NU, Arjunan A, Sundaraj S. Computer-based Respiratory Sound Analysis: A Systematic Review. IETE Tech Rev 2013;30:248\u201356<\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bianca K. Chung, Brad Tritle, \"The power of mobile devices and patient engagement\", <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=7YMsAgAAQBAJ&pg=PA93\" target=\"_blank\">p. 93<\/a>, chapter 8 in Jan Oldenburg (ed), <i>Engage! Transforming Healthcare Through Digital Patient Engagement<\/i>, Himss Books, 2012 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1938904397.<\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">William Hanson, <i>Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health Care<\/i>, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=FKlKjUgduP0C&pg=PA22\" target=\"_blank\">pp. 20\u201322<\/a>, Macmillan, 2011 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0230120938.<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Matt McFarland, \"Eko\u2019s stethoscope shows the potential of digital technology to reinvent health care\", <a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/www.washingtonpost.com\/news\/innovations\/wp\/2015\/09\/02\/ekos-stethoscope-shows-the-potential-of-digital-technology-to-reinvent-health-care\/\" target=\"_blank\">[1]<\/a>, Washington Post<\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Arup Kumar Majhi (2016-08-16). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=-7zfDAAAQBAJ&pg=PA47\" target=\"_blank\"><i>Bedside Clinics In Obstetrics<\/i><\/a>. Academic Publishers. pp. 47\u2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-93-83420-87-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Bedside+Clinics+In+Obstetrics&rft.pages=47-&rft.pub=Academic+Publishers&rft.date=2016-08-16&rft.isbn=978-93-83420-87-2&rft.au=Arup+Kumar+Majhi&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D-7zfDAAAQBAJ%26pg%3DPA47&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">S. Ananthi, <i>A Textbook of Medical Instruments<\/i>, pp. 290\u201396, New Age International, 2006 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 8122415725.<\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mc Loughlin MJ and Mc Loughlin S. Cardiac auscultation: Preliminary findings of a pilot study using continuous Wave Doppler and comparison with classic auscultation Int J Cardiol. 2013 Jul 31; 167(2):5 90\u201391<\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.amazon.com\/Cardiac-Auscultation-Continuous-Stethoscope-ebook\/dp\/B00AXFB2IG\/ref=sr_1_3?s=digital-text&ie=UTF8&qid=1369946217&sr=1-3&keywords=mario+mc+loughlin\" target=\"_blank\">\"Amazon.com: Cardiac Auscultation With Continuous Wave Doppler Stethoscope: A new method 200 years after Laennec's invention eBook: Mario Jorge Mc Loughlin, Santiago Mc Loughlin: Kindle Store\"<\/a>. <i>amazon.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 September<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=amazon.com&rft.atitle=Amazon.com%3A+Cardiac+Auscultation+With+Continuous+Wave+Doppler+Stethoscope%3A+A+new+method+200+years+after+Laennec%27s+invention+eBook%3A+Mario+Jorge+Mc+Loughlin%2C+Santiago+Mc+Loughlin%3A+Kindle+Store&rft_id=https%3A%2F%2Fwww.amazon.com%2FCardiac-Auscultation-Continuous-Stethoscope-ebook%2Fdp%2FB00AXFB2IG%2Fref%3Dsr_1_3%3Fs%3Ddigital-text%26ie%3DUTF8%26qid%3D1369946217%26sr%3D1-3%26keywords%3Dmario%2Bmc%2Bloughlin&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/github.com\/GliaX\/Stethoscope\" target=\"_blank\">Official project site<\/a> at GitHub<\/span>\n<\/li>\n<li id=\"cite_note-TheRegister-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-TheRegister_26-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Pauli, Darren (2015-08-14). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theregister.co.uk\/2015\/08\/14\/printed_stethoscope_cccamp\/\" target=\"_blank\">\"Gazan medico team 3D-prints world-leading stethoscope for 30c\"<\/a>. United Kingdom: The Register<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-08-17<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Gazan+medico+team+3D-prints+world-leading+stethoscope+for+30c&rft.date=2015-08-14&rft.aulast=Pauli&rft.aufirst=Darren&rft_id=https%3A%2F%2Fwww.theregister.co.uk%2F2015%2F08%2F14%2Fprinted_stethoscope_cccamp%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStethoscope\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.med.ucla.edu\/wilkes\/intro.html\" target=\"_blank\">The Auscultation Assistant<\/a>, provides heart sounds, heart murmurs, and breath sounds in order to help medical students and others improve their physical diagnosis skills<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/depts.washington.edu\/physdx\/heart\/demo.html\" target=\"_blank\">Demonstrations: Heart Sounds & Murmurs<\/a> University of Washington School of Medicine<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dig.library.vcu.edu\/cdm\/search\/collection\/mar\/searchterm\/stethoscopes\/field\/subjec\/mode\/all\/conn\/and\/order\/title\" target=\"_blank\">VCU Libraries Medical Artifacts Collection: Stethoscopes<\/a><\/li>\n<li>\"The invention of the stethoscope: A milestone in cardiology\", analysis of Laennec's text (1819) on <i><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bibnum.education.fr\/sciencesdelavie\/medecine-clinique\/de-l-auscultation-mediate\" target=\"_blank\">BibNum<\/a><\/i> <small>[click '\u00e0 t\u00e9l\u00e9charger' for English version]<\/small>.<\/li><\/ul>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1253\nCached time: 20181217161905\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.440 seconds\nReal time usage: 0.588 seconds\nPreprocessor visited node count: 2084\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 86897\/2097152 bytes\nTemplate argument size: 853\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 55662\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.182\/10.000 seconds\nLua memory usage: 7.42 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 421.591 1 -total\n<\/p>\n<pre>61.78% 260.450 1 Template:Reflist\n21.69% 91.424 2 Template:Cite_journal\n 9.44% 39.796 4 Template:Navbox\n 9.42% 39.711 1 Template:ISSN\n 6.82% 28.737 1 Template:Health_care\n 6.74% 28.400 1 Template:Convert\n 6.09% 25.691 4 Template:Catalog_lookup_link\n 5.68% 23.926 4 Template:Citation\n 5.52% 23.251 3 Template:ISBN\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:28714-1!canonical and timestamp 20181217161905 and revision id 871950832\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Stethoscope\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214633\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.160 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 151.402 1 - wikipedia:Stethoscope\n100.00% 151.402 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8531-0!*!*!*!*!*!* and timestamp 20181217214633 and revision id 24956\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Stethoscope\">https:\/\/www.limswiki.org\/index.php\/Stethoscope<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ec9f11e03c504147cf9b12f3a830c694_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d2\/Stethoscope-2.png\/440px-Stethoscope-2.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Laennecs_stethoscope%2C_c_1820._%289660576833%29.jpg\/440px-Laennecs_stethoscope%2C_c_1820._%289660576833%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f0\/H%C3%B6rrohr_Stethoskop_Meyers_1890.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Toraube2.jpg\/360px-Toraube2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/1\/1d\/Early_flexible_stethoscopes.jpg\/440px-Early_flexible_stethoscopes.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6d\/Standardized-Patient-Program-examining-t_he-abdomen.jpg\/440px-Standardized-Patient-Program-examining-t_he-abdomen.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Stethoscope.svg\/440px-Stethoscope.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ef\/Stethoscope_pink.JPG\/300px-Stethoscope_pink.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b0\/Pinard_horn_Uganda_US_Army_nurse.jpg\/300px-Pinard_horn_Uganda_US_Army_nurse.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d8\/Nuvola_apps_package_favorite.svg\/56px-Nuvola_apps_package_favorite.svg.png"],"ec9f11e03c504147cf9b12f3a830c694_timestamp":1545083193,"72d9ba12bb6959b1256cad03177fab61_type":"article","72d9ba12bb6959b1256cad03177fab61_title":"Sphygmomanometer","72d9ba12bb6959b1256cad03177fab61_url":"https:\/\/www.limswiki.org\/index.php\/Sphygmomanometer","72d9ba12bb6959b1256cad03177fab61_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSphygmomanometer\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n Sanitas BP 120\/74 mmHg as result on electronic sphygmomanometer\n Aneroid sphygmomanometer with an adult cuff\n Aneroid sphygmomanometer dial, bulb, and air valve\n Clinical mercury manometer\n Clinical WelchAllyn sphygmomanometer\n\nA sphygmomanometer, also known as a blood pressure meter, blood pressure monitor, or blood pressure gauge, is a device used to measure blood pressure, composed of an inflatable cuff to collapse and then release the artery under the cuff in a controlled manner,[1] and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. Manual sphygmomanometers are used in conjunction with a stethoscope.\nA sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or aneroid gauge), and a mechanism for inflation which may be a manually operated bulb and valve or a pump operated electrically.\n\nContents \n\n1 Types \n\n1.1 Manual \n1.2 Digital \n\n\n2 Operation \n3 Significance \n4 History \n5 Etymology \n6 References \n7 External links \n\n\nTypes \nBoth manual and digital meters are currently employed, with different trade-offs in accuracy versus convenience.\n\nManual \nA stethoscope is generally required for auscultation (see below). Manual meters are used by trained practitioners, and, while it is possible to obtain a basic reading through palpation alone, this only yields the systolic pressure.\n\nMercury sphygmomanometers are considered the gold standard. They show blood pressure by affecting the height of a column of mercury, which does not require recalibration.[2] Because of their accuracy, they are often used in clinical trials of drugs and in clinical evaluations of high-risk patients, including pregnant women. A wall mounted mercury sphygmomanometer is also known as a Baumanometer.[3]\nAneroid sphygmomanometers (mechanical types with a dial) are in common use; they may require calibration checks, unlike mercury manometers. Aneroid sphygmomanometers are considered safer than mercury sphygmomanometers, although inexpensive ones are less accurate.[4] A major cause of departure from calibration is mechanical jarring. Aneroids mounted on walls or stands are not susceptible to this particular problem.\nDigital \nDigital meters employ oscillometric measurements and electronic calculations rather than auscultation. They may use manual or automatic inflation, but both types are electronic, easy to operate without training, and can be used in noisy environments. They measure systolic and diastolic pressures by oscillometric detection, employing either deformable membranes that are measured using differential capacitance, or differential piezoresistance, and they include a microprocessor.[5] They accurately measure mean blood pressure and pulse rate, while systolic and diastolic pressures are obtained less accurately than with manual meters,[6] and calibration is also a concern.[7][8][9] Digital oscillometric monitors may not be advisable for some patients, such as those suffering from arteriosclerosis, arrhythmia, preeclampsia, pulsus alternans, and pulsus paradoxus, as their calculations may not correct for these conditions,[citation needed ] and in these cases, an analog sphygmomanometer is preferable when used by a trained person. Digital instruments may use a cuff placed, in order of accuracy[10] and inverse order of portability and convenience, around the upper arm, the wrist, or a finger.[11] Recently, a group of researchers at Michigan State University developed a smartphone based device that uses oscillometry to estimate blood pressure.[12][13]The oscillometric method of detection used gives blood pressure readings that differ from those determined by auscultation, and vary according to many factors, such as pulse pressure, heart rate and arterial stiffness,[14] although some instruments are claimed also to measure arterial stiffness, and some can detect irregular heartbeats.\n\nOperation \n Medical student taking blood pressure at the brachial artery\nIn humans, the cuff is normally placed smoothly and snugly around an upper arm, at roughly the same vertical height as the heart while the subject is seated with the arm supported. Other sites of placement depend on species, it may include the flipper or tail. It is essential that the correct size of cuff is selected for the patient. Too small a cuff results in too high a pressure, while too large a cuff results in too low a pressure. For clinical measurements it is usual to measure and record both arms in the initial consultation to determine if the pressure is significantly higher in one arm than the other. A difference of 10 mm Hg may be a sign of coarctation of the aorta. If the arms read differently, the higher reading arm would be used for later readings.[citation needed ] The cuff is inflated until the artery is completely occluded.\nWith a manual instrument, listening with a stethoscope to the brachial artery at the elbow, the examiner slowly releases the pressure in the cuff. As the pressure in the cuffs falls, a \"whooshing\" or pounding sound is heard (see Korotkoff sounds) when blood flow first starts again in the artery. The pressure at which this sound began is noted and recorded as the systolic blood pressure. The cuff pressure is further released until the sound can no longer be heard. This is recorded as the diastolic blood pressure. In noisy environments where auscultation is impossible (such as the scenes often encountered in emergency medicine), systolic blood pressure alone may be read by releasing the pressure until a radial pulse is palpated (felt). In veterinary medicine, auscultation is rarely of use, and palpation or visualization of pulse distal to the sphygmomanometer is used to detect systolic pressure.\nDigital instruments use a cuff which may be placed, according to the instrument, around the upper arm, wrist, or a finger, in all cases elevated to the same height as the heart. They inflate the cuff and gradually reduce the pressure in the same way as a manual meter, and measure blood pressures by the oscillometric method.[5]\n\nSignificance \nMain article: Blood pressure\nBy observing the mercury in the column while releasing the air pressure with a control valve, one can read the values of the blood pressure in mm Hg. The peak pressure in the arteries during the cardiac cycle is the systolic pressure, and the lowest pressure (at the resting phase of the cardiac cycle) is the diastolic pressure. A stethoscope is used in the auscultatory method. Systolic pressure (first phase) is identified with the first of the continuous Korotkoff sounds. Diastolic pressure is identified at the moment the Korotkoff sounds disappear (fifth phase).\nMeasurement of the blood pressure is carried out in the diagnosis and treatment of hypertension (high blood pressure), and in many other healthcare scenarios.\n\n\n\n Medical portal \nHistory \n A French sphygmomanometer used during World War I\nThe sphygmomanometer was invented by Samuel Siegfried Karl Ritter von Basch in the year 1881.[1] Scipione Riva-Rocci introduced a more easily used version in 1896. In 1901, pioneering neurosurgeon Dr. Harvey Cushing brought an example of Riva-Rocci's device to the USA, modernized it and popularized it within the medical community. Further improvement came in 1905 when Russian physician Nikolai Korotkov included diastolic blood pressure measurement following his discovery of \"Korotkoff sounds.\" William A. Baum invented the Baumanometer in 1915, while working for a doctors' group that handled insurance and employment physicals.[3]\n\nEtymology \nThe word sphygmomanometer (\/\u02cc s f \u026a \u0261 m o\u028a m \u0259 \u02c8 n \u0252 m \u026a t \u0259r \/ , SFIG -moh-m\u0259-NOM -i-t\u0259r) uses the combining form of sphygmo- + manometer. The roots involved are as follows: Greek \u03c3\u03c6\u03c5\u03b3\u03bc\u03cc\u03c2 sphygmos \"pulse\", plus the scientific term manometer (from French manom\u00e8tre), i.e. \"pressure meter\", itself coined from \u03bc\u03b1\u03bd\u03cc\u03c2 manos \"thin, sparse\", and \u03bc\u03ad\u03c4\u03c1\u03bf\u03bd metron \"measure\".[15][16][17]\nMost sphygmomanometers were mechanical gauges with dial faces during the first half of the 20th century. Since the advent of electronic medical devices, names such as \"meter\" and \"monitor\" can also apply, as devices can automatically monitor blood pressure on an ongoing basis.\n\nReferences \n\n\n^ a b Booth, J (1977). \"A short history of blood pressure measurement\". Proceedings of the Royal Society of Medicine. 70 (11): 793\u20139. PMC 1543468 . PMID 341169. \n\n^ \"Comparing Mercury and Aneroid Sphygmomanometers\". Sustainable Hospitals \/ Lowell Center for Sustainable Production. Sustainable Hospitals \/ Lowell Center for Sustainable Production. 2003. Retrieved 23 February 2015 . \n\n^ a b \"Turning Mercury Into Solid Gold\". nytimes.com. 2005-03-27. Retrieved 2018-07-05 . \n\n^ Misrin, J. \"Aneroid Sphygmomanometer: A Battle for Safer Blood Pressure Apparatus\". Retrieved 27 February 2012 . \n\n^ a b Oscillometry, Explanation of oscillometric detection in Medical Electronics, N Townsend, p48-51 \n\n^ \"Oscillometric Method - Methods of Blood Pressure Measurement - Measurement of Blood PressureMethods of Blood Pressure Measurement -\". www.severehypertension.net. Retrieved 2017-04-13 . \n\n^ Can we trust automatic sphygmomanometer validations?\nTurner MJ.\nJournal of Hypertension. 28(12), December 2010, pp. 2353\u20132356\ndoi: 10.1097\/HJH.0b013e32833e1011. \n\n^ Automated Sphygmomanometers Should Not Replace Manual Ones, Based on Current Evidence\nMartin J. Turner and Johan M. van Schalkwyk\nAmerican Journal of Hypertension. 21(8), p. 845. \n\n^ Sphygmomanometer calibration--why, how and how often?\nTurner MJ1, Speechly C, Bignell N.\nAustralian Family Physician. October 2007; 36(10):834-838. \n\n^ Inaccuracy of wrist-cuff oscillometric blood pressure devices: an arm position artefact? Adnan Mourad, Alastair Gillies, Shane Carney, Clinical methods and pathophysiology \n\n^ \"Blutdruckmessger\u00e4t - Handgelenk - Blutdruckmessger\u00e4t - Test\" (in German). Blutdruckmessgeraet-vergleich-test.de. Retrieved 27 September 2016 . \n\n^ Chandrasekhar, Anand (2018-03-07). \"Smartphone-based blood pressure monitoring via the oscillometric finger-pressing method\". Science Translational Medicine. 10 (431). doi:10.1126\/scitranslmed.aap8674. PMID 29515001. \n\n^ Chandrasekhar, Anand (2018-09-03). \"An iPhone Application for Blood Pressure Monitoring via the Oscillometric Finger Pressing Method\". Scientific Reports. 8 (1). doi:10.1038\/s41598-018-31632-x. \n\n^ van Montfrans GA. \"Oscillometric blood pressure measurement: progress and problems\". Blood Press Monit. 6: 287\u201390. PMID 12055403. \n\n^ Harper, Douglas. \"sphygmomanometer\". Online Etymology Dictionary. \n\n^ Harper, Douglas. \"manometer\". Online Etymology Dictionary. \n\n^ \u03c3\u03c6\u03c5\u03b3\u03bc\u03cc\u03c2 , \u03bc\u03b1\u03bd\u03cc\u03c2 , \u03bc\u03ad\u03c4\u03c1\u03bf\u03bd . Liddell, Henry George; Scott, Robert; A Greek\u2013English Lexicon at the Perseus Project. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Sphygmomanometers.\nUS patent 2560237, R. H. Miller, \"Sphygmomanometer\", issued 1951-07-10   \nUS patent 6752764, Man S. Oh, \"Pocket sphygmomanometer\", issued 2004-06-22   \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sphygmomanometer\">https:\/\/www.limswiki.org\/index.php\/Sphygmomanometer<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:25.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 566 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","72d9ba12bb6959b1256cad03177fab61_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sphygmomanometer skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sphygmomanometer<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"mw-stack stack-container stack-right mobile-float-reset\"><div style=\"overflow: hidden; margin: 1px;\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2017_Sfigmomanometr_elektroniczny.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3f\/2017_Sfigmomanometr_elektroniczny.jpg\/220px-2017_Sfigmomanometr_elektroniczny.jpg\" width=\"220\" height=\"166\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2017_Sfigmomanometr_elektroniczny.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sanitas BP 120\/74 <a href=\"https:\/\/en.wikipedia.org\/wiki\/MmHg\" class=\"mw-redirect\" title=\"MmHg\" rel=\"external_link\" target=\"_blank\">mmHg<\/a> as result on electronic sphygmomanometer<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sphygmomanometer%26Cuff.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ae\/Sphygmomanometer%26Cuff.JPG\/220px-Sphygmomanometer%26Cuff.JPG\" width=\"220\" height=\"144\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sphygmomanometer%26Cuff.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Aneroid sphygmomanometer with an adult cuff<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sphygmomanometer.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Sphygmomanometer.JPG\/220px-Sphygmomanometer.JPG\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sphygmomanometer.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Aneroid sphygmomanometer dial, bulb, and air valve<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Clinical_Mercury_Manometer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/16\/Clinical_Mercury_Manometer.jpg\/220px-Clinical_Mercury_Manometer.jpg\" width=\"220\" height=\"246\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Clinical_Mercury_Manometer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Clinical mercury manometer<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Advanced_Digital_Sphygmomanometer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f1\/Advanced_Digital_Sphygmomanometer.jpg\/220px-Advanced_Digital_Sphygmomanometer.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Advanced_Digital_Sphygmomanometer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Clinical WelchAllyn sphygmomanometer<\/div><\/div><\/div>\n<\/div><\/div>\n<p>A <b>sphygmomanometer<\/b>, also known as a <b>blood pressure meter<\/b>, <b>blood pressure monitor<\/b>, or <b>blood pressure gauge<\/b>, is a device used to measure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a>, composed of an inflatable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cuff\" title=\"Cuff\" rel=\"external_link\" target=\"_blank\">cuff<\/a> to collapse and then release the artery under the cuff in a controlled manner,<sup id=\"rdp-ebb-cite_ref-Booth1977_1-0\" class=\"reference\"><a href=\"#cite_note-Booth1977-1\" rel=\"external_link\">[1]<\/a><\/sup> and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">mercury<\/a> or mechanical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manometer\" class=\"mw-redirect\" title=\"Manometer\" rel=\"external_link\" target=\"_blank\">manometer<\/a> to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. Manual sphygmomanometers are used in conjunction with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stethoscope\" title=\"Stethoscope\" rel=\"external_link\" target=\"_blank\">stethoscope<\/a>.\n<\/p><p>A sphygmomanometer consists of an inflatable cuff, a measuring unit (the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_measurement#Liquid_column\" title=\"Pressure measurement\" rel=\"external_link\" target=\"_blank\">mercury manometer, or aneroid gauge<\/a>), and a mechanism for inflation which may be a manually operated bulb and valve or a pump operated electrically.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>Both manual and digital meters are currently employed, with different trade-offs in accuracy versus convenience.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Manual\">Manual<\/span><\/h3>\n<p>A stethoscope is generally required for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auscultation\" title=\"Auscultation\" rel=\"external_link\" target=\"_blank\">auscultation<\/a> (see below). Manual meters are used by trained practitioners, and, while it is possible to obtain a basic reading through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palpation\" title=\"Palpation\" rel=\"external_link\" target=\"_blank\">palpation<\/a> alone, this only yields the systolic pressure.\n<\/p>\n<ul><li>Mercury sphygmomanometers are considered the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gold_standard_(test)\" title=\"Gold standard (test)\" rel=\"external_link\" target=\"_blank\">gold standard<\/a>. They show blood pressure by affecting the height of a column of mercury, which does not require recalibration.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Because of their accuracy, they are often used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trial\" title=\"Clinical trial\" rel=\"external_link\" target=\"_blank\">clinical trials<\/a> of drugs and in clinical evaluations of high-risk patients, including pregnant women. A wall mounted mercury sphygmomanometer is also known as a <b>Baumanometer<\/b>.<sup id=\"rdp-ebb-cite_ref-nytimes_3-0\" class=\"reference\"><a href=\"#cite_note-nytimes-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Manometer#Aneroid\" class=\"mw-redirect\" title=\"Manometer\" rel=\"external_link\" target=\"_blank\">Aneroid<\/a> sphygmomanometers (mechanical types with a dial) are in common use; they may require calibration checks, unlike mercury manometers. Aneroid sphygmomanometers are considered safer than mercury sphygmomanometers, although inexpensive ones are less accurate.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> A major cause of departure from calibration is mechanical jarring. Aneroids mounted on walls or stands are not susceptible to this particular problem.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Digital\">Digital<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_data\" title=\"Digital data\" rel=\"external_link\" target=\"_blank\">Digital<\/a> meters employ <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure_measurement#Oscillometric\" title=\"Blood pressure measurement\" rel=\"external_link\" target=\"_blank\">oscillometric<\/a> measurements and electronic calculations rather than auscultation. They may use manual or automatic inflation, but both types are electronic, easy to operate without training, and can be used in noisy environments. They measure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Systole_(medicine)\" class=\"mw-redirect\" title=\"Systole (medicine)\" rel=\"external_link\" target=\"_blank\">systolic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diastolic_pressure\" class=\"mw-redirect\" title=\"Diastolic pressure\" rel=\"external_link\" target=\"_blank\">diastolic pressures<\/a> by oscillometric detection, employing either deformable membranes that are measured using differential capacitance, or differential piezoresistance, and they include a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microprocessor\" title=\"Microprocessor\" rel=\"external_link\" target=\"_blank\">microprocessor<\/a>.<sup id=\"rdp-ebb-cite_ref-oscillometric_5-0\" class=\"reference\"><a href=\"#cite_note-oscillometric-5\" rel=\"external_link\">[5]<\/a><\/sup> They accurately measure mean blood pressure and pulse rate, while systolic and diastolic pressures are obtained less accurately than with manual meters,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> and calibration is also a concern.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Digital oscillometric monitors may not be advisable for some patients, such as those suffering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arteriosclerosis\" title=\"Arteriosclerosis\" rel=\"external_link\" target=\"_blank\">arteriosclerosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_arrhythmia\" title=\"Heart arrhythmia\" rel=\"external_link\" target=\"_blank\">arrhythmia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Preeclampsia\" class=\"mw-redirect\" title=\"Preeclampsia\" rel=\"external_link\" target=\"_blank\">preeclampsia<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsus_alternans\" title=\"Pulsus alternans\" rel=\"external_link\" target=\"_blank\">pulsus alternans<\/a><\/i>, and <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsus_paradoxus\" title=\"Pulsus paradoxus\" rel=\"external_link\" target=\"_blank\">pulsus paradoxus<\/a><\/i>, as their calculations may not correct for these conditions,<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2012)\">citation needed<\/span><\/a><\/i>]<\/sup> and in these cases, an analog sphygmomanometer is preferable when used by a trained person. Digital instruments may use a cuff placed, in order of accuracy<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> and inverse order of portability and convenience, around the upper arm, the wrist, or a finger.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> Recently, a group of researchers at Michigan State University developed a smartphone based device that uses oscillometry to estimate blood pressure.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>The oscillometric method of detection used gives blood pressure readings that differ from those determined by auscultation, and vary according to many factors, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_pressure\" title=\"Pulse pressure\" rel=\"external_link\" target=\"_blank\">pulse pressure<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_rate\" title=\"Heart rate\" rel=\"external_link\" target=\"_blank\">heart rate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_stiffness\" title=\"Arterial stiffness\" rel=\"external_link\" target=\"_blank\">arterial stiffness<\/a>,<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> although some instruments are claimed also to measure arterial stiffness, and some can detect irregular heartbeats.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Operation\">Operation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MMSA_Checking_Blood_Pressure.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/1\/13\/MMSA_Checking_Blood_Pressure.JPG\/220px-MMSA_Checking_Blood_Pressure.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MMSA_Checking_Blood_Pressure.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Medical student taking blood pressure at the brachial artery<\/div><\/div><\/div>\n<p>In humans, the cuff is normally placed smoothly and snugly around an upper <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arm\" title=\"Arm\" rel=\"external_link\" target=\"_blank\">arm<\/a>, at roughly the same vertical height as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> while the subject is seated with the arm supported. Other sites of placement depend on species, it may include the flipper or tail. It is essential that the correct size of cuff is selected for the patient. Too small a cuff results in too high a pressure, while too large a cuff results in too low a pressure. For clinical measurements it is usual to measure and record both arms in the initial consultation to determine if the pressure is significantly higher in one arm than the other. A difference of 10 mm Hg may be a sign of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coarctation_of_the_aorta\" title=\"Coarctation of the aorta\" rel=\"external_link\" target=\"_blank\">coarctation of the aorta<\/a>. If the arms read differently, the higher reading arm would be used for later readings.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> The cuff is inflated until the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> is completely <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_occlusion\" title=\"Vascular occlusion\" rel=\"external_link\" target=\"_blank\">occluded<\/a>.\n<\/p><p>With a manual instrument, listening with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stethoscope\" title=\"Stethoscope\" rel=\"external_link\" target=\"_blank\">stethoscope<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brachial_artery\" title=\"Brachial artery\" rel=\"external_link\" target=\"_blank\">brachial artery<\/a> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elbow-joint\" class=\"mw-redirect\" title=\"Elbow-joint\" rel=\"external_link\" target=\"_blank\">elbow<\/a>, the examiner slowly releases the pressure in the cuff. As the pressure in the cuffs falls, a \"whooshing\" or pounding sound is heard (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Korotkoff_sounds\" title=\"Korotkoff sounds\" rel=\"external_link\" target=\"_blank\">Korotkoff sounds<\/a>) when blood flow first starts again in the artery. The pressure at which this sound began is noted and recorded as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Systolic_blood_pressure\" class=\"mw-redirect\" title=\"Systolic blood pressure\" rel=\"external_link\" target=\"_blank\">systolic blood pressure<\/a>. The cuff pressure is further released until the sound can no longer be heard. This is recorded as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diastolic_blood_pressure\" class=\"mw-redirect\" title=\"Diastolic blood pressure\" rel=\"external_link\" target=\"_blank\">diastolic blood pressure<\/a>. In noisy environments where auscultation is impossible (such as the scenes often encountered in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_medicine\" title=\"Emergency medicine\" rel=\"external_link\" target=\"_blank\">emergency medicine<\/a>), systolic blood pressure alone may be read by releasing the pressure until a radial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse\" title=\"Pulse\" rel=\"external_link\" target=\"_blank\">pulse<\/a> is palpated (felt). In veterinary medicine, auscultation is rarely of use, and palpation or visualization of pulse distal to the sphygmomanometer is used to detect systolic pressure.\n<\/p><p>Digital instruments use a cuff which may be placed, according to the instrument, around the upper arm, wrist, or a finger, in all cases elevated to the same height as the heart. They inflate the cuff and gradually reduce the pressure in the same way as a manual meter, and measure blood pressures by the oscillometric method.<sup id=\"rdp-ebb-cite_ref-oscillometric_5-1\" class=\"reference\"><a href=\"#cite_note-oscillometric-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Significance\">Significance<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">Blood pressure<\/a><\/div>\n<p>By observing the mercury in the column while releasing the air pressure with a control valve, one can read the values of the blood pressure in mm Hg. The peak pressure in the arteries during the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_cycle\" title=\"Cardiac cycle\" rel=\"external_link\" target=\"_blank\">cardiac cycle<\/a> is the systolic pressure, and the lowest pressure (at the resting phase of the cardiac cycle) is the diastolic pressure. A stethoscope is used in the auscultatory method. Systolic pressure (first phase) is identified with the first of the continuous Korotkoff sounds. Diastolic pressure is identified at the moment the Korotkoff sounds disappear (fifth phase).\n<\/p><p>Measurement of the blood pressure is carried out in the diagnosis and treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypertension\" title=\"Hypertension\" rel=\"external_link\" target=\"_blank\">hypertension<\/a> (high blood pressure), and in many other healthcare scenarios.\n<\/p>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/fd\/Portal-puzzle.svg\/32px-Portal-puzzle.svg.png\" width=\"32\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medical\" class=\"mw-redirect\" title=\"Portal:Medical\" rel=\"external_link\" target=\"_blank\">Medical portal<\/a><\/span><\/li><\/ul><\/div>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sphygmomanometer_WWI_Memorial_de_Verdun.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Sphygmomanometer_WWI_Memorial_de_Verdun.JPG\/220px-Sphygmomanometer_WWI_Memorial_de_Verdun.JPG\" width=\"220\" height=\"244\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sphygmomanometer_WWI_Memorial_de_Verdun.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A French sphygmomanometer used during <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_War_I\" title=\"World War I\" rel=\"external_link\" target=\"_blank\">World War I<\/a><\/div><\/div><\/div>\n<p>The sphygmomanometer was invented by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Samuel_Siegfried_Karl_Ritter_von_Basch\" class=\"mw-redirect\" title=\"Samuel Siegfried Karl Ritter von Basch\" rel=\"external_link\" target=\"_blank\">Samuel Siegfried Karl Ritter von Basch<\/a> in the year 1881.<sup id=\"rdp-ebb-cite_ref-Booth1977_1-1\" class=\"reference\"><a href=\"#cite_note-Booth1977-1\" rel=\"external_link\">[1]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scipione_Riva-Rocci\" title=\"Scipione Riva-Rocci\" rel=\"external_link\" target=\"_blank\">Scipione Riva-Rocci<\/a> introduced a more easily used version in 1896. In 1901, pioneering <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurosurgeon\" class=\"mw-redirect\" title=\"Neurosurgeon\" rel=\"external_link\" target=\"_blank\">neurosurgeon<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvey_Williams_Cushing\" class=\"mw-redirect\" title=\"Harvey Williams Cushing\" rel=\"external_link\" target=\"_blank\">Dr. Harvey Cushing<\/a> brought an example of Riva-Rocci's device to the USA, modernized it and popularized it within the medical community. Further improvement came in 1905 when Russian physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nikolai_Korotkov\" title=\"Nikolai Korotkov\" rel=\"external_link\" target=\"_blank\">Nikolai Korotkov<\/a> included <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diastolic\" class=\"mw-redirect\" title=\"Diastolic\" rel=\"external_link\" target=\"_blank\">diastolic<\/a> blood pressure measurement following his discovery of \"Korotkoff sounds.\" William A. Baum invented the Baumanometer in 1915, while working for a doctors' group that handled insurance and employment physicals.<sup id=\"rdp-ebb-cite_ref-nytimes_3-1\" class=\"reference\"><a href=\"#cite_note-nytimes-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Etymology\">Etymology<\/span><\/h2>\n<p>The word <i>sphygmomanometer<\/i> (<span class=\"nowrap\"><span class=\"IPA nopopups noexcerpt\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Help:IPA\/English\" title=\"Help:IPA\/English\" rel=\"external_link\" target=\"_blank\">\/<span style=\"border-bottom:1px dotted\"><span title=\"\/\u02cc\/: secondary stress follows\">\u02cc<\/span><span title=\"'s' in 'sigh'\">s<\/span><span title=\"'f' in 'find'\">f<\/span><span title=\"\/\u026a\/: 'i' in 'kit'\">\u026a<\/span><span title=\"\/\u0261\/: 'g' in 'guy'\">\u0261<\/span><span title=\"'m' in 'my'\">m<\/span><span title=\"\/o\u028a\/: 'o' in 'code'\">o\u028a<\/span><span title=\"'m' in 'my'\">m<\/span><span title=\"\/\u0259\/: 'a' in 'about'\">\u0259<\/span><span title=\"\/\u02c8\/: primary stress follows\">\u02c8<\/span><span title=\"'n' in 'nigh'\">n<\/span><span title=\"\/\u0252\/: 'o' in 'body'\">\u0252<\/span><span title=\"'m' in 'my'\">m<\/span><span title=\"\/\u026a\/: 'i' in 'kit'\">\u026a<\/span><span title=\"'t' in 'tie'\">t<\/span><span title=\"\/\u0259r\/: 'er' in 'letter'\">\u0259r<\/span><\/span>\/<\/a><\/span><\/span>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Help:Pronunciation_respelling_key\" title=\"Help:Pronunciation respelling key\" rel=\"external_link\" target=\"_blank\"><i title=\"English pronunciation respelling\"><span style=\"font-size:90%\">SFIG<\/span>-moh-m\u0259-<span style=\"font-size:90%\">NOM<\/span>-i-t\u0259r<\/i><\/a>) uses the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Classical_compound\" title=\"Classical compound\" rel=\"external_link\" target=\"_blank\">combining form<\/a> of <i><a href=\"https:\/\/en.wiktionary.org\/wiki\/sphygm-#Prefix\" class=\"extiw\" title=\"wikt:sphygm-\" rel=\"external_link\" target=\"_blank\">sphygmo-<\/a><\/i> + <i><a href=\"https:\/\/en.wiktionary.org\/wiki\/manometer#Noun\" class=\"extiw\" title=\"wikt:manometer\" rel=\"external_link\" target=\"_blank\">manometer<\/a><\/i>. The roots involved are as follows: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_language\" title=\"Greek language\" rel=\"external_link\" target=\"_blank\">Greek<\/a> <span lang=\"el\" title=\"Greek language text\">\u03c3\u03c6\u03c5\u03b3\u03bc\u03cc\u03c2<\/span> <i>sphygmos<\/i> \"pulse\", plus the scientific term <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Manometer\" class=\"mw-redirect\" title=\"Manometer\" rel=\"external_link\" target=\"_blank\">manometer<\/a><\/i> (from French <i>manom\u00e8tre<\/i>), i.e. \"pressure meter\", itself coined from <span lang=\"el\" title=\"Greek language text\">\u03bc\u03b1\u03bd\u03cc\u03c2<\/span> <i>manos<\/i> \"thin, sparse\", and <span lang=\"el\" title=\"Greek language text\">\u03bc\u03ad\u03c4\u03c1\u03bf\u03bd<\/span> <i>metron<\/i> \"measure\".<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>Most sphygmomanometers were mechanical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gauge_(instrument)\" title=\"Gauge (instrument)\" rel=\"external_link\" target=\"_blank\">gauges<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dial_(measurement)\" title=\"Dial (measurement)\" rel=\"external_link\" target=\"_blank\">dial<\/a> faces during the first half of the 20th century. Since the advent of electronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a>, names such as \"meter\" and \"monitor\" can also apply, as devices can automatically <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">monitor<\/a> blood pressure on an ongoing basis.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Booth1977-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Booth1977_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Booth1977_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Booth, J (1977). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1543468\" target=\"_blank\">\"A short history of blood pressure measurement\"<\/a>. <i>Proceedings of the Royal Society of Medicine<\/i>. <b>70<\/b> (11): 793\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1543468\" target=\"_blank\">1543468<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/341169\" target=\"_blank\">341169<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+Royal+Society+of+Medicine&rft.atitle=A+short+history+of+blood+pressure+measurement&rft.volume=70&rft.issue=11&rft.pages=793-9&rft.date=1977&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1543468&rft_id=info%3Apmid%2F341169&rft.aulast=Booth&rft.aufirst=J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1543468&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sustainablehospitals.org\/HTMLSrc\/IP_Merc_Tools_CompSphyg.html\" target=\"_blank\">\"Comparing Mercury and Aneroid Sphygmomanometers\"<\/a>. <i>Sustainable Hospitals \/ Lowell Center for Sustainable Production<\/i>. Sustainable Hospitals \/ Lowell Center for Sustainable Production. 2003<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 February<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Sustainable+Hospitals+%2F+Lowell+Center+for+Sustainable+Production&rft.atitle=Comparing+Mercury+and+Aneroid+Sphygmomanometers&rft.date=2003&rft_id=http%3A%2F%2Fwww.sustainablehospitals.org%2FHTMLSrc%2FIP_Merc_Tools_CompSphyg.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-nytimes-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-nytimes_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nytimes_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2005\/03\/27\/nyregion\/turning-mercury-into-solid-gold.html\" target=\"_blank\">\"Turning Mercury Into Solid Gold\"<\/a>. <i>nytimes.com<\/i>. 2005-03-27<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-07-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nytimes.com&rft.atitle=Turning+Mercury+Into+Solid+Gold&rft.date=2005-03-27&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2005%2F03%2F27%2Fnyregion%2Fturning-mercury-into-solid-gold.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Misrin, J. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sphygmomanometerhq.com\/aneroid-sphygmomanometer-battle-for-safer-blood-pressure-apparatus\/\" target=\"_blank\">\"Aneroid Sphygmomanometer: A Battle for Safer Blood Pressure Apparatus\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">27 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Aneroid+Sphygmomanometer%3A+A+Battle+for+Safer+Blood+Pressure+Apparatus&rft.aulast=Misrin&rft.aufirst=J&rft_id=http%3A%2F%2Fwww.sphygmomanometerhq.com%2Faneroid-sphygmomanometer-battle-for-safer-blood-pressure-apparatus%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-oscillometric-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-oscillometric_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-oscillometric_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.geriatria.unimo.it\/PDF\/IPERTENSIONE\/Oscillometry.pdf\" target=\"_blank\">Oscillometry, Explanation of oscillometric detection in Medical Electronics, N Townsend, p48-51<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.severehypertension.net\/hbp\/more\/oscillometric-method\/\" target=\"_blank\">\"Oscillometric Method - Methods of Blood Pressure Measurement - Measurement of Blood PressureMethods of Blood Pressure Measurement -\"<\/a>. <i>www.severehypertension.net<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-04-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.severehypertension.net&rft.atitle=Oscillometric+Method+-+Methods+of+Blood+Pressure+Measurement+-+Measurement+of+Blood+PressureMethods+of+Blood+Pressure+Measurement+-&rft_id=http%3A%2F%2Fwww.severehypertension.net%2Fhbp%2Fmore%2Foscillometric-method%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Can we trust automatic sphygmomanometer validations?\nTurner MJ.\nJournal of Hypertension. <b>28<\/b>(12), December 2010, pp. 2353\u20132356\ndoi: 10.1097\/HJH.0b013e32833e1011.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Automated Sphygmomanometers Should Not Replace Manual Ones, Based on Current Evidence\nMartin J. Turner and Johan M. van Schalkwyk\nAmerican Journal of Hypertension. <b>21<\/b>(8), p. 845.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Sphygmomanometer calibration--why, how and how often?\nTurner MJ1, Speechly C, Bignell N.\nAustralian Family Physician. October 2007; <b>36<\/b>(10):834-838.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dableducational.org\/pdfs\/september05\/051-05_Wrist_device_inaccuracy_JBP_Monit_May2005.pdf\" target=\"_blank\">Inaccuracy of wrist-cuff oscillometric blood pressure devices: an arm position artefact? Adnan Mourad, Alastair Gillies, Shane Carney, Clinical methods and pathophysiology<\/a><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/blutdruckmessgeraet-vergleich-test.de\/blutdruckmessgeraet-handgelenk\/\" target=\"_blank\">\"Blutdruckmessger\u00e4t - Handgelenk - Blutdruckmessger\u00e4t - Test\"<\/a> (in German). Blutdruckmessgeraet-vergleich-test.de<span class=\"reference-accessdate\">. 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oscillometric finger-pressing method\"<\/a>. <i>Science Translational Medicine<\/i>. <b>10<\/b> (431). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscitranslmed.aap8674\" target=\"_blank\">10.1126\/scitranslmed.aap8674<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29515001\" target=\"_blank\">29515001<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science+Translational+Medicine&rft.atitle=Smartphone-based+blood+pressure+monitoring+via+the+oscillometric+finger-pressing+method&rft.volume=10&rft.issue=431&rft.date=2018-03-07&rft_id=info%3Adoi%2F10.1126%2Fscitranslmed.aap8674&rft_id=info%3Apmid%2F29515001&rft.aulast=Chandrasekhar&rft.aufirst=Anand&rft_id=http%3A%2F%2Fstm.sciencemag.org%2Fcontent%2F10%2F431%2Feaap8674&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chandrasekhar, Anand (2018-09-03). <a rel=\"external_link\" class=\"external text\" 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scientific+Reports&rft.atitle=An+iPhone+Application+for+Blood+Pressure+Monitoring+via+the+Oscillometric+Finger+Pressing+Method&rft.volume=8&rft.issue=1&rft.date=2018-09-03&rft_id=info%3Adoi%2F10.1038%2Fs41598-018-31632-x&rft.aulast=Chandrasekhar&rft.aufirst=Anand&rft_id=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41598-018-31632-x&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">van Montfrans GA. \"Oscillometric blood pressure measurement: progress and problems\". <i>Blood Press Monit<\/i>. <b>6<\/b>: 287\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12055403\" target=\"_blank\">12055403<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Blood+Press+Monit&rft.atitle=Oscillometric+blood+pressure+measurement%3A+progress+and+problems&rft.volume=6&rft.pages=287-90&rft_id=info%3Apmid%2F12055403&rft.au=van+Montfrans+GA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Harper, Douglas. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.etymonline.com\/?term=sphygmomanometer\" target=\"_blank\">\"sphygmomanometer\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Online_Etymology_Dictionary\" title=\"Online Etymology Dictionary\" rel=\"external_link\" target=\"_blank\">Online Etymology Dictionary<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Online+Etymology+Dictionary&rft.atitle=sphygmomanometer&rft.aulast=Harper&rft.aufirst=Douglas&rft_id=http%3A%2F%2Fwww.etymonline.com%2F%3Fterm%3Dsphygmomanometer&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Harper, Douglas. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.etymonline.com\/?term=manometer\" target=\"_blank\">\"manometer\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Online_Etymology_Dictionary\" title=\"Online Etymology Dictionary\" rel=\"external_link\" target=\"_blank\">Online Etymology Dictionary<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Online+Etymology+Dictionary&rft.atitle=manometer&rft.aulast=Harper&rft.aufirst=Douglas&rft_id=http%3A%2F%2Fwww.etymonline.com%2F%3Fterm%3Dmanometer&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASphygmomanometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus:text:1999.04.0057:entry=sfugmo\/s\" target=\"_blank\"><span lang=\"grc\" title=\"Ancient Greek language text\">\u03c3\u03c6\u03c5\u03b3\u03bc\u03cc\u03c2<\/span><\/a>, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus:text:1999.04.0057:entry=mano\/s\" target=\"_blank\"><span lang=\"grc\" title=\"Ancient Greek language text\">\u03bc\u03b1\u03bd\u03cc\u03c2<\/span><\/a>, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus:text:1999.04.0057:entry=me\/tron\" target=\"_blank\"><span lang=\"grc\" title=\"Ancient Greek language text\">\u03bc\u03ad\u03c4\u03c1\u03bf\u03bd<\/span><\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Liddell\" title=\"Henry Liddell\" rel=\"external_link\" target=\"_blank\">Liddell, Henry George<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Scott_(philologist)\" title=\"Robert Scott (philologist)\" rel=\"external_link\" target=\"_blank\">Scott, Robert<\/a>; <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/A_Greek%E2%80%93English_Lexicon\" title=\"A Greek\u2013English Lexicon\" rel=\"external_link\" target=\"_blank\">A Greek\u2013English Lexicon<\/a><\/i> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perseus_Project\" title=\"Perseus Project\" rel=\"external_link\" target=\"_blank\">Perseus Project<\/a>.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><span class=\"citation patent\" id=\"rdp-ebb-CITEREFR._H._Miller1951\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/worldwide.espacenet.com\/textdoc?DB=EPODOC&IDX=US2560237\" target=\"_blank\">US patent 2560237<\/a>, R. H. Miller, \"Sphygmomanometer\", issued 1951-07-10<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Apatent&rft.number=2560237&rft.cc=US&rft.title=Sphygmomanometer&rft.inventor=R.+H.+Miller&rft.date=1951-07-10\"><span style=\"display: none;\"> <\/span><\/span><\/li>\n<li><span class=\"citation patent\" id=\"rdp-ebb-CITEREFMan_S._Oh2004\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/worldwide.espacenet.com\/textdoc?DB=EPODOC&IDX=US6752764\" target=\"_blank\">US patent 6752764<\/a>, Man S. Oh, \"Pocket sphygmomanometer\", issued 2004-06-22<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Apatent&rft.number=6752764&rft.cc=US&rft.title=Pocket+sphygmomanometer&rft.inventor=Man+S.+Oh&rft.date=2004-06-22\"><span style=\"display: none;\"> <\/span><\/span><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1242\nCached time: 20181217050516\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.572 seconds\nReal time usage: 0.755 seconds\nPreprocessor visited node count: 1738\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 36288\/2097152 bytes\nTemplate argument size: 3290\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 33732\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.361\/10.000 seconds\nLua memory usage: 12.52 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 673.702 1 -total\n<\/p>\n<pre>30.72% 206.987 1 Template:Reflist\n29.51% 198.826 6 Template:Lang\n18.05% 121.626 4 Template:Cite_journal\n11.55% 77.811 2 Template:Citation_needed\n10.26% 69.146 2 Template:Fix\n 9.24% 62.282 1 Template:Commons_category\n 6.61% 44.547 4 Template:Category_handler\n 5.88% 39.636 1 Template:Stack\n 5.57% 37.534 6 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:412531-1!canonical and timestamp 20181217050516 and revision id 873376666\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sphygmomanometer\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214633\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.180 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 174.239 1 - wikipedia:Sphygmomanometer\n100.00% 174.239 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8530-0!*!*!*!*!*!* and timestamp 20181217214633 and revision id 24955\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sphygmomanometer\">https:\/\/www.limswiki.org\/index.php\/Sphygmomanometer<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","72d9ba12bb6959b1256cad03177fab61_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3f\/2017_Sfigmomanometr_elektroniczny.jpg\/440px-2017_Sfigmomanometr_elektroniczny.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ae\/Sphygmomanometer%26Cuff.JPG\/440px-Sphygmomanometer%26Cuff.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Sphygmomanometer.JPG\/440px-Sphygmomanometer.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/16\/Clinical_Mercury_Manometer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f1\/Advanced_Digital_Sphygmomanometer.jpg\/440px-Advanced_Digital_Sphygmomanometer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/1\/13\/MMSA_Checking_Blood_Pressure.JPG\/440px-MMSA_Checking_Blood_Pressure.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Sphygmomanometer_WWI_Memorial_de_Verdun.JPG\/440px-Sphygmomanometer_WWI_Memorial_de_Verdun.JPG"],"72d9ba12bb6959b1256cad03177fab61_timestamp":1545083192,"5a80c3f7dd667e0b3d02ffd9c6e41281_type":"article","5a80c3f7dd667e0b3d02ffd9c6e41281_title":"Reflex hammer","5a80c3f7dd667e0b3d02ffd9c6e41281_url":"https:\/\/www.limswiki.org\/index.php\/Reflex_hammer","5a80c3f7dd667e0b3d02ffd9c6e41281_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tReflex hammer\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t A Buck-Reflex-Hammer\nA reflex hammer is a medical instrument used by practitioners to test deep tendon reflexes. Testing for reflexes is an important part of the neurological physical examination in order to detect abnormalities in the central or peripheral nervous system.\nReflex hammers can also be used for chest percussion.[1]\n\nContents \n\n1 Models of reflex hammer \n2 Method of use \n3 See also \n4 References \n\n\nModels of reflex hammer \n The Taylor hammer appears on the far left. The other tools, from top to bottom, are: Babinski hammer, Queen square hammer, Wartenberg wheel, and Buck hammer (disassembled to show components).\n The Queen Square reflex hammer, shown with a plastic handle and a tip that tapers to allow for plantar reflex testing\n Tr\u00f6mner reflex hammer\nPrior to the development of specialized reflex hammers, hammers specific for percussion of the chest were used to elicit reflexes.[2] However, this proved to be cumbersome, as the weight of the chest percussion hammer was insufficient to generate an adequate stimulus for a reflex.\nStarting in the late 19th century, several models of specific reflex hammers were created:\n\nThe Taylor or tomahawk reflex hammer was designed by John Madison Taylor in 1888 [3] and is the most well known reflex hammer in the USA. It consists of a triangular rubber component which is attached to a flat metallic handle. The traditional Taylor hammer is significantly lighter in weight when compared to the heavier European hammers.\nThe Queen Square reflex hammer was designed for use at the National Hospital for Nervous Diseases (now the National Hospital for Neurology and Neurosurgery) in Queen Square, London. It was originally made with a bamboo or cane handle of varying length, of average 10 to 16 inches (25 to 40 centimetres), attached to a 2-inch (5 centimetre) metal disk with a plastic bumper.[4] The Queen Square hammer is also now made with plastic molds, and often has a sharp tapered end to allow for testing of plantar reflexes though this is no longer recommended due to tightened infection control. It is the reflex hammer of choice of the UK neurologist.\nThe Babinski reflex hammer was designed by Joseph Babi\u0144ski in 1912[2] and is similar to the Queen Square hammer, except that it has a metallic handle that is often detachable.[5] Babinski hammers can also be telescoping, allowing for compact storage. Babinski's hammer was popularized in clinical use in America by the neurologist Abraham Rabiner, who was given the instrument as a peace offering by Babinski after the two brawled at a black tie affair in Vienna.[2]\nThe Tr\u00f6mner reflex hammer was designed by Ernst Tr\u00f6mner. This model is shaped like a two-headed mallet. The larger mallet is used to elicit tendon stretch reflexes, and the smaller mallet is used to elicit percussion myotonia.\nOther reflex hammer types include the Buck, Berliner and Stookey reflex hammers.[2]\nThere are numerous models available from various commercial sources.\n\nMethod of use \nThe strength of a reflex is used to gauge central and peripheral nervous system disorders, with the former resulting in hyperreflexia, or exaggerated reflexes, and the latter resulting in hyporeflexia or diminished reflexes. However, the strength of the stimulus used to extract the reflex also affects the magnitude of the reflex. Attempts have been made to determine the force required to elicit a reflex,[6] but vary depending on the hammer used, and are difficult to quantify.\nThe Taylor hammer is usually held at the end by the physician, and the entire device is swung in an arc-like motion onto the tendon in question. The Queen Square and Babinski hammers are usually held perpendicular to the tendon in question, and are passively swung with gravity assistance onto the tendon.[1]\nThe Jendrassik maneuver, which entails interlocking of flexed fingers to distract a patient and prime the reflex response, can also be used to accentuate reflexes.[7] In cases of hyperreflexia, the physician may place his finger on top of the tendon, and tap the finger with the hammer. Sometimes a reflex hammer may not be necessary to elicit hyperreflexia, with finger tapping over the tendon being sufficient as a stimulus.[1]\n\nSee also \nPhysical examination\nNeurology\nReferences \n\n\n^ a b c Swartz MH. Textbook of Physical Diagnosis: History and Examination. Third edition. Philadelphia: WB Saunders; 1998 \n\n^ a b c d Lanska DJ. The history of reflex hammers. Neurology. 1989 Nov;39(11):1542-9. PMID 2682351 \n\n^ Lanska DJ, Lanska MJ. John Madison Taylor (1855-1931) and the first reflex hammer. J Child Neurol. 1990 Jan;5(1):38-9. PMID 2405048 \n\n^ Lanska DJ, Dietrichs E. [History of the reflex hammer] Tidsskr Nor Laegeforen. 1998 Dec 10;118(30):4666-8. PMID 9914749 \n\n^ Lanska DJ. The Babinski reflex hammer. Neurology. 1999 Aug 11;53(3):655 PMID 10449145 \n\n^ Marshall GL, Little JW. Deep tendon reflexes: a study of quantitative methods. J Spinal Cord Med. 2002 Summer;25(2):94-9. PMID 12137223. \n\n^ Delwaide PJ, Toulouse P. The Jendrassik maneuver: quantitative analysis of reflex reinforcement by remote voluntary muscle contraction.\nAdv Neurol. 1983;39:661-9. PMID 6660115 \n\n\nvteMedical instruments and implantsDiagnostics and research\nLaboratory diagnosis & research\nMicrobiology\nPathology\nRadiology\nToxicology\nSterilizationMicrobiological sterilization, disinfection, quarantine & biological waste managementFundamental clinical specializations\nDentistry\nGeneral medicine\nGeneral surgery\nSystem non-specific clinical specializations\nAnesthesiology\nOncology\nPhysical medicine & Rehabilitation\nPlastic surgery\nPreventive medicine\nSystem specific clinical specialties\nCardiology\nDermatology\nEndocrinology\nGastroenterology\nNephrology\nNeurology\nObstetrics & Gynecology\nOphthalmology\nOrthopedics\nOtorhinolaryngology (ENT)\nPulmonology\nPsychiatry\nUrology\nVascular surgery\nPost-mortem examinations\nAnatomy\nForensic sciences\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Reflex_hammer\">https:\/\/www.limswiki.org\/index.php\/Reflex_hammer<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:23.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 854 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5a80c3f7dd667e0b3d02ffd9c6e41281_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Reflex_hammer skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Reflex hammer<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Percussionshammer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Percussionshammer.jpg\/220px-Percussionshammer.jpg\" width=\"220\" height=\"126\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Percussionshammer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A Buck-Reflex-Hammer<\/div><\/div><\/div>\n<p>A <b>reflex hammer<\/b> is a medical instrument used by practitioners to test deep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendon\" title=\"Tendon\" rel=\"external_link\" target=\"_blank\">tendon<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reflex\" title=\"Reflex\" rel=\"external_link\" target=\"_blank\">reflexes<\/a>. Testing for reflexes is an important part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurological_examination\" title=\"Neurological examination\" rel=\"external_link\" target=\"_blank\">neurological physical examination<\/a> in order to detect abnormalities in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_nervous_system\" title=\"Peripheral nervous system\" rel=\"external_link\" target=\"_blank\">peripheral<\/a> nervous system.\n<\/p><p>Reflex hammers can also be used for chest <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percussion_(medicine)\" title=\"Percussion (medicine)\" rel=\"external_link\" target=\"_blank\">percussion<\/a>.<sup id=\"rdp-ebb-cite_ref-Swartz_1-0\" class=\"reference\"><a href=\"#cite_note-Swartz-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Models_of_reflex_hammer\">Models of reflex hammer<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Neurological_tools.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4c\/Neurological_tools.jpg\/220px-Neurological_tools.jpg\" width=\"220\" height=\"98\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Neurological_tools.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The Taylor hammer appears on the far left. The other tools, from top to bottom, are: Babinski hammer, Queen square hammer, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wartenberg_wheel\" title=\"Wartenberg wheel\" rel=\"external_link\" target=\"_blank\">Wartenberg wheel<\/a>, and Buck hammer (disassembled to show components).<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Queen_square.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Queen_square.jpg\/170px-Queen_square.jpg\" width=\"170\" height=\"356\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Queen_square.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The <b>Queen Square<\/b> reflex hammer, shown with a plastic handle and a tip that tapers to allow for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plantar_reflex\" title=\"Plantar reflex\" rel=\"external_link\" target=\"_blank\">plantar reflex<\/a> testing<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Reflexhammer_nach_Tr%C3%B6mner.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fa\/Reflexhammer_nach_Tr%C3%B6mner.jpg\/220px-Reflexhammer_nach_Tr%C3%B6mner.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Reflexhammer_nach_Tr%C3%B6mner.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tr\u00f6mner reflex hammer<\/div><\/div><\/div>\n<p>Prior to the development of specialized reflex hammers, hammers specific for percussion of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest\" class=\"mw-redirect\" title=\"Chest\" rel=\"external_link\" target=\"_blank\">chest<\/a> were used to elicit reflexes.<sup id=\"rdp-ebb-cite_ref-History_2-0\" class=\"reference\"><a href=\"#cite_note-History-2\" rel=\"external_link\">[2]<\/a><\/sup> However, this proved to be cumbersome, as the weight of the chest percussion hammer was insufficient to generate an adequate stimulus for a reflex.\n<\/p><p>Starting in the late 19th century, several models of specific reflex hammers were created:\n<\/p>\n<ul><li>The <b>Taylor<\/b> or <b>tomahawk<\/b> reflex hammer was designed by John Madison Taylor in 1888 <sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> and is the most well known reflex hammer in the USA. It consists of a triangular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rubber\" class=\"mw-redirect\" title=\"Rubber\" rel=\"external_link\" target=\"_blank\">rubber<\/a> component which is attached to a flat metallic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Handle_(grip)\" class=\"mw-redirect\" title=\"Handle (grip)\" rel=\"external_link\" target=\"_blank\">handle<\/a>. The traditional Taylor hammer is significantly lighter in weight when compared to the heavier European hammers.<\/li>\n<li>The <b>Queen Square<\/b> reflex hammer was designed for use at the <i>National Hospital for Nervous Diseases<\/i> (now the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Hospital_for_Neurology_and_Neurosurgery\" title=\"National Hospital for Neurology and Neurosurgery\" rel=\"external_link\" target=\"_blank\">National Hospital for Neurology and Neurosurgery<\/a>) in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Queen_Square,_London\" title=\"Queen Square, London\" rel=\"external_link\" target=\"_blank\">Queen Square, London<\/a>. It was originally made with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bamboo\" title=\"Bamboo\" rel=\"external_link\" target=\"_blank\">bamboo<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arundo\" title=\"Arundo\" rel=\"external_link\" target=\"_blank\">cane<\/a> handle of varying length, of average 10 to 16 inches (25 to 40 centimetres), attached to a 2-inch (5 centimetre) metal disk with a plastic bumper.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> The Queen Square hammer is also now made with plastic molds, and often has a sharp tapered end to allow for testing of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plantar_reflex\" title=\"Plantar reflex\" rel=\"external_link\" target=\"_blank\">plantar reflexes<\/a> though this is no longer recommended due to tightened <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection_control\" title=\"Infection control\" rel=\"external_link\" target=\"_blank\">infection control<\/a>. It is the reflex hammer of choice of the UK neurologist.<\/li>\n<li>The <b>Babinski<\/b> reflex hammer was designed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joseph_Babi%C5%84ski\" class=\"mw-redirect\" title=\"Joseph Babi\u0144ski\" rel=\"external_link\" target=\"_blank\">Joseph Babi\u0144ski<\/a> in 1912<sup id=\"rdp-ebb-cite_ref-History_2-1\" class=\"reference\"><a href=\"#cite_note-History-2\" rel=\"external_link\">[2]<\/a><\/sup> and is similar to the Queen Square hammer, except that it has a metallic handle that is often detachable.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Babinski hammers can also be telescoping, allowing for compact storage. Babinski's hammer was popularized in clinical use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">America<\/a> by the neurologist Abraham Rabiner, who was given the instrument as a peace offering by Babinski after the two brawled at a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Black_tie\" title=\"Black tie\" rel=\"external_link\" target=\"_blank\">black tie<\/a> affair in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vienna\" title=\"Vienna\" rel=\"external_link\" target=\"_blank\">Vienna<\/a>.<sup id=\"rdp-ebb-cite_ref-History_2-2\" class=\"reference\"><a href=\"#cite_note-History-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li>\n<li>The <b>Tr\u00f6mner<\/b> reflex hammer was designed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ernst_Tr%C3%B6mner\" title=\"Ernst Tr\u00f6mner\" rel=\"external_link\" target=\"_blank\">Ernst Tr\u00f6mner<\/a>. This model is shaped like a two-headed mallet. The larger mallet is used to elicit tendon stretch reflexes, and the smaller mallet is used to elicit percussion <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myotonia\" title=\"Myotonia\" rel=\"external_link\" target=\"_blank\">myotonia<\/a>.<\/li>\n<li><b>Other<\/b> reflex hammer types include the Buck, Berliner and Stookey reflex hammers.<sup id=\"rdp-ebb-cite_ref-History_2-3\" class=\"reference\"><a href=\"#cite_note-History-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li><\/ul>\n<p>There are numerous models available from various commercial sources.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Method_of_use\">Method of use<\/span><\/h2>\n<p>The strength of a reflex is used to gauge central and peripheral nervous system disorders, with the former resulting in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperreflexia\" title=\"Hyperreflexia\" rel=\"external_link\" target=\"_blank\">hyperreflexia<\/a>, or exaggerated reflexes, and the latter resulting in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyporeflexia\" title=\"Hyporeflexia\" rel=\"external_link\" target=\"_blank\">hyporeflexia<\/a> or diminished reflexes. However, the strength of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stimulus_(physiology)\" title=\"Stimulus (physiology)\" rel=\"external_link\" target=\"_blank\">stimulus<\/a> used to extract the reflex also affects the magnitude of the reflex. Attempts have been made to determine the force required to elicit a reflex,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> but vary depending on the hammer used, and are difficult to quantify.\n<\/p><p>The Taylor hammer is usually held at the end by the physician, and the entire device is swung in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arc_(geometry)\" title=\"Arc (geometry)\" rel=\"external_link\" target=\"_blank\">arc<\/a>-like motion onto the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendon\" title=\"Tendon\" rel=\"external_link\" target=\"_blank\">tendon<\/a> in question. The Queen Square and Babinski hammers are usually held <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perpendicular\" title=\"Perpendicular\" rel=\"external_link\" target=\"_blank\">perpendicular<\/a> to the tendon in question, and are passively swung with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gravity\" title=\"Gravity\" rel=\"external_link\" target=\"_blank\">gravity<\/a> assistance onto the tendon.<sup id=\"rdp-ebb-cite_ref-Swartz_1-1\" class=\"reference\"><a href=\"#cite_note-Swartz-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jendrassik_maneuver\" title=\"Jendrassik maneuver\" rel=\"external_link\" target=\"_blank\">Jendrassik maneuver<\/a>, which entails interlocking of flexed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Finger\" title=\"Finger\" rel=\"external_link\" target=\"_blank\">fingers<\/a> to distract a patient and prime the reflex response, can also be used to accentuate reflexes.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> In cases of hyperreflexia, the physician may place his finger on top of the tendon, and tap the finger with the hammer. Sometimes a reflex hammer may not be necessary to elicit hyperreflexia, with finger tapping over the tendon being sufficient as a stimulus.<sup id=\"rdp-ebb-cite_ref-Swartz_1-2\" class=\"reference\"><a href=\"#cite_note-Swartz-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_examination\" title=\"Physical examination\" rel=\"external_link\" target=\"_blank\">Physical examination<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurology\" title=\"Neurology\" rel=\"external_link\" target=\"_blank\">Neurology<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Swartz-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Swartz_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Swartz_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Swartz_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Swartz MH. <i>Textbook of Physical Diagnosis: History and Examination.<\/i> Third edition. Philadelphia: WB Saunders; 1998<\/span>\n<\/li>\n<li id=\"cite_note-History-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-History_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Lanska DJ. The history of reflex hammers. <i>Neurology<\/i>. 1989 Nov;39(11):1542-9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2682351\" target=\"_blank\">2682351<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lanska DJ, Lanska MJ. John Madison Taylor (1855-1931) and the first reflex hammer. <i>J Child Neurol.<\/i> 1990 Jan;5(1):38-9. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2405048\" target=\"_blank\">2405048<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lanska DJ, Dietrichs E. [History of the reflex hammer] <i>Tidsskr Nor Laegeforen<\/i>. 1998 Dec 10;118(30):4666-8. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9914749\" target=\"_blank\">9914749<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lanska DJ. The Babinski reflex hammer. <i>Neurology.<\/i> 1999 Aug 11;53(3):655 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10449145\" target=\"_blank\">10449145<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Marshall GL, Little JW. Deep tendon reflexes: a study of quantitative methods. <i>J Spinal Cord Med.<\/i> 2002 Summer;25(2):94-9. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12137223\" target=\"_blank\">12137223<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Delwaide PJ, Toulouse P. The Jendrassik maneuver: quantitative analysis of reflex reinforcement by remote voluntary muscle contraction.\n<i>Adv Neurol.<\/i> 1983;39:661-9. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6660115\" target=\"_blank\">6660115<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1333\nCached time: 20181203094146\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.148 seconds\nReal time usage: 0.201 seconds\nPreprocessor visited node count: 818\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17735\/2097152 bytes\nTemplate argument size: 229\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 13628\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.020\/10.000 seconds\nLua memory usage: 1.04 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 123.921 1 -total\n<\/p>\n<pre>85.66% 106.148 1 Template:Reflist\n68.27% 84.605 6 Template:PMID\n64.99% 80.537 6 Template:Catalog_lookup_link\n14.27% 17.687 1 Template:Medical_instruments_and_implants\n10.72% 13.289 1 Template:Navbox\n 6.89% 8.538 12 Template:Yesno-no\n 4.10% 5.076 12 Template:Yesno\n 2.44% 3.020 1 Template:Main_other\n 2.09% 2.588 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:5489731-1!canonical and timestamp 20181203094146 and revision id 868072803\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Reflex_hammer\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214632\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.617 1 - wikipedia:Reflex_hammer\n100.00% 144.617 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8529-0!*!*!*!*!*!* and timestamp 20181217214632 and revision id 24954\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Reflex_hammer\">https:\/\/www.limswiki.org\/index.php\/Reflex_hammer<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5a80c3f7dd667e0b3d02ffd9c6e41281_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Percussionshammer.jpg\/440px-Percussionshammer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4c\/Neurological_tools.jpg\/440px-Neurological_tools.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Queen_square.jpg\/340px-Queen_square.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fa\/Reflexhammer_nach_Tr%C3%B6mner.jpg\/440px-Reflexhammer_nach_Tr%C3%B6mner.jpg"],"5a80c3f7dd667e0b3d02ffd9c6e41281_timestamp":1545083192,"9df5dd3e6ed93f579f91e2c63f4fdad9_type":"article","9df5dd3e6ed93f579f91e2c63f4fdad9_title":"Otoscope","9df5dd3e6ed93f579f91e2c63f4fdad9_url":"https:\/\/www.limswiki.org\/index.php\/Otoscope","9df5dd3e6ed93f579f91e2c63f4fdad9_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOtoscope\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article does not cite any sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2017) (Learn how and when to remove this template message)\n Otoscope - Image of an otoscope (center)\n Anatomy of the human ear.\n Right tympanic membrane as seen through a speculum.\nAn otoscope or auriscope is a medical device which is used to look into the ears. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane or eardrum. Because the eardrum is the border separating the external ear canal from the middle ear, its characteristics can be indicative of various diseases of the middle ear space. The presence of cerumen (ear wax), shed skin, pus, canal skin edema, foreign body, and various ear diseases can obscure any view of the eardrum and thus severely compromise the value of otoscopy done with a common otoscope. \nThe most commonly used otoscopes consist of a handle and a head. The head contains a light source and a simple low-power magnifying lens, typically around 8 diopters (3.00x Mag). The distal (front) end of the otoscope has an attachment for disposable plastic ear specula. The examiner first straightens the ear canal by pulling on the pinna and then inserts the ear speculum side of the otoscope into the external ear. It is important to brace the hand holding the otoscope against the patient's head to avoid injury to the ear canal by placing the index finger or little finger against the head. The examiner can then look through a lens on the rear of the instrument and see inside the ear canal. In many models, the lens can be removed, which allows the examiner to insert instruments through the otoscope into the ear canal, such as for removing earwax (cerumen). Most models also have an insertion point for a bulb capable of pushing air through the speculum which is called pneumatic otoscope. This puff of air allows an examiner to test the mobility of the tympanic membrane.\nMany otoscopes used in doctors offices are wall-mounted while others are portable. Wall-mounted otoscopes are attached by a flexible power cord to a base, which serves to hold the otoscope when it's not in use and also serves as a source of electric power, being plugged into an electric outlet. Portable models are powered by batteries in the handle; these batteries are usually rechargeable and can be recharged from a base unit. Otoscopes are often sold with ophthalmoscopes as a diagnostic set.\nDiseases which may be diagnosed by an otoscope include otitis media and otitis externa, infection of the middle and outer parts of the ear, respectively.\nOtoscopes are also frequently used for examining patients' noses (avoiding the need for a separate nasal speculum) and (with the speculum removed) upper throats.\nThe most commonly used otoscopes\u2014those used in emergency rooms, pediatric offices, general practice, and by internists- are monocular devices. They provide only a two-dimensional view of the ear canal, its contents, and usually at least a portion of the eardrum, depending on what is within the ear canal and its status. Another method of performing otoscopy (visualization of the ear) is use of a binocular microscope, in conjunction with a larger metal ear speculum, with the patient supine and the head tilted, which provides a much larger field of view and the added advantages of a stable head, far superior lighting, and most importantly, depth perception. A binocular (two-eyed) view is required in order to judge depth. If wax or another material obstructs the canal and\/or a view of the entire eardrum, it can easily and confidently be removed with specialized suction tips and other microscopic ear instruments, whereas the absence of depth perception with the one-eyed view of a common otoscope makes removal of anything more laborious and hazardous. Another major advantage of the binocular microscope is that both of the examiner's hands are free, since the microscope is suspended from a stand. The microscope has up to 40x power magnification, which allows much more detailed viewing of the entire ear canal, and of the entire eardrum unless edema of the canal skin prevents it. Subtle changes in the anatomy are much more easily detected and interpreted than with a monocular view otoscope. Traditionally only ENT specialists (otolaryngologists) and otologists (subspecialty ear doctors) acquire binocular microscopes and the necessary skills and training to use them, and incorporate their routine use in evaluating patient's ear complaints. Studies have shown that reliance on a monocular otoscope to diagnose ear disease results in a more than 50% chance of misdiagnosis, as compared to binocular microscopic otoscopy. The expense of acquiring a binocular microscope is only one obstacle to its being more widely adapted to general medicine. The low level of familiarity with binocular otoscopy among pediatric and general medicine professors in physician training programs is probably a more difficult obstacle to overcome. Thus, the standard of general otologic diagnosis and ear care remains, for the most part, the largely antiquated monocular otoscope.\n\nSee also \nIntraoral camera\nExternal links \n\n\n\nWikimedia Commons has media related to Otoscope.\nAn article detailing the use of otoscopes from one of the first issues of the Student BMJ available online published in July 1995.\nThis archived version of a similar page from wisc.edu contains images.\nThis archived page from indstate.edu gives another overview with images.\nPhisick Pictures and information about antique otoscopes\nvteMedical tests relating to hearing and balance (R30\u2013R39, 788)Hearing\nHearing test\nRinne test\nTone decay test\nWeber test\nAudiometry\npure tone\nvisual reinforcement\nBalance\nDix\u2013Hallpike test\nUnterberger test\nRomberg's test\nVestibulo\u2013ocular reflex\nOther\nOtoscope\npneumatic\ntympanometry\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Otoscope\">https:\/\/www.limswiki.org\/index.php\/Otoscope<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:22.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 557 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9df5dd3e6ed93f579f91e2c63f4fdad9_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Otoscope skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Otoscope<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Otoscope.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dc\/Otoscope.jpg\/200px-Otoscope.jpg\" width=\"200\" height=\"171\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Otoscope.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Otoscope<\/b> - Image of an otoscope (center)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ear-anatomy-text-small-en.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Ear-anatomy-text-small-en.svg\/200px-Ear-anatomy-text-small-en.svg.png\" width=\"200\" height=\"152\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ear-anatomy-text-small-en.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Anatomy of the human ear.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray909.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Gray909.png\/200px-Gray909.png\" width=\"200\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray909.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Right tympanic membrane as seen through a speculum.<\/div><\/div><\/div>\n<p>An <b>otoscope<\/b> or <b>auriscope<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> which is used to look into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">ears<\/a>. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view of the ear canal and tympanic membrane or eardrum. Because the eardrum is the border separating the external ear canal from the middle ear, its characteristics can be indicative of various diseases of the middle ear space. The presence of cerumen (ear wax), shed skin, pus, canal skin edema, foreign body, and various ear diseases can obscure any view of the eardrum and thus severely compromise the value of otoscopy done with a common otoscope. \n<\/p><p>The most commonly used otoscopes consist of a handle and a head. The head contains a light source and a simple low-power <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnifying_glass\" title=\"Magnifying glass\" rel=\"external_link\" target=\"_blank\">magnifying lens<\/a>, typically around 8 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diopter\" class=\"mw-redirect\" title=\"Diopter\" rel=\"external_link\" target=\"_blank\">diopters<\/a> (3.00x Mag). The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location#Proximal_and_distal\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">distal<\/a> (front) end of the otoscope has an attachment for disposable plastic ear <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speculum_(medical)\" title=\"Speculum (medical)\" rel=\"external_link\" target=\"_blank\">specula<\/a>. The examiner first straightens the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear_canal\" title=\"Ear canal\" rel=\"external_link\" target=\"_blank\">ear canal<\/a> by pulling on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pinna_(anatomy)\" class=\"mw-redirect\" title=\"Pinna (anatomy)\" rel=\"external_link\" target=\"_blank\">pinna<\/a> and then inserts the ear speculum side of the otoscope into the external ear. It is important to brace the hand holding the otoscope against the patient's head to avoid injury to the ear canal by placing the index finger or little finger against the head. The examiner can then look through a lens on the rear of the instrument and see inside the ear canal. In many models, the lens can be removed, which allows the examiner to insert instruments through the otoscope into the ear canal, such as for removing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Earwax\" title=\"Earwax\" rel=\"external_link\" target=\"_blank\">earwax<\/a> (cerumen). Most models also have an insertion point for a bulb capable of pushing air through the speculum which is called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumatic_otoscopy\" title=\"Pneumatic otoscopy\" rel=\"external_link\" target=\"_blank\">pneumatic otoscope<\/a>. This puff of air allows an examiner to test the mobility of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tympanic_membrane\" class=\"mw-redirect\" title=\"Tympanic membrane\" rel=\"external_link\" target=\"_blank\">tympanic membrane<\/a>.\n<\/p><p>Many otoscopes used in doctors offices are wall-mounted while others are portable. Wall-mounted otoscopes are attached by a flexible power cord to a base, which serves to hold the otoscope when it's not in use and also serves as a source of electric power, being plugged into an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Domestic_AC_power_plugs_and_sockets\" class=\"mw-redirect\" title=\"Domestic AC power plugs and sockets\" rel=\"external_link\" target=\"_blank\">electric outlet<\/a>. Portable models are powered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Battery_(electricity)\" class=\"mw-redirect\" title=\"Battery (electricity)\" rel=\"external_link\" target=\"_blank\">batteries<\/a> in the handle; these batteries are usually rechargeable and can be recharged from a base unit. Otoscopes are often sold with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ophthalmoscope\" class=\"mw-redirect\" title=\"Ophthalmoscope\" rel=\"external_link\" target=\"_blank\">ophthalmoscopes<\/a> as a diagnostic set.\n<\/p><p>Diseases which may be diagnosed by an otoscope include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otitis media<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_externa\" title=\"Otitis externa\" rel=\"external_link\" target=\"_blank\">otitis externa<\/a>, infection of the middle and outer parts of the ear, respectively.\n<\/p><p>Otoscopes are also frequently used for examining patients' noses (avoiding the need for a separate nasal speculum) and (with the speculum removed) upper throats.\n<\/p><p>The most commonly used otoscopes\u2014those used in emergency rooms, pediatric offices, general practice, and by internists- are monocular devices. They provide only a two-dimensional view of the ear canal, its contents, and usually at least a portion of the eardrum, depending on what is within the ear canal and its status. Another method of performing otoscopy (visualization of the ear) is use of a binocular microscope, in conjunction with a larger metal ear speculum, with the patient supine and the head tilted, which provides a much larger field of view and the added advantages of a stable head, far superior lighting, and most importantly, depth perception. A binocular (two-eyed) view is required in order to judge depth. If wax or another material obstructs the canal and\/or a view of the entire eardrum, it can easily and confidently be removed with specialized suction tips and other microscopic ear instruments, whereas the absence of depth perception with the one-eyed view of a common otoscope makes removal of anything more laborious and hazardous. Another major advantage of the binocular microscope is that both of the examiner's hands are free, since the microscope is suspended from a stand. The microscope has up to 40x power magnification, which allows much more detailed viewing of the entire ear canal, and of the entire eardrum unless edema of the canal skin prevents it. Subtle changes in the anatomy are much more easily detected and interpreted than with a monocular view otoscope. Traditionally only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otorhinolaryngology\" title=\"Otorhinolaryngology\" rel=\"external_link\" target=\"_blank\">ENT<\/a> specialists (otolaryngologists) and otologists (subspecialty ear doctors) acquire binocular microscopes and the necessary skills and training to use them, and incorporate their routine use in evaluating patient's ear complaints. Studies have shown that reliance on a monocular otoscope to diagnose ear disease results in a more than 50% chance of misdiagnosis, as compared to binocular microscopic otoscopy. The expense of acquiring a binocular microscope is only one obstacle to its being more widely adapted to general medicine. The low level of familiarity with binocular otoscopy among pediatric and general medicine professors in physician training programs is probably a more difficult obstacle to overcome. Thus, the standard of general otologic diagnosis and ear care remains, for the most part, the largely antiquated monocular otoscope.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraoral_camera\" title=\"Intraoral camera\" rel=\"external_link\" target=\"_blank\">Intraoral camera<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110708075047\/http:\/\/archive.student.bmj.com\/back_issues\/0795\/7-otos.htm\" target=\"_blank\">An article detailing the use of otoscopes<\/a> from one of the first issues of the Student BMJ available online published in July 1995.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070321073959\/http:\/\/www.comdis.wisc.edu\/staff\/mrchial\/howotoscope.htm\" target=\"_blank\">This archived version<\/a> of a similar page from wisc.edu contains images.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070204052853\/http:\/\/web.indstate.edu\/thcme\/PSP\/eLabs\/otoscope.htm\" target=\"_blank\">This archived page from indstate.edu<\/a> gives another overview with images.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.phisick.com\/zent.htm#diag\" target=\"_blank\">Phisick<\/a> Pictures and information about antique otoscopes<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1268\nCached time: 20181207033020\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.096 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 252\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 14250\/2097152 bytes\nTemplate argument size: 189\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.043\/10.000 seconds\nLua memory usage: 2.15 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 128.773 1 -total\n<\/p>\n<pre>46.03% 59.271 1 Template:Commons_category\n44.05% 56.730 1 Template:Unreferenced\n30.75% 39.595 1 Template:Ambox\n10.06% 12.954 1 Template:Commons\n 9.75% 12.562 1 Template:Ear_tests\n 8.19% 10.545 1 Template:Sister_project\n 8.00% 10.305 1 Template:Navbox\n 5.26% 6.779 1 Template:Side_box\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3083335-1!canonical and timestamp 20181207033020 and revision id 832977971\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Otoscope\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214632\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.186 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 172.797 1 - wikipedia:Otoscope\n100.00% 172.797 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8528-0!*!*!*!*!*!* and timestamp 20181217214632 and revision id 24953\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Otoscope\">https:\/\/www.limswiki.org\/index.php\/Otoscope<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9df5dd3e6ed93f579f91e2c63f4fdad9_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/d\/dc\/Otoscope.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Ear-anatomy-text-small-en.svg\/400px-Ear-anatomy-text-small-en.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Gray909.png\/400px-Gray909.png"],"9df5dd3e6ed93f579f91e2c63f4fdad9_timestamp":1545083192,"9a1d7345fb8133b2264b2b32a94b04a0_type":"article","9a1d7345fb8133b2264b2b32a94b04a0_title":"Medical thermometer","9a1d7345fb8133b2264b2b32a94b04a0_url":"https:\/\/www.limswiki.org\/index.php\/Medical_thermometer","9a1d7345fb8133b2264b2b32a94b04a0_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical thermometer\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tclinical thermometerMedical diagnosticsA medical\/clinical mercury thermometer showing the temperature of 37.7 \u00b0CPurposetakes body temperature reading\n\r\n\nA medical thermometer (also called clinical thermometer) is used for measuring human or animal body temperature. The tip of the thermometer is inserted into the mouth under the tongue (oral or sub-lingual temperature), under the armpit (axillary temperature), or into the rectum via the anus (rectal temperature).\n\nContents \n\n1 History \n2 Classification by location \n\n2.1 Oral \n2.2 Armpit \n2.3 Rectal Thermometer \n2.4 Ear \n2.5 Temporal artery \n2.6 Forehead \n\n\n3 Classification by technology \n\n3.1 Liquid-filled \n\n3.1.1 Mercury \n\n\n3.2 Phase-change (dot matrix) thermometers \n3.3 Liquid crystal \n3.4 Electronic \n\n3.4.1 Contact \n3.4.2 Remote \n3.4.3 Accuracy \n\n\n3.5 Basal thermometer \n\n\n4 See also \n5 Footnotes \n6 References \n\n\nHistory \nThe medical thermometer began as an instrument more appropriately called a water thermoscope, constructed by Galileo Galilei circa 1592\u20131593. It lacked an accurate scale with which to measure temperature and could be affected by changes in atmospheric pressure.[1][2]\nItalian physician Santorio Santorio is the first known individual to have put a measurable scale on the thermoscope and wrote of it in 1625, though he possibly invented one as early as 1612. His models were bulky, impractical and took a fair amount of time to take an accurate oral reading of the patient's temperature.[1][2]\nTwo individuals switched from water to alcohol in the thermometer.\n\nThe earliest is Ferdinando II de' Medici, Grand Duke of Tuscany (1610\u20131670), who created an enclosed thermometer that used alcohol circa 1654.[2]\nDaniel Gabriel Fahrenheit (1686\u20131736), a Polish-born Dutch physicist, engineer, and glass blower, made contributions to thermometers as well. He created an alcohol thermometer in 1709 and later innovated the mercury thermometer in 1714. Mercury, he found, responded more quickly to temperature changes than the previously used water.\nFahrenheit also created the temperature scale which is named after him, having recorded the system in 1724. The scale is still only mainly used for everyday applications in the United States, its territories and associated states (all served by the U.S. National Weather Service) as well as the Bahamas, Belize, and the Cayman Islands.[1][2][3][4]\nProminent Dutch mathematician, astronomer and physicist Christiaan Huygens created a clinical thermometer in 1665, to which he added an early form of the centigrade scale by setting the scale to the freezing and boiling points of water.[1] By 1742 Swedish astronomer Anders Celsius created the Celsius temperature scale that was the reverse of the modern scale, in that 0 was the boiling point of water, while 100 was freezing. It would later be reversed by Swedish botanist Carolus Linnaeus (1707\u20131778) in 1744.[2][5]\nWorking independently of Celsius, the Lyonnais physicist Jean-Pierre Christin, permanent secretary of the Acad\u00e9mie des sciences, belles-lettres et arts de LyonFR, developed a similar scale in which 0 represented the freezing point of water and 100 represented boiling.[6][7] On 19 May 1743 he published the design of a mercury thermometer, the \"Thermometer of Lyon\" built by the craftsman Pierre Casati that used this scale.[8][9][10]\nThe medical thermometer was used by Dutch chemist and physician Hermann Boerhaave (1668\u20131738), as well as his notable students Gerard van Swieten (1700\u201372) and Anton de Haen (1704\u201376). It was also utilized around the same time by Scottish physician George Martine (1700\u20131741). De Haen made particular strides in medicine with the thermometer. By observing the correlation in a patient's change in temperature and the physical symptoms of the illness, he concluded that a record of one's temperature could inform the doctor of a patient's health. However, his proposals were not met with enthusiasm by his peers and the medical thermometer remained a scarcely used instrument in medicine.[1]\nThermometers remained cumbersome to transport and use. By the mid 19th century, the medical thermometer was still a foot long (30.28 cm) and took as long as twenty minutes to take an accurate temperature reading. Between 1866-1867, Sir Thomas Clifford Allbutt (1836\u20131925) designed a medical thermometer that was much more portable, measuring only six inches long and taking only five minutes to record a patient's temperature.[1][2]\nIn 1868, German physician, pioneer psychiatrist, and medical professor Carl Reinhold August Wunderlich published his studies that consisted of over one million readings from twenty-five thousand patients' temperatures, taken in the underarm. With his findings, he was able to conclude a healthy human's temperature fell within the range of 36.3 to 37.5 \u00b0C (97.34 to 99.5 \u00b0F).[1]\nDr. Theodor H. Benzinger (13 April 1905 - 26 Oct 1999) invented the ear thermometer in 1964. Born in Stuttgart, Germany, he immigrated to the U.S. in 1947 and became a naturalized citizen in 1955. He worked from 1947 to 1970 in the bioenergetics division at the Naval Medical Research Center in Bethesda, Maryland.[11][12]\n\nClassification by location \nThe temperature can be measured in various locations on the body which maintain a fairly stable temperature (mainly sub-lingual, axillary, rectal, vaginal, forehead, or temporal artery). The normal temperature varies slightly with the location; an oral reading of 37 \u00b0C does not correspond to rectal, temporal, etc. readings of the same value. When a temperature is quoted the location should also be specified. If a temperature is stated without qualification (e.g., typical body temperature) it is usually assumed to be sub-lingual. The differences between core temperature and measurements at different locations, known as clinical bias, is discussed in the article on normal human body temperature. Measurements are subject to both site-dependent clinical bias and variability between a series of measurements (standard deviations of the differences). For example, one study found that the clinical bias of rectal temperatures was greater than for ear temperature measured by a selection of thermometers under test, but variability was less.[13]\n\nOral \nOral temperature may only be taken from a patient who is capable of holding the thermometer securely under the tongue, which generally excludes small children or people who are unconscious or overcome by coughing, weakness, or vomiting. (This is less of a problem with fast-reacting digital thermometers, but is certainly an issue with mercury thermometers, which take several minutes to stabilise their reading.) If the patient has drunk a hot or cold liquid beforehand time must be allowed for the mouth temperature to return to its normal value.[14]\nThe typical range of a sub-lingual thermometer for use in humans is from about 35 \u00b0C to 42 \u00b0C or 90 \u00b0F to 110 \u00b0F.\n\nArmpit \nThe armpit (axilla) temperature is measured by holding the thermometer tightly under the armpit. One needs to hold the thermometer for several minutes to get an accurate measurement. The axillary temperature plus 1 \u00b0C is a good guide to the rectal temperature in patients older than 1 month.[15] The accuracy from the axilla is known to be inferior to the rectal temperature.[16]\n\nRectal Thermometer \nMain article: Rectal thermometry\n different test prods (top: universal test prod, bottom: rectal test prod)\nRectal Thermometer temperature-taking, especially if performed by a person other than the patient, should be facilitated with the use of a water-based personal lubricant. Although rectal temperature is the most accurate, this method may be considered unpleasant, or embarrassing in some countries or cultures, especially if used on patients older than young children; also, if not taken the correct way, rectal temperature-taking can be uncomfortable and in some cases painful for the patient. Rectal temperature-taking is considered the method of choice for infants.[17]\n\nEar \nThe ear thermometer was invented by Dr. Theodor H. Benzinger in 1964. At the time, he was seeking a way to get a reading as close to the brain's temperature as possible, since the hypothalamus at the brain's base regulates the core body temperature. He accomplished this by using the ear canal's ear drum's blood vessels, which are shared with the hypothalamus. Before the ear thermometer's invention, easy temperature readings could only be taken from the mouth, rectum or underarm. Previously, if doctors wanted to record an accurate brain temperature, electrodes needed to be attached to the patient's hypothalamus.[12]\nThis tympanic thermometer has a projection (protected by a one-time hygienic sheath) that contains the infrared probe; the projection is gently placed in the ear canal and a button pressed; the temperature is read and displayed within about a second. These thermometers are used both in the home and in medical facilities.\nThere are factors that make readings of this thermometer to some extent unreliable, for example faulty placement in the external ear canal by the operator, and wax blocking the canal. Such error-producing factors usually cause readings to be below the true value, so that a fever can fail to be detected.[citation needed ]\n\nTemporal artery \nA temporal artery thermometer, which uses the infrared principle report temperature, were not very accurate and therefore caution should be used.[18]\n\nForehead \nThe band thermometer is applied to the patient's brow. It is typically a band coated with different temperature-sensitive markings using plastic strip thermometer or similar technology; at a given temperature the markings (numerals indicating the temperature) in one region are at the right temperature to become visible. This type may give an indication of fever, but is not considered accurate.\n\nClassification by technology \nLiquid-filled \nThe traditional thermometer is a glass tube with a bulb at one end containing a liquid which expands in a uniform manner with temperature. The tube itself is narrow (capillary) and has calibration markings along it. The liquid is often mercury, but alcohol thermometers use a colored alcohol. Medically, a maximum thermometer is often used, which indicates the maximum temperature reached even after it is removed from the body.\nTo use the thermometer, the bulb is placed in the location where the temperature is to be measured and left long enough to be certain to reach thermal equilibrium\u2014typically three minutes. Maximum-reading is achieved by means of a constriction in the neck close to the bulb. As the temperature of the bulb rises, the liquid expands up the tube through the constriction. When the temperature falls, the column of liquid breaks at the constriction and cannot return to the bulb, thus remaining stationary in the tube. After reading the value, the thermometer must be reset by repeatedly swinging it sharply to shake the liquid back through the constriction.\n\nMercury \nMercury-in-glass thermometers have been considered the most accurate liquid-filled types. However, mercury is a toxic heavy metal, and mercury has only been used in clinical thermometers if protected from breakage of the tube.\nThe tube must be very narrow to minimise the amount of mercury in it\u2014the temperature of the tube is not controlled, so it must contain very much less mercury than the bulb to minimise the effect of the temperature of the tube\u2014and this makes the reading rather difficult as the narrow mercury column is not very visible. Visibility is less of a problem with a coloured liquid.\nIn the 1990s it was decided[19] that mercury-based thermometers were too risky to handle; the vigorous swinging needed to \"reset\" a mercury maximum thermometer makes it easy to accidentally break it and spill the moderately poisonous mercury. Mercury thermometers have largely been replaced by electronic digital thermometers, or, more rarely, thermometers based on liquids other than mercury (such as galinstan, coloured alcohols and heat-sensitive liquid crystals).\n\n Phase-change (dot matrix) thermometers \nPhase-change thermometers use samples of inert chemicals which melt at progressively higher temperatures from 35.5 \u00b0C to 40.5 \u00b0C in steps of 0.1 \u00b0C. They are mounted as small dots in a matrix on a thin plastic spatula with a protective transparent cover. This is placed under the patient\u2019s tongue. After a short time the spatula is removed and it can be seen which dots have melted and which have not: the temperature is taken as the melting temperature of the last dot to melt.\nThese are cheap disposable devices and avoid the need for sterilizing for re-use. [20]\n\nLiquid crystal \nA liquid crystal thermometer contains heat-sensitive (thermochromic) liquid crystals in a plastic strip that change color to indicate different temperatures.\n\nElectronic \n Electronic clinical thermometer\n Quick test based on thermo chromic colours\nSince compact and inexpensive methods of measuring and displaying temperature became available, electronic thermometers (often called digital, because they display numeric values) have been used. Many display readings to great precision (0.1 \u00b0C or 0.2 \u00b0F, sometimes half that), but this should not be taken as a guarantee of accuracy: specified accuracy must be checked in documentation and maintained by periodical recalibration. A typical inexpensive electronic ear thermometer for home use has a displayed resolution of 0.1 \u00b0C, but a stated accuracy within \u00b10.2 \u00b0C (\u00b10.35 \u00b0F) when new.[21] The first electronic clinical thermometer, invented in 1954, used a flexible probe that contained a Carboloy thermistor.[22]\nTypes of Digital Thermometer\n \nResistance temperature detectors (RTDs)\n\n<\/p>RTDs are wire windings or other thin film serpentines that exhibit changes in resistance with changes in temperature.They measure temperature using the positive temperature coefficient of electrical resistance of metals. The hotter they become, the higher the value of their electrical resistance. Platinum is the most commonly used material because it is nearly linear over a wide range of temperatures, is very accurate, and has a fast response time. RTDs can also be made of copper or nickel.\no Advantages of RTDs include their stable output for long periods of time. They are also easy to calibrate and provide very accurate readings.\no Disadvantages include a smaller overall temperature range, higher initial cost, and a less rugged design\n\n<\/p>Thermocouples\n \nThermocouples are accurate, highly sensitive to small temperature changes, and quickly respond to changes to the environment. They consist of a pair of dissimilar metal wires joined at one end. The metal pair generates a net thermoelectric voltage between their opening and according to the size of the temperature difference between the ends.\n\u2022Advantages of thermocouples include their high accuracy and reliable operation over an extremely wide range of temperatures. They are also well-suited for making automated measurements both inexpensive and durable.\n\u2022Disadvantages include errors caused by their use over an extended period of time, and that two temperatures are required to make measurements. Thermocouple materials are subject to corrosion, which can affect the thermoelectric voltage\n\n<\/p>Thermistor\n \nThermistor elements are the most sensitive temperature sensors available. A thermistor is a semiconductor device with an electrical resistance that is proportional to temperature. There are two types of products.\n\u2022Negative temperature coefficient (NTC) devices are used in temperature sensing and are the most common type of thermistor. NTCs have temperatures that vary inversely with their resistance, so that when the temperature increases, the resistance decreases, and vice versa. NTCs are constructed from oxides of materials such as nickel, copper, and iron.\n\u2022 Positive temperature coefficient (PTC) devices are used in electric current control. They function in an opposite manner than NTC in that the resistance increases as temperature increases. PTCs are constructed from thermally sensitive silicons or polycrystalline ceramic materials.\n\u2022 There are several advantage and disadvantages to using an NTC thermistor thermometer.\n\u2022 Advantages include their small size and high degree of stability. NTCs are also long lasting and very accurate.\n\u2022 Disadvantages include their non-linearity, and unsuitability for use in extreme temperatures\n\n<\/p>\nContact \nSome electronic thermometers may work by contact (the electronic sensor is placed in the location where temperature is to be measured, and left long enough to reach equilibrium). These typically reach equilibrium faster than mercury thermometers; the thermometer may beep when equilibrium has been reached, or the time may be specified in the manufacturer's documentation.\n\nRemote \nOther electronic thermometers work by remote sensing: an infrared sensor responds to the radiation spectrum emitted from the location. Although these are not in direct contact with the area being measured, they may still contact part of the body (a thermometer which senses the temperature of the eardrum without touching it is inserted into the ear canal). To eliminate the risk of patient cross-infection, disposable probe covers and single-use clinical thermometers of all types are used in clinics and hospitals.\n\nAccuracy \nAccording to a 2001 research, electronic thermometers on the market significantly underestimate higher temperatures and overestimate lower temperatures. The researchers conclude that \"the current generation of electronic, digital clinical thermometers, in general, may not be sufficiently accurate or reliable to replace the traditional glass\/mercury thermometers\"[23][24]\n\nBasal thermometer \nA basal thermometer is a thermometer used to take the basal (base) body temperature, the temperature upon waking. Basal body temperature is much less affected than daytime temperature by environmental factors such as exercise and food intake. This allows small changes in body temperature to be detected\nGlass oral thermometers typically have markings every 0.1 \u00b0C or 0.2 \u00b0F. Basal temperature is stable enough to require accuracy of at least 0.05 \u00b0C or 0.1 \u00b0F, so special glass basal thermometers are distinct from glass oral thermometers. Digital thermometers which have sufficient resolution (0.05 \u00b0C or 0.1 \u00b0F is sufficient) may be suitable for monitoring basal body temperatures; the specification should be checked to ensure absolute accuracy, and thermometers (like most digital instruments) should be calibrated at specified intervals. If only the variation of basal temperature is required, absolute accuracy is not so important so long as the readings do not have large variability (e.g., if real temperature varies from 37.00 \u00b0C to 37.28 \u00b0C, a thermometer which inaccurately but consistently reads a change from 37.17 \u00b0C to 37.45 \u00b0C will indicate the magnitude of the change). Some digital thermometers are marketed as \"basal thermometers\" and have extra features such as a larger display, expanded memory functions, or beeping to confirm the thermometer is placed properly.\n\nSee also \n\n\n Medical portal \nThermometer\nLiquid crystal thermometer\nFootnotes \n\n\n^ a b c d e f g \"A Brief History of the Clinical Thermometer\". QJM. Oxford University Press. 1 April 2002. Retrieved 26 July 2016 . \n\n^ a b c d e f \"History of the Thermometer: Timeline created by TheArctech in Science and Technology\". Timetoast.com. Timetoast. Retrieved 16 July 2016 . \n\n^ Encyclop\u00e6dia Britannica \"Science & Technology: Daniel Gabriel Fahrenheit\" [1] \n\n^ \"782 - Aerodrome reports and forecasts: A user's handbook to the codes\". World Meteorological Organization. Retrieved 23 September 2009 . \n\n^ Citation: Uppsala University (Sweden), Linnaeus' thermometer \n\n^ Don Rittner; Ronald A. Bailey (2005): Encyclopedia of Chemistry. Facts On File, Manhattan, New York City. pp. 43. \n\n^ Smith, Jacqueline (2009). \"Appendix I: Chronology\". The Facts on File Dictionary of Weather and Climate. Infobase Publishing. p. 246. ISBN 978-1-4381-0951-0. 1743 Jean-Pierre Christin inverts the fixed points on Celsius' scale, to produce the scale used today. \n\n^ Mercure de France (1743): MEMOIRE sur la dilatation du Mercure dans le Thermom\u00e9tre. Chaubert; Jean de Nully, Pissot, Duchesne, Paris. pp. 1609\u20131610. \n\n^ Journal helv\u00e9tique (1743): LION. Imprimerie des Journalistes, Neuch\u00e2tel. pp. 308-310. \n\n^ Memoires pour L'Histoire des Sciences et des Beaux Arts (1743): DE LYON. Chaubert, Par\u00eds. pp. 2125-2128. \n\n^ \"Medical Dictionary: Ear Thermometer\". enacademic.com. Academic Dictionaries and Encyclopedias. 2011. Retrieved 26 July 2016 . \n\n^ a b \"Dr. Theodor H. Benzinger, 94, Inventor of the Ear Thermometer\". nytimes.com. The New York Times. 30 October 1999. Retrieved 26 July 2016 . \n\n^ Rotello, LC; Crawford, L; Terndrup, TE (1996). \"Comparison of infrared ear thermometer derived and equilibrated rectal temperatures in estimating pulmonary artery temperatures\". Critical Care Medicine. 24 (9): 1501\u20136. doi:10.1097\/00003246-199609000-00012. PMID 8797622. \n\n^ Newman, Bruce H.; Martin, Christin A. (2001). \"The effect of hot beverages, cold beverages, and chewing gum on oral temperature\". Transfusion. 41 (10): 1241\u20133. doi:10.1046\/j.1537-2995.2001.41101241.x. PMID 11606822. \n\n^ http:\/\/archpedi.jamanetwork.com\/article.aspx?articleid=517797 \n\n^ S.T. Zengeya and I. Blumenthal (December 1996). \"Modern electronic and chemical thermometers used in the axilla are inaccurate\". European Journal of Pediatrics. 155 (12): 1005\u20131008. doi:10.1007\/BF02532519. ISSN 1432-1076. PMID 8956933. Retrieved 2010-02-26 . \n\n^ Fundamentals of Nursing by Barbara Kozier et al., 7th edition, p. 495 \n\n^ Kiekkas, P; Stefanopoulos, N; Bakalis, N; Kefaliakos, A; Karanikolas, M (April 2016). \"Agreement of infrared temporal artery thermometry with other thermometry methods in adults: systematic review\". Journal of clinical nursing. 25 (7\u20138): 894\u2013905. doi:10.1111\/jocn.13117. PMID 26994990. \n\n^ Directive 2007\/51\/EC as of 22 January 2013 \n\n^ (http:\/\/www.npl.co.uk\/publications\/good-practice-online-modules\/temperature\/temperature-measurements-in-healthcare\/phase-change-(dot-matrix)-thermometers\/) \n\n^ Specification of typical inexpensive electronic ear thermometer \n\n^ \"Takes Temperature in Seconds.\" Popular Mechanics, November 1954, p. 123. \n\n^ Latman, NS; Hans, P; Nicholson, L; Delee Zint, S; Lewis, K; Shirey, A (2001). \"Evaluation & Technology\". PMID 11494651. \n\n^ \"An investigation into the accuracy of different types of thermometers\" Nursing Times.net, 1 October 2002. \n\n\nReferences \nAllbutt, T.C., \u201cMedical Thermometry\u201d, British and Foreign Medico-Chirurgical Review, Vol.45, No.90, (April 1870), pp.429-441; Vo.46, No.91, (July 1870), pp.144-156.\n\nvteHealth care\nEconomics\nEquipment\nGuidelines\nIndustry\nPhilosophy\nPolicy\nProviders\nRanking\nReform\nSystem\nProfessions\nMedicine\nNursing\nHealthcare science\nDentistry\nAllied health professions\nPharmacy\nHealth information management\nSettings\nAssisted living\nClinic\nHospital\nNursing home\nMedical school (Academic health science centre, Teaching hospital)\nCare\nAcute\nChronic\nEnd-of-life\nHospice\nOverutilization\nPalliative\nPrimary\nSelf\nTotal\nSkills \/ Training\nBedside manner\nCultural competence\nDiagnosis\nEducation\nUniversal precautions\nBy country\nUnited States\nreform debate in the United States\nUnited Kingdom\nCanada\nAustralia\nNew Zealand\n(Category Healthcare by country)\n\n Category\n\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_thermometer\">https:\/\/www.limswiki.org\/index.php\/Medical_thermometer<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:20.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 979 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9a1d7345fb8133b2264b2b32a94b04a0_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_thermometer skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical thermometer<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><br \/>\nA <b>medical thermometer<\/b> (also called <b>clinical thermometer<\/b>) is used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Temperature_examination\" class=\"mw-redirect\" title=\"Temperature examination\" rel=\"external_link\" target=\"_blank\">measuring<\/a> human or animal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_temperature\" class=\"mw-redirect\" title=\"Body temperature\" rel=\"external_link\" target=\"_blank\">body temperature<\/a>. The tip of the thermometer is inserted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mouth\" title=\"Mouth\" rel=\"external_link\" target=\"_blank\">mouth<\/a> under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongue\" title=\"Tongue\" rel=\"external_link\" target=\"_blank\">tongue<\/a> (<i>oral<\/i> or <i>sub-lingual temperature<\/i>), under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Underarm\" class=\"mw-redirect\" title=\"Underarm\" rel=\"external_link\" target=\"_blank\">armpit<\/a> (<i>axillary temperature<\/i>), or into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectum\" title=\"Rectum\" rel=\"external_link\" target=\"_blank\">rectum<\/a> via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anus\" title=\"Anus\" rel=\"external_link\" target=\"_blank\">anus<\/a> (<i>rectal temperature<\/i>).\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The medical thermometer began as an instrument more appropriately called a water <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoscope\" title=\"Thermoscope\" rel=\"external_link\" target=\"_blank\">thermoscope<\/a>, constructed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Galileo_Galilei\" title=\"Galileo Galilei\" rel=\"external_link\" target=\"_blank\">Galileo Galilei<\/a> circa 1592\u20131593. It lacked an accurate scale with which to measure temperature and could be affected by changes in atmospheric pressure.<sup id=\"rdp-ebb-cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-0\" class=\"reference\"><a href=\"#cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-History_of_the_Thermometer_2-0\" class=\"reference\"><a href=\"#cite_note-History_of_the_Thermometer-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Italians\" title=\"Italians\" rel=\"external_link\" target=\"_blank\">Italian<\/a> physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Santorio_Santorio\" title=\"Santorio Santorio\" rel=\"external_link\" target=\"_blank\">Santorio Santorio<\/a> is the first known individual to have put a measurable scale on the thermoscope and wrote of it in 1625, though he possibly invented one as early as 1612. His models were bulky, impractical and took a fair amount of time to take an accurate oral reading of the patient's temperature.<sup id=\"rdp-ebb-cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-1\" class=\"reference\"><a href=\"#cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-History_of_the_Thermometer_2-1\" class=\"reference\"><a href=\"#cite_note-History_of_the_Thermometer-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Two individuals switched from water to alcohol in the thermometer.\n<\/p>\n<ul><li>The earliest is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferdinando_II_de%27_Medici,_Grand_Duke_of_Tuscany\" title=\"Ferdinando II de' Medici, Grand Duke of Tuscany\" rel=\"external_link\" target=\"_blank\">Ferdinando II de' Medici, Grand Duke of Tuscany<\/a> (1610\u20131670), who created an enclosed thermometer that used alcohol circa 1654.<sup id=\"rdp-ebb-cite_ref-History_of_the_Thermometer_2-2\" class=\"reference\"><a href=\"#cite_note-History_of_the_Thermometer-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Daniel_Gabriel_Fahrenheit\" title=\"Daniel Gabriel Fahrenheit\" rel=\"external_link\" target=\"_blank\">Daniel Gabriel Fahrenheit<\/a> (1686\u20131736), a Polish-born Dutch physicist, engineer, and glass blower, made contributions to thermometers as well. He created an alcohol thermometer in 1709 and later innovated the mercury thermometer in 1714. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">Mercury<\/a>, he found, responded more quickly to temperature changes than the previously used water.<\/li><\/ul>\n<p>Fahrenheit also created the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fahrenheit\" title=\"Fahrenheit\" rel=\"external_link\" target=\"_blank\">temperature scale which is named after him<\/a>, having recorded the system in 1724. The scale is still only mainly used for everyday applications in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>, its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Territories_of_the_United_States\" title=\"Territories of the United States\" rel=\"external_link\" target=\"_blank\">territories and associated states<\/a> (all served by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Weather_Service\" title=\"National Weather Service\" rel=\"external_link\" target=\"_blank\">U.S. National Weather Service<\/a>) as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Bahamas\" title=\"The Bahamas\" rel=\"external_link\" target=\"_blank\">the Bahamas<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Belize\" title=\"Belize\" rel=\"external_link\" target=\"_blank\">Belize<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Cayman_Islands\" class=\"mw-redirect\" title=\"The Cayman Islands\" rel=\"external_link\" target=\"_blank\">the Cayman Islands<\/a>.<sup id=\"rdp-ebb-cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-2\" class=\"reference\"><a href=\"#cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-History_of_the_Thermometer_2-3\" class=\"reference\"><a href=\"#cite_note-History_of_the_Thermometer-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-britannica.com_3-0\" class=\"reference\"><a href=\"#cite_note-britannica.com-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Prominent Dutch mathematician, astronomer and physicist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Christiaan_Huygens\" title=\"Christiaan Huygens\" rel=\"external_link\" target=\"_blank\">Christiaan Huygens<\/a> created a clinical thermometer in 1665, to which he added an early form of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Celsius#History\" title=\"Celsius\" rel=\"external_link\" target=\"_blank\">centigrade<\/a> scale by setting the scale to the freezing and boiling points of water.<sup id=\"rdp-ebb-cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-3\" class=\"reference\"><a href=\"#cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\" rel=\"external_link\">[1]<\/a><\/sup> By 1742 Swedish astronomer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anders_Celsius\" title=\"Anders Celsius\" rel=\"external_link\" target=\"_blank\">Anders Celsius<\/a> created the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Celsius\" title=\"Celsius\" rel=\"external_link\" target=\"_blank\">Celsius<\/a> temperature scale that was the reverse of the modern scale, in that <i>0<\/i> was the boiling point of water, while <i>100<\/i> was freezing. It would later be reversed by Swedish botanist Carolus Linnaeus (1707\u20131778) in 1744.<sup id=\"rdp-ebb-cite_ref-History_of_the_Thermometer_2-4\" class=\"reference\"><a href=\"#cite_note-History_of_the_Thermometer-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-'Linnaeus'_thermometer_1_5-0\" class=\"reference\"><a href=\"#39;_thermometer_1-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Working independently of Celsius, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lyon\" title=\"Lyon\" rel=\"external_link\" target=\"_blank\">Lyonnais<\/a> physicist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jean-Pierre_Christin\" title=\"Jean-Pierre Christin\" rel=\"external_link\" target=\"_blank\">Jean-Pierre Christin<\/a>, permanent secretary of the <i>Acad\u00e9mie des sciences, belles-lettres et arts de Lyon<\/i><sup><a href=\"https:\/\/fr.wikipedia.org\/wiki\/Acad%C3%A9mie_des_sciences,_belles-lettres_et_arts_de_Lyon\" class=\"extiw\" title=\"fr:Acad\u00e9mie des sciences, belles-lettres et arts de Lyon\" rel=\"external_link\" target=\"_blank\">FR<\/a><\/sup>, developed a similar scale in which <i>0<\/i> represented the freezing point of water and <i>100<\/i> represented boiling.<sup id=\"rdp-ebb-cite_ref-EOC_1_6-0\" class=\"reference\"><a href=\"#cite_note-EOC_1-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-TFOFDOWAC_1_7-0\" class=\"reference\"><a href=\"#cite_note-TFOFDOWAC_1-7\" rel=\"external_link\">[7]<\/a><\/sup> On 19 May 1743 he published the design of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_thermometer\" class=\"mw-redirect\" title=\"Mercury thermometer\" rel=\"external_link\" target=\"_blank\">mercury thermometer<\/a>, the \"Thermometer of Lyon\" built by the craftsman Pierre Casati that used this scale.<sup id=\"rdp-ebb-cite_ref-MSLDDMDLT_1_8-0\" class=\"reference\"><a href=\"#cite_note-MSLDDMDLT_1-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-IDJ_1_9-0\" class=\"reference\"><a href=\"#cite_note-IDJ_1-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MPLHDSEDBA_1_10-0\" class=\"reference\"><a href=\"#cite_note-MPLHDSEDBA_1-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>The medical thermometer was used by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dutch_people\" title=\"Dutch people\" rel=\"external_link\" target=\"_blank\">Dutch<\/a> chemist and physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hermann_Boerhaave\" class=\"mw-redirect\" title=\"Hermann Boerhaave\" rel=\"external_link\" target=\"_blank\">Hermann Boerhaave<\/a> (1668\u20131738), as well as his notable students <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gerard_van_Swieten\" title=\"Gerard van Swieten\" rel=\"external_link\" target=\"_blank\">Gerard van Swieten<\/a> (1700\u201372) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anton_de_Haen\" title=\"Anton de Haen\" rel=\"external_link\" target=\"_blank\">Anton de Haen<\/a> (1704\u201376). It was also utilized around the same time by Scottish physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/George_Martine_(physician)\" title=\"George Martine (physician)\" rel=\"external_link\" target=\"_blank\">George Martine<\/a> (1700\u20131741). De Haen made particular strides in medicine with the thermometer. By observing the correlation in a patient's change in temperature and the physical symptoms of the illness, he concluded that a record of one's temperature could inform the doctor of a patient's health. However, his proposals were not met with enthusiasm by his peers and the medical thermometer remained a scarcely used instrument in medicine.<sup id=\"rdp-ebb-cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-4\" class=\"reference\"><a href=\"#cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Thermometers remained cumbersome to transport and use. By the mid 19th century, the medical thermometer was still a foot long (30.28 cm) and took as long as twenty minutes to take an accurate temperature reading. Between 1866-1867, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clifford_Allbutt\" title=\"Clifford Allbutt\" rel=\"external_link\" target=\"_blank\">Sir Thomas Clifford Allbutt<\/a> (1836\u20131925) designed a medical thermometer that was much more portable, measuring only six inches long and taking only five minutes to record a patient's temperature.<sup id=\"rdp-ebb-cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-5\" class=\"reference\"><a href=\"#cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-History_of_the_Thermometer_2-5\" class=\"reference\"><a href=\"#cite_note-History_of_the_Thermometer-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In 1868, German physician, pioneer psychiatrist, and medical professor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Reinhold_August_Wunderlich\" title=\"Carl Reinhold August Wunderlich\" rel=\"external_link\" target=\"_blank\">Carl Reinhold August Wunderlich<\/a> published his studies that consisted of over one million readings from twenty-five thousand patients' temperatures, taken in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axilla\" title=\"Axilla\" rel=\"external_link\" target=\"_blank\">underarm<\/a>. With his findings, he was able to conclude a healthy human's temperature fell within the range of 36.3 to 37.5 \u00b0C (97.34 to 99.5 \u00b0F).<sup id=\"rdp-ebb-cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-6\" class=\"reference\"><a href=\"#cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p> (13 April 1905 - 26 Oct 1999) invented the ear thermometer in 1964. Born in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stuttgart\" title=\"Stuttgart\" rel=\"external_link\" target=\"_blank\">Stuttgart<\/a>, Germany, he immigrated to the U.S. in 1947 and became a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Naturalization\" title=\"Naturalization\" rel=\"external_link\" target=\"_blank\">naturalized citizen<\/a> in 1955. He worked from 1947 to 1970 in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioenergetics\" title=\"Bioenergetics\" rel=\"external_link\" target=\"_blank\">bioenergetics<\/a> division at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Naval_Medical_Research_Center\" title=\"Naval Medical Research Center\" rel=\"external_link\" target=\"_blank\">Naval Medical Research Center<\/a> in Bethesda, Maryland.<sup id=\"rdp-ebb-cite_ref-Medical_Dictionary:_Ear_Thermometer_11-0\" class=\"reference\"><a href=\"#cite_note-Medical_Dictionary:_Ear_Thermometer-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Dr._Benzinger_Obituary_12-0\" class=\"reference\"><a href=\"#cite_note-Dr._Benzinger_Obituary-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Classification_by_location\">Classification by location<\/span><\/h2>\n<p>The temperature can be measured in various locations on the body which maintain a fairly stable temperature (mainly sub-lingual, axillary, rectal, vaginal, forehead, or temporal artery). The normal temperature varies slightly with the location; an oral reading of 37 \u00b0C does not correspond to rectal, temporal, etc. readings of the same value. When a temperature is quoted the location should also be specified. If a temperature is stated without qualification (e.g., typical body temperature) it is usually assumed to be sub-lingual. The differences between core temperature and measurements at different locations, known as <i>clinical bias<\/i>, is discussed in the article on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Normal_human_body_temperature\" class=\"mw-redirect\" title=\"Normal human body temperature\" rel=\"external_link\" target=\"_blank\">normal human body temperature<\/a>. Measurements are subject to both site-dependent clinical bias and variability between a series of measurements (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Standard_deviation\" title=\"Standard deviation\" rel=\"external_link\" target=\"_blank\">standard deviations<\/a> of the differences). For example, one study found that the clinical bias of rectal temperatures was greater than for ear temperature measured by a selection of thermometers under test, but variability was less.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Oral\">Oral<\/span><\/h3>\n<p>Oral temperature may only be taken from a patient who is capable of holding the thermometer securely under the tongue, which generally excludes small children or people who are unconscious or overcome by coughing, weakness, or vomiting. (This is less of a problem with fast-reacting digital thermometers, but is certainly an issue with mercury thermometers, which take several minutes to stabilise their reading.) If the patient has drunk a hot or cold liquid beforehand time must be allowed for the mouth temperature to return to its normal value.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>The typical range of a sub-lingual thermometer for use in humans is from about 35 \u00b0C to 42 \u00b0C or 90 \u00b0F to 110 \u00b0F.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Armpit\">Armpit<\/span><\/h3>\n<p>The armpit (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Axilla\" title=\"Axilla\" rel=\"external_link\" target=\"_blank\">axilla<\/a>) temperature is measured by holding the thermometer tightly under the armpit. One needs to hold the thermometer for several minutes to get an accurate measurement. The axillary temperature plus 1 \u00b0C is a good guide to the rectal temperature in patients older than 1 month.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The accuracy from the axilla is known to be inferior to the rectal temperature.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Rectal_Thermometer\">Rectal Thermometer<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectal_thermometry\" title=\"Rectal thermometry\" rel=\"external_link\" target=\"_blank\">Rectal thermometry<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fieberthermometermessspitzen.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Fieberthermometermessspitzen.jpg\/220px-Fieberthermometermessspitzen.jpg\" width=\"220\" height=\"154\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fieberthermometermessspitzen.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>different test prods (top: universal test prod, bottom: rectal test prod)<\/div><\/div><\/div>\n<p>Rectal Thermometer temperature-taking, especially if performed by a person other than the patient, should be facilitated with the use of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water-based_personal_lubricant\" class=\"mw-redirect\" title=\"Water-based personal lubricant\" rel=\"external_link\" target=\"_blank\">water-based personal lubricant<\/a>. Although rectal temperature is the most accurate, this method may be considered unpleasant, or embarrassing in some countries or cultures, especially if used on patients older than young children; also, if not taken the correct way, rectal temperature-taking can be uncomfortable and in some cases painful for the patient. Rectal temperature-taking is considered the method of choice for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infant\" title=\"Infant\" rel=\"external_link\" target=\"_blank\">infants<\/a>.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Ear\">Ear<\/span><\/h3>\n<p>The ear thermometer was invented by Dr. Theodor H. Benzinger in 1964. At the time, he was seeking a way to get a reading as close to the brain's temperature as possible, since the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypothalamus\" title=\"Hypothalamus\" rel=\"external_link\" target=\"_blank\">hypothalamus<\/a> at the brain's base regulates the core body temperature. He accomplished this by using the ear canal's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear_drum\" class=\"mw-redirect\" title=\"Ear drum\" rel=\"external_link\" target=\"_blank\">ear drum<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessels\" class=\"mw-redirect\" title=\"Blood vessels\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a>, which are shared with the hypothalamus. Before the ear thermometer's invention, easy temperature readings could only be taken from the mouth, rectum or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axilla\" title=\"Axilla\" rel=\"external_link\" target=\"_blank\">underarm<\/a>. Previously, if doctors wanted to record an accurate brain temperature, electrodes needed to be attached to the patient's hypothalamus.<sup id=\"rdp-ebb-cite_ref-Dr._Benzinger_Obituary_12-1\" class=\"reference\"><a href=\"#cite_note-Dr._Benzinger_Obituary-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>This tympanic thermometer has a projection (protected by a one-time hygienic sheath) that contains the infrared probe; the projection is gently placed in the ear canal and a button pressed; the temperature is read and displayed within about a second. These thermometers are used both in the home and in medical facilities.\n<\/p><p>There are factors that make readings of this thermometer to some extent unreliable, for example faulty placement in the external ear canal by the operator, and wax blocking the canal. Such error-producing factors usually cause readings to be below the true value, so that a fever can fail to be detected.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Temporal_artery\">Temporal artery<\/span><\/h3>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superficial_temporal_artery\" title=\"Superficial temporal artery\" rel=\"external_link\" target=\"_blank\">temporal artery<\/a> thermometer, which uses the infrared principle report temperature, were not very accurate and therefore caution should be used.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Forehead\">Forehead<\/span><\/h3>\n<p>The band thermometer is applied to the patient's brow. It is typically a band coated with different temperature-sensitive markings using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_strip_thermometer\" class=\"mw-redirect\" title=\"Plastic strip thermometer\" rel=\"external_link\" target=\"_blank\">plastic strip thermometer<\/a> or similar technology; at a given temperature the markings (numerals indicating the temperature) in one region are at the right temperature to become visible. This type may give an indication of fever, but is not considered accurate.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Classification_by_technology\">Classification by technology<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Liquid-filled\">Liquid-filled<\/span><\/h3>\n<p>The traditional thermometer is a glass tube with a bulb at one end containing a liquid which expands in a uniform manner with temperature. The tube itself is narrow (capillary) and has calibration markings along it. The liquid is often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">mercury<\/a>, but <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcohol_thermometer\" title=\"Alcohol thermometer\" rel=\"external_link\" target=\"_blank\">alcohol thermometers<\/a> use a colored alcohol. Medically, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maximum_thermometer\" class=\"mw-redirect\" title=\"Maximum thermometer\" rel=\"external_link\" target=\"_blank\">maximum thermometer<\/a> is often used, which indicates the maximum temperature reached even after it is removed from the body.\n<\/p><p>To use the thermometer, the bulb is placed in the location where the temperature is to be measured and left long enough to be certain to reach <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_equilibrium\" title=\"Thermal equilibrium\" rel=\"external_link\" target=\"_blank\">thermal equilibrium<\/a>\u2014typically three minutes. Maximum-reading is achieved by means of a constriction in the neck close to the bulb. As the temperature of the bulb rises, the liquid expands up the tube through the constriction. When the temperature falls, the column of liquid breaks at the constriction and cannot return to the bulb, thus remaining stationary in the tube. After reading the value, the thermometer must be reset by repeatedly swinging it sharply to shake the liquid back through the constriction.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Mercury\">Mercury<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury-in-glass_thermometer\" title=\"Mercury-in-glass thermometer\" rel=\"external_link\" target=\"_blank\">Mercury-in-glass thermometers<\/a> have been considered the most accurate liquid-filled types. However, mercury is a toxic heavy metal, and mercury has only been used in clinical thermometers if protected from breakage of the tube.\n<\/p><p>The tube must be very narrow to minimise the amount of mercury in it\u2014the temperature of the tube is not controlled, so it must contain very much less mercury than the bulb to minimise the effect of the temperature of the tube\u2014and this makes the reading rather difficult as the narrow mercury column is not very visible. Visibility is less of a problem with a coloured liquid.\n<\/p><p>In the 1990s it was decided<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> that mercury-based thermometers were too risky to handle; the vigorous swinging needed to \"reset\" a mercury maximum thermometer makes it easy to accidentally break it and spill the moderately <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_poisoning\" title=\"Mercury poisoning\" rel=\"external_link\" target=\"_blank\">poisonous<\/a> mercury. Mercury thermometers have largely been replaced by electronic digital thermometers, or, more rarely, thermometers based on liquids other than mercury (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Galinstan\" title=\"Galinstan\" rel=\"external_link\" target=\"_blank\">galinstan<\/a>, coloured <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcohol\" title=\"Alcohol\" rel=\"external_link\" target=\"_blank\">alcohols<\/a> and heat-sensitive liquid crystals).\n<\/p>\n<h3><span id=\"rdp-ebb-Phase-change_.28dot_matrix.29_thermometers\"><\/span><span class=\"mw-headline\" id=\"Phase-change_(dot_matrix)_thermometers\">Phase-change (dot matrix) thermometers<\/span><\/h3>\n<p>Phase-change thermometers use samples of inert chemicals which melt at progressively higher temperatures from 35.5 \u00b0C to 40.5 \u00b0C in steps of 0.1 \u00b0C. They are mounted as small dots in a matrix on a thin plastic spatula with a protective transparent cover. This is placed under the patient\u2019s tongue. After a short time the spatula is removed and it can be seen which dots have melted and which have not: the temperature is taken as the melting temperature of the last dot to melt.\nThese are cheap disposable devices and avoid the need for sterilizing for re-use. <sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Liquid_crystal\">Liquid crystal<\/span><\/h3>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liquid_crystal_thermometer\" title=\"Liquid crystal thermometer\" rel=\"external_link\" target=\"_blank\">liquid crystal thermometer<\/a> contains heat-sensitive (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermochromic\" class=\"mw-redirect\" title=\"Thermochromic\" rel=\"external_link\" target=\"_blank\">thermochromic<\/a>) liquid crystals in a plastic strip that change color to indicate different temperatures.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Electronic\">Electronic<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fieberthermometer_BW_2.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Fieberthermometer_BW_2.JPG\/220px-Fieberthermometer_BW_2.JPG\" width=\"220\" height=\"75\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fieberthermometer_BW_2.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Electronic clinical thermometer<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fieber-schnelltest.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/94\/Fieber-schnelltest.jpg\/220px-Fieber-schnelltest.jpg\" width=\"220\" height=\"246\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fieber-schnelltest.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Quick test based on thermo chromic colours<\/div><\/div><\/div>\n<p>Since compact and inexpensive methods of measuring and displaying temperature became available, electronic thermometers (often called <i>digital<\/i>, because they display numeric values) have been used. Many display readings to great <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accuracy_and_precision\" title=\"Accuracy and precision\" rel=\"external_link\" target=\"_blank\">precision<\/a> (0.1 \u00b0C or 0.2 \u00b0F, sometimes half that), but this should not be taken as a guarantee of accuracy: specified accuracy must be checked in documentation and maintained by periodical recalibration. A typical inexpensive electronic ear thermometer for home use has a displayed resolution of 0.1 \u00b0C, but a stated accuracy within \u00b10.2 \u00b0C (\u00b10.35 \u00b0F) when new.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> The first electronic clinical thermometer, invented in 1954, used a flexible probe that contained a Carboloy thermistor.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p><b>Types of Digital Thermometer<\/b>\n<\/p><p><span id=\"rdp-ebb-Resistance_temperature_detectors\"><\/span>\n<p><b>Resistance temperature detectors (RTDs)<\/b>\n<\/p>\n<\/p><p>RTDs are wire windings or other thin film serpentines that exhibit changes in resistance with changes in temperature.They measure temperature using the positive temperature coefficient of electrical resistance of metals. The hotter they become, the higher the value of their electrical resistance. Platinum is the most commonly used material because it is nearly linear over a wide range of temperatures, is very accurate, and has a fast response time. RTDs can also be made of copper or nickel.\n<p>o Advantages of RTDs include their stable output for long periods of time. They are also easy to calibrate and provide very accurate readings.\no Disadvantages include a smaller overall temperature range, higher initial cost, and a less rugged design\n<\/p>\n<\/p><p><b>Thermocouples<\/b>\n<\/p><p><span id=\"rdp-ebb-Thermocouples\"><\/span>\n<p>Thermocouples are accurate, highly sensitive to small temperature changes, and quickly respond to changes to the environment. They consist of a pair of dissimilar metal wires joined at one end. The metal pair generates a net thermoelectric voltage between their opening and according to the size of the temperature difference between the ends.\n\u2022Advantages of thermocouples include their high accuracy and reliable operation over an extremely wide range of temperatures. They are also well-suited for making automated measurements both inexpensive and durable.\n\u2022Disadvantages include errors caused by their use over an extended period of time, and that two temperatures are required to make measurements. Thermocouple materials are subject to corrosion, which can affect the thermoelectric voltage\n<\/p>\n<\/p><p><b>Thermistor<\/b>\n<\/p><p><span id=\"rdp-ebb-Thermistor\"><\/span>\n<p>Thermistor elements are the most sensitive temperature sensors available. A thermistor is a semiconductor device with an electrical resistance that is proportional to temperature. There are two types of products.\n\u2022Negative temperature coefficient (NTC) devices are used in temperature sensing and are the most common type of thermistor. NTCs have temperatures that vary inversely with their resistance, so that when the temperature increases, the resistance decreases, and vice versa. NTCs are constructed from oxides of materials such as nickel, copper, and iron.\n\u2022 Positive temperature coefficient (PTC) devices are used in electric current control. They function in an opposite manner than NTC in that the resistance increases as temperature increases. PTCs are constructed from thermally sensitive silicons or polycrystalline ceramic materials.\n\u2022 There are several advantage and disadvantages to using an NTC thermistor thermometer.\n\u2022 Advantages include their small size and high degree of stability. NTCs are also long lasting and very accurate.\n\u2022 Disadvantages include their non-linearity, and unsuitability for use in extreme temperatures\n<\/p>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Contact\">Contact<\/span><\/h4>\n<p>Some electronic thermometers may work by contact (the electronic sensor is placed in the location where temperature is to be measured, and left long enough to reach equilibrium). These typically reach equilibrium faster than mercury thermometers; the thermometer may beep when equilibrium has been reached, or the time may be specified in the manufacturer's documentation.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Remote\">Remote<\/span><\/h4>\n<p>Other electronic thermometers work by remote sensing: an infrared sensor responds to the radiation <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spectrum\" title=\"Spectrum\" rel=\"external_link\" target=\"_blank\">spectrum<\/a> emitted from the location. Although these are not in direct contact with the area being measured, they may still contact part of the body (a thermometer which senses the temperature of the eardrum without touching it is inserted into the ear canal). To eliminate the risk of patient cross-infection, disposable probe covers and single-use clinical thermometers of all types are used in clinics and hospitals.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Accuracy\">Accuracy<\/span><\/h4>\n<p>According to a 2001 research, electronic thermometers on the market significantly underestimate higher temperatures and overestimate lower temperatures. The researchers conclude that \"the current generation of electronic, digital clinical thermometers, in general, may not be sufficiently accurate or reliable to replace the traditional glass\/mercury thermometers\"<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Basal_thermometer\">Basal thermometer<\/span><\/h3>\n<p>A basal thermometer is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermometer\" title=\"Thermometer\" rel=\"external_link\" target=\"_blank\">thermometer<\/a> used to take the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Basal_body_temperature\" title=\"Basal body temperature\" rel=\"external_link\" target=\"_blank\">basal (base) body temperature<\/a>, the temperature upon waking. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Basal_body_temperature\" title=\"Basal body temperature\" rel=\"external_link\" target=\"_blank\">Basal body temperature<\/a> is much less affected than daytime temperature by environmental factors such as exercise and food intake. This allows small changes in body temperature to be detected\n<\/p><p>Glass oral thermometers typically have markings every 0.1 \u00b0C or 0.2 \u00b0F. Basal temperature is stable enough to require accuracy of at least 0.05 \u00b0C or 0.1 \u00b0F, so special glass basal thermometers are distinct from glass oral thermometers. Digital thermometers which have sufficient resolution (0.05 \u00b0C or 0.1 \u00b0F is sufficient) may be suitable for monitoring basal body temperatures; the specification should be checked to ensure absolute accuracy, and thermometers (like most digital instruments) should be calibrated at specified intervals. If only the variation of basal temperature is required, absolute accuracy is not so important so long as the readings do not have large variability (e.g., if real temperature varies from 37.00 \u00b0C to 37.28 \u00b0C, a thermometer which inaccurately but consistently reads a change from 37.17 \u00b0C to 37.45 \u00b0C will indicate the magnitude of the change). Some digital thermometers are marketed as \"basal thermometers\" and have extra features such as a larger display, expanded memory functions, or beeping to confirm the thermometer is placed properly.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/fd\/Portal-puzzle.svg\/32px-Portal-puzzle.svg.png\" width=\"32\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medical\" class=\"mw-redirect\" title=\"Portal:Medical\" rel=\"external_link\" target=\"_blank\">Medical portal<\/a><\/span><\/li><\/ul><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermometer\" title=\"Thermometer\" rel=\"external_link\" target=\"_blank\">Thermometer<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Liquid_crystal_thermometer\" title=\"Liquid crystal thermometer\" rel=\"external_link\" target=\"_blank\">Liquid crystal thermometer<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Footnotes\">Footnotes<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-A_Brief_History_of_the_Clinical_Thermometer-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-A_Brief_History_of_the_Clinical_Thermometer_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/qjmed.oxfordjournals.org\/content\/95\/4\/251\" target=\"_blank\">\"A Brief History of the Clinical Thermometer\"<\/a>. <i>QJM<\/i>. Oxford University Press. 1 April 2002<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 July<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=QJM&rft.atitle=A+Brief+History+of+the+Clinical+Thermometer&rft.date=2002-04-01&rft_id=http%3A%2F%2Fqjmed.oxfordjournals.org%2Fcontent%2F95%2F4%2F251&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+thermometer\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-History_of_the_Thermometer-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-History_of_the_Thermometer_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_of_the_Thermometer_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_of_the_Thermometer_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_of_the_Thermometer_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_of_the_Thermometer_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-History_of_the_Thermometer_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.timetoast.com\/timelines\/history-of-the-thermometer--8\" target=\"_blank\">\"History of the Thermometer: Timeline created by TheArctech in Science and Technology\"<\/a>. <i>Timetoast.com<\/i>. Timetoast<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">23 September<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=World+Meteorological+Organization&rft.atitle=782+-+Aerodrome+reports+and+forecasts%3A+A+user%27s+handbook+to+the+codes&rft_id=http%3A%2F%2Fwww.wmo.int%2Fe-catalog%2Fdetail_en.php%3FPUB_ID%3D70%26SORT%3DN%26q%3DAerodrome%2520Reports%2520and%2520Forecasts&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+thermometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-'Linnaeus'_thermometer_1-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#39;_thermometer_1_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Citation: Uppsala University (Sweden), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.linnaeus.uu.se\/online\/life\/6_32.html\" target=\"_blank\"><i>Linnaeus' thermometer<\/i><\/a><\/span>\n<\/li>\n<li id=\"cite_note-EOC_1-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-EOC_1_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Don_Rittner\" title=\"Don Rittner\" rel=\"external_link\" target=\"_blank\">Don Rittner<\/a>; Ronald A. Bailey (2005): <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\"><i>Encyclopedia of Chemistry.<\/i><\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infobase_Publishing\" title=\"Infobase Publishing\" rel=\"external_link\" target=\"_blank\">Facts On File<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manhattan\" title=\"Manhattan\" rel=\"external_link\" target=\"_blank\">Manhattan<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_City\" title=\"New York City\" rel=\"external_link\" target=\"_blank\">New York City<\/a>. pp. 43.<\/span>\n<\/li>\n<li id=\"cite_note-TFOFDOWAC_1-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-TFOFDOWAC_1_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Smith, Jacqueline (2009). \"Appendix I: Chronology\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=lAfa1orgvwQC&pg=PA246\" target=\"_blank\"><i>The Facts on File Dictionary of Weather and Climate<\/i><\/a>. Infobase Publishing. p. 246. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4381-0951-0. <q>1743 Jean-Pierre Christin inverts the fixed points on Celsius' scale, to produce the scale used today.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Appendix+I%3A+Chronology&rft.btitle=The+Facts+on+File+Dictionary+of+Weather+and+Climate&rft.pages=246&rft.pub=Infobase+Publishing&rft.date=2009&rft.isbn=978-1-4381-0951-0&rft.aulast=Smith&rft.aufirst=Jacqueline&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DlAfa1orgvwQC%26pg%3DPA246&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+thermometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MSLDDMDLT_1-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MSLDDMDLT_1_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercure_de_France\" title=\"Mercure de France\" rel=\"external_link\" target=\"_blank\">Mercure de France<\/a><\/i> (1743): <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=true\"><i>MEMOIRE sur la dilatation du Mercure dans le Thermom\u00e9tre.<\/i><\/a> Chaubert; Jean de Nully, Pissot, Duchesne, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paris\" title=\"Paris\" rel=\"external_link\" target=\"_blank\">Paris<\/a>. pp. 1609\u20131610.<\/span>\n<\/li>\n<li id=\"cite_note-IDJ_1-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-IDJ_1_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Journal helv\u00e9tique<\/i> (1743): <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=true\"><i>LION.<\/i><\/a> Imprimerie des Journalistes, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuch%C3%A2tel\" title=\"Neuch\u00e2tel\" rel=\"external_link\" target=\"_blank\">Neuch\u00e2tel<\/a>. pp. 308-310.<\/span>\n<\/li>\n<li id=\"cite_note-MPLHDSEDBA_1-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MPLHDSEDBA_1_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Memoires pour L'Histoire des Sciences et des Beaux Arts<\/i> (1743): <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=true\"><i>DE LYON.<\/i><\/a> Chaubert, Par\u00eds. pp. 2125-2128.<\/span>\n<\/li>\n<li id=\"cite_note-Medical_Dictionary:_Ear_Thermometer-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Medical_Dictionary:_Ear_Thermometer_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medicine.academic.ru\/2596\/Ear_thermometer\" target=\"_blank\">\"Medical Dictionary: Ear Thermometer\"<\/a>. <i>enacademic.com<\/i>. 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Blumenthal (December 1996). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.springerlink.com\/content\/e321364274471520\/\" target=\"_blank\">\"Modern electronic and chemical thermometers used in the axilla are inaccurate\"<\/a>. <i>European Journal of Pediatrics<\/i>. <b>155<\/b> (12): 1005\u20131008. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF02532519\" target=\"_blank\">10.1007\/BF02532519<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1432-1076\" target=\"_blank\">1432-1076<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8956933\" target=\"_blank\">8956933<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-02-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Pediatrics&rft.atitle=Modern+electronic+and+chemical+thermometers+used+in+the+axilla+are+inaccurate&rft.volume=155&rft.issue=12&rft.pages=1005-1008&rft.date=1996-12&rft.issn=1432-1076&rft_id=info%3Apmid%2F8956933&rft_id=info%3Adoi%2F10.1007%2FBF02532519&rft.au=S.T.+Zengeya+and+I.+Blumenthal&rft_id=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe321364274471520%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+thermometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Fundamentals of Nursing by Barbara Kozier et al., 7th edition, p. 495<\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kiekkas, P; Stefanopoulos, N; Bakalis, N; Kefaliakos, A; Karanikolas, M (April 2016). \"Agreement of infrared temporal artery thermometry with other thermometry methods in adults: systematic review\". <i>Journal of clinical nursing<\/i>. <b>25<\/b> (7\u20138): 894\u2013905. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fjocn.13117\" target=\"_blank\">10.1111\/jocn.13117<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26994990\" target=\"_blank\">26994990<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+clinical+nursing&rft.atitle=Agreement+of+infrared+temporal+artery+thermometry+with+other+thermometry+methods+in+adults%3A+systematic+review.&rft.volume=25&rft.issue=7%E2%80%938&rft.pages=894-905&rft.date=2016-04&rft_id=info%3Adoi%2F10.1111%2Fjocn.13117&rft_id=info%3Apmid%2F26994990&rft.aulast=Kiekkas&rft.aufirst=P&rft.au=Stefanopoulos%2C+N&rft.au=Bakalis%2C+N&rft.au=Kefaliakos%2C+A&rft.au=Karanikolas%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+thermometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Directive 2007\/51\/EC as of 22 January 2013<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">(<a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.npl.co.uk\/publications\/good-practice-online-modules\/temperature\/temperature-measurements-in-healthcare\/phase-change-(dot-matrix)-thermometers\/)\" target=\"_blank\">http:\/\/www.npl.co.uk\/publications\/good-practice-online-modules\/temperature\/temperature-measurements-in-healthcare\/phase-change-(dot-matrix)-thermometers\/)<\/a><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.landisgyr.biz\/pdfs\/EarT.pdf\" target=\"_blank\">Specification of typical inexpensive electronic ear thermometer<\/a><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=true\">\"Takes Temperature in Seconds.\"<\/a> <i>Popular Mechanics<\/i>, November 1954, p. 123.<\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Latman, NS; Hans, P; Nicholson, L; Delee Zint, S; Lewis, K; Shirey, A (2001). \"Evaluation & Technology\". <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11494651\" target=\"_blank\">11494651<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Evaluation+%26+Technology&rft.date=2001&rft_id=info%3Apmid%2F11494651&rft.aulast=Latman&rft.aufirst=NS&rft.au=Hans%2C+P&rft.au=Nicholson%2C+L&rft.au=Delee+Zint%2C+S&rft.au=Lewis%2C+K&rft.au=Shirey%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+thermometer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nursingtimes.net\/an-investigation-into-the-accuracy-of-different-types-of-thermometers\/197691.article\" target=\"_blank\">\"An investigation into the accuracy of different types of thermometers\"<\/a> <i>Nursing Times.net<\/i>, 1 October 2002.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thomas_Clifford_Allbutt\" class=\"mw-redirect\" title=\"Thomas Clifford Allbutt\" rel=\"external_link\" target=\"_blank\">Allbutt, T.C.<\/a>, \u201cMedical Thermometry\u201d, <i>British and Foreign Medico-Chirurgical Review<\/i>, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/stream\/britishforeignme45londuoft#page\/428\/mode\/2up\" target=\"_blank\">Vol.45, No.90, (April 1870), pp.429-441<\/a>; <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/stream\/britishforeignme46londuoft#page\/144\/mode\/2up\" target=\"_blank\">Vo.46, No.91, (July 1870), pp.144-156.<\/a>\n<\/p>\n\n<p class=\"mw-empty-elt\">\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1250\nCached time: 20181217153253\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.376 seconds\nReal time usage: 0.504 seconds\nPreprocessor visited node count: 1382\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 38821\/2097152 bytes\nTemplate argument size: 811\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 40662\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.178\/10.000 seconds\nLua memory usage: 4.39 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 407.362 1 -total\n<\/p>\n<pre>45.55% 185.565 1 Template:Reflist\n19.69% 80.217 5 Template:Cite_web\n16.37% 66.693 5 Template:Cite_journal\n14.87% 60.576 1 Template:Citation_needed\n13.37% 54.476 1 Template:Fix\n11.63% 47.379 1 Template:Infobox_diagnostic\n10.42% 42.447 1 Template:Infobox\n 8.99% 36.632 2 Template:Category_handler\n 5.64% 22.975 1 Template:Health_care\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4311569-1!canonical and timestamp 20181217153252 and revision id 868989441\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_thermometer\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214632\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.830 1 - wikipedia:Medical_thermometer\n100.00% 160.830 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8527-0!*!*!*!*!*!* and timestamp 20181217214632 and revision id 24952\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_thermometer\">https:\/\/www.limswiki.org\/index.php\/Medical_thermometer<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9a1d7345fb8133b2264b2b32a94b04a0_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f3\/Quecksilber-Fieberthermometer.jpg\/580px-Quecksilber-Fieberthermometer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Fieberthermometermessspitzen.jpg\/440px-Fieberthermometermessspitzen.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Fieberthermometer_BW_2.JPG\/440px-Fieberthermometer_BW_2.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/94\/Fieber-schnelltest.jpg\/440px-Fieber-schnelltest.jpg"],"9a1d7345fb8133b2264b2b32a94b04a0_timestamp":1545083191,"861d9174733cf567ee6f61af1bd00ced_type":"article","861d9174733cf567ee6f61af1bd00ced_title":"Hypodermic needle","861d9174733cf567ee6f61af1bd00ced_url":"https:\/\/www.limswiki.org\/index.php\/Hypodermic_needle","861d9174733cf567ee6f61af1bd00ced_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHypodermic needle\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor the theory on mass media effects, see Hypodermic needle model.\n\"Hypodermic\" redirects here. For the song by The Offspring, see Ignition (The Offspring album).\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (August 2010) (Learn how and when to remove this template message)\n Different bevels on hypodermic needles\n Syringe on left, hypodermic needle with attached colour coded Luer-Lok connector on right\n Hypodermic needle features\nA hypodermic needle (from Greek \u1f51\u03c0\u03bf- (under-), and \u03b4\u03ad\u03c1\u03bc\u03b1 (skin)), one of a category of medical tools which enter the skin, called sharps,[1] is a very thin, hollow tube with a sharp tip that contains a small opening at the pointed end. It is commonly used with a syringe, a hand-operated device with a plunger, to inject substances into the body (e.g., saline solution, solutions containing various drugs or liquid medicines) or extract fluids from the body (e.g., blood). They are used to take liquid samples from the body, for example taking blood from a vein in venipuncture. Large bore hypodermic intervention is especially useful in catastrophic blood loss or treating shock.\nA hypodermic needle is used for rapid delivery of liquids, or when the injected substance cannot be ingested, either because it would not be absorbed (as with insulin), or because it would harm the liver. There are many possible routes for an injection, with the arm being a common location.\nThe hypodermic needle also serves an important role in research environments where sterile conditions are required. The hypodermic needle significantly reduces contamination during inoculation of a sterile substrate. The hypodermic needle reduces contamination for two reasons: First, its surface is extremely smooth, which prevents airborne pathogens from becoming trapped between irregularities on the needle's surface, which would subsequently be transferred into the media (e.g. agar) as contaminants; second, the needle's surface is extremely sharp, which significantly reduces the diameter of the hole remaining after puncturing the membrane and consequently prevents microbes larger than this hole from contaminating the substrate.[2][3][4][5]\n\nContents \n\n1 History \n\n1.1 Early use and experimentation \n1.2 19th century development \n1.3 Modern improvements \n\n\n2 Manufacture \n3 Gauge \n4 Non-specialist use \n5 Phobia \n6 See also \n7 References \n8 External links \n\n\nHistory \nEarly use and experimentation \nThe ancient Greeks and Romans knew injection as a method of medicinal delivery from observations of snakebites and poisoned weapons.[6] There are also references to \"anointing\" and \"inunction\" in the Old Testament as well as the works of Homer, but injection as a legitimate medical tool was not truly explored until the 17th century.[7] \nChristopher Wren performed the earliest confirmed experiments with crude hypodermic needles, performing intravenous injection into dogs in 1656.[7] These experiments consisted of using animal bladders (as the syringe) and goose quills (as the needle) to administer drugs such as opium intravenously to dogs. Wren and others' main interest was to learn if medicines traditionally administered orally would be effective intravenously.\nIn the 1660s, J. D. Major of Kiel and J. S. Elsholtz of Berlin were the first to experiment with injections in humans.[6][8] These early experiments were generally ineffective and in some cases fatal. Injection fell out of favor for two centuries.\n\n19th century development \nThe 19th century saw the development of medicines that were effective in small doses, such as opiates and strychnine. This spurred a renewed interest in direct, controlled application of medicine. \"Some controversy surrounds the question of priority in hypodermic medication.\"[9] Dr. Francis Rynd is generally credited with the first successful injection in 1844.[10][11] Dr. Alexander Wood\u2019s main contribution was the all-glass syringe in 1851, which allowed the user to estimate dosage based on the levels of liquid observed through the glass.[12] Wood used hypodermic needles and syringes primarily for the application of localized, subcutaneous injection (localized anesthesia) and therefore was not as interested in precise dosages.[8] Simultaneous to Wood's work in Edinburgh, Dr. Charles Pravaz of Lyon also experimented with sub-dermal injections in sheep using a syringe of his own design. Pravaz designed a syringe measuring 3 cm (1.18 in) long and 5 mm (0.2 in) in diameter; it was made entirely of silver.[13] \nDr. Charles Hunter, a London surgeon, is credited with the coining of the term \"hypodermic\" to describe subcutaneous injection in 1858. The name originates from two Greek words: hypo, \"under\", and derma, \"skin\". Furthermore, Hunter is credited with acknowledging the systemic effects of injection after noticing that a patient's pain was alleviated regardless of the injection\u2019s proximity to the pained area.[7][8] Hunter and Wood were involved in lengthy legal disputes over not only the origin of the modern hypodermic needle, but also because of their disagreement to the medicine's effect once administered.\n\nModern improvements \nDr. Wood can be largely credited with the popularization and acceptance of injection as a medical technique, as well as the widespread use and acceptance of the hypodermic needle. The basic technology of the hypodermic needle has stayed largely unchanged since the 19th century, but as the years progressed and medical and chemical knowledge improved, small refinements have been made to increase safety and efficacy, with needles being designed and tailored for very particular uses. The trend of needle specification for use began in the 1920s, particularly for the administration of insulin to diabetics.[14] The onset of World War II spurred the early development of partially disposable syringes for the administration of morphine and penicillin on the battlefield. Development of the fully disposable hypodermic needle was spurred on in the 1950s for several reasons. The Korean War created blood shortages and in response disposable, sterile syringes were developed for collecting blood. The widespread immunization against polio during the period required the development of a fully disposable syringe system.[14][dead link ] \nThe 1950s also saw the rise and recognition of cross-contamination from used needles. This led to the development of the first fully disposable plastic syringe by New Zealand pharmacist Colin Murdoch in 1956.[15] This period also marked a shift in interest from needle specifications to general sterility and safety. The 1980s saw the rise of the HIV epidemic and with it renewed concern over the safety of cross-contamination from used needles. New safety controls were designed on disposable needles to ensure the safety of medical workers in particular. These controls were implemented on the needles themselves, such as retractable needles, but also in the handling of used needles, particularly in the use of hard-surface disposal receptacles found in every medical office today.[14][dead link ] . The modern two-piece hypodermic needle was invented by Manuel Jal\u00f3n Corominas, a Spanish engineer in 1978.[16]\n\nManufacture \nHypodermic needles are normally made from a stainless-steel tube[17] through a process known as tube drawing where the tube is drawn through progressively smaller dies to make the needle. The needles are designed with the same general features, including a barrel, plunger, needle and cap. The end of the needle is bevelled to create a sharp pointed tip, letting the needle easily penetrate the skin.[18]\n\nGauge \n Six hypodermic needles on Luer connectors. These needles are normally used with other medical devices, such as a syringe; from top to bottom: 26G \u00d7 ​1⁄2 \u2033 (0.45 \u00d7 12 mm) (brown)25G \u00d7 ​5⁄8 \u2033 (0.5 \u00d7 16 mm) (orange)22G \u00d7 ​1  1⁄4 \u2033 (0.7 \u00d7 30 mm) (black)21G \u00d7 ​1  1⁄2 \u2033 (0.8 \u00d7 40 mm) (green)20G \u00d7 ​1  1⁄2 \u2033 (0.9 \u00d7 40 mm) (yellow)19G \u00d7 ​1  1⁄2 \u2033 (1.1 \u00d7 40 mm) (cream) See also Birmingham gauge.\nFurther information: Birmingham gauge\nThe main system for measuring the diameter of a hypodermic needle is the Birmingham gauge (whereas French gauge is used mainly for catheters). Various needle lengths are available for any given gauge. Needles in common medical use range from 7 gauge (the largest) to 33 (the smallest). 21-gauge needles are most commonly used for drawing blood for testing purposes, and 16- or 17-gauge needles are most commonly used for blood donation, as the resulting lower pressure is less harmful to red blood cells (it also allows more blood to be collected in a shorter time).[19] Although reusable needles remain useful for some scientific applications, disposable needles are far more common in medicine. Disposable needles are embedded in a plastic or aluminium hub that attaches to the syringe barrel by means of a press-fit or twist-on fitting. These are sometimes referred to as \"Luer Lock\" connections, referring to the trademark Luer-Lok. The male and female luer lock and hub-- produced by pharmaceutical equipment manufacturers-- are two of the most critical parts of disposable hypodermic needles.[20]\n\nNon-specialist use \nHypodermic needles are usually used by medical professionals (dentists, phlebotomists, physicians, nurses, paramedics), but they are sometimes used by patients themselves. This is most common with type one diabetics, who may require several insulin injections a day.[21] It also occurs with patients who have asthma or other severe allergies. Such patients may need to take desensitization injections or they may need to carry injectable medicines to use for first aid in case of a severe allergic reaction. In the latter case, such patients often carry a syringe loaded with epinephrine (e.g. EpiPen),[22] diphenhydramine (e.g. Benadryl), or dexamethasone. Rapid injection of one of these drugs may stop a severe allergic reaction.\nMultiple sclerosis patients may also treat themselves by injection; several MS therapies, including various interferon preparations, are designed to be self-administered by subcutaneous or intramuscular injection.[23] In some countries, erectile dysfunction patients may be prescribed Alprostadil in injectable form, which is self-injected directly into the base or side of the penis with a very fine hypodermic needle.\nHypodermic needles are also used by untrained users in recreational intravenous drug use (e.g., injecting solutions of heroin and water). Before governments attained current levels of awareness about the spread of disease through shared needles, hypodermic syringes in many countries were available only by prescription. Thus, in order to limit the spread of blood-borne diseases such as hepatitis and HIV through shared injection equipment, many countries have needle exchange programs in most larger cities. In some countries, such programs are wholly or partially subsidized by the government. Blunted needles, manufactured without a sharp bevel and usually non-sterile, are used industrially for filling small containers or accurately applying small amounts of solvent or glue.\n\nPhobia \nMain article: Fear of needles\nIt is estimated that anywhere from nearly 3.5 to 10% of the world\u2019s population may have a phobia of needles (trypanophobia)[24], and it is much more common in children, ages 5\u201317. Patients can ask for a patch from the nurse to numb the area of where the injection will take place to reduce pain.[25] For children and teenagers various techniques may be effective at reducing distress or pain related to needles.[26] Techniques include: distraction, hypnosis, combined cognitive behaviour therapy, and breathing techniques.[26]\n\nSee also \nCannula\nCatheter\nIntravenous therapy\nNanoneedle\nNeedle biopsy\nNeedle gauge comparison chart\nNeedle remover\nPin prick attack\nTuohy needle\nReferences \n\n\n^ \"Handling sharps and needles: MedlinePlus Medical Encyclopedia\". medlineplus.gov. Retrieved 4 April 2018 . \n\n^ Elsheikh, HA; Ali, BH; Homeida, AM; Lutfi, AA; Hapke, HJ (May\u2013Jun 1992). \"The effects of fascioliasis on the activities of some drug-metabolizing enzymes in desert sheep liver\". The British veterinary journal. 148 (3): 249\u201357. doi:10.1016\/0007-1935(92)90048-6. PMID 1617399. \n\n^ Korenman, SG (September 1975). \"Estrogen receptor assay in human breast cancer\". Journal of the National Cancer Institute. 55 (3): 543\u20135. doi:10.1093\/jnci\/55.3.543. PMID 169381. \n\n^ Scott, Gene E.; Zummo, Natale (1 January 1988). \"Sources of Resistance in Maize to Kernel Infection by Aspergillus flavus in the Field\". Crop Science. 28 (3): 504. doi:10.2135\/cropsci1988.0011183X002800030016x. \n\n^ \"Experimental Infection of Host Grasses and Sedges with Atkinsonella hypoxylon and Balansia cyperi (Balansiae, Clavicipitaceae)\". Mycologia. 80 (3): 291\u2013297. 1988. doi:10.2307\/3807624. JSTOR 3807624. \n\n^ a b Norn S, Kruse PR, Kruse E (2006). \"On the history of injection\". Dan Medicinhist Arbog. 34: 104\u20131. CS1 maint: Multiple names: authors list (link) \n\n^ a b c Kotwal, Atul. \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practice\". Social Science & Medicine Volume 60, Issue 5, March 2005, pp. 1133\u20131147 \n\n^ a b c Ball C (Jun 2006). \"The early development of intravenous apparatus\". Anaesth Intensive Care. 34 (Suppl 1): 22\u20136. \n\n^ Logan Clendening, Source Book of Medical History, p. 419 (1960) \n\n^ Walter Reginald Bett, The History and Conquest of Common Diseases p. 145 (1954) \n\n^ \"The Irish doctor who invented the syringe\". irishtimes.com. Retrieved 4 April 2018 . \n\n^ Kotwal, Atul. \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices\". Social Science & Medicine Volume 60, Issue 5, March 2005, pp. 1133\u20131147 \n\n^ Syringe, Discoveriesinmedicine.com \n\n^ a b c Beckton Dickinson and Company, \"Four Major Phases of Injection Device Development\", Syringe and Needle History Archived May 8, 2015, at the Wayback Machine. \n\n^ \"Hypodermic syringe\". www.sciencemuseum.org.uk. Retrieved 4 April 2018 . \n\n^ \"The Disposable Syringe\". spanishgenetics.weebly.com. Retrieved 2018-12-13 . \n\n^ How do they get the hole through a hypodermic needle? at The Straight Dope. \n\n^ \"How syringe is made - material, production process, manufacture, making, history, used, processing, parts\". How Products Are Made. Retrieved 2018-01-03 . \n\n^ Blood Transfusions and Angio Size? Archived 2016-03-03 at the Wayback Machine. \n\n^ \"Medical Industry Cycle Times | Davenport Machine\". Davenport Machine. Retrieved 2018-01-03 . \n\n^ \"Giving an Insulin Injection\". Drugs.com. Retrieved 2010-08-19 . \n\n^ \"How to Stop Allergic Reactions\". EpiPen. Retrieved 2010-08-19 . \n\n^ \"Multiple Sclerosis Treatments\". mult-sclerosis.org. 2008-01-21. Retrieved 2013-01-13 . \n\n^ \"Fear of Needles Phobia \u2013 Trypanophobia\". www.fearof.net. Retrieved 2018-01-03 . \n\n^ \"The Needle Phobia Page\". Futurescience.com. Retrieved 2010-08-19 . \n\n^ a b Birnie, Kathryn A.; Noel, Melanie; Chambers, Christine T.; Uman, Lindsay S.; Parker, Jennifer A. (2018-10-04). \"Psychological interventions for needle-related procedural pain and distress in children and adolescents\". The Cochrane Database of Systematic Reviews. 10: CD005179. doi:10.1002\/14651858.CD005179.pub4. ISSN 1469-493X. PMID 30284240. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Hypodermic needles.\nThe Needle Phobia Page\nNeedle Phobia and Dental Injections\nCalifornia Company Creates Medical Device That Could Change the Course of Medicine as We Know It\nvteRoutes of administration, dosage formsOralDigestive\r\ntract (enteral)Solids\nPill\nTablet\nCapsule\nPastille\nTime release technology\nOsmotic delivery system (OROS)\n\r\nLiquids\nDecoction\nElixir\nElectuary\nEmulsion\nExtended-release syrup\nEffervescent powder or tablet\nHerbal tea\nHydrogel\nMolecular encapsulation\nPowder\nSoftgel\nSolution\nSuspension\nSyrup\nSyrup Concentrate for dilution and\/or addition of carbonated water\nTincture\nBuccal (sublabial), sublingualSolids\nOrally disintegrating tablet (ODT)\nFilm\nLollipop\nSublingual drops\nLozenges\nEffervescent buccal tablet\nChewing gum\nLiquids\nMouthwash\nToothpaste\nOintment\nOral spray\nRespiratory\r\ntractSolids\nSmoking device\nDry-powder inhaler (DPI)\n\r\n0 \r\n0 Liquids\nAnaesthetic vaporizer\nVaporizer\nNebulizer\nMetered-dose inhaler (MDI)\nGas\nOxygen mask and Nasal cannula\nOxygen concentrator\nAnaesthetic machine\nRelative analgesia machine\nOphthalmic,\r\notologic, nasal\nNasal spray\nEar drops\nEye drops\nOintment\nHydrogel\nNanosphere suspension\nInsufflation\nMucoadhesive microdisc (microsphere tablet)Urogenital\nOintment\nPessary (vaginal suppository)\nVaginal ring\nVaginal douche\nIntrauterine device (IUD)\nExtra-amniotic infusion\nIntravesical infusion\nRectal (enteral)\nOintment\nSuppository\nEnema\nSolution\nHydrogel\nMurphy drip\nNutrient enemaDermal\nOintment\nTopical cream\nTopical gel\nLiniment\nPaste\nFilm\nDMSO drug solution\nElectrophoretic dermal delivery system\nHydrogel\nLiposomes\nTransfersome vesicles\nCream\nLotion\nLip balm\nMedicated shampoo\nDermal patch\nTransdermal patch\nContact (rubbed into break in the skin)\nTransdermal spray\nJet injectorInjection,\r\ninfusion\r\n(into tissue\/blood)Skin\nIntradermal\nSubcutaneous\nTransdermal implant\nOrgans\nIntracavernous\nIntravitreal\nIntra-articular injection\nTransscleral\nCentral nervous system\nIntracerebral\nIntrathecal\nEpidural\nCirculatory, musculoskeletal\nIntravenous\nIntracardiac\nIntramuscular\nIntraosseous\nIntraperitoneal\nNanocell injection\nPatient-Controlled Analgesia pump\nPIC line\n\n Category\n WikiProject\n Pharmacy portal\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hypodermic_needle\">https:\/\/www.limswiki.org\/index.php\/Hypodermic_needle<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","861d9174733cf567ee6f61af1bd00ced_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Hypodermic_needle skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Hypodermic needle<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For the theory on mass media effects, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle_model\" title=\"Hypodermic needle model\" rel=\"external_link\" target=\"_blank\">Hypodermic needle model<\/a>.<\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Hypodermic\" redirects here. For the song by The Offspring, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ignition_(The_Offspring_album)\" title=\"Ignition (The Offspring album)\" rel=\"external_link\" target=\"_blank\">Ignition (The Offspring album)<\/a>.<\/div>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NeedleBevels.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1b\/NeedleBevels.svg\/220px-NeedleBevels.svg.png\" width=\"220\" height=\"102\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NeedleBevels.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Different <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bevel\" title=\"Bevel\" rel=\"external_link\" target=\"_blank\">bevels<\/a> on hypodermic needles<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Syringe_and_hypodermic.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/79\/Syringe_and_hypodermic.jpg\/220px-Syringe_and_hypodermic.jpg\" width=\"220\" height=\"38\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Syringe_and_hypodermic.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Syringe\" title=\"Syringe\" rel=\"external_link\" target=\"_blank\">Syringe<\/a> on left, hypodermic needle with attached <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colour_code\" class=\"mw-redirect\" title=\"Colour code\" rel=\"external_link\" target=\"_blank\">colour coded<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Luer_Taper\" class=\"mw-redirect\" title=\"Luer Taper\" rel=\"external_link\" target=\"_blank\">Luer-Lok<\/a> connector on right<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AgujaHipod%C3%A9rmica.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/AgujaHipod%C3%A9rmica.png\/220px-AgujaHipod%C3%A9rmica.png\" width=\"220\" height=\"127\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AgujaHipod%C3%A9rmica.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hypodermic needle features<\/div><\/div><\/div>\n<p>A <b>hypodermic needle<\/b> (from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_Language\" class=\"mw-redirect\" title=\"Greek Language\" rel=\"external_link\" target=\"_blank\">Greek<\/a> \u1f51\u03c0\u03bf- (under-), and \u03b4\u03ad\u03c1\u03bc\u03b1 (skin)), one of a category of medical tools which enter the skin, called <b>sharps<\/b>,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> is a very thin, hollow tube with a sharp tip that contains a small opening at the pointed end. It is commonly used with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Syringe\" title=\"Syringe\" rel=\"external_link\" target=\"_blank\">syringe<\/a>, a hand-operated device with a plunger, to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_(medicine)\" title=\"Injection (medicine)\" rel=\"external_link\" target=\"_blank\">inject<\/a> substances into the body (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_solution\" class=\"mw-redirect\" title=\"Saline solution\" rel=\"external_link\" target=\"_blank\">saline solution<\/a>, solutions containing various drugs or liquid medicines) or extract fluids from the body (e.g., blood). They are used to take liquid samples from the body, for example taking <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Venipuncture\" title=\"Venipuncture\" rel=\"external_link\" target=\"_blank\">venipuncture<\/a>. Large bore hypodermic intervention is especially useful in catastrophic blood loss or treating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shock_(circulatory)\" title=\"Shock (circulatory)\" rel=\"external_link\" target=\"_blank\">shock<\/a>.\n<\/p><p>A hypodermic needle is used for rapid delivery of liquids, or when the injected substance cannot be ingested, either because it would not be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Absorption_(pharmacokinetics)\" class=\"mw-redirect\" title=\"Absorption (pharmacokinetics)\" rel=\"external_link\" target=\"_blank\">absorbed<\/a> (as with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a>), or because it would harm the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a>. There are many possible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_(medicine)\" title=\"Injection (medicine)\" rel=\"external_link\" target=\"_blank\">routes<\/a> for an injection, with the arm being a common location.\n<\/p><p>The hypodermic needle also serves an important role in research environments where sterile conditions are required. The hypodermic needle significantly reduces contamination during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inoculation\" title=\"Inoculation\" rel=\"external_link\" target=\"_blank\">inoculation<\/a> of a sterile <a href=\"https:\/\/en.wikipedia.org\/wiki\/Substrate_(biology)\" title=\"Substrate (biology)\" rel=\"external_link\" target=\"_blank\">substrate<\/a>. The hypodermic needle reduces contamination for two reasons: First, its surface is extremely smooth, which prevents airborne <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathogens\" class=\"mw-redirect\" title=\"Pathogens\" rel=\"external_link\" target=\"_blank\">pathogens<\/a> from becoming trapped between irregularities on the needle's surface, which would subsequently be transferred into the media (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agar\" title=\"Agar\" rel=\"external_link\" target=\"_blank\">agar<\/a>) as contaminants; second, the needle's surface is extremely sharp, which significantly reduces the diameter of the hole remaining after puncturing the membrane and consequently prevents microbes larger than this hole from contaminating the substrate.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Early_use_and_experimentation\">Early use and experimentation<\/span><\/h3>\n<p>The ancient Greeks and Romans knew injection as a method of medicinal delivery from observations of snakebites and poisoned weapons.<sup id=\"rdp-ebb-cite_ref-ReferenceA_6-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-6\" rel=\"external_link\">[6]<\/a><\/sup> There are also references to \"anointing\" and \"inunction\" in the Old Testament as well as the works of Homer, but injection as a legitimate medical tool was not truly explored until the 17th century.<sup id=\"rdp-ebb-cite_ref-Kotwal,_Atul_2005_7-0\" class=\"reference\"><a href=\"#cite_note-Kotwal,_Atul_2005-7\" rel=\"external_link\">[7]<\/a><\/sup> \n<a href=\"https:\/\/en.wikipedia.org\/wiki\/Christopher_Wren\" title=\"Christopher Wren\" rel=\"external_link\" target=\"_blank\">Christopher Wren<\/a> performed the earliest confirmed experiments with crude hypodermic needles, performing intravenous injection into dogs in 1656.<sup id=\"rdp-ebb-cite_ref-Kotwal,_Atul_2005_7-1\" class=\"reference\"><a href=\"#cite_note-Kotwal,_Atul_2005-7\" rel=\"external_link\">[7]<\/a><\/sup> These experiments consisted of using animal bladders (as the syringe) and goose quills (as the needle) to administer drugs such as opium intravenously to dogs. Wren and others' main interest was to learn if medicines traditionally administered orally would be effective intravenously.\nIn the 1660s, J. D. Major of Kiel and J. S. Elsholtz of Berlin were the first to experiment with injections in humans.<sup id=\"rdp-ebb-cite_ref-ReferenceA_6-1\" class=\"reference\"><a href=\"#cite_note-ReferenceA-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ReferenceB_8-0\" class=\"reference\"><a href=\"#cite_note-ReferenceB-8\" rel=\"external_link\">[8]<\/a><\/sup> These early experiments were generally ineffective and in some cases fatal. Injection fell out of favor for two centuries.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"19th_century_development\">19th century development<\/span><\/h3>\n<p>The 19th century saw the development of medicines that were effective in small doses, such as opiates and strychnine. This spurred a renewed interest in direct, controlled application of medicine. \"Some controversy surrounds the question of priority in hypodermic medication.\"<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Francis_Rynd\" title=\"Francis Rynd\" rel=\"external_link\" target=\"_blank\">Dr. Francis Rynd<\/a> is generally credited with the first successful injection in 1844.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alexander_Wood_(physician)\" title=\"Alexander Wood (physician)\" rel=\"external_link\" target=\"_blank\">Dr. Alexander Wood<\/a>\u2019s main contribution was the all-glass syringe in 1851, which allowed the user to estimate dosage based on the levels of liquid observed through the glass.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Wood used hypodermic needles and syringes primarily for the application of localized, subcutaneous injection (localized anesthesia) and therefore was not as interested in precise dosages.<sup id=\"rdp-ebb-cite_ref-ReferenceB_8-1\" class=\"reference\"><a href=\"#cite_note-ReferenceB-8\" rel=\"external_link\">[8]<\/a><\/sup> Simultaneous to Wood's work in Edinburgh, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Pravaz\" title=\"Charles Pravaz\" rel=\"external_link\" target=\"_blank\">Dr. Charles Pravaz<\/a> of Lyon also experimented with sub-dermal injections in sheep using a syringe of his own design. Pravaz designed a syringe measuring 3 cm (1.18 in) long and 5 mm (0.2 in) in diameter; it was made entirely of silver.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> \n, a London surgeon, is credited with the coining of the term \"hypodermic\" to describe subcutaneous injection in 1858. The name originates from two Greek words: <i>hypo<\/i>, \"under\", and <i>derma<\/i>, \"skin\". Furthermore, Hunter is credited with acknowledging the systemic effects of injection after noticing that a patient's pain was alleviated regardless of the injection\u2019s proximity to the pained area.<sup id=\"rdp-ebb-cite_ref-Kotwal,_Atul_2005_7-2\" class=\"reference\"><a href=\"#cite_note-Kotwal,_Atul_2005-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ReferenceB_8-2\" class=\"reference\"><a href=\"#cite_note-ReferenceB-8\" rel=\"external_link\">[8]<\/a><\/sup> Hunter and Wood were involved in lengthy legal disputes over not only the origin of the modern hypodermic needle, but also because of their disagreement to the medicine's effect once administered.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Modern_improvements\">Modern improvements<\/span><\/h3>\n<p>Dr. Wood can be largely credited with the popularization and acceptance of injection as a medical technique, as well as the widespread use and acceptance of the hypodermic needle. The basic technology of the hypodermic needle has stayed largely unchanged since the 19th century, but as the years progressed and medical and chemical knowledge improved, small refinements have been made to increase safety and efficacy, with needles being designed and tailored for very particular uses. The trend of needle specification for use began in the 1920s, particularly for the administration of insulin to diabetics.<sup id=\"rdp-ebb-cite_ref-beckton_14-0\" class=\"reference\"><a href=\"#cite_note-beckton-14\" rel=\"external_link\">[14]<\/a><\/sup> The onset of World War II spurred the early development of partially disposable syringes for the administration of morphine and penicillin on the battlefield. Development of the fully disposable hypodermic needle was spurred on in the 1950s for several reasons. The Korean War created blood shortages and in response disposable, sterile syringes were developed for collecting blood. The widespread immunization against polio during the period required the development of a fully disposable syringe system.<sup id=\"rdp-ebb-cite_ref-beckton_14-1\" class=\"reference\"><a href=\"#cite_note-beckton-14\" rel=\"external_link\">[14]<\/a><\/sup><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since January 2015\">dead link<\/span><\/a><\/i>]<\/span><\/sup>\n<\/p><p>The 1950s also saw the rise and recognition of cross-contamination from used needles. This led to the development of the first fully disposable plastic syringe by New Zealand pharmacist Colin Murdoch in 1956.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> This period also marked a shift in interest from needle specifications to general sterility and safety. The 1980s saw the rise of the HIV epidemic and with it renewed concern over the safety of cross-contamination from used needles. New safety controls were designed on disposable needles to ensure the safety of medical workers in particular. These controls were implemented on the needles themselves, such as retractable needles, but also in the handling of used needles, particularly in the use of hard-surface disposal receptacles found in every medical office today.<sup id=\"rdp-ebb-cite_ref-beckton_14-2\" class=\"reference\"><a href=\"#cite_note-beckton-14\" rel=\"external_link\">[14]<\/a><\/sup><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since January 2015\">dead link<\/span><\/a><\/i>]<\/span><\/sup>. The modern two-piece hypodermic needle was invented by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manuel_Jal%C3%B3n_Corominas\" title=\"Manuel Jal\u00f3n Corominas\" rel=\"external_link\" target=\"_blank\">Manuel Jal\u00f3n Corominas<\/a>, a Spanish engineer in 1978.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Manufacture\">Manufacture<\/span><\/h2>\n<p>Hypodermic needles are normally made from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless-steel\" class=\"mw-redirect\" title=\"Stainless-steel\" rel=\"external_link\" target=\"_blank\">stainless-steel<\/a> tube<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> through a process known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tube_drawing\" title=\"Tube drawing\" rel=\"external_link\" target=\"_blank\">tube drawing<\/a> where the tube is drawn through progressively smaller <a href=\"https:\/\/en.wikipedia.org\/wiki\/Die_(manufacturing)\" title=\"Die (manufacturing)\" rel=\"external_link\" target=\"_blank\">dies<\/a> to make the needle. The needles are designed with the same general features, including a barrel, plunger, needle and cap. The end of the needle is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bevel\" title=\"Bevel\" rel=\"external_link\" target=\"_blank\">bevelled<\/a> to create a sharp pointed tip, letting the needle easily penetrate the skin.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Gauge\">Gauge<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HypodermicNeedles.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/19\/HypodermicNeedles.jpg\/300px-HypodermicNeedles.jpg\" width=\"300\" height=\"225\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HypodermicNeedles.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Six hypodermic needles on Luer connectors. These needles are normally used with other medical devices, such as a syringe; from top to bottom: <div><ul><li>26G \u00d7 ​<span class=\"frac nowrap\"><sup>1<\/sup>⁄<sub>2<\/sub><\/span>\u2033 (0.45 \u00d7 12 mm) (brown)<\/li><li>25G \u00d7 ​<span class=\"frac nowrap\"><sup>5<\/sup>⁄<sub>8<\/sub><\/span>\u2033 (0.5 \u00d7 16 mm) (orange)<\/li><li>22G \u00d7 ​<span class=\"frac nowrap\">1<span class=\"visualhide\"> <\/span><sup>1<\/sup>⁄<sub>4<\/sub><\/span>\u2033 (0.7 \u00d7 30 mm) (black)<\/li><li>21G \u00d7 ​<span class=\"frac nowrap\">1<span class=\"visualhide\"> <\/span><sup>1<\/sup>⁄<sub>2<\/sub><\/span>\u2033 (0.8 \u00d7 40 mm) (green)<\/li><li>20G \u00d7 ​<span class=\"frac nowrap\">1<span class=\"visualhide\"> <\/span><sup>1<\/sup>⁄<sub>2<\/sub><\/span>\u2033 (0.9 \u00d7 40 mm) (yellow)<\/li><li>19G \u00d7 ​<span class=\"frac nowrap\">1<span class=\"visualhide\"> <\/span><sup>1<\/sup>⁄<sub>2<\/sub><\/span>\u2033 (1.1 \u00d7 40 mm) (cream)<\/li><\/ul><\/div> See also <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birmingham_gauge\" title=\"Birmingham gauge\" rel=\"external_link\" target=\"_blank\">Birmingham gauge<\/a>.<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birmingham_gauge\" title=\"Birmingham gauge\" rel=\"external_link\" target=\"_blank\">Birmingham gauge<\/a><\/div>\n<p>The main system for measuring the diameter of a hypodermic needle is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birmingham_gauge\" title=\"Birmingham gauge\" rel=\"external_link\" target=\"_blank\">Birmingham gauge<\/a> (whereas <a href=\"https:\/\/en.wikipedia.org\/wiki\/French_catheter_scale\" title=\"French catheter scale\" rel=\"external_link\" target=\"_blank\">French gauge<\/a> is used mainly for catheters). Various needle lengths are available for any given gauge. Needles in common medical use range from 7 gauge (the largest) to 33 (the smallest). 21-gauge needles are most commonly used for drawing blood for testing purposes, and 16- or 17-gauge needles are most commonly used for blood donation, as the resulting lower pressure is less harmful to red blood cells (it also allows more blood to be collected in a shorter time).<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> Although reusable needles remain useful for some scientific applications, disposable needles are far more common in medicine. Disposable needles are embedded in a plastic or aluminium hub that attaches to the syringe barrel by means of a press-fit or twist-on fitting. These are sometimes referred to as \"Luer Lock\" connections, referring to the trademark <a href=\"https:\/\/en.wikipedia.org\/wiki\/Luer-Lok\" class=\"mw-redirect\" title=\"Luer-Lok\" rel=\"external_link\" target=\"_blank\">Luer-Lok<\/a>. The male and female luer lock and hub-- produced by pharmaceutical equipment manufacturers-- are two of the most critical parts of disposable hypodermic needles.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Non-specialist_use\">Non-specialist use<\/span><\/h2>\n<p>Hypodermic needles are usually used by medical professionals (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentist\" title=\"Dentist\" rel=\"external_link\" target=\"_blank\">dentists<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phlebotomist\" class=\"mw-redirect\" title=\"Phlebotomist\" rel=\"external_link\" target=\"_blank\">phlebotomists<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physicians<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nurse\" class=\"mw-redirect\" title=\"Nurse\" rel=\"external_link\" target=\"_blank\">nurses<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramedic\" title=\"Paramedic\" rel=\"external_link\" target=\"_blank\">paramedics<\/a>), but they are sometimes used by patients themselves. This is most common with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus_type_1\" title=\"Diabetes mellitus type 1\" rel=\"external_link\" target=\"_blank\">type one diabetics<\/a>, who may require several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a> injections a day.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> It also occurs with patients who have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asthma\" title=\"Asthma\" rel=\"external_link\" target=\"_blank\">asthma<\/a> or other severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergy\" title=\"Allergy\" rel=\"external_link\" target=\"_blank\">allergies<\/a>. Such patients may need to take <a href=\"https:\/\/en.wikipedia.org\/wiki\/Desensitization_(medicine)\" title=\"Desensitization (medicine)\" rel=\"external_link\" target=\"_blank\">desensitization<\/a> injections or they may need to carry injectable medicines to use for first aid in case of a severe allergic reaction. In the latter case, such patients often carry a syringe loaded with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epinephrine\" class=\"mw-redirect\" title=\"Epinephrine\" rel=\"external_link\" target=\"_blank\">epinephrine<\/a> (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/EpiPen\" class=\"mw-redirect\" title=\"EpiPen\" rel=\"external_link\" target=\"_blank\">EpiPen<\/a>),<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diphenhydramine\" title=\"Diphenhydramine\" rel=\"external_link\" target=\"_blank\">diphenhydramine<\/a> (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benadryl\" title=\"Benadryl\" rel=\"external_link\" target=\"_blank\">Benadryl<\/a>), or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dexamethasone\" title=\"Dexamethasone\" rel=\"external_link\" target=\"_blank\">dexamethasone<\/a>. Rapid injection of one of these drugs may stop a severe allergic reaction.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">Multiple sclerosis<\/a> patients may also treat themselves by injection; several MS therapies, including various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interferon\" title=\"Interferon\" rel=\"external_link\" target=\"_blank\">interferon<\/a> preparations, are designed to be self-administered by subcutaneous or intramuscular injection.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> In some countries, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erectile_dysfunction\" title=\"Erectile dysfunction\" rel=\"external_link\" target=\"_blank\">erectile dysfunction<\/a> patients may be prescribed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alprostadil\" class=\"mw-redirect\" title=\"Alprostadil\" rel=\"external_link\" target=\"_blank\">Alprostadil<\/a> in injectable form, which is self-injected directly into the base or side of the penis with a very fine hypodermic needle.\n<\/p><p>Hypodermic needles are also used by untrained users in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_injection#Recreational_drugs\" title=\"Drug injection\" rel=\"external_link\" target=\"_blank\">recreational intravenous drug use<\/a> (e.g., injecting solutions of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heroin\" title=\"Heroin\" rel=\"external_link\" target=\"_blank\">heroin<\/a> and water). Before governments attained current levels of awareness about the spread of disease through shared needles, hypodermic syringes in many countries were available only by prescription. Thus, in order to limit the spread of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood-borne_disease\" title=\"Blood-borne disease\" rel=\"external_link\" target=\"_blank\">blood-borne diseases<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis\" title=\"Hepatitis\" rel=\"external_link\" target=\"_blank\">hepatitis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/HIV\" title=\"HIV\" rel=\"external_link\" target=\"_blank\">HIV<\/a> through shared injection equipment, many countries have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle-exchange_programme\" class=\"mw-redirect\" title=\"Needle-exchange programme\" rel=\"external_link\" target=\"_blank\">needle exchange programs<\/a> in most larger cities. In some countries, such programs are wholly or partially subsidized by the government. Blunted needles, manufactured without a sharp bevel and usually non-sterile, are used industrially for filling small containers or accurately applying small amounts of solvent or glue.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Phobia\">Phobia<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fear_of_needles\" title=\"Fear of needles\" rel=\"external_link\" target=\"_blank\">Fear of needles<\/a><\/div>\n<p>It is estimated that anywhere from nearly 3.5 to 10% of the world\u2019s population may have a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phobia\" title=\"Phobia\" rel=\"external_link\" target=\"_blank\">phobia<\/a> of needles (trypanophobia)<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>, and it is much more common in children, ages 5\u201317. Patients can ask for a patch from the nurse to numb the area of where the injection will take place to reduce pain.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> For children and teenagers various techniques may be effective at reducing distress or pain related to needles.<sup id=\"rdp-ebb-cite_ref-:0_26-0\" class=\"reference\"><a href=\"#cite_note-:0-26\" rel=\"external_link\">[26]<\/a><\/sup> Techniques include: distraction, hypnosis, combined cognitive behaviour therapy, and breathing techniques.<sup id=\"rdp-ebb-cite_ref-:0_26-1\" class=\"reference\"><a href=\"#cite_note-:0-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">Cannula<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">Catheter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">Intravenous therapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanoneedle\" title=\"Nanoneedle\" rel=\"external_link\" target=\"_blank\">Nanoneedle<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_biopsy\" class=\"mw-redirect\" title=\"Needle biopsy\" rel=\"external_link\" target=\"_blank\">Needle biopsy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_gauge_comparison_chart\" class=\"mw-redirect\" title=\"Needle gauge comparison chart\" rel=\"external_link\" target=\"_blank\">Needle gauge comparison chart<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_remover\" class=\"mw-redirect\" title=\"Needle remover\" rel=\"external_link\" target=\"_blank\">Needle remover<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pin_prick_attack\" title=\"Pin prick attack\" rel=\"external_link\" target=\"_blank\">Pin prick attack<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuohy_needle\" title=\"Tuohy needle\" rel=\"external_link\" target=\"_blank\">Tuohy needle<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000444.htm\" target=\"_blank\">\"Handling sharps and needles: MedlinePlus Medical Encyclopedia\"<\/a>. <i>medlineplus.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=medlineplus.gov&rft.atitle=Handling+sharps+and+needles%3A+MedlinePlus+Medical+Encyclopedia&rft_id=https%3A%2F%2Fmedlineplus.gov%2Fency%2Fpatientinstructions%2F000444.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Elsheikh, HA; Ali, BH; Homeida, AM; Lutfi, AA; Hapke, HJ (May\u2013Jun 1992). \"The effects of fascioliasis on the activities of some drug-metabolizing enzymes in desert sheep liver\". <i>The British veterinary journal<\/i>. <b>148<\/b> (3): 249\u201357. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0007-1935%2892%2990048-6\" target=\"_blank\">10.1016\/0007-1935(92)90048-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1617399\" target=\"_blank\">1617399<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+British+veterinary+journal&rft.atitle=The+effects+of+fascioliasis+on+the+activities+of+some+drug-metabolizing+enzymes+in+desert+sheep+liver.&rft.volume=148&rft.issue=3&rft.pages=249-57&rft.date=1992-05%2F1992-06&rft_id=info%3Adoi%2F10.1016%2F0007-1935%2892%2990048-6&rft_id=info%3Apmid%2F1617399&rft.aulast=Elsheikh&rft.aufirst=HA&rft.au=Ali%2C+BH&rft.au=Homeida%2C+AM&rft.au=Lutfi%2C+AA&rft.au=Hapke%2C+HJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Korenman, SG (September 1975). \"Estrogen receptor assay in human breast cancer\". <i>Journal of the National Cancer Institute<\/i>. <b>55<\/b> (3): 543\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fjnci%2F55.3.543\" target=\"_blank\">10.1093\/jnci\/55.3.543<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/169381\" target=\"_blank\">169381<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+National+Cancer+Institute&rft.atitle=Estrogen+receptor+assay+in+human+breast+cancer.&rft.volume=55&rft.issue=3&rft.pages=543-5&rft.date=1975-09&rft_id=info%3Adoi%2F10.1093%2Fjnci%2F55.3.543&rft_id=info%3Apmid%2F169381&rft.aulast=Korenman&rft.aufirst=SG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Scott, Gene E.; Zummo, Natale (1 January 1988). \"Sources of Resistance in Maize to Kernel Infection by Aspergillus flavus in the Field\". <i>Crop Science<\/i>. <b>28<\/b> (3): 504. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2135%2Fcropsci1988.0011183X002800030016x\" target=\"_blank\">10.2135\/cropsci1988.0011183X002800030016x<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Crop+Science&rft.atitle=Sources+of+Resistance+in+Maize+to+Kernel+Infection+by+Aspergillus+flavus+in+the+Field&rft.volume=28&rft.issue=3&rft.pages=504&rft.date=1988-01-01&rft_id=info%3Adoi%2F10.2135%2Fcropsci1988.0011183X002800030016x&rft.aulast=Scott&rft.aufirst=Gene+E.&rft.au=Zummo%2C+Natale&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Experimental Infection of Host Grasses and Sedges with Atkinsonella hypoxylon and Balansia cyperi (Balansiae, Clavicipitaceae)\". <i>Mycologia<\/i>. <b>80<\/b> (3): 291\u2013297. 1988. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2307%2F3807624\" target=\"_blank\">10.2307\/3807624<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/3807624\" target=\"_blank\">3807624<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Mycologia&rft.atitle=Experimental+Infection+of+Host+Grasses+and+Sedges+with+Atkinsonella+hypoxylon+and+Balansia+cyperi+%28Balansiae%2C+Clavicipitaceae%29&rft.volume=80&rft.issue=3&rft.pages=291-297&rft.date=1988&rft_id=info%3Adoi%2F10.2307%2F3807624&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F3807624&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ReferenceA-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ReferenceA_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ReferenceA_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Norn S, Kruse PR, Kruse E (2006). \"On the history of injection\". <i>Dan Medicinhist Arbog<\/i>. <b>34<\/b>: 104\u20131.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dan+Medicinhist+Arbog&rft.atitle=On+the+history+of+injection&rft.volume=34&rft.pages=104-1&rft.date=2006&rft.au=Norn+S%2C+Kruse+PR%2C+Kruse+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Kotwal,_Atul_2005-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kotwal,_Atul_2005_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kotwal,_Atul_2005_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kotwal,_Atul_2005_7-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kotwal, Atul. \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practice\". <i>Social Science & Medicine<\/i> Volume 60, Issue 5, March 2005, pp. 1133\u20131147<\/span>\n<\/li>\n<li id=\"cite_note-ReferenceB-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ReferenceB_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ReferenceB_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ReferenceB_8-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ball C (Jun 2006). \"The early development of intravenous apparatus\". <i>Anaesth Intensive Care<\/i>. <b>34<\/b> (Suppl 1): 22\u20136.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anaesth+Intensive+Care&rft.atitle=The+early+development+of+intravenous+apparatus&rft.volume=34&rft.issue=Suppl+1&rft.pages=22-6&rft.date=2006-06&rft.au=Ball+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Logan Clendening, <i>Source Book of Medical History<\/i>, p. 419 (1960)<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Walter Reginald Bett, <i>The History and Conquest of Common Diseases<\/i> p. 145 (1954)<\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.irishtimes.com\/news\/the-irish-doctor-who-invented-the-syringe-1.1105651\" target=\"_blank\">\"The Irish doctor who invented the syringe\"<\/a>. <i>irishtimes.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=irishtimes.com&rft.atitle=The+Irish+doctor+who+invented+the+syringe&rft_id=http%3A%2F%2Fwww.irishtimes.com%2Fnews%2Fthe-irish-doctor-who-invented-the-syringe-1.1105651&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kotwal, Atul. \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices\". <i>Social Science & Medicine<\/i> Volume 60, Issue 5, March 2005, pp. 1133\u20131147<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.discoveriesinmedicine.com\/Ra-Thy\/Syringe.html\" target=\"_blank\">Syringe<\/a>, Discoveriesinmedicine.com<\/span>\n<\/li>\n<li id=\"cite_note-beckton-14\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-beckton_14-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-beckton_14-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-beckton_14-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Beckton Dickinson and Company, \"Four Major Phases of Injection Device Development\", <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ahrn.net\/library_upload\/uploadfile\/file2376.pdf\" target=\"_blank\">Syringe and Needle History<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150508145312\/http:\/\/www.ahrn.net\/library_upload\/uploadfile\/file2376.pdf\" target=\"_blank\">Archived<\/a> May 8, 2015, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencemuseum.org.uk\/broughttolife\/techniques\/hypodermicsyringe.aspx\" target=\"_blank\">\"Hypodermic syringe\"<\/a>. <i>www.sciencemuseum.org.uk<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.sciencemuseum.org.uk&rft.atitle=Hypodermic+syringe&rft_id=http%3A%2F%2Fwww.sciencemuseum.org.uk%2Fbroughttolife%2Ftechniques%2Fhypodermicsyringe.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spanishgenetics.weebly.com\/the-disposable-syringe.html\" target=\"_blank\">\"The Disposable Syringe\"<\/a>. <i>spanishgenetics.weebly.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-12-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=spanishgenetics.weebly.com&rft.atitle=The+Disposable+Syringe&rft_id=http%3A%2F%2Fspanishgenetics.weebly.com%2Fthe-disposable-syringe.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.straightdope.com\/mailbag\/msyringe.html\" target=\"_blank\">How do they get the hole through a hypodermic needle?<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Straight_Dope\" title=\"The Straight Dope\" rel=\"external_link\" target=\"_blank\">The Straight Dope<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.madehow.com\/Volume-3\/Syringe.html\" target=\"_blank\">\"How syringe is made - material, production process, manufacture, making, history, used, processing, parts\"<\/a>. How Products Are Made<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-01-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=How+syringe+is+made+-+material%2C+production+process%2C+manufacture%2C+making%2C+history%2C+used%2C+processing%2C+parts&rft.pub=How+Products+Are+Made&rft_id=http%3A%2F%2Fwww.madehow.com%2FVolume-3%2FSyringe.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iv-therapy.net\/node\/512\" target=\"_blank\">Blood Transfusions and Angio Size?<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160303232229\/http:\/\/www.iv-therapy.net\/node\/512\" target=\"_blank\">Archived<\/a> 2016-03-03 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.davenportmachine.com\/cycle-times\/medical\" target=\"_blank\">\"Medical Industry Cycle Times | Davenport Machine\"<\/a>. <i>Davenport Machine<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-01-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Davenport+Machine&rft.atitle=Medical+Industry+Cycle+Times+%7C+Davenport+Machine&rft_id=https%3A%2F%2Fwww.davenportmachine.com%2Fcycle-times%2Fmedical&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.drugs.com\/cg\/giving-an-insulin-injection.html\" target=\"_blank\">\"Giving an Insulin Injection\"<\/a>. Drugs.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-08-19<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Giving+an+Insulin+Injection&rft.pub=Drugs.com&rft_id=https%3A%2F%2Fwww.drugs.com%2Fcg%2Fgiving-an-insulin-injection.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.epipen.com\/\" target=\"_blank\">\"How to Stop Allergic Reactions\"<\/a>. EpiPen<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-08-19<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=How+to+Stop+Allergic+Reactions&rft.pub=EpiPen&rft_id=http%3A%2F%2Fwww.epipen.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mult-sclerosis.org\/mstreatments.html\" target=\"_blank\">\"Multiple Sclerosis Treatments\"<\/a>. mult-sclerosis.org. 2008-01-21<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-01-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Multiple+Sclerosis+Treatments&rft.pub=mult-sclerosis.org&rft.date=2008-01-21&rft_id=http%3A%2F%2Fwww.mult-sclerosis.org%2Fmstreatments.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fearof.net\/fear-of-needles-phobia-trypanophobia\/\" target=\"_blank\">\"Fear of Needles Phobia \u2013 Trypanophobia\"<\/a>. <i>www.fearof.net<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-01-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fearof.net&rft.atitle=Fear+of+Needles+Phobia+%E2%80%93+Trypanophobia&rft_id=http%3A%2F%2Fwww.fearof.net%2Ffear-of-needles-phobia-trypanophobia%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.futurescience.com\/needles.html\" target=\"_blank\">\"The Needle Phobia Page\"<\/a>. Futurescience.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-08-19<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Needle+Phobia+Page&rft.pub=Futurescience.com&rft_id=http%3A%2F%2Fwww.futurescience.com%2Fneedles.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-26\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_26-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_26-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Birnie, Kathryn A.; Noel, Melanie; Chambers, Christine T.; Uman, Lindsay S.; Parker, Jennifer A. (2018-10-04). \"Psychological interventions for needle-related procedural pain and distress in children and adolescents\". <i>The Cochrane Database of Systematic Reviews<\/i>. <b>10<\/b>: CD005179. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD005179.pub4\" target=\"_blank\">10.1002\/14651858.CD005179.pub4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1469-493X\" target=\"_blank\">1469-493X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30284240\" target=\"_blank\">30284240<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Psychological+interventions+for+needle-related+procedural+pain+and+distress+in+children+and+adolescents&rft.volume=10&rft.pages=CD005179&rft.date=2018-10-04&rft.issn=1469-493X&rft_id=info%3Apmid%2F30284240&rft_id=info%3Adoi%2F10.1002%2F14651858.CD005179.pub4&rft.aulast=Birnie&rft.aufirst=Kathryn+A.&rft.au=Noel%2C+Melanie&rft.au=Chambers%2C+Christine+T.&rft.au=Uman%2C+Lindsay+S.&rft.au=Parker%2C+Jennifer+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypodermic+needle\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160123071127\/http:\/\/www.needlephobia.com\/\" target=\"_blank\">The Needle Phobia Page<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dentalfearcentral.org\/fears\/needle-phobia\/\" target=\"_blank\">Needle Phobia and Dental Injections<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140221174130\/http:\/\/m.prnewswire.com\/news-releases\/california-company-creates-medical-device-that-could-change-the-course-of-medicine-as-we-know-it-236378101.html\" target=\"_blank\">California Company Creates Medical Device That Could Change the Course of Medicine as We Know It<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1244\nCached time: 20181215215325\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.484 seconds\nReal time usage: 0.674 seconds\nPreprocessor visited node count: 1800\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 99158\/2097152 bytes\nTemplate argument size: 1677\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 51790\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.231\/10.000 seconds\nLua memory usage: 6.04 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 519.949 1 -total\n<\/p>\n<pre>47.53% 247.150 1 Template:Reflist\n20.37% 105.926 10 Template:Cite_web\n16.17% 84.089 6 Template:Navbox\n15.76% 81.969 7 Template:Cite_journal\n12.50% 64.978 1 Template:Dosage_forms\n10.56% 54.895 1 Template:Commons_category\n 7.69% 39.986 1 Template:Refimprove\n 6.18% 32.151 1 Template:Ambox\n 5.31% 27.586 1 Template:For\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:320351-1!canonical and timestamp 20181215215324 and revision id 873568841\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214631\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.025 seconds\nReal time usage: 0.175 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 167.105 1 - wikipedia:Hypodermic_needle\n100.00% 167.105 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8526-0!*!*!*!*!*!* and timestamp 20181217214631 and revision id 24951\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hypodermic_needle\">https:\/\/www.limswiki.org\/index.php\/Hypodermic_needle<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","861d9174733cf567ee6f61af1bd00ced_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1b\/NeedleBevels.svg\/440px-NeedleBevels.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/79\/Syringe_and_hypodermic.jpg\/440px-Syringe_and_hypodermic.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/AgujaHipod%C3%A9rmica.png\/440px-AgujaHipod%C3%A9rmica.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/19\/HypodermicNeedles.jpg\/600px-HypodermicNeedles.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/FlattenedRoundPills.jpg\/120px-FlattenedRoundPills.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Hexaaquatitanium%28III%29-solution.jpg\/120px-Hexaaquatitanium%28III%29-solution.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/Inhaler.jpg\/120px-Inhaler.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/Action_photo_of_nasal_spray_on_a_black_background.jpg\/60px-Action_photo_of_nasal_spray_on_a_black_background.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/98\/Glycerin_suppositories.jpg\/60px-Glycerin_suppositories.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/SPF15SunBlock.JPG\/80px-SPF15SunBlock.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Injection_Syringe_01.jpg\/120px-Injection_Syringe_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/Tabletten.JPG\/32px-Tabletten.JPG"],"861d9174733cf567ee6f61af1bd00ced_timestamp":1545083191,"0e8d17422dd0e78773ae4216dd43a20b_type":"article","0e8d17422dd0e78773ae4216dd43a20b_title":"Electrocardiograph machine","0e8d17422dd0e78773ae4216dd43a20b_url":"https:\/\/www.limswiki.org\/index.php\/Electrocardiography","0e8d17422dd0e78773ae4216dd43a20b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tElectrocardiography\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"ECG\" and \"EKG\" redirect here. For other uses, see ECG (disambiguation) and EKG (disambiguation).\nNot to be confused with other types of electrography or with echocardiography.\n\n\nElectrocardiographyECG of a heart in normal sinus rhythmICD-10-PCSR94.31ICD-9-CM89.52MeSHD004562 MedlinePlus003868 [edit on Wikidata]\nElectrocardiography (ECG or EKG[a]) is the process of recording the electrical activity of the heart[4] over a period of time using electrodes placed over the skin. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle's electrophysiologic pattern of depolarizing and repolarizing during each heartbeat. It is very commonly performed to detect any cardiac problems.\nIn a conventional 12-lead ECG, ten electrodes are placed on the patient's limbs and on the surface of the chest. The overall magnitude of the heart's electrical potential is then measured from twelve different angles (\"leads\") and is recorded over a period of time (usually ten seconds). In this way, the overall magnitude and direction of the heart's electrical depolarization is captured at each moment throughout the cardiac cycle.[5] The graph of voltage versus time produced by this noninvasive medical procedure is an electrocardiogram.\nThere are three main components to an ECG: the P wave, which represents the depolarization of the atria; the QRS complex, which represents the depolarization of the ventricles; and the T wave, which represents the repolarization of the ventricles.[6] It can also be further broken down into the following:\n\nO is the origin or datum point preceding the cycle\nP is the atrial systole contraction pulse\nQ is a downward deflection immediately preceding the ventricular contraction\nR is the peak of the ventricular contraction\nS is the downward deflection immediately after the ventricular contraction\nT is the recovery of the ventricles\nU is the successor of the T wave but it is small and not always observed\nDuring each heartbeat, a healthy heart has an orderly progression of depolarization that starts with pacemaker cells in the sinoatrial node, spreads throughout the atrium, passes through the atrioventricular node down into the bundle of His and into the Purkinje fibers, spreading down and to the left throughout the ventricles.[6] This orderly pattern of depolarization gives rise to the characteristic ECG tracing. To the trained clinician, an ECG conveys a large amount of information about the structure of the heart and the function of its electrical conduction system.[7] Among other things, an ECG can be used to measure the rate and rhythm of heartbeats, the size and position of the heart chambers, the presence of any damage to the heart's muscle cells or conduction system, the effects of heart drugs, and the function of implanted pacemakers.[8]\n\nContents \n\n1 Medical uses \n2 Electrocardiographs \n3 Electrodes and leads \n\n3.1 Limb leads \n3.2 Augmented limb leads \n3.3 Precordial leads \n3.4 Specialized leads \n3.5 Lead locations on an ECG report \n3.6 Contiguity of leads \n\n\n4 Electrophysiology \n5 Interpretation \n\n5.1 Theory \n5.2 Electrocardiogram grid \n5.3 Rate and rhythm \n5.4 Axis \n5.5 Amplitudes and intervals \n5.6 Ischemia and infarction \n5.7 Artifacts \n\n\n6 Diagnosis \n7 History \n8 See also \n9 Notes \n10 References \n11 External links \n\n\nMedical uses \n A 12-lead ECG of a 26-year-old male with an incomplete RBBB\nThe overall goal of performing an ECG is to obtain information about the structure and function of the heart. Medical uses for this information are varied and generally need knowledge of the structure and\/or function of the heart to be interpreted. Some indications for performing an ECG include:\n\nSuspected myocardial infarction (heart attack) or chest pain\nST elevated myocardial infarction (STEMI)[9]\nnon-ST elevated myocardial infarction (NSTEMI)[10]\nSuspected pulmonary embolism or shortness of breath\nA third heart sound, fourth heart sound, a cardiac murmur[11] or other findings suggestive of a structural heart disease\nPerceived arrhythmia either by pulse or palpitations\nMonitoring of known cardiac arrhythmias\nFainting or collapse[11]\nSeizures[11]\nMonitoring the effects of a medication on the heart (e.g. drug-induced QT prolongation)\nAssessing severity of electrolyte abnormalities, such as hyperkalemia\nHypertrophic cardiomyopathy screening in adolescents as part of a sports physical out of concern for sudden cardiac death (varies by country)\nPerioperative monitoring in which any form of anesthesia is involved (e.g. monitored anesthesia care, general anesthesia); typically both intraoperative and postoperative\nAs a part of a preoperative assessment some time before a surgical procedure (especially for those with known cardiovascular disease or who are undergoing invasive, cardiac, vascular or pulmonary procedures, or who will receive general anesthesia)\nCardiac stress testing\nComputed tomography angiography (CTA) and magnetic resonance angiography (MRA) of the heart (ECG is used to \"gate\" the scanning so that the anatomical position of the heart is steady)\nBiotelemetry of patients for any of the above reasons and such monitoring can include internal and external defibrillators and pacemakers\nThe United States Preventive Services Task Force does not recommend an ECG for routine screening in patients without symptoms and those at low risk for coronary artery disease.[12][13] This is because an ECG may falsely indicate the existence of a problem, leading to misdiagnosis, the recommendation of invasive procedures, or overtreatment. However, persons employed in certain critical occupations, such as aircraft pilots,[14] may be required to have an ECG as part of their routine health evaluations.\nContinuous ECG monitoring is used to monitor critically ill patients, patients undergoing general anesthesia,[11] and patients who have an infrequently occurring cardiac arrhythmia that would unlikely be seen on a conventional ten-second ECG.\nIn the United States, a 12-lead ECG is commonly performed by specialized technicians that may be certified as electrocardiogram technicians.\nECG interpretation is a component of many healthcare fields (nurses and physicians and cardiac surgeons being the most obvious), but anyone trained to interpret an ECG is free to do so.\nHowever, \"official\" interpretation is performed by a cardiologist.\nCertain fields such as anesthesia utilize continuous ECG monitoring, and knowledge of interpreting ECGs is crucial to their jobs.\n\n<\/p>One additional form of ECG is used in clinical cardiac electrophysiology in which a catheter is used to measure the electrical activity.\nThe catheter is inserted through the femoral vein and can have several electrodes along its length to record the direction of electrical activity from within the heart.\n\n<\/p>Evidence does not support the use of ECGs among those without symptoms or at low risk of cardiovascular disease as an effort for prevention.[15]\n\nElectrocardiographs \n An electrocardiograph with integrated display and keyboard on a wheeled cart\nAn electrocardiograph is a machine that is used to perform electrocardiography, and produces the electrocardiogram.\nThe first electrocardiographs are discussed later and are electrically primitive compared to today's machines.\nThe fundamental component to an ECG is the instrumentation amplifier, which is responsible for taking the voltage difference between leads (see below) and amplifying the signal.\nECG voltages measured across the body are on the order of hundreds of microvolts up to 1 millivolt (the small square on a standard ECG is 100 microvolts).\nThis low voltage necessitates a low noise circuit and instrumentation amplifiers.\n\n<\/p>Early ECGs were constructed with analog electronics and the signal could drive a motor to print the signal on paper.\nToday, electrocardiographs use analog-to-digital converters to convert to a digital signal that can then be manipulated with digital electronics.\nThis permits digital recording of ECGs and use on computers.\n\n<\/p>There are other components to the ECG:[16]\n\nSafety features that include voltage protection for the patient and operator. Since the machines are powered by mains power, it is conceivable that either person could be subjected to voltage capable of causing death. Additionally, the heart is sensitive to the AC frequencies typically used for mains power (50 or 60 Hz).\nDefibrillation protection: any ECG used in healthcare may be attached to a person who requires defibrillation and the ECG needs to protect itself from this source of energy.\nElectrostatic discharge is similar to defibrillation discharge and requires voltage protection up to 18,000 volts.\nAdditionally circuitry called the right leg driver can be used to reduce common-mode interference (typically the 50 or 60 Hz mains power).\nThe typical design for a portable ECG is a combined unit that includes a screen, keyboard, and printer on a small wheeled cart.\nThe unit connects to a long cable that branches to each lead and attaches to a conductive pad on the patient.\nThe ECG may include a rhythm analysis algorithm that produces a computerized interpretation of the ECG.\nThe results from these algorithms are considered \"preliminary\" until verified and\/or modified by someone trained in interpreting ECGs.\nIncluded in this analysis is computation of common parameters that include PR interval, QT interval, corrected QT (QTc) interval, PR axis, QRS axis, and more.\nEarlier designs recorded each lead sequentially but current designs employ circuits that can record all leads simultaneously.\nThe former introduces problems in interpretation since there may be beat-to-beat changes in the rhythm, which makes it unwise to compare across beats.\n\n<\/p>More recent advancements in electrocardiography include work in diminishing the size of the unit to make it more portable and therefore more accessible to larger groups of patients. To achieve this, these smaller devices rely on only two electrodes which together deliver \"lead I\" of the standard ECG.[17]\n\nElectrodes and leads \n Proper placement of the limb electrodes. The limb electrodes can be far down on the limbs or close to the hips\/shoulders as long as they are placed symmetrically.[18]\n Placement of the precordial electrodes\nElectrodes are the actual conductive pads attached to the body surface. Any pair of electrodes can measure the electrical potential difference between the two corresponding locations of attachment. Such a pair forms a lead. However, \"leads\" can also be formed between a physical electrode and a virtual electrode, known as the Wilson's central terminal, whose potential is defined as the average potential measured by three limb electrodes that are attached to the right arm, the left arm, and the left foot, respectively. \nCommonly, 10 electrodes attached to the body are used to form 12 ECG leads, with each lead measuring a specific electrical potential difference (as listed in the table below).[citation needed ]\nLeads are broken down into three types: limb; augmented limb; and precordial or chest. The 12-lead ECG has a total of three limb leads and three augmented limb leads arranged like spokes of a wheel in the coronal plane (vertical), and six precordial leads or chest leads that lie on the perpendicular transverse plane (horizontal).[citation needed ]\nIn medical settings, the term leads is also sometimes used to refer to the electrodes themselves, although this is technically incorrect. This misuse of terminology can be the source of confusion.[citation needed ]\nThe 10 electrodes in a 12-lead ECG are listed below.[19]\n\n\n\n\nElectrode name\n\nElectrode placement\n\n\nRA\n\nOn the right arm, avoiding thick muscle.\n\n\nLA\n\nIn the same location where RA was placed, but on the left arm.\n\n\nRL\n\nOn the right leg, lower end of inner aspect of calf muscle. (Avoid bony prominences)\n\n\nLL\n\nIn the same location where RL was placed, but on the left leg.\n\n\nV1\n\nIn the fourth intercostal space (between ribs 4 and 5) just to the right of the sternum (breastbone).\n\n\nV2\n\nIn the fourth intercostal space (between ribs 4 and 5) just to the left of the sternum.\n\n\nV3\n\nBetween leads V2 and V4.\n\n\nV4\n\nIn the fifth intercostal space (between ribs 5 and 6) in the mid-clavicular line.\n\n\nV5\n\nHorizontally even with V4, in the left anterior axillary line.\n\n\nV6\n\nHorizontally even with V4 and V5 in the mid-axillary line.\n\nTwo types of electrodes in common use are a flat paper-thin sticker and a self-adhesive circular pad.\nThe former are typically used in a single ECG recording while the latter are for continuous recordings as they stick longer.\nEach electrode consists of an electrically conductive electrolyte gel and a silver\/silver chloride conductor.[20]\nThe gel typically contains potassium chloride \u2013 sometimes silver chloride as well \u2013 to permit electron conduction from the skin to the wire and to the electrocardiogram.\nThe common virtual electrode, known as the Wilson's central terminal (VW), is produced by averaging the measurements from the electrodes RA, LA, and LL to give an average potential of the body:\n\n\n \n \n \n \n V\n \n W\n \n \n =\n \n \n 1\n 3\n \n \n (\n R\n A\n +\n L\n A\n +\n L\n L\n )\n \n \n {\\displaystyle V_{W}={\\frac {1}{3}}(RA+LA+LL)}\n \n \nIn a 12-lead ECG, all leads except the limb leads are unipolar (aVR, aVL, aVF, V1, V2, V3, V4, V5, and V6).\nThe measurement of a voltage requires two contacts and so, electrically, the unipolar leads are measured from the common lead (negative) and the unipolar lead (positive).\nThis averaging for the common lead and the abstract unipolar lead concept makes for a more challenging understanding and is complicated by sloppy usage of \"lead\" and \"electrode.\"\n\nLimb leads \n The limb leads and augmented limb leads (Wilson's central terminal is used as the negative pole for the latter in this representation)\n \nLeads I, II and III are called the limb leads. The electrodes that form these signals are located on the limbs \u2013 one on each arm and one on the left leg.[21][22][23] The limb leads form the points of what is known as Einthoven's triangle.[24]\n\nLead I is the voltage between the (positive) left arm (LA) electrode and right arm (RA) electrode:\n\n \n \n \n I\n =\n L\n A\n −\n R\n A\n \n \n {\\displaystyle I=LA-RA}\n \n \nLead II is the voltage between the (positive) left leg (LL) electrode and the right arm (RA) electrode:\n\n \n \n \n I\n I\n =\n L\n L\n −\n R\n A\n \n \n {\\displaystyle II=LL-RA}\n \n \nLead III is the voltage between the (positive) left leg (LL) electrode and the left arm (LA) electrode:\n\n \n \n \n I\n I\n I\n =\n L\n L\n −\n L\n A\n \n \n {\\displaystyle III=LL-LA}\n \n \nAugmented limb leads \nLeads aVR, aVL, and aVF are the augmented limb leads. They are derived from the same three electrodes as leads I, II, and III, but they use Goldberger's central terminal as their negative pole. Goldberger's central terminal is a combination of inputs from two limb electrodes, with a different combination for each augmented lead. It is referred to immediately below as \"the negative pole.\"\n\nLead augmented vector right (aVR) has the positive electrode on the right arm. The negative pole is a combination of the left arm electrode and the left leg electrode:\n\n \n \n \n a\n V\n R\n =\n R\n A\n −\n \n \n 1\n 2\n \n \n (\n L\n A\n +\n L\n L\n )\n =\n \n \n 3\n 2\n \n \n (\n R\n A\n −\n \n V\n \n W\n \n \n )\n \n \n {\\displaystyle aVR=RA-{\\frac {1}{2}}(LA+LL)={\\frac {3}{2}}(RA-V_{W})}\n \n \nLead augmented vector left (aVL) has the positive electrode on the left arm. The negative pole is a combination of the right arm electrode and the left leg electrode:\n\n \n \n \n a\n V\n L\n =\n L\n A\n −\n \n \n 1\n 2\n \n \n (\n R\n A\n +\n L\n L\n )\n =\n \n \n 3\n 2\n \n \n (\n L\n A\n −\n \n V\n \n W\n \n \n )\n \n \n {\\displaystyle aVL=LA-{\\frac {1}{2}}(RA+LL)={\\frac {3}{2}}(LA-V_{W})}\n \n \nLead augmented vector foot (aVF) has the positive electrode on the left leg. The negative pole is a combination of the right arm electrode and the left arm electrode:\n\n \n \n \n a\n V\n F\n =\n L\n L\n −\n \n \n 1\n 2\n \n \n (\n R\n A\n +\n L\n A\n )\n =\n \n \n 3\n 2\n \n \n (\n L\n L\n −\n \n V\n \n W\n \n \n )\n \n \n {\\displaystyle aVF=LL-{\\frac {1}{2}}(RA+LA)={\\frac {3}{2}}(LL-V_{W})}\n \n \nTogether with leads I, II, and III, augmented limb leads aVR, aVL, and aVF form the basis of the hexaxial reference system, which is used to calculate the heart's electrical axis in the frontal plane.\n\nPrecordial leads \nThe precordial leads lie in the transverse (horizontal) plane, perpendicular to the other six leads. The six precordial electrodes act as the positive poles for the six corresponding precordial leads: (V1, V2, V3, V4, V5 and V6). Wilson's central terminal is used as the negative pole.\n\nSpecialized leads \nAdditional electrodes may rarely be placed to generate other leads for specific diagnostic purposes. Right-sided precordial leads may be used to better study pathology of the right ventricle or for dextrocardia (and are denoted with an R (e.g., V5R). Posterior leads (V7 to V9) may be used to demonstrate the presence of a posterior myocardial infarction. A Lewis lead (requiring an electrode at the right sternal border in the second intercostal space) can be used to study pathological rhythms arising in the right atrium.\nAn esophogeal lead can be inserted to a part of the esophagus where the distance to the posterior wall of the left atrium is only approximately 5\u20136 mm (remaining constant in people of different age and weight).[25] An esophageal lead avails for a more accurate differentiation between certain cardiac arrhythmias, particularly atrial flutter, AV nodal reentrant tachycardia and orthodromic atrioventricular reentrant tachycardia.[26] It can also evaluate the risk in people with Wolff-Parkinson-White syndrome, as well as terminate supraventricular tachycardia caused by re-entry.[26]\nAn intracardiac electrogram (ICEG) is essentially an ECG with some added intracardiac leads (that is, inside the heart). The standard ECG leads (external leads) are I, II, III, aVL, V1, and V6. Two to four intracardiac leads are added via cardiac catheterization. The word \"electrogram\" (EGM) without further specification usually means an intracardiac electrogram.\n\nLead locations on an ECG report \nA standard 12-lead ECG report (an electrocardiograph) shows a 2.5 second tracing of each of the twelve leads. The tracings are most commonly arranged in a grid of four columns and three rows. the first column is the limb leads (I, II, and III), the second column is the augmented limb leads (aVR, aVL, and aVF), and the last two columns are the precordial leads (V1 to V6).\nAdditionally, a rhythm strip may be included as a fourth or fifth row.\nThe timing across the page is continuous and not tracings of the 12 leads for the same time period.\nIn other words, if the output were traced by needles on paper, each row would switch which leads as the paper is pulled under the needle.\nFor example, the top row would first trace lead I, then switch to lead aVR, then switch to V1, and then switch to V4 and so none of these four tracings of the leads are from the same time period as they are traced in sequence through time.\n\n<\/p>\n Contiguity of leads \n Diagram showing the contiguous leads in the same color in the standard 12-lead layout\nEach of the 12 ECG leads records the electrical activity of the heart from a different angle, and therefore align with different anatomical areas of the heart. Two leads that look at neighboring anatomical areas are said to be contiguous.\n\n\n\n\nCategory\n\nLeads\n\nActivity\n\n\nInferior leads\n\nLeads II, III and aVF\n\nLook at electrical activity from the vantage point of the inferior surface (diaphragmatic surface of heart)\n\n\nLateral leads\n\nI, aVL, V5 and V6\n\nLook at the electrical activity from the vantage point of the lateral wall of left ventricle\n\n\nSeptal leads\n\nV1 and V2\n\nLook at electrical activity from the vantage point of the septal surface of the heart (interventricular septum)\n\n\nAnterior leads\n\nV3 and V4\n\nLook at electrical activity from the vantage point of the anterior wall of the right and left ventricles (Sternocostal surface of heart)\n\nIn addition, any two precordial leads next to one another are considered to be contiguous. For example, though V4 is an anterior lead and V5 is a lateral lead, they are contiguous because they are next to one another.\n\nElectrophysiology \nMain article: Cardiac electrophysiology\nThe formal study of the electrical conduction system of the heart is called cardiac electrophysiology (EP).\nAn electrophysiology study involves a formal study of the conduction system and can be done for various reasons.\nDuring such a study, catheters are used to access the heart and some of these catheters include electrodes that can be placed anywhere in the heart to record the electrical activity from within the heart.\nSome catheters contain several electrodes and can record the propagation of electrical activity.\n\nInterpretation \nInterpretation of the ECG is fundamentally about understanding the electrical conduction system of the heart.\nNormal conduction starts and propagates in a predictable pattern, and deviation from this pattern can be a normal variation or be pathological.\nAn ECG does not equate with mechanical pumping activity of the heart, for example, pulseless electrical activity produces an ECG that should pump blood but no pulses are felt (and constitutes a medical emergency and CPR should be performed).\nVentricular fibrillation produces an ECG but is too dysfunctional to produce a life-sustaining cardiac output. Certain rhythms are known to have good cardiac output and some are known to have bad cardiac output.\nUltimately, an echocardiogram or other anatomical imaging modality is useful in assessing the mechanical function of the heart.\nLike all medical tests, what constitutes \"normal\" is based on population studies. The heartrate range of between 60 and 100 beats per minute (bpm) is considered normal since data shows this to be the usual resting heart rate.\n\nTheory \n QRS is upright in a lead when its axis is aligned with that lead's vector\n Schematic representation of a normal ECG\nInterpretation of the ECG is ultimately that of pattern recognition.\nIn order to understand the patterns found, it is helpful to understand the theory of what ECGs represent.\nThe theory is rooted in electromagnetics and boils down to the four following points:\n\ndepolarization of the heart toward the positive electrode produces a positive deflection\ndepolarization of the heart away from the positive electrode produces a negative deflection\nrepolarization of the heart toward the positive electrode produces a negative deflection\nrepolarization of the heart away from the positive electrode produces a positive deflection\nThus, the overall direction of depolarization and repolarization produces a vector that produces positive or negative deflection on the ECG depending on which lead it points to.\nFor example, depolarizing from right to left would produce a positive deflection in lead I because the two vectors point in the same direction.\nIn contrast, that same depolarization would produce minimal deflection in V1 and V2 because the vectors are perpendicular and this phenomenon is called isoelectric.\nNormal rhythm produces four entities \u2013 a P wave, a QRS complex, a T wave, and a U wave \u2013 that each have a fairly unique pattern.\n\nThe P wave represents atrial depolarization.\nThe QRS complex represents ventricular depolarization.\nThe T wave represents ventricular repolarization.\nThe U wave represents papillary muscle repolarization.\nHowever, the U wave is not typically seen and its absence is generally ignored.\nChanges in the structure of the heart and its surroundings (including blood composition) change the patterns of these four entities.\n\nElectrocardiogram grid \nECGs are normally printed on a grid.\nThe horizontal axis represents time and the vertical axis represents voltage.\nThe standard values on this grid are shown in the adjacent image:\n\nA small box is 1 mm \u00d7 1 mm and represents 0.1 mV \u00d7 0.04 seconds.\nA large box is 5 mm \u00d7 5 mm and represents 0.5 mV \u00d7 0.20 seconds.\nThe \"large\" box is represented by a heavier line weight than the small boxes.\n\n\n\nNot all aspects of an ECG rely on precise recordings or having a known scaling of amplitude or time.\nFor example, determining if the tracing is a sinus rhythm only requires feature recognition and matching, and not measurement of amplitudes or times (i.e., the scale of the grids are irrelevant).\nAn example to the contrary, the voltage requirements of left ventricular hypertrophy require knowing the grid scale.\n\nRate and rhythm \nIn a normal heart, the heart rate is the rate in which the sinoatrial node depolarizes as it is the source of depolarization of the heart.\nHeart rate, like other vital signs like blood pressure and respiratory rate, change with age.\nIn adults, a normal heart rate is between 60 and 100 bpm (normocardic) where in children it is higher.\nA heart rate less than normal is called bradycardia (<60 in adults) and higher than normal is tachycardia (>100 in adults).\nA complication of this is when the atria and ventricles are not in synchrony and the \"heart rate\" must be specified as atrial or ventricular (e.g., the ventricular rate in ventricular fibrillation is 300\u2013600 bpm, whereas the atrial rate can be normal [60\u2013100] or faster [100\u2013150]).\nIn normal resting hearts, the physiologic rhythm of the heart is normal sinus rhythm (NSR).\nNormal sinus rhythm produces the prototypical pattern of P wave, QRS complex, and T wave.\nGenerally, deviation from normal sinus rhythm is considered a cardiac arrhythmia.\nThus, the first question in interpreting an ECG is whether or not there is a sinus rhythm.\nA criterion for sinus rhythm is that P waves and QRS complexes appear 1-to-1, thus implying that the P wave causes the QRS complex.\n\n<\/p>Once sinus rhythm is established, or not, the second question is the rate.\nFor a sinus rhythm this is either the rate of P waves or QRS complexes since they are 1-to-1.\nIf the rate is too fast then it is sinus tachycardia and if it is too slow then it is sinus bradycardia.\n\n<\/p>If it is not a sinus rhythm, then determining the rhythm is necessary before proceeding with further interpretation.\nSome arrhythmias with characteristic findings:\n\n<\/p>\nAbsent P waves with \"irregularly irregular\" QRS complexes is the hallmark of atrial fibrillation\nA \"saw tooth\" pattern with QRS complexes is the hallmark of atrial flutter\nSine wave pattern is the hallmark of ventricular flutter\nAbsent P waves with wide QRS complexes and a fast heart rate is ventricular tachycardia\nDetermination of rate and rhythm is necessary in order to make sense of further interpretation.\n\nAxis \nThe heart has several axes, but the most common by far is the axis of the QRS complex (references to \"the axis\" imply the QRS axis).\nEach axis can be computationally determined to result in a number representing degrees of deviation from zero, or it can be categorized into a few types.\nThe QRS axis is the general direction of the ventricular depolarization wavefront (or mean electrical vector) in the frontal plane.\nIt is often sufficient to classify the axis as one of three types: normal, left deviated, or right deviated.\nPopulation data shows that a normal QRS axis is from \u221230\u00b0 to 105\u00b0, with 0\u00b0 being along lead I and positive being inferior and negative being superior (best understood graphically as the hexaxial reference system).[27]\nBeyond +105\u00b0 is right axis deviation and beyond \u221230\u00b0 is left axis deviation (the third quadrant of \u221290\u00b0 to \u2212180\u00b0 is very rare and is an indeterminate axis).\nA shortcut for determining if the QRS axis is normal is if the QRS complex is mostly positive in lead I and lead II (or lead I and aVF if +90\u00b0 is the upper limit of normal).\n\n<\/p>The normal QRS axis is generally down and to the left, following the anatomical orientation of the heart within the chest. An abnormal axis suggests a change in the physical shape and orientation of the heart or a defect in its conduction system that causes the ventricles to depolarize in an abnormal way.\n\n\n\n\nClassification\n\nAngle\n\nNotes\n\n\nNormal\n\n\u221230\u00b0 to 105\u00b0\n\nNormal\n\n\nLeft axis deviation\n\n\u221230\u00b0 to \u221290\u00b0\n\nMay indicate left ventricular hypertrophy, left anterior fascicular block, or an old inferior STEMI\n\n\nRight axis deviation\n\n+105\u00b0 to +180\u00b0\n\nMay indicate right ventricular hypertrophy, left posterior fascicular block, or an old lateral STEMI\n\n\nIndeterminate axis\n\n+180\u00b0 to \u221290\u00b0\n\nRarely seen; considered an 'electrical no-man's land'\n\nThe extent of a normal axis can be +90\u00b0 or 105\u00b0 depending on the source.\n\nAmplitudes and intervals \n Animation of a normal ECG wave\nAll of the waves on an ECG tracing and the intervals between them have a predictable time duration, a range of acceptable amplitudes (voltages), and a typical morphology. Any deviation from the normal tracing is potentially pathological and therefore of clinical significance.\nFor ease of measuring the amplitudes and intervals, an ECG is printed on graph paper at a standard scale: each 1 mm (one small box on the standard ECG paper) represents 40 milliseconds of time on the x-axis, and 0.1 millivolts on the y-axis.\n\n\n\n\nFeature\n\nDescription\n\nPathology\n\nDuration\n\n\nP wave\n\nThe P wave represents depolarization of the atria. Atrial depolarization spreads from the SA node towards the AV node, and from the right atrium to the left atrium.\n\nThe P wave is typically upright in most leads except for aVR; an unusual P wave axis (inverted in other leads) can indicate an ectopic atrial pacemaker. If the P wave is of unusually long duration, it may represent atrial enlargement. Typically a large right atrium gives a tall, peaked P wave while a large left atrium gives a two-humped bifid P wave.\n\n<80 ms\n\n\nPR interval\n\nThe PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. This interval reflects the time the electrical impulse takes to travel from the sinus node through the AV node.\n\nA PR interval shorter than 120 ms suggests that the electrical impulse is bypassing the AV node, as in Wolf-Parkinson-White syndrome. A PR interval consistently longer than 200 ms diagnoses first degree atrioventricular block. The PR segment (the portion of the tracing after the P wave and before the QRS complex) is typically completely flat, but may be depressed in pericarditis.\n\n120 to 200 ms\n\n\nQRS complex\n\nThe QRS complex represents the rapid depolarization of the right and left ventricles. The ventricles have a large muscle mass compared to the atria, so the QRS complex usually has a much larger amplitude than the P wave.\n\nIf the QRS complex is wide (longer than 120 ms) it suggests disruption of the heart's conduction system, such as in LBBB, RBBB, or ventricular rhythms such as ventricular tachycardia. Metabolic issues such as severe hyperkalemia, or tricyclic antidepressant overdose can also widen the QRS complex. An unusually tall QRS complex may represent left ventricular hypertrophy while a very low-amplitude QRS complex may represent a pericardial effusion or infiltrative myocardial disease.\n\n80 to 100 ms\n\n\nJ-point\n\nThe J-point is the point at which the QRS complex finishes and the ST segment begins.\n\nThe J-point may be elevated as a normal variant. The appearance of a separate J wave or Osborn wave at the J-point is pathognomonic of hypothermia or hypercalcemia.[28]\n\n\n\n\nST segment\n\nThe ST segment connects the QRS complex and the T wave; it represents the period when the ventricles are depolarized.\n\nIt is usually isoelectric, but may be depressed or elevated with myocardial infarction or ischemia. ST depression can also be caused by LVH or digoxin. ST elevation can also be caused by pericarditis, Brugada syndrome, or can be a normal variant (J-point elevation).\n\n\n\n\nT wave\n\nThe T wave represents the repolarization of the ventricles. It is generally upright in all leads except aVR and lead V1.\n\nInverted T waves can be a sign of myocardial ischemia, left ventricular hypertrophy, high intracranial pressure, or metabolic abnormalities. Peaked T waves can be a sign of hyperkalemia or very early myocardial infarction.\n\n160 ms\n\n\nCorrected QT interval (QTc)\n\nThe QT interval is measured from the beginning of the QRS complex to the end of the T wave. Acceptable ranges vary with heart rate, so it must be corrected to the QTc by dividing by the square root of the RR interval.\n\nA prolonged QTc interval is a risk factor for ventricular tachyarrhythmias and sudden death. Long QT can arise as a genetic syndrome, or as a side effect of certain medications. An unusually short QTc can be seen in severe hypercalcemia.\n\n<440 ms\n\n\nU wave\n\nThe U wave is hypothesized to be caused by the repolarization of the interventricular septum. It normally has a low amplitude, and even more often is completely absent.\n\nIf the U wave is very prominent, suspect hypokalemia, hypercalcemia or hyperthyroidism.[29]\n\n\n\n\nIschemia and infarction \nMain article: Electrocardiography in myocardial infarction\nIschemia or non-ST elevation myocardial infarctions (non-STEMIs) may manifest as ST depression or inversion of T waves. It may also affect the high frequency band of the QRS.\nST elevation myocardial infarctions (STEMIs) have different characteristic ECG findings based on the amount of time elapsed since the MI first occurred. The earliest sign is hyperacute T waves, peaked T waves due to local hyperkalemia in ischemic myocardium. This then progresses over a period of minutes to elevations of the ST segment by at least 1 mm. Over a period of hours, a pathologic Q wave may appear and the T wave will invert. Over a period of days the ST elevation will resolve. Pathologic Q waves generally will remain permanently.[30]\nThe coronary artery that has been occluded can be identified in an STEMI based on the location of ST elevation. The left anterior descending (LAD) artery supplies the anterior wall of the heart, and therefore causes ST elevations in anterior leads (V1 and V2). The LCx supplies the lateral aspect of the heart and therefore causes ST elevations in lateral leads (I, aVL and V6). The right coronary artery (RCA) usually supplies the inferior aspect of the heart, and therefore causes ST elevations in inferior leads (II, III and aVF).\n\nArtifacts \nAn ECG tracing is affected by patient motion. Some rhythmic motions (such as shivering or tremors) can create the illusion of cardiac arrhythmia.[31] Artifacts are distorted signals caused by a secondary internal or external sources, such as muscle movement or interference from an electrical device.[32][33]\nDistortion poses significant challenges to healthcare providers,[32] who employ various techniques[34] and strategies to safely recognize[35] these false signals.[medical citation needed ] Accurately separating the ECG artifact from the true ECG signal can have a significant impact on patient outcomes and legal liabilities.[36][unreliable medical source? ]\nImproper lead placement (for example, reversing two of the limb leads) has been estimated to occur in 0.4% to 4% of all ECG recordings,[37] and has resulted in improper diagnosis and treatment including unnecessary use of thrombolytic therapy.[38][39]\n\nDiagnosis \nNumerous diagnoses and findings can be made based upon electrocardiography, and many are discussed above. Overall, the diagnoses are made based on the patterns. For example, an \"irregularly irregular\" QRS complex without P waves is the hallmark of atrial fibrillation; however, other findings can be present as well, such as a bundle branch block that alters the shape of the QRS complexes. ECGs can be interpreted in isolation but should be applied \u2013 like all diagnostic tests \u2013 in the context of the patient. For example, an observation of peaked T waves is not sufficient to diagnose hyperkalemia; such a diagnosis should be verified by measuring the blood potassium level. Conversely, a discovery of hyperkalemia should be followed by an ECG for manifestations such as peaked T waves, widened QRS complexes, and loss of P waves. The following is an organized list of possible ECG-based diagnoses.\nRhythm disturbances or arrhythmias:\n\nAtrial fibrillation and atrial flutter without rapid ventricular response\nPremature atrial contraction (PACs) and premature ventricular contraction (PVCs)\nSinus arrhythmia\nSinus bradycardia and sinus tachycardia\nSinus pause and sinoatrial arrest\nSick sinus syndrome: bradycardia-tachycardia syndrome\nSupraventricular tachycardia\nAtrial fibrillation with rapid ventricular response\nAtrial flutter with rapid ventricular response\nAV nodal reentrant tachycardia\nAtrioventricular reentrant tachycardia\nJunctional ectopic tachycardia\nAtrial tachycardia\nEctopic atrial tachycardia (unicentric)\nMultifocal atrial tachycardia\nParoxysmal atrial tachycardia\nSinoatrial nodal reentrant tachycardia\nTorsades de pointes (polymorphic ventricular tachycardia)\nWide complex tachycardia\nVentricular flutter\nVentricular fibrillation\nVentricular tachycardia (monomorphic ventricular tachycardia)\nPre-excitation syndrome\nLown\u2013Ganong\u2013Levine syndrome\nWolff\u2013Parkinson\u2013White syndrome\nJ wave (Osborn wave)\nHeart block and conduction problems:\n\nAberration\nSinoatrial block: first, second, and third-degree\nAV node\nFirst-degree AV block\nSecond-degree AV block (Mobitz [Wenckebach] I and II)\nThird-degree AV block or complete AV block\nRight bundle\nIncomplete right bundle branch block\nComplete right bundle branch block (RBBB)\nLeft bundle\nComplete left bundle branch block (LBBB)\nIncomplete left bundle branch block\nLeft anterior fascicular block (LAFB)\nLeft posterior fascicular block (LPFB)\nBifascicular block (LAFB plus LPFB)\nTrifascicular block (LAFP plus FPFB plus RBBB)\nQT syndromes\nBrugada syndrome\nShort QT syndrome\nLong QT syndromes, genetic and drug-induced\nRight and left atrial abnormality\nElectrolytes disturbances and intoxication:\n\nDigitalis intoxication\nCalcium: hypocalcemia and hypercalcemia\nPotassium: hypokalemia and hyperkalemia\nIschemia and infarction:\n\nWellens' syndrome (LAD occlusion)\nde Winter T waves (LAD occlusion) [40]\nST elevation and ST depression\nHigh Frequency QRS changes\nMyocardial infarction (heart attack)\nNon-Q wave myocardial infarction\nNSTEMI\nSTEMI\nSgarbossa's criteria for ischemia with a LBBB\nStructural:\n\nAcute pericarditis\nRight and left ventricular hypertrophy\nRight ventricular strain or S1Q3T3 (can be seen in pulmonary embolism)\nHistory \n An early commercial ECG device (1911)\n ECG from 1957\nThe etymology of the word is derived from the Greek electro, because it is related to electrical activity, kardia, Greek for heart, and graph, a Greek root meaning \"to write\".\nAlexander Muirhead is reported to have attached wires to a feverish patient's wrist to obtain a record of the patient's heartbeat in 1872 at St Bartholomew's Hospital.[41] Another early pioneer was Augustus Waller, of St Mary's Hospital in London.[42] His electrocardiograph machine consisted of a Lippmann capillary electrometer fixed to a projector. The trace from the heartbeat was projected onto a photographic plate that was itself fixed to a toy train. This allowed a heartbeat to be recorded in real time.\nAn initial breakthrough came when Willem Einthoven, working in Leiden, the Netherlands, used the string galvanometer (the first practical electrocardiograph) he invented in 1901.[43] This device was much more sensitive than both the capillary electrometer Waller used and the string galvanometer that had been invented separately in 1897 by the French engineer Cl\u00e9ment Ader.[44] Einthoven had previously, in 1895, assigned the letters P, Q, R, S, and T to the deflections in the theoretical waveform he created using equations which corrected the actual waveform obtained by the capillary electrometer to compensate for the imprecision of that instrument. Using letters different from A, B, C, and D (the letters used for the capillary electrometer's waveform) facilitated comparison when the uncorrected and corrected lines were drawn on the same graph.[45] Einthoven probably chose the initial letter P to follow the example set by Descartes in geometry.[45] When a more precise waveform was obtained using the string galvanometer, which matched the corrected capillary electrometer waveform, he continued to use the letters P, Q, R, S, and T,[45] and these letters are still in use today. Einthoven also described the electrocardiographic features of a number of cardiovascular disorders. In 1924, he was awarded the Nobel Prize in Medicine for his discovery.[46]\nBy 1927, General Electric had developed a portable apparatus that could produce electrocardiograms without the use of the string galvanometer. This device instead combined amplifier tubes similar to those used in a radio with an internal lamp and a moving mirror that directed the tracing of the electric pulses onto film.[47]\nIn 1937, Taro Takemi invented a new portable electrocardiograph machine.[48]\nThough the basic principles of that era are still in use today, many advances in electrocardiography have been made over the years. Instrumentation has evolved from a cumbersome laboratory apparatus to compact electronic systems that often include computerized interpretation of the electrocardiogram.[49]\nIn September 2018, Apple Inc., introduced the Apple Watch Series 4, with a built-in titanium electrode in the digital crown and the sapphire crystal electronic heart sensor, which allows the watch to give a single lead electrocardiogram using only the watch interface.[50]\n\nSee also \nElectrical conduction system of the heart\nElectrogastrogram\nElectropalatography\nElectroretinography\nHeart rate\nHeart rate monitor\nEmergency medicine\nNotes \n\n\n^ The version with '-K-', more commonly used in American English than in British English, is an early-20th-century loanword from the German acronym EKG for Elektrokardiogramm (electrocardiogram),[1] which reflects that German physicians were pioneers in the field at the time. Today AMA style and \u2013 under its stylistic influence \u2013 most American medical publications use ECG instead of EKG.[2] The German term Elektrokardiogramm as well as the English equivalent, electrocardiogram, consist of the New Latin\/international scientific vocabulary elements elektro- (cognate electro-) and kardi- (cognate 'cardi-'), the latter from Greek kardia (heart).[3] The '-K-' version is more often retained under circumstances where there may be verbal confusion between ECG and EEG (electroencephalography) due to similar pronunciation. \n\n\nReferences \n\n\n^ EKG. Oxford Online Dictionaries \n\n^ \"15.3.1 Electrocardiographic Terms\", AMA Manual of Style, American Medical Association \n\n^ \"Merriam-Webster's Collegiate Dictionary\" . Merriam-Webster. \n\n^ Lilly, Leonard S, ed. (2016). Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty (sixth ed.). Lippincott Williams & Wilkins. p. 74. ISBN 978-1451192759. \n\n^ Aswini Kumar MD. \"ECG- simplified\". LifeHugger. Retrieved 11 February 2010 . \n\n^ a b Lilly 2016, pp. 80. \n\n^ Walraven, G. (2011). Basic arrhythmias (7th ed.), pp. 1\u201311 \n\n^ Braunwald E. (ed) (1997), Heart Disease: A Textbook of Cardiovascular Medicine, Fifth Edition, p. 108, Philadelphia, W.B. Saunders Co.. ISBN 0-7216-5666-8. \n\n^ \"What is a STEMI? - ECG Medical Training\". ECG Medical Training. 2015-06-24. Retrieved 2018-06-24 . \n\n^ \"What is NSTEMI? What You NEED to Know \u2022 MyHeart\". MyHeart. 2015-04-30. Retrieved 2018-06-24 . \n\n^ a b c d Masters, Jo; Bowden, Carole; Martin, Carole (2003). Textbook of veterinary medical nursing. Oxford: Butterworth-Heinemann. p. 244. ISBN 978-0-7506-5171-4. \n\n^ Moyer VA (2 October 2012). \"Screening for coronary heart disease with electrocardiography: U.S. Preventive Services Task Force recommendation statement\". Annals of Internal Medicine. 157 (7): 512\u201318. doi:10.7326\/0003-4819-157-7-201210020-00514. PMID 22847227. \n\n^ Consumer Reports; American Academy of Family Physicians; ABIM Foundation (April 2012), \"EKGs and exercise stress tests: When you need them for heart disease \u2014 and when you don't\" (PDF) , Choosing Wisely, Consumer Reports, retrieved 14 August 2012 \n\n^ \"Summary of Medical Standards\" (PDF) . U.S. Federal Aviation Administration. 2006. Retrieved 27 December 2013 . \n\n^ US Preventive Services Task, Force.; Curry, SJ; Krist, AH; Owens, DK; Barry, MJ; Caughey, AB; Davidson, KW; Doubeni, CA; Epling JW, Jr; Kemper, AR; Kubik, M; Landefeld, CS; Mangione, CM; Silverstein, M; Simon, MA; Tseng, CW; Wong, JB (12 June 2018). \"Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement\". JAMA. 319 (22): 2308\u20132314. doi:10.1001\/jama.2018.6848. PMID 29896632. \n\n^ \"Mitigation Strategies for ECG Design Challenges\" (PDF) . Analog Devices. Retrieved 24 April 2016 . \n\n^ \"FDA approves AliveCor heart monitor\". Techcrunch. Retrieved 2018-08-25 . \n\n^ Macfarlane, P.W.; Coleman (1995). \"Resting 12-Lead Electrode\" (PDF) . Society for Cardiological Science and Technology. Retrieved 21 October 2017 . \n\n^ \"12-Lead ECG Placement Guide with Illustrations\". Cables and Sensors. Retrieved 11 July 2017 . \n\n^ Kavuru, Madhav S.; Vesselle, Hubert; Thomas, Cecil W. (1987). Advances in Body Surface Potential Mapping (BSPM) Instrumentation. Pediatric and Fundamental Electrocardiography. Developments in Cardiovascular Medicine. 56. pp. 315\u2013327. doi:10.1007\/978-1-4613-2323-5_15. ISBN 978-1-4612-9428-3. ISSN 0166-9842. \n\n^ Sensors, Cables and. \"12-Lead ECG Placement Guide with Illustrations | Cables and Sensors\". Cables and Sensors. Retrieved 2017-10-21 . \n\n^ \"Limb Leads \u2013 ECG Lead Placement \u2013 Normal Function of the Heart \u2013 Cardiology Teaching Package \u2013 Practice Learning \u2013 Division of Nursing \u2013 The University of Nottingham\". Nottingham.ac.uk. Retrieved 15 August 2009 . \n\n^ \"Lesson 1: The Standard 12 Lead ECG\". Library.med.utah.edu. Archived from the original on 22 March 2009. Retrieved 15 August 2009 . \n\n^ Jin, Benjamin E.; Wulff, Heike; Widdicombe, Jonathan H.; Zheng, Jie; Bers, Donald M.; Puglisi, Jose L. (December 2012). \"A simple device to illustrate the Einthoven triangle\". Advances in Physiology Education. 36 (4): 319\u201324. doi:10.1152\/advan.00029.2012. ISSN 1043-4046. PMC 3776430 . PMID 23209014. \n\n^ Meigas, K; Kaik, J; Anier, A (2008). \"Device and methods for performing transesophageal stimulation at reduced pacing current threshold\". Estonian Journal of Engineering. 57 (2): 154. doi:10.3176\/eng.2008.2.05. \n\n^ a b Pehrson, Steen M.; Blomstr\u00f6-Lundqvist, Carina; Ljungstr\u00f6, Erik; Blomstr\u00f6, Per (1994). \"Clinical value of transesophageal atrial stimulation and recording in patients with arrhythmia-related symptoms or documented supraventricular tachycardia-correlation to clinical history and invasive studies\". Clinical Cardiology. 17 (10): 528\u201334. doi:10.1002\/clc.4960171004. PMID 8001299. \n\n^ Surawicz, Borys; Knillans, Timothy (2008). Chou's electrocardiography in clinical practice : adult and pediatric (6th ed.). Philadelphia, PA: Saunders\/Elsevier. p. 12. ISBN 978-1416037743. \n\n^ Otero J, Lenihan DJ (2000). \"The \"normothermic\" Osborn wave induced by severe hypercalcemia\". Tex Heart Inst J. 27 (3): 316\u201317. PMC 101092 . PMID 11093425. \n\n^ Houghton, Andrew R; Gray, David (2012). Making Sense of the ECG, Third Edition. Hodder Education. p. 214. ISBN 978-1-4441-6654-5. \n\n^ Alpert JS, Thygesen K, Antman E, Bassand JP (2000). \"Myocardial infarction redefined \u2013 a consensus document of The Joint European Society of Cardiology\/American College of Cardiology Committee for the redefinition of myocardial infarction\". J Am Coll Cardiol. 36 (3): 959\u201369. doi:10.1016\/S0735-1097(00)00804-4. PMID 10987628. \n\n^ Segura-Sampedro, Juan Jos\u00e9; Parra-L\u00f3pez, Loreto; Sampedro-Abascal, Consuelo; Mu\u00f1oz-Rodr\u00edguez, Juan Carlos (2015). \"Atrial flutter EKG can be useless without the proper electrophysiological basis\". International Journal of Cardiology. 179: 68\u201369. doi:10.1016\/j.ijcard.2014.10.076. PMID 25464416. \n\n^ a b Takla, George; Petre, John H.; Doyle, D John; Horibe, Mayumi; Gopakumaran, Bala (2006). \"The Problem of Artifacts in Patient Monitor Data During Surgery: A Clinical and Methodological Review\". Anesthesia & Analgesia. 103 (5): 1196\u2013204. doi:10.1213\/01.ane.0000247964.47706.5d. PMID 17056954. \n\n^ Kligfield, Paul; Gettes, Leonard S.; Bailey, James J.; Childers, Rory; Deal, Barbara J.; Hancock, E. William; van Herpen, Gerard; Kors, Jan A.; Macfarlane, Peter (2007-03-13). \"Recommendations for the standardization and interpretation of the electrocardiogram: part I: The electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology\". Circulation. 115 (10): 1306\u201324. doi:10.1161\/CIRCULATIONAHA.106.180200. PMID 17322457. \n\n^ \"Minimizing ECG Artifact\" (PDF) . Physio-Control. Physio-Control, Inc., Redmond WA. 2015. Retrieved 21 October 2017 . \n\n^ Jafary, Fahim H (2007). \"The \"incidental\" episode of ventricular fibrillation: A case report\". Journal of Medical Case Reports. 1: 72. doi:10.1186\/1752-1947-1-72. PMC 2000884 . PMID 17760955. \n\n^ Mangalmurti, Sandeep; Seabury, Seth A.; Chandra, Amitabh; Lakdawalla, Darius; Oetgen, William J.; Jena, Anupam B. (2014). \"Medical professional liability risk among US cardiologists\". American Heart Journal. 167 (5): 690\u201396. doi:10.1016\/j.ahj.2014.02.007. PMC 4153384 . PMID 24766979. \n\n^ Incorrect electrode cable connection during electrocardiographic recording (2007) Velislav N. Batchvarov, Marek Malik, A. John Camm, Europace, Oct 2007 \n\n^ Chanarin, N., Caplin, J., & Peacock, A. (1990). \"Pseudo reinfarction\": a consequence of electrocardiogram lead transposition following myocardial infarction. Clinical cardiology, 13(9), 668\u201369. \n\n^ Guijarro-Morales A., Gil-Extremera B., Maldonado-Mart\u00edn A. (1991). \"ECG diagnostic errors due to improper connection of the right arm and leg cables\". International Journal of Cardiology. 30 (2): 233\u201335. doi:10.1016\/0167-5273(91)90103-v. CS1 maint: Multiple names: authors list (link) \n\n^ de Winter, Robert (6 Nov 2008). \"A New ECG Sign of Proximal LAD Occlusion\". NEJM. 359 (19): 2071\u20133. doi:10.1056\/NEJMc0804737. PMID 18987380. \n\n^ Ronald M. Birse,rev. Patricia E. Knowlden Oxford Dictionary of National Biography 2004 (Subscription required) \u2013 (original source is his biography written by his wife \u2013 Elizabeth Muirhead. Alexandernn Muirhead 1848\u20131920. Oxford, Blackwell: privately printed 1926.) \n\n^ Waller AD (1887). \"A demonstration on man of electromotive changes accompanying the heart's beat\". J Physiol. 8 (5): 229\u201334. doi:10.1113\/jphysiol.1887.sp000257. PMC 1485094 . PMID 16991463. \n\n^ Rivera-Ruiz M, Cajavilca C, Varon J (29 September 1927). \"Einthoven's String Galvanometer: The First Electrocardiograph\". Texas Heart Institute Journal \/ from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital. 35 (2): 174\u201378. PMC 2435435 . PMID 18612490. \n\n^ Interwoven W (1901). \"Un nouveau galvanometre\". Arch Neerl Sc Ex Nat. 6: 625. \n\n^ a b c Hurst JW (3 November 1998). \"Naming of the Waves in the ECG, With a Brief Account of Their Genesis\". Circulation. 98 (18): 1937\u201342. doi:10.1161\/01.CIR.98.18.1937. PMID 9799216. \n\n^ Cooper JK (1986). \"Electrocardiography 100 years ago. Origins, pioneers, and contributors\". N Engl J Med. 315 (7): 461\u201364. doi:10.1056\/NEJM198608143150721. PMID 3526152. \n\n^ Blackford, John M., MD (1 May 1927). \"Electrocardiography: A Short Talk Before the Staff of the Hospital\". Clinics of the Virginia Mason Hospital. 6 (1): 28\u201334. CS1 maint: Multiple names: authors list (link) \n\n^ \"Dr. Taro Takemi\". Takemi Program in International Health. 2012-08-27. Retrieved 2017-10-21 . \n\n^ Mark, Jonathan B. (1998). Atlas of cardiovascular monitoring. New York: Churchill Livingstone. ISBN 978-0-443-08891-9. \n\n^ \"Apple Watch Series 4 - Health\". Apple. Retrieved 2018-09-27 . \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to ECG.\nThe whole ECG course on 1 A4 paper from ECGpedia, a wiki encyclopedia for a course on interpretation of ECG\nWave Maven \u2013 a large database of practice ECG questions provided by Beth Israel Deaconess Medical Center\nPysioBank \u2013 a free scientific database with physiologic signals (here ecg) \nEKG Academy \u2013 free EKG lectures, drills and quizzes\nECG Learning Center created by Eccles Health Sciences Library at University of Utah\nvteEmergency medicineEmergency medicine\nEmergency department\nEmergency medical services\nEmergency nursing\nEmergency psychiatry\nGolden hour\nMedical emergency\nInternational emergency medicine\nPediatric emergency medicine\nPre-hospital emergency medicine\nMajor trauma\nTrauma center\nTriage\nEquipment\nBag valve mask (BVM)\nChest tube\nDefibrillation (AED\nICD)\nElectrocardiogram (ECG\/EKG)\nIntraosseous infusion (IO)\nIntravenous therapy (IV)\nTracheal intubation\nLaryngeal tube\nCombitube\nNasopharyngeal airway (NPA)\nOropharyngeal airway (OPA)\nPocket mask\nDrugs\nAdenosine\nAmiodarone\nAtropine\nDopamine\nEpinephrine \/ Adrenaline\nNaloxone\nMagnesium sulfate\nSodium bicarbonate\nOrganisations\nInternational Federation for Emergency Medicine (International Conference on Emergency Medicine)\nAmerican College of Emergency Physicians\nAustralasian College for Emergency Medicine\nCanadian Association of Emergency Physicians\nRoyal College of Emergency Medicine\nEuropean Society of Emergency Medicine\nAsian Society for Emergency Medicine\nCourses \/ Life support\nAcute Care of at-Risk Newborns (ACoRN)\nAdvanced cardiac life support (ACLS)\nAdvanced trauma life support (ATLS)\nBasic life support (BLS)\nCardiopulmonary resuscitation (CPR)\nCare of the Critically Ill Surgical Patient (CCrISP)\nFirst aid\nNeonatal Resuscitation Program (NRP)\nPediatric Advanced Life Support (PALS)\nScoring systems\nNACA score\nInjury Severity Score\n\n Book\n Category\n Outline\n\nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\nvteMedical test: ElectrodiagnosisHeart\nElectrocardiography\nVectorcardiography\nMagnetocardiography\nCentral nervous system\nElectroencephalography (Intracranial EEG, stereoelectroencephalography)\nMagnetoencephalography\nPeripheral nervous system\nElectromyography (Facial electromyography)\nNerve conduction study\nEars\nElectrocochleography\nEyes\nElectronystagmography\nElectrooculography\nElectroretinography\nDigestive system\nElectrogastrogram\nMagnetogastrography\n\nvtePhysiology of the cardiovascular systemHeartCardiac output\nCardiac cycle\nCardiac output\nHeart rate\nStroke volume\nStroke volume\nEnd-diastolic volume\nEnd-systolic volume\nAfterload\nPreload\nFrank\u2013Starling law\nCardiac function curve\nVenous return curve\nWiggers diagram\nPressure volume diagram\nUltrasound\nFractional shortening = (End-diastolic dimension\nEnd-systolic dimension) \/ End-diastolic dimension\nAortic valve area calculation\nEjection fraction\nCardiac index\nHeart rate\nCardiac pacemaker\nChronotropic (Heart rate)\nDromotropic (Conduction velocity)\nInotropic (Contractility)\nBathmotropic (Excitability)\nLusitropic (Relaxation)\nConduction\nConduction system\nCardiac electrophysiology\nAction potential\ncardiac \natrial\nventricular\nEffective refractory period\nPacemaker potential\nElectrocardiography\nP wave\nPR interval\nQRS complex\nQT interval\nST segment\nT wave\nU wave\nHexaxial reference system\nChamber pressure\nCentral venous\nRight\natrial\nventricular\npulmonary artery\nwedge\nLeft\natrial\nventricular\nAortic\nOther\nVentricular remodeling\nVascular system\/\r\nHemodynamicsBlood flow\nCompliance\nVascular resistance\nPulse\nPerfusion\nBlood pressure\nPulse pressure\nSystolic\nDiastolic\nMean arterial pressure\nJugular venous pressure\nPortal venous pressure\nRegulation of BP\nBaroreflex\nKinin\u2013kallikrein system\nRenin\u2013angiotensin system\nVasoconstrictors\nVasodilators\nAutoregulation\nMyogenic mechanism\nTubuloglomerular feedback\nCerebral autoregulation\nParaganglia\nAortic body\nCarotid body\nGlomus cell\n\nAuthority control \nGND: 4014280-2 \nNDL: 00571014 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Electrocardiography\">https:\/\/www.limswiki.org\/index.php\/Electrocardiography<\/a>\n\t\t\t\t\tCategory: Medical and 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noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0e8d17422dd0e78773ae4216dd43a20b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Electrocardiography skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Electrocardiography<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"ECG\" and \"EKG\" redirect here. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/ECG_(disambiguation)\" class=\"mw-disambig\" title=\"ECG (disambiguation)\" rel=\"external_link\" target=\"_blank\">ECG (disambiguation)<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/EKG_(disambiguation)\" class=\"mw-disambig\" title=\"EKG (disambiguation)\" rel=\"external_link\" target=\"_blank\">EKG (disambiguation)<\/a>.<\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Not to be confused with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrography_(disambiguation)\" class=\"mw-disambig\" title=\"Electrography (disambiguation)\" rel=\"external_link\" target=\"_blank\">other types of electrography<\/a> or with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echocardiography\" title=\"Echocardiography\" rel=\"external_link\" target=\"_blank\">echocardiography<\/a>.<\/div>\n<p class=\"mw-empty-elt\">\n<\/p>\n\n<p><b>Electrocardiography<\/b> (<b>ECG<\/b> or <b>EKG<\/b><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[a]<\/a><\/sup>) is the process of recording the electrical activity of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[4]<\/a><\/sup> over a period of time using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a> placed over the skin. These electrodes detect the tiny electrical changes on the skin that arise from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_muscle\" title=\"Cardiac muscle\" rel=\"external_link\" target=\"_blank\">heart muscle<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrophysiology\" title=\"Electrophysiology\" rel=\"external_link\" target=\"_blank\">electrophysiologic<\/a> pattern of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Depolarization\" title=\"Depolarization\" rel=\"external_link\" target=\"_blank\">depolarizing<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repolarization\" title=\"Repolarization\" rel=\"external_link\" target=\"_blank\">repolarizing<\/a> during each <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_cycle\" title=\"Cardiac cycle\" rel=\"external_link\" target=\"_blank\">heartbeat<\/a>. It is very commonly performed to detect any cardiac problems.\n<\/p><p>In a conventional 12-lead ECG, ten electrodes are placed on the patient's limbs and on the surface of the chest. The overall <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnitude_(mathematics)\" title=\"Magnitude (mathematics)\" rel=\"external_link\" target=\"_blank\">magnitude<\/a> of the heart's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_potential\" class=\"mw-redirect\" title=\"Electrical potential\" rel=\"external_link\" target=\"_blank\">electrical potential<\/a> is then measured from twelve different angles (\"leads\") and is recorded over a period of time (usually ten seconds). In this way, the overall magnitude and direction of the heart's electrical depolarization is captured at each moment throughout the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_cycle\" title=\"Cardiac cycle\" rel=\"external_link\" target=\"_blank\">cardiac cycle<\/a>.<sup id=\"rdp-ebb-cite_ref-LHC_6-0\" class=\"reference\"><a href=\"#cite_note-LHC-6\" rel=\"external_link\">[5]<\/a><\/sup> The graph of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Voltage\" title=\"Voltage\" rel=\"external_link\" target=\"_blank\">voltage<\/a> versus time produced by this <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-invasive_(medical)\" class=\"mw-redirect\" title=\"Non-invasive (medical)\" rel=\"external_link\" target=\"_blank\">noninvasive<\/a> medical procedure is an <b>electrocardiogram<\/b>.\n<\/p><p>There are three main components to an ECG: the <a href=\"https:\/\/en.wikipedia.org\/wiki\/P_wave_(electrocardiography)\" title=\"P wave (electrocardiography)\" rel=\"external_link\" target=\"_blank\">P wave<\/a>, which represents the depolarization of the atria; the <a href=\"https:\/\/en.wikipedia.org\/wiki\/QRS_complex\" title=\"QRS complex\" rel=\"external_link\" target=\"_blank\">QRS complex<\/a>, which represents the depolarization of the ventricles; and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/T_wave\" title=\"T wave\" rel=\"external_link\" target=\"_blank\">T wave<\/a>, which represents the repolarization of the ventricles.<sup id=\"rdp-ebb-cite_ref-FOOTNOTELilly201680_7-0\" class=\"reference\"><a href=\"#cite_note-FOOTNOTELilly201680-7\" rel=\"external_link\">[6]<\/a><\/sup> It can also be further broken down into the following:\n<\/p>\n<ul><li>O is the origin or datum point preceding the cycle<\/li>\n<li>P is the atrial systole contraction pulse<\/li>\n<li>Q is a downward deflection immediately preceding the ventricular contraction<\/li>\n<li>R is the peak of the ventricular contraction<\/li>\n<li>S is the downward deflection immediately after the ventricular contraction<\/li>\n<li>T is the recovery of the ventricles<\/li>\n<li>U is the successor of the T wave but it is small and not always observed<\/li><\/ul>\n<p>During each heartbeat, a healthy heart has an orderly progression of depolarization that starts with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker_cells\" class=\"mw-redirect\" title=\"Pacemaker cells\" rel=\"external_link\" target=\"_blank\">pacemaker cells<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinoatrial_node\" title=\"Sinoatrial node\" rel=\"external_link\" target=\"_blank\">sinoatrial node<\/a>, spreads throughout the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrium_(heart)\" title=\"Atrium (heart)\" rel=\"external_link\" target=\"_blank\">atrium<\/a>, passes through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrioventricular_node\" title=\"Atrioventricular node\" rel=\"external_link\" target=\"_blank\">atrioventricular node<\/a> down into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bundle_of_His\" title=\"Bundle of His\" rel=\"external_link\" target=\"_blank\">bundle of His<\/a> and into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Purkinje_fibers\" title=\"Purkinje fibers\" rel=\"external_link\" target=\"_blank\">Purkinje fibers<\/a>, spreading down and to the left throughout the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricle_(heart)\" title=\"Ventricle (heart)\" rel=\"external_link\" target=\"_blank\">ventricles<\/a>.<sup id=\"rdp-ebb-cite_ref-FOOTNOTELilly201680_7-1\" class=\"reference\"><a href=\"#cite_note-FOOTNOTELilly201680-7\" rel=\"external_link\">[6]<\/a><\/sup> This orderly pattern of depolarization gives rise to the characteristic ECG tracing. To the trained <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinician\" title=\"Clinician\" rel=\"external_link\" target=\"_blank\">clinician<\/a>, an ECG conveys a large amount of information about the structure of the heart and the function of its electrical conduction system.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[7]<\/a><\/sup> Among other things, an ECG can be used to measure the rate and rhythm of heartbeats, the size and position of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_chambers\" class=\"mw-redirect\" title=\"Heart chambers\" rel=\"external_link\" target=\"_blank\">heart chambers<\/a>, the presence of any damage to the heart's muscle cells or conduction system, the effects of heart drugs, and the function of implanted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_pacemaker\" class=\"mw-redirect\" title=\"Artificial pacemaker\" rel=\"external_link\" target=\"_blank\">pacemakers<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:327px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12leadECG.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/12leadECG.jpg\/325px-12leadECG.jpg\" width=\"325\" height=\"127\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12leadECG.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A 12-lead ECG of a 26-year-old male with an incomplete <a href=\"https:\/\/en.wikipedia.org\/wiki\/RBBB\" class=\"mw-redirect\" title=\"RBBB\" rel=\"external_link\" target=\"_blank\">RBBB<\/a><\/div><\/div><\/div>\n<p>The overall goal of performing an ECG is to obtain information about the structure and function of the heart. Medical uses for this information are varied and generally need knowledge of the structure and\/or function of the heart to be interpreted. Some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Indication_(medicine)\" title=\"Indication (medicine)\" rel=\"external_link\" target=\"_blank\">indications<\/a> for performing an ECG include:\n<\/p>\n<ul><li>Suspected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">myocardial infarction<\/a> (heart attack) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_pain\" title=\"Chest pain\" rel=\"external_link\" target=\"_blank\">chest pain<\/a>\n<ul><li>ST elevated myocardial infarction (STEMI)<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>non-ST elevated myocardial infarction (NSTEMI)<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul><\/li>\n<li>Suspected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_embolism\" title=\"Pulmonary embolism\" rel=\"external_link\" target=\"_blank\">pulmonary embolism<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shortness_of_breath\" title=\"Shortness of breath\" rel=\"external_link\" target=\"_blank\">shortness of breath<\/a><\/li>\n<li>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Third_heart_sound\" title=\"Third heart sound\" rel=\"external_link\" target=\"_blank\">third heart sound<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fourth_heart_sound\" title=\"Fourth heart sound\" rel=\"external_link\" target=\"_blank\">fourth heart sound<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_murmur\" class=\"mw-redirect\" title=\"Cardiac murmur\" rel=\"external_link\" target=\"_blank\">cardiac murmur<\/a><sup id=\"rdp-ebb-cite_ref-masters_12-0\" class=\"reference\"><a href=\"#cite_note-masters-12\" rel=\"external_link\">[11]<\/a><\/sup> or other findings suggestive of a structural heart disease<\/li>\n<li>Perceived <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_dysrhythmia\" class=\"mw-redirect\" title=\"Cardiac dysrhythmia\" rel=\"external_link\" target=\"_blank\">arrhythmia<\/a> either by pulse or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palpitations\" title=\"Palpitations\" rel=\"external_link\" target=\"_blank\">palpitations<\/a><\/li>\n<li>Monitoring of known cardiac arrhythmias<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Syncope_(medicine)\" title=\"Syncope (medicine)\" rel=\"external_link\" target=\"_blank\">Fainting<\/a> or collapse<sup id=\"rdp-ebb-cite_ref-masters_12-1\" class=\"reference\"><a href=\"#cite_note-masters-12\" rel=\"external_link\">[11]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Seizure\" class=\"mw-redirect\" title=\"Seizure\" rel=\"external_link\" target=\"_blank\">Seizures<\/a><sup id=\"rdp-ebb-cite_ref-masters_12-2\" class=\"reference\"><a href=\"#cite_note-masters-12\" rel=\"external_link\">[11]<\/a><\/sup><\/li>\n<li>Monitoring the effects of a medication on the heart (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug-induced_QT_prolongation\" title=\"Drug-induced QT prolongation\" rel=\"external_link\" target=\"_blank\">drug-induced QT prolongation<\/a>)<\/li>\n<li>Assessing severity of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrolyte_imbalance\" title=\"Electrolyte imbalance\" rel=\"external_link\" target=\"_blank\">electrolyte abnormalities<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperkalemia\" title=\"Hyperkalemia\" rel=\"external_link\" target=\"_blank\">hyperkalemia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypertrophic_cardiomyopathy\" title=\"Hypertrophic cardiomyopathy\" rel=\"external_link\" target=\"_blank\">Hypertrophic cardiomyopathy<\/a> screening in adolescents as part of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sports_physical\" class=\"mw-redirect\" title=\"Sports physical\" rel=\"external_link\" target=\"_blank\">sports physical<\/a> out of concern for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sudden_cardiac_death\" class=\"mw-redirect\" title=\"Sudden cardiac death\" rel=\"external_link\" target=\"_blank\">sudden cardiac death<\/a> (varies by country)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Perioperative\" title=\"Perioperative\" rel=\"external_link\" target=\"_blank\">Perioperative<\/a> monitoring in which any form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia\" title=\"Anesthesia\" rel=\"external_link\" target=\"_blank\">anesthesia<\/a> is involved (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraoperative_neurophysiological_monitoring\" title=\"Intraoperative neurophysiological monitoring\" rel=\"external_link\" target=\"_blank\">monitored anesthesia care<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>); typically both intraoperative and postoperative<\/li>\n<li>As a part of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Preoperative_care\" title=\"Preoperative care\" rel=\"external_link\" target=\"_blank\">preoperative assessment<\/a> some time before a surgical procedure (especially for those with known cardiovascular disease or who are undergoing invasive, cardiac, vascular or pulmonary procedures, or who will receive <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anaesthesia\" title=\"General anaesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_stress_test\" title=\"Cardiac stress test\" rel=\"external_link\" target=\"_blank\">Cardiac stress testing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography_angiography\" title=\"Computed tomography angiography\" rel=\"external_link\" target=\"_blank\">Computed tomography angiography<\/a> (CTA) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_angiography\" title=\"Magnetic resonance angiography\" rel=\"external_link\" target=\"_blank\">magnetic resonance angiography<\/a> (MRA) of the heart (ECG is used to \"gate\" the scanning so that the anatomical position of the heart is steady)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biotelemetry\" title=\"Biotelemetry\" rel=\"external_link\" target=\"_blank\">Biotelemetry<\/a> of patients for any of the above reasons and such monitoring can include internal and external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defibrillator\" class=\"mw-redirect\" title=\"Defibrillator\" rel=\"external_link\" target=\"_blank\">defibrillators<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">pacemakers<\/a><\/li><\/ul>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Preventive_Services_Task_Force\" title=\"United States Preventive Services Task Force\" rel=\"external_link\" target=\"_blank\">United States Preventive Services Task Force<\/a> does not recommend an ECG for routine screening in patients without symptoms and those at low risk for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_heart_disease\" class=\"mw-redirect\" title=\"Coronary heart disease\" rel=\"external_link\" target=\"_blank\">coronary artery disease<\/a>.<sup id=\"rdp-ebb-cite_ref-Annals2012_13-0\" class=\"reference\"><a href=\"#cite_note-Annals2012-13\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-whenyouneedEKGs_14-0\" class=\"reference\"><a href=\"#cite_note-whenyouneedEKGs-14\" rel=\"external_link\">[13]<\/a><\/sup> This is because an ECG may falsely indicate the existence of a problem, leading to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Misdiagnosis\" class=\"mw-redirect\" title=\"Misdiagnosis\" rel=\"external_link\" target=\"_blank\">misdiagnosis<\/a>, the recommendation of invasive procedures, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Overtreatment\" class=\"mw-redirect\" title=\"Overtreatment\" rel=\"external_link\" target=\"_blank\">overtreatment<\/a>. However, persons employed in certain critical occupations, such as aircraft pilots,<sup id=\"rdp-ebb-cite_ref-FAA_Medical_Standards_2006_15-0\" class=\"reference\"><a href=\"#cite_note-FAA_Medical_Standards_2006-15\" rel=\"external_link\">[14]<\/a><\/sup> may be required to have an ECG as part of their routine health evaluations.\n<\/p><p><i>Continuous<\/i> ECG monitoring is used to monitor critically ill patients, patients undergoing general anesthesia,<sup id=\"rdp-ebb-cite_ref-masters_12-3\" class=\"reference\"><a href=\"#cite_note-masters-12\" rel=\"external_link\">[11]<\/a><\/sup> and patients who have an infrequently occurring cardiac arrhythmia that would unlikely be seen on a conventional ten-second ECG.\n<\/p><p>In the United States, a 12-lead ECG is commonly performed by specialized technicians that may be certified as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiogram_technician\" class=\"mw-redirect\" title=\"Electrocardiogram technician\" rel=\"external_link\" target=\"_blank\">electrocardiogram technicians<\/a>.\n<p>ECG interpretation is a component of many healthcare fields (nurses and physicians and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgeons\" class=\"mw-redirect\" title=\"Cardiac surgeons\" rel=\"external_link\" target=\"_blank\">cardiac surgeons<\/a> being the most obvious), but anyone trained to interpret an ECG is free to do so.\nHowever, \"official\" interpretation is performed by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiologist\" class=\"mw-redirect\" title=\"Cardiologist\" rel=\"external_link\" target=\"_blank\">cardiologist<\/a>.\nCertain fields such as anesthesia utilize continuous ECG monitoring, and knowledge of interpreting ECGs is crucial to their jobs.\n<\/p>\n<\/p><p>One additional form of ECG is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_cardiac_electrophysiology\" title=\"Clinical cardiac electrophysiology\" rel=\"external_link\" target=\"_blank\">clinical cardiac electrophysiology<\/a> in which a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> is used to measure the electrical activity.\n<p>The catheter is inserted through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_vein\" title=\"Femoral vein\" rel=\"external_link\" target=\"_blank\">femoral vein<\/a> and can have several electrodes along its length to record the direction of electrical activity from within the heart.\n<\/p>\n<\/p><p>Evidence does not support the use of ECGs among those without symptoms or at low risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiovascular_disease\" title=\"Cardiovascular disease\" rel=\"external_link\" target=\"_blank\">cardiovascular disease<\/a> as an effort for prevention.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Electrocardiographs\">Electrocardiographs<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:De-Modern_ecg_(CardioNetworks_ECGpedia).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/De-Modern_ecg_%28CardioNetworks_ECGpedia%29.jpg\/300px-De-Modern_ecg_%28CardioNetworks_ECGpedia%29.jpg\" width=\"300\" height=\"358\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:De-Modern_ecg_(CardioNetworks_ECGpedia).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An electrocardiograph with integrated display and keyboard on a wheeled cart<\/div><\/div><\/div>\n<p>An electrocardiograph is a machine that is used to perform electrocardiography, and produces the electrocardiogram.\nThe first electrocardiographs are discussed later and are electrically primitive compared to today's machines.\n<\/p><p>The fundamental component to an ECG is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Instrumentation_amplifier\" title=\"Instrumentation amplifier\" rel=\"external_link\" target=\"_blank\">instrumentation amplifier<\/a>, which is responsible for taking the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Voltage_difference\" class=\"mw-redirect\" title=\"Voltage difference\" rel=\"external_link\" target=\"_blank\">voltage difference<\/a> between leads (see below) and amplifying the signal.\n<p>ECG voltages measured across the body are on the order of hundreds of micro<a href=\"https:\/\/en.wikipedia.org\/wiki\/Volt\" title=\"Volt\" rel=\"external_link\" target=\"_blank\">volts<\/a> up to 1 millivolt (the small square on a standard ECG is 100 microvolts).\nThis low voltage necessitates a low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Noise_(electronics)\" title=\"Noise (electronics)\" rel=\"external_link\" target=\"_blank\">noise<\/a> circuit and instrumentation amplifiers.\n<\/p>\n<\/p><p>Early ECGs were constructed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analog_electronics\" class=\"mw-redirect\" title=\"Analog electronics\" rel=\"external_link\" target=\"_blank\">analog electronics<\/a> and the signal could drive a motor to print the signal on paper.\n<p>Today, electrocardiographs use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analog-to-digital_converter\" title=\"Analog-to-digital converter\" rel=\"external_link\" target=\"_blank\">analog-to-digital converters<\/a> to convert to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_signal\" title=\"Digital signal\" rel=\"external_link\" target=\"_blank\">digital signal<\/a> that can then be manipulated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_electronics\" title=\"Digital electronics\" rel=\"external_link\" target=\"_blank\">digital electronics<\/a>.\nThis permits digital recording of ECGs and use on computers.\n<\/p>\n<\/p><p>There are other components to the ECG:<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<ul><li>Safety features that include voltage protection for the patient and operator. Since the machines are powered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mains_power\" class=\"mw-redirect\" title=\"Mains power\" rel=\"external_link\" target=\"_blank\">mains power<\/a>, it is conceivable that either person could be subjected to voltage capable of causing death. Additionally, the heart is sensitive to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alternating_current\" title=\"Alternating current\" rel=\"external_link\" target=\"_blank\">AC<\/a> frequencies typically used for mains power (50 or 60 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hertz\" title=\"Hertz\" rel=\"external_link\" target=\"_blank\">Hz<\/a>).<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Defibrillation\" title=\"Defibrillation\" rel=\"external_link\" target=\"_blank\">Defibrillation<\/a> protection: any ECG used in healthcare may be attached to a person who requires defibrillation and the ECG needs to protect itself from this source of energy.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrostatic_discharge\" title=\"Electrostatic discharge\" rel=\"external_link\" target=\"_blank\">Electrostatic discharge<\/a> is similar to defibrillation discharge and requires voltage protection up to 18,000 volts.<\/li>\n<li>Additionally circuitry called the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Driven_right_leg_circuit\" title=\"Driven right leg circuit\" rel=\"external_link\" target=\"_blank\">right leg driver<\/a> can be used to reduce <a href=\"https:\/\/en.wikipedia.org\/wiki\/Common-mode_interference\" title=\"Common-mode interference\" rel=\"external_link\" target=\"_blank\">common-mode interference<\/a> (typically the 50 or 60 Hz mains power).<\/li><\/ul>\n<p>The typical design for a portable ECG is a combined unit that includes a screen, keyboard, and printer on a small wheeled cart.\nThe unit connects to a long cable that branches to each lead and attaches to a conductive pad on the patient.\n<\/p><p>The ECG may include a rhythm analysis <a href=\"https:\/\/en.wikipedia.org\/wiki\/Algorithm\" title=\"Algorithm\" rel=\"external_link\" target=\"_blank\">algorithm<\/a> that produces a computerized interpretation of the ECG.\n<p>The results from these algorithms are considered \"preliminary\" until verified and\/or modified by someone trained in interpreting ECGs.\nIncluded in this analysis is computation of common parameters that include <a href=\"https:\/\/en.wikipedia.org\/wiki\/PR_interval\" title=\"PR interval\" rel=\"external_link\" target=\"_blank\">PR interval<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/QT_interval\" title=\"QT interval\" rel=\"external_link\" target=\"_blank\">QT interval<\/a>, corrected QT (QTc) interval, PR axis, QRS axis, and more.\nEarlier designs recorded each lead sequentially but current designs employ circuits that can record all leads simultaneously.\nThe former introduces problems in interpretation since there may be beat-to-beat changes in the rhythm, which makes it unwise to compare across beats.\n<\/p>\n<\/p><p>More recent advancements in electrocardiography include work in diminishing the size of the unit to make it more portable and therefore more accessible to larger groups of patients. To achieve this, these smaller devices rely on only two electrodes which together deliver \"lead I\" of the standard ECG.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Electrodes_and_leads\">Electrodes and leads<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Limb_leads.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/Limb_leads.svg\/220px-Limb_leads.svg.png\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Limb_leads.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Proper placement of the limb electrodes. The limb electrodes can be far down on the limbs or close to the hips\/shoulders as long as they are placed symmetrically.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[18]<\/a><\/sup><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Precordial_leads_in_ECG.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/41\/Precordial_leads_in_ECG.png\/220px-Precordial_leads_in_ECG.png\" width=\"220\" height=\"291\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Precordial_leads_in_ECG.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Placement of the precordial electrodes<\/div><\/div><\/div>\n<p>Electrodes are the actual conductive pads attached to the body surface. Any pair of electrodes can measure the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_potential_difference\" class=\"mw-redirect\" title=\"Electrical potential difference\" rel=\"external_link\" target=\"_blank\">electrical potential difference<\/a> between the two corresponding locations of attachment. Such a pair forms <i>a lead<\/i>. However, \"leads\" can also be formed between a physical electrode and a <i>virtual electrode,<\/i> known as <i>the Wilson's central terminal<\/i>, whose potential is defined as the average potential measured by three limb electrodes that are attached to the right arm, the left arm, and the left foot, respectively. \n<\/p><p>Commonly, 10 electrodes attached to the body are used to form 12 ECG leads, with each lead measuring a specific electrical potential difference (as listed in the table below).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Leads are broken down into three types: limb; augmented limb; and precordial or chest. The 12-lead ECG has a total of three <i>limb leads<\/i> and three <i>augmented limb leads<\/i> arranged like spokes of a wheel in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronal_plane\" title=\"Coronal plane\" rel=\"external_link\" target=\"_blank\">coronal plane<\/a> (vertical), and six <i>precordial leads<\/i> or <i>chest leads<\/i> that lie on the perpendicular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transverse_plane\" title=\"Transverse plane\" rel=\"external_link\" target=\"_blank\">transverse plane<\/a> (horizontal).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In medical settings, the term <i>leads<\/i> is also sometimes used to refer to the electrodes themselves, although this is technically incorrect. This misuse of terminology can be the source of confusion.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The 10 electrodes in a 12-lead ECG are listed below.<sup id=\"rdp-ebb-cite_ref-CablesAndSensors_20-0\" class=\"reference\"><a href=\"#cite_note-CablesAndSensors-20\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Electrode name\n<\/th>\n<th>Electrode placement\n<\/th><\/tr>\n<tr>\n<td>RA\n<\/td>\n<td>On the right arm, avoiding thick <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a>.\n<\/td><\/tr>\n<tr>\n<td>LA\n<\/td>\n<td>In the same location where RA was placed, but on the left arm.\n<\/td><\/tr>\n<tr>\n<td>RL\n<\/td>\n<td>On the right leg, lower end of inner aspect of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Triceps_surae_muscle\" title=\"Triceps surae muscle\" rel=\"external_link\" target=\"_blank\">calf muscle<\/a>. (Avoid bony prominences)\n<\/td><\/tr>\n<tr>\n<td>LL\n<\/td>\n<td>In the same location where RL was placed, but on the left leg.\n<\/td><\/tr>\n<tr>\n<td>V<sub>1<\/sub>\n<\/td>\n<td>In the fourth <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intercostal_space\" title=\"Intercostal space\" rel=\"external_link\" target=\"_blank\">intercostal space<\/a> (between ribs 4 and 5) just to the right of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sternum\" title=\"Sternum\" rel=\"external_link\" target=\"_blank\">sternum<\/a> (breastbone).\n<\/td><\/tr>\n<tr>\n<td>V<sub>2<\/sub>\n<\/td>\n<td>In the fourth intercostal space (between ribs 4 and 5) just to the left of the sternum.\n<\/td><\/tr>\n<tr>\n<td>V<sub>3<\/sub>\n<\/td>\n<td>Between leads V<sub>2<\/sub> and V<sub>4<\/sub>.\n<\/td><\/tr>\n<tr>\n<td>V<sub>4<\/sub>\n<\/td>\n<td>In the fifth intercostal space (between ribs 5 and 6) in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mid-clavicular_line\" class=\"mw-redirect\" title=\"Mid-clavicular line\" rel=\"external_link\" target=\"_blank\">mid-clavicular line<\/a>.\n<\/td><\/tr>\n<tr>\n<td>V<sub>5<\/sub>\n<\/td>\n<td>Horizontally even with V<sub>4<\/sub>, in the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_axillary_line\" class=\"mw-redirect\" title=\"Anterior axillary line\" rel=\"external_link\" target=\"_blank\">anterior axillary line<\/a>.\n<\/td><\/tr>\n<tr>\n<td>V<sub>6<\/sub>\n<\/td>\n<td>Horizontally even with V<sub>4<\/sub> and V<sub>5<\/sub> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Midaxillary_line\" class=\"mw-redirect\" title=\"Midaxillary line\" rel=\"external_link\" target=\"_blank\">mid-axillary line<\/a>.\n<\/td><\/tr><\/tbody><\/table>\n<p>Two types of electrodes in common use are a flat paper-thin sticker and a self-adhesive circular pad.\nThe former are typically used in a single ECG recording while the latter are for continuous recordings as they stick longer.\nEach electrode consists of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrically_conductive\" class=\"mw-redirect\" title=\"Electrically conductive\" rel=\"external_link\" target=\"_blank\">electrically conductive<\/a> electrolyte gel and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver_chloride_electrode#Biological_electrode_systems\" title=\"Silver chloride electrode\" rel=\"external_link\" target=\"_blank\">silver\/silver chloride<\/a> conductor.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[20]<\/a><\/sup>\nThe gel typically contains <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_chloride\" title=\"Potassium chloride\" rel=\"external_link\" target=\"_blank\">potassium chloride<\/a> \u2013 sometimes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver_chloride\" title=\"Silver chloride\" rel=\"external_link\" target=\"_blank\">silver chloride<\/a> as well \u2013 to permit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron\" title=\"Electron\" rel=\"external_link\" target=\"_blank\">electron<\/a> conduction from the skin to the wire and to the electrocardiogram.\n<\/p><p>The common virtual electrode, known as the Wilson's central terminal (V<sub>W<\/sub>), is produced by averaging the measurements from the electrodes RA, LA, and LL to give an average potential of the body:\n<\/p>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/0e6d42ea32aab13b15d6e51930624cbf1641d7c3\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -1.838ex; width:25.895ex; height:5.176ex;\" alt=\" V_W = \\frac{1}{3}(RA+LA+LL) \"\/><\/span><\/dd><\/dl>\n<p>In a 12-lead ECG, all leads except the limb leads are unipolar (aVR, aVL, aVF, V<sub>1<\/sub>, V<sub>2<\/sub>, V<sub>3<\/sub>, V<sub>4<\/sub>, V<sub>5<\/sub>, and V<sub>6<\/sub>).\nThe measurement of a voltage requires two contacts and so, electrically, the unipolar leads are measured from the common lead (negative) and the unipolar lead (positive).\nThis averaging for the common lead and the abstract unipolar lead concept makes for a more challenging understanding and is complicated by sloppy usage of \"lead\" and \"electrode.\"\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Limb_leads\">Limb leads<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:602px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Limb_leads_of_EKG.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/19\/Limb_leads_of_EKG.png\/600px-Limb_leads_of_EKG.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Limb_leads_of_EKG.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The limb leads and augmented limb leads (Wilson's central terminal is used as the negative pole for the latter in this representation)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:EKG_leads.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"EKG leads.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/EKG_leads.png\/300px-EKG_leads.png\" width=\"300\" height=\"268\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:EKG_leads.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><\/div><\/div><\/div>\n<p>Leads I, II and III are called the <i>limb leads<\/i>. The electrodes that form these signals are located on the limbs \u2013 one on each arm and one on the left leg.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[23]<\/a><\/sup> The limb leads form the points of what is known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Einthoven%27s_triangle\" title=\"Einthoven's triangle\" rel=\"external_link\" target=\"_blank\">Einthoven's triangle<\/a>.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<ul><li>Lead I is the voltage between the (positive) left arm (LA) electrode and right arm (RA) electrode:<\/li><\/ul>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/41f044d2fd4d470cdafd94d5ffbfda0aaff905c2\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.505ex; width:13.944ex; height:2.343ex;\" alt=\" I = LA - RA \"\/><\/span><\/dd><\/dl>\n<ul><li>Lead II is the voltage between the (positive) left leg (LL) electrode and the right arm (RA) electrode:<\/li><\/ul>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/96c9c507b3a67bd37355721fd1f89e2d63233f74\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.505ex; width:14.955ex; height:2.343ex;\" alt=\" II = LL - RA \"\/><\/span><\/dd><\/dl>\n<ul><li>Lead III is the voltage between the (positive) left leg (LL) electrode and the left arm (LA) electrode:<\/li><\/ul>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/0b3ff3dd11cbc992ac0acad4edf384c6112bac36\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.505ex; width:15.946ex; height:2.343ex;\" alt=\" III = LL - LA \"\/><\/span><\/dd><\/dl>\n<h3><span class=\"mw-headline\" id=\"Augmented_limb_leads\">Augmented limb leads<\/span><\/h3>\n<p>Leads aVR, aVL, and aVF are the <i>augmented limb leads<\/i>. They are derived from the same three electrodes as leads I, II, and III, but they use Goldberger's central terminal as their negative pole. Goldberger's central terminal is a combination of inputs from two limb electrodes, with a different combination for each augmented lead. It is referred to immediately below as \"the negative pole.\"\n<\/p>\n<ul><li>Lead <i>augmented vector right<\/i> (aVR) has the positive electrode on the right arm. The negative pole is a combination of the left arm electrode and the left leg electrode:<\/li><\/ul>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/daf15fc5cc643651c933c6fe1975317d131ce124\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -1.838ex; width:43.93ex; height:5.176ex;\" alt=\" aVR = RA - \\frac{1}{2} (LA + LL) = \\frac 32 (RA - V_W) \"\/><\/span><\/dd><\/dl>\n<ul><li>Lead <i>augmented vector left<\/i> (aVL) has the positive electrode on the left arm. The negative pole is a combination of the right arm electrode and the left leg electrode:<\/li><\/ul>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/4b39fb58ce4ea0fa48547fbf121b13dc01d8e934\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -1.838ex; width:43.568ex; height:5.176ex;\" alt=\" aVL = LA - \\frac{1}{2} (RA + LL) = \\frac 32 (LA - V_W) \"\/><\/span><\/dd><\/dl>\n<ul><li>Lead <i>augmented vector foot<\/i> (aVF) has the positive electrode on the left leg. The negative pole is a combination of the right arm electrode and the left arm electrode:<\/li><\/ul>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/2b4e8d97775efdc8b82dfd724d0524ade48ca84f\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -1.838ex; width:43.566ex; height:5.176ex;\" alt=\" aVF = LL - \\frac{1}{2} (RA + LA) = \\frac 32 (LL - V_W) \"\/><\/span><\/dd><\/dl>\n<p>Together with leads I, II, and III, augmented limb leads aVR, aVL, and aVF form the basis of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hexaxial_reference_system\" title=\"Hexaxial reference system\" rel=\"external_link\" target=\"_blank\">hexaxial reference system<\/a>, which is used to calculate the heart's electrical axis in the frontal plane.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Precordial_leads\">Precordial leads<\/span><\/h3>\n<p>The <i>precordial leads<\/i> lie in the transverse (horizontal) plane, perpendicular to the other six leads. The six precordial electrodes act as the positive poles for the six corresponding precordial leads: (V<sub>1<\/sub>, V<sub>2<\/sub>, V<sub>3<\/sub>, V<sub>4<\/sub>, V<sub>5<\/sub> and V<sub>6<\/sub>). Wilson's central terminal is used as the negative pole.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Specialized_leads\">Specialized leads<\/span><\/h3>\n<p>Additional electrodes may rarely be placed to generate other leads for specific diagnostic purposes. <i>Right-sided<\/i> precordial leads may be used to better study pathology of the right ventricle or for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dextrocardia\" title=\"Dextrocardia\" rel=\"external_link\" target=\"_blank\">dextrocardia<\/a> (and are denoted with an R (e.g., V<sub>5R<\/sub>). <i>Posterior leads<\/i> (V<sub>7<\/sub> to V<sub>9<\/sub>) may be used to demonstrate the presence of a posterior myocardial infarction. A <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lewis_lead\" title=\"Lewis lead\" rel=\"external_link\" target=\"_blank\">Lewis lead<\/a><\/i> (requiring an electrode at the right sternal border in the second intercostal space) can be used to study pathological rhythms arising in the right atrium.\n<\/p><p>An <i>esophogeal lead<\/i> can be inserted to a part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagus\" title=\"Esophagus\" rel=\"external_link\" target=\"_blank\">esophagus<\/a> where the distance to the posterior wall of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_atrium\" class=\"mw-redirect\" title=\"Left atrium\" rel=\"external_link\" target=\"_blank\">left atrium<\/a> is only approximately 5\u20136 mm (remaining constant in people of different age and weight).<sup id=\"rdp-ebb-cite_ref-MeigasKaik2008_26-0\" class=\"reference\"><a href=\"#cite_note-MeigasKaik2008-26\" rel=\"external_link\">[25]<\/a><\/sup> An esophageal lead avails for a more accurate differentiation between certain cardiac arrhythmias, particularly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_flutter\" title=\"Atrial flutter\" rel=\"external_link\" target=\"_blank\">atrial flutter<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/AV_nodal_reentrant_tachycardia\" title=\"AV nodal reentrant tachycardia\" rel=\"external_link\" target=\"_blank\">AV nodal reentrant tachycardia<\/a> and orthodromic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrioventricular_reentrant_tachycardia\" title=\"Atrioventricular reentrant tachycardia\" rel=\"external_link\" target=\"_blank\">atrioventricular reentrant tachycardia<\/a>.<sup id=\"rdp-ebb-cite_ref-PehrsonBlomstr\u00f6-LUNDQVIST1994_27-0\" class=\"reference\"><a href=\"#cite_note-PehrsonBlomstr\u00f6-LUNDQVIST1994-27\" rel=\"external_link\">[26]<\/a><\/sup> It can also evaluate the risk in people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wolff-Parkinson-White_syndrome\" class=\"mw-redirect\" title=\"Wolff-Parkinson-White syndrome\" rel=\"external_link\" target=\"_blank\">Wolff-Parkinson-White syndrome<\/a>, as well as terminate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Supraventricular_tachycardia\" title=\"Supraventricular tachycardia\" rel=\"external_link\" target=\"_blank\">supraventricular tachycardia<\/a> caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_arrhythmia#Re-entry\" class=\"mw-redirect\" title=\"Cardiac arrhythmia\" rel=\"external_link\" target=\"_blank\">re-entry<\/a>.<sup id=\"rdp-ebb-cite_ref-PehrsonBlomstr\u00f6-LUNDQVIST1994_27-1\" class=\"reference\"><a href=\"#cite_note-PehrsonBlomstr\u00f6-LUNDQVIST1994-27\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>An intracardiac electrogram (ICEG) is essentially an ECG with some added <i>intracardiac leads<\/i> (that is, inside the heart). The standard ECG leads (external leads) are I, II, III, aVL, V<sub>1<\/sub>, and V<sub>6<\/sub>. Two to four intracardiac leads are added via cardiac catheterization. The word \"electrogram\" (EGM) without further specification usually means an intracardiac electrogram.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lead_locations_on_an_ECG_report\">Lead locations on an ECG report<\/span><\/h3>\n<p>A standard 12-lead ECG report (an electrocardiograph) shows a 2.5 second tracing of each of the twelve leads. The tracings are most commonly arranged in a grid of four columns and three rows. the first column is the limb leads (I, II, and III), the second column is the augmented limb leads (aVR, aVL, and aVF), and the last two columns are the precordial leads (V<sub>1<\/sub> to V<sub>6<\/sub>).\nAdditionally, a rhythm strip may be included as a fourth or fifth row.\n<\/p><p>The timing across the page is continuous and not tracings of the 12 leads for the same time period.\n<p>In other words, if the output were traced by needles on paper, each row would switch which leads as the paper is pulled under the needle.\nFor example, the top row would first trace lead I, then switch to lead aVR, then switch to V<sub>1<\/sub>, and then switch to V<sub>4<\/sub> and so none of these four tracings of the leads are from the same time period as they are traced in sequence through time.\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Contiguity_of_leads\"><span id=\"rdp-ebb-Lead_groups\"><\/span>Contiguity of leads<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Contiguous_leads.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/Contiguous_leads.svg\/300px-Contiguous_leads.svg.png\" width=\"300\" height=\"154\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Contiguous_leads.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Diagram showing the contiguous leads in the same color in the standard 12-lead layout<\/div><\/div><\/div>\n<p>Each of the 12 ECG leads records the electrical activity of the heart from a different angle, and therefore align with different anatomical areas of the heart. Two leads that look at neighboring anatomical areas are said to be <i>contiguous<\/i>.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Category\n<\/th>\n<th>Leads\n<\/th>\n<th>Activity\n<\/th><\/tr>\n<tr>\n<td>Inferior leads\n<\/td>\n<td>Leads II, III and aVF\n<\/td>\n<td>Look at electrical activity from the vantage point of the <a href=\"https:\/\/en.wiktionary.org\/wiki\/inferior\" class=\"extiw\" title=\"wikt:inferior\" rel=\"external_link\" target=\"_blank\">inferior<\/a> surface (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Diaphragmatic_surface_of_heart\" class=\"mw-redirect\" title=\"Diaphragmatic surface of heart\" rel=\"external_link\" target=\"_blank\">diaphragmatic surface of heart<\/a>)\n<\/td><\/tr>\n<tr>\n<td>Lateral leads\n<\/td>\n<td>I, aVL, V<sub>5<\/sub> and V<sub>6<\/sub>\n<\/td>\n<td>Look at the electrical activity from the vantage point of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lateral_(anatomy)\" class=\"mw-redirect\" title=\"Lateral (anatomy)\" rel=\"external_link\" target=\"_blank\">lateral<\/a> wall of left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricle_(heart)\" title=\"Ventricle (heart)\" rel=\"external_link\" target=\"_blank\">ventricle<\/a>\n<\/td><\/tr>\n<tr>\n<td>Septal leads\n<\/td>\n<td>V<sub>1<\/sub> and V<sub>2<\/sub>\n<\/td>\n<td>Look at electrical activity from the vantage point of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Septal\" class=\"mw-redirect\" title=\"Septal\" rel=\"external_link\" target=\"_blank\">septal<\/a> surface of the heart (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventricular_septum\" title=\"Interventricular septum\" rel=\"external_link\" target=\"_blank\">interventricular septum<\/a>)\n<\/td><\/tr>\n<tr>\n<td>Anterior leads\n<\/td>\n<td>V<sub>3<\/sub> and V<sub>4<\/sub>\n<\/td>\n<td>Look at electrical activity from the vantage point of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior\" class=\"mw-redirect\" title=\"Anterior\" rel=\"external_link\" target=\"_blank\">anterior<\/a> wall of the right and left ventricles (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Sternocostal_surface_of_heart\" class=\"mw-redirect\" title=\"Sternocostal surface of heart\" rel=\"external_link\" target=\"_blank\">Sternocostal surface of heart<\/a>)\n<\/td><\/tr><\/tbody><\/table>\n<p>In addition, any two precordial leads next to one another are considered to be contiguous. For example, though V<sub>4<\/sub> is an anterior lead and V<sub>5<\/sub> is a lateral lead, they are contiguous because they are next to one another.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Electrophysiology\">Electrophysiology<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_electrophysiology\" title=\"Cardiac electrophysiology\" rel=\"external_link\" target=\"_blank\">Cardiac electrophysiology<\/a><\/div>\n<p>The formal study of the electrical conduction system of the heart is called cardiac electrophysiology (EP).\nAn <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrophysiology_study\" title=\"Electrophysiology study\" rel=\"external_link\" target=\"_blank\">electrophysiology study<\/a> involves a formal study of the conduction system and can be done for various reasons.\nDuring such a study, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheters<\/a> are used to access the heart and some of these catheters include electrodes that can be placed anywhere in the heart to record the electrical activity from within the heart.\nSome catheters contain several electrodes and can record the propagation of electrical activity.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Interpretation\">Interpretation<\/span><\/h2>\n<p>Interpretation of the ECG is fundamentally about understanding the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_conduction_system_of_the_heart\" title=\"Electrical conduction system of the heart\" rel=\"external_link\" target=\"_blank\">electrical conduction system of the heart<\/a>.\nNormal conduction starts and propagates in a predictable pattern, and deviation from this pattern can be a normal variation or be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathological\" class=\"mw-redirect\" title=\"Pathological\" rel=\"external_link\" target=\"_blank\">pathological<\/a>.\nAn ECG does not equate with mechanical pumping activity of the heart, for example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulseless_electrical_activity\" title=\"Pulseless electrical activity\" rel=\"external_link\" target=\"_blank\">pulseless electrical activity<\/a> produces an ECG that should pump blood but no pulses are felt (and constitutes a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_emergency\" title=\"Medical emergency\" rel=\"external_link\" target=\"_blank\">medical emergency<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_resuscitation\" title=\"Cardiopulmonary resuscitation\" rel=\"external_link\" target=\"_blank\">CPR<\/a> should be performed).\n<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_fibrillation\" title=\"Ventricular fibrillation\" rel=\"external_link\" target=\"_blank\">Ventricular fibrillation<\/a> produces an ECG but is too dysfunctional to produce a life-sustaining cardiac output. Certain rhythms are known to have good cardiac output and some are known to have bad cardiac output.\nUltimately, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echocardiogram\" class=\"mw-redirect\" title=\"Echocardiogram\" rel=\"external_link\" target=\"_blank\">echocardiogram<\/a> or other anatomical imaging modality is useful in assessing the mechanical function of the heart.\n<\/p><p>Like all medical tests, what constitutes \"normal\" is based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Population_studies\" class=\"mw-redirect\" title=\"Population studies\" rel=\"external_link\" target=\"_blank\">population studies<\/a>. The heartrate range of between 60 and 100 beats per minute (bpm) is considered normal since data shows this to be the usual resting heart rate.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Theory\">Theory<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:232px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ECG_Vector.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/94\/ECG_Vector.svg\/230px-ECG_Vector.svg.png\" width=\"230\" height=\"230\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ECG_Vector.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>QRS is upright in a lead when its axis is aligned with that lead's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Euclidean_vector\" title=\"Euclidean vector\" rel=\"external_link\" target=\"_blank\">vector<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:282px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:EKG_Complex_en.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/EKG_Complex_en.svg\/280px-EKG_Complex_en.svg.png\" width=\"280\" height=\"219\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:EKG_Complex_en.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Schematic representation of a normal ECG<\/div><\/div><\/div>\n<p>Interpretation of the ECG is ultimately that of pattern recognition.\nIn order to understand the patterns found, it is helpful to understand the theory of what ECGs represent.\nThe theory is rooted in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetics\" class=\"mw-redirect\" title=\"Electromagnetics\" rel=\"external_link\" target=\"_blank\">electromagnetics<\/a> and boils down to the four following points:\n<\/p>\n<ul><li>depolarization of the heart <i>toward<\/i> the positive electrode produces a positive deflection<\/li>\n<li>depolarization of the heart <i>away<\/i> from the positive electrode produces a negative deflection<\/li>\n<li>repolarization of the heart <i>toward<\/i> the positive electrode produces a negative deflection<\/li>\n<li>repolarization of the heart <i>away<\/i> from the positive electrode produces a positive deflection<\/li><\/ul>\n<p>Thus, the overall direction of depolarization and repolarization produces a vector that produces positive or negative deflection on the ECG depending on which lead it points to.\nFor example, depolarizing from right to left would produce a positive deflection in lead I because the two vectors point in the same direction.\nIn contrast, that same depolarization would produce minimal deflection in V<sub>1<\/sub> and V<sub>2<\/sub> because the vectors are perpendicular and this phenomenon is called isoelectric.\n<\/p><p>Normal rhythm produces four entities \u2013 a P wave, a QRS complex, a T wave, and a U wave \u2013 that each have a fairly unique pattern.\n<\/p>\n<ul><li>The P wave represents atrial depolarization.<\/li>\n<li>The QRS complex represents ventricular depolarization.<\/li>\n<li>The T wave represents ventricular repolarization.<\/li>\n<li>The U wave represents papillary muscle repolarization.<\/li><\/ul>\n<p>However, the U wave is not typically seen and its absence is generally ignored.\nChanges in the structure of the heart and its surroundings (including blood composition) change the patterns of these four entities.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Electrocardiogram_grid\">Electrocardiogram grid<\/span><\/h3>\n<p>ECGs are normally printed on a grid.\nThe horizontal axis represents time and the vertical axis represents voltage.\nThe standard values on this grid are shown in the adjacent image:\n<\/p>\n<ul><li>A small box is 1 mm \u00d7 1 mm and represents 0.1 mV \u00d7 0.04 seconds.<\/li>\n<li>A large box is 5 mm \u00d7 5 mm and represents 0.5 mV \u00d7 0.20 seconds.<\/li><\/ul>\n<p>The \"large\" box is represented by a heavier <a href=\"https:\/\/en.wikipedia.org\/wiki\/Font_weight\" class=\"mw-redirect\" title=\"Font weight\" rel=\"external_link\" target=\"_blank\">line weight<\/a> than the small boxes.\n<\/p>\n<div class=\"floatleft\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ECG_Paper_v2.svg\" class=\"image\" title=\"Measuring time and voltage with ECG graph paper\" rel=\"external_link\" target=\"_blank\"><img alt=\"Measuring time and voltage with ECG graph paper\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/ECG_Paper_v2.svg\/500px-ECG_Paper_v2.svg.png\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a><\/div>\n<div style=\"clear:both;\"><\/div>\n<p>Not all aspects of an ECG rely on precise recordings or having a known scaling of amplitude or time.\nFor example, determining if the tracing is a sinus rhythm only requires feature recognition and matching, and not measurement of amplitudes or times (i.e., the scale of the grids are irrelevant).\nAn example to the contrary, the voltage requirements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_ventricular_hypertrophy\" title=\"Left ventricular hypertrophy\" rel=\"external_link\" target=\"_blank\">left ventricular hypertrophy<\/a> require knowing the grid scale.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Rate_and_rhythm\">Rate and rhythm<\/span><\/h3>\n<p>In a normal heart, the heart rate is the rate in which the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinoatrial_node\" title=\"Sinoatrial node\" rel=\"external_link\" target=\"_blank\">sinoatrial node<\/a> depolarizes as it is the source of depolarization of the heart.\nHeart rate, like other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vital_signs\" title=\"Vital signs\" rel=\"external_link\" target=\"_blank\">vital signs<\/a> like blood pressure and respiratory rate, change with age.\nIn adults, a normal heart rate is between 60 and 100 bpm (normocardic) where in children it is higher.\nA heart rate less than normal is called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bradycardia\" title=\"Bradycardia\" rel=\"external_link\" target=\"_blank\">bradycardia<\/a> (<60 in adults) and higher than normal is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tachycardia\" title=\"Tachycardia\" rel=\"external_link\" target=\"_blank\">tachycardia<\/a> (>100 in adults).\nA complication of this is when the atria and ventricles are not in synchrony and the \"heart rate\" must be specified as atrial or ventricular (e.g., the ventricular rate in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_fibrillation\" title=\"Ventricular fibrillation\" rel=\"external_link\" target=\"_blank\">ventricular fibrillation<\/a> is 300\u2013600 bpm, whereas the atrial rate can be normal [60\u2013100] or faster [100\u2013150]).\n<\/p><p>In normal resting hearts, the physiologic rhythm of the heart is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Normal_sinus_rhythm\" class=\"mw-redirect\" title=\"Normal sinus rhythm\" rel=\"external_link\" target=\"_blank\">normal sinus rhythm<\/a> (NSR).\n<p>Normal sinus rhythm produces the prototypical pattern of P wave, QRS complex, and T wave.\nGenerally, deviation from normal sinus rhythm is considered a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_arrhythmia\" class=\"mw-redirect\" title=\"Cardiac arrhythmia\" rel=\"external_link\" target=\"_blank\">cardiac arrhythmia<\/a>.\nThus, the first question in interpreting an ECG is whether or not there is a sinus rhythm.\nA criterion for sinus rhythm is that P waves and QRS complexes appear 1-to-1, thus implying that the P wave causes the QRS complex.\n<\/p>\n<\/p><p>Once sinus rhythm is established, or not, the second question is the rate.\n<p>For a sinus rhythm this is either the rate of P waves or QRS complexes since they are 1-to-1.\nIf the rate is too fast then it is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_tachycardia\" title=\"Sinus tachycardia\" rel=\"external_link\" target=\"_blank\">sinus tachycardia<\/a> and if it is too slow then it is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_bradycardia\" title=\"Sinus bradycardia\" rel=\"external_link\" target=\"_blank\">sinus bradycardia<\/a>.\n<\/p>\n<\/p><p>If it is not a sinus rhythm, then determining the rhythm is necessary before proceeding with further interpretation.\n<p>Some arrhythmias with characteristic findings:\n<\/p>\n<\/p>\n<ul><li>Absent P waves with \"irregularly irregular\" QRS complexes is the hallmark of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a><\/li>\n<li>A \"saw tooth\" pattern with QRS complexes is the hallmark of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_flutter\" title=\"Atrial flutter\" rel=\"external_link\" target=\"_blank\">atrial flutter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sine_wave\" title=\"Sine wave\" rel=\"external_link\" target=\"_blank\">Sine wave<\/a> pattern is the hallmark of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_flutter\" title=\"Ventricular flutter\" rel=\"external_link\" target=\"_blank\">ventricular flutter<\/a><\/li>\n<li>Absent P waves with wide QRS complexes and a fast heart rate is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_tachycardia\" title=\"Ventricular tachycardia\" rel=\"external_link\" target=\"_blank\">ventricular tachycardia<\/a><\/li><\/ul>\n<p>Determination of rate and rhythm is necessary in order to make sense of further interpretation.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Axis\">Axis<\/span><\/h3>\n<p>The heart has several axes, but the most common by far is the axis of the QRS complex (references to \"the axis\" imply the QRS axis).\nEach axis can be computationally determined to result in a number representing degrees of deviation from zero, or it can be categorized into a few types.\n<\/p><p>The QRS axis is the general direction of the ventricular depolarization wavefront (or mean electrical vector) in the frontal plane.\n<p>It is often sufficient to classify the axis as one of three types: normal, left deviated, or right deviated.\nPopulation data shows that a normal QRS axis is from \u221230\u00b0 to 105\u00b0, with 0\u00b0 being along lead I and positive being inferior and negative being superior (best understood graphically as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hexaxial_reference_system\" title=\"Hexaxial reference system\" rel=\"external_link\" target=\"_blank\">hexaxial reference system<\/a>).<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[27]<\/a><\/sup>\nBeyond +105\u00b0 is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_axis_deviation\" title=\"Right axis deviation\" rel=\"external_link\" target=\"_blank\">right axis deviation<\/a> and beyond \u221230\u00b0 is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_axis_deviation\" title=\"Left axis deviation\" rel=\"external_link\" target=\"_blank\">left axis deviation<\/a> (the third quadrant of \u221290\u00b0 to \u2212180\u00b0 is very rare and is an indeterminate axis).\nA shortcut for determining if the QRS axis is normal is if the QRS complex is mostly positive in lead I and lead II (or lead I and aVF if +90\u00b0 is the upper limit of normal).\n<\/p>\n<\/p><p>The normal QRS axis is generally <i>down and to the left<\/i>, following the anatomical orientation of the heart within the chest. An abnormal axis suggests a change in the physical shape and orientation of the heart or a defect in its conduction system that causes the ventricles to depolarize in an abnormal way.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Classification\n<\/th>\n<th>Angle\n<\/th>\n<th>Notes\n<\/th><\/tr>\n<tr>\n<td>Normal\n<\/td>\n<td>\u221230\u00b0 to 105\u00b0\n<\/td>\n<td>Normal\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_axis_deviation\" title=\"Left axis deviation\" rel=\"external_link\" target=\"_blank\">Left axis deviation<\/a>\n<\/td>\n<td>\u221230\u00b0 to \u221290\u00b0\n<\/td>\n<td>May indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_ventricular_hypertrophy\" title=\"Left ventricular hypertrophy\" rel=\"external_link\" target=\"_blank\">left ventricular hypertrophy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_anterior_fascicular_block\" title=\"Left anterior fascicular block\" rel=\"external_link\" target=\"_blank\">left anterior fascicular block<\/a>, or an old inferior STEMI\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_axis_deviation\" title=\"Right axis deviation\" rel=\"external_link\" target=\"_blank\">Right axis deviation<\/a>\n<\/td>\n<td>+105\u00b0 to +180\u00b0\n<\/td>\n<td>May indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_ventricular_hypertrophy\" title=\"Right ventricular hypertrophy\" rel=\"external_link\" target=\"_blank\">right ventricular hypertrophy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_posterior_fascicular_block\" title=\"Left posterior fascicular block\" rel=\"external_link\" target=\"_blank\">left posterior fascicular block<\/a>, or an old lateral STEMI\n<\/td><\/tr>\n<tr>\n<td><i>Indeterminate axis<\/i>\n<\/td>\n<td>+180\u00b0 to \u221290\u00b0\n<\/td>\n<td>Rarely seen; considered an 'electrical no-man's land'\n<\/td><\/tr><\/tbody><\/table>\n<p>The extent of a normal axis can be +90\u00b0 or 105\u00b0 depending on the source.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Amplitudes_and_intervals\">Amplitudes and intervals<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ECG_principle_slow.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e5\/ECG_principle_slow.gif\/220px-ECG_principle_slow.gif\" width=\"220\" height=\"251\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ECG_principle_slow.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Animation of a normal ECG wave<\/div><\/div><\/div>\n<p>All of the waves on an ECG tracing and the intervals between them have a predictable time duration, a range of acceptable amplitudes (voltages), and a typical morphology. Any deviation from the normal tracing is potentially pathological and therefore of clinical significance.\n<\/p><p>For ease of measuring the amplitudes and intervals, an ECG is printed on graph paper at a standard scale: each 1 mm (one small box on the standard ECG paper) represents 40 milliseconds of time on the x-axis, and 0.1 millivolts on the y-axis.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Feature\n<\/th>\n<th>Description\n<\/th>\n<th>Pathology\n<\/th>\n<th>Duration\n<\/th><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/P_wave_(electrocardiography)\" title=\"P wave (electrocardiography)\" rel=\"external_link\" target=\"_blank\">P wave<\/a>\n<\/td>\n<td>The P wave represents depolarization of the atria. Atrial depolarization spreads from the SA node towards the AV node, and from the right <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrium_(anatomy)\" class=\"mw-redirect\" title=\"Atrium (anatomy)\" rel=\"external_link\" target=\"_blank\">atrium<\/a> to the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrium_(anatomy)\" class=\"mw-redirect\" title=\"Atrium (anatomy)\" rel=\"external_link\" target=\"_blank\">atrium<\/a>.\n<\/td>\n<td>The P wave is typically upright in most leads except for aVR; an unusual P wave axis (inverted in other leads) can indicate an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ectopic_pacemaker\" title=\"Ectopic pacemaker\" rel=\"external_link\" target=\"_blank\">ectopic atrial pacemaker<\/a>. If the P wave is of unusually long duration, it may represent atrial enlargement. Typically a large <i>right atrium<\/i> gives a tall, peaked P wave while a large <i>left atrium<\/i> gives a two-humped bifid P wave.\n<\/td>\n<td><80 ms\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/PR_interval\" title=\"PR interval\" rel=\"external_link\" target=\"_blank\">PR interval<\/a>\n<\/td>\n<td>The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. This interval reflects the time the electrical impulse takes to travel from the sinus node through the AV node.\n<\/td>\n<td>A PR interval shorter than 120 ms suggests that the electrical impulse is bypassing the AV node, as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wolf-Parkinson-White_syndrome\" class=\"mw-redirect\" title=\"Wolf-Parkinson-White syndrome\" rel=\"external_link\" target=\"_blank\">Wolf-Parkinson-White syndrome<\/a>. A PR interval consistently longer than 200 ms diagnoses <a href=\"https:\/\/en.wikipedia.org\/wiki\/First_degree_atrioventricular_block\" class=\"mw-redirect\" title=\"First degree atrioventricular block\" rel=\"external_link\" target=\"_blank\">first degree atrioventricular block<\/a>. The PR segment (the portion of the tracing after the P wave and before the QRS complex) is typically completely flat, but may be depressed in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericarditis\" title=\"Pericarditis\" rel=\"external_link\" target=\"_blank\">pericarditis<\/a>.\n<\/td>\n<td>120 to 200 ms\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/QRS_complex\" title=\"QRS complex\" rel=\"external_link\" target=\"_blank\">QRS complex<\/a>\n<\/td>\n<td>The QRS complex represents the rapid depolarization of the right and left ventricles. The ventricles have a large muscle mass compared to the atria, so the QRS complex usually has a much larger amplitude than the P wave.\n<\/td>\n<td>If the QRS complex is wide (longer than 120 ms) it suggests disruption of the heart's conduction system, such as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/LBBB\" class=\"mw-redirect\" title=\"LBBB\" rel=\"external_link\" target=\"_blank\">LBBB<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/RBBB\" class=\"mw-redirect\" title=\"RBBB\" rel=\"external_link\" target=\"_blank\">RBBB<\/a>, or ventricular rhythms such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_tachycardia\" title=\"Ventricular tachycardia\" rel=\"external_link\" target=\"_blank\">ventricular tachycardia<\/a>. Metabolic issues such as severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperkalemia\" title=\"Hyperkalemia\" rel=\"external_link\" target=\"_blank\">hyperkalemia<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricyclic_antidepressant_overdose\" title=\"Tricyclic antidepressant overdose\" rel=\"external_link\" target=\"_blank\">tricyclic antidepressant overdose<\/a> can also widen the QRS complex. An unusually tall QRS complex may represent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_ventricular_hypertrophy\" title=\"Left ventricular hypertrophy\" rel=\"external_link\" target=\"_blank\">left ventricular hypertrophy<\/a> while a very low-amplitude QRS complex may represent a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericardial_effusion\" title=\"Pericardial effusion\" rel=\"external_link\" target=\"_blank\">pericardial effusion<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restrictive_cardiomyopathy\" title=\"Restrictive cardiomyopathy\" rel=\"external_link\" target=\"_blank\">infiltrative myocardial disease<\/a>.\n<\/td>\n<td>80 to 100 ms\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/J-point\" class=\"mw-redirect\" title=\"J-point\" rel=\"external_link\" target=\"_blank\">J-point<\/a>\n<\/td>\n<td>The J-point is the point at which the QRS complex finishes and the ST segment begins.\n<\/td>\n<td>The J-point may be elevated as a normal variant. The appearance of a separate <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osborn_wave\" class=\"mw-redirect\" title=\"Osborn wave\" rel=\"external_link\" target=\"_blank\">J wave<\/a><\/i> or <i>Osborn wave<\/i> at the J-point is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathognomonic\" title=\"Pathognomonic\" rel=\"external_link\" target=\"_blank\">pathognomonic<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypothermia\" title=\"Hypothermia\" rel=\"external_link\" target=\"_blank\">hypothermia<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypercalcemia\" class=\"mw-redirect\" title=\"Hypercalcemia\" rel=\"external_link\" target=\"_blank\">hypercalcemia<\/a>.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/ST_segment\" title=\"ST segment\" rel=\"external_link\" target=\"_blank\">ST segment<\/a>\n<\/td>\n<td>The ST segment connects the QRS complex and the T wave; it represents the period when the ventricles are depolarized.\n<\/td>\n<td>It is usually isoelectric, but may be depressed or elevated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">myocardial infarction<\/a> or ischemia. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ST_depression\" title=\"ST depression\" rel=\"external_link\" target=\"_blank\">ST depression<\/a> can also be caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/LVH\" class=\"mw-redirect\" title=\"LVH\" rel=\"external_link\" target=\"_blank\">LVH<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digoxin\" title=\"Digoxin\" rel=\"external_link\" target=\"_blank\">digoxin<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ST_elevation\" title=\"ST elevation\" rel=\"external_link\" target=\"_blank\">ST elevation<\/a> can also be caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericarditis\" title=\"Pericarditis\" rel=\"external_link\" target=\"_blank\">pericarditis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brugada_syndrome\" title=\"Brugada syndrome\" rel=\"external_link\" target=\"_blank\">Brugada syndrome<\/a>, or can be a normal variant (J-point elevation).\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/T_wave\" title=\"T wave\" rel=\"external_link\" target=\"_blank\">T wave<\/a>\n<\/td>\n<td>The T wave represents the repolarization of the ventricles. It is generally upright in all leads except aVR and lead V1.\n<\/td>\n<td>Inverted T waves can be a sign of myocardial ischemia, <a href=\"https:\/\/en.wikipedia.org\/wiki\/LVH\" class=\"mw-redirect\" title=\"LVH\" rel=\"external_link\" target=\"_blank\">left ventricular hypertrophy<\/a>, high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure\" title=\"Intracranial pressure\" rel=\"external_link\" target=\"_blank\">intracranial pressure<\/a>, or metabolic abnormalities. Peaked T waves can be a sign of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperkalemia\" title=\"Hyperkalemia\" rel=\"external_link\" target=\"_blank\">hyperkalemia<\/a> or very early <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">myocardial infarction<\/a>.\n<\/td>\n<td>160 ms\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrected_QT_interval\" class=\"mw-redirect\" title=\"Corrected QT interval\" rel=\"external_link\" target=\"_blank\">Corrected QT interval<\/a> (QTc)\n<\/td>\n<td>The QT interval is measured from the beginning of the QRS complex to the end of the T wave. Acceptable ranges vary with heart rate, so it must be <i>corrected<\/i> to the QTc by dividing by the square root of the RR interval.\n<\/td>\n<td>A prolonged QTc interval is a risk factor for ventricular tachyarrhythmias and sudden death. Long QT can arise as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Long_QT_syndrome\" title=\"Long QT syndrome\" rel=\"external_link\" target=\"_blank\">genetic syndrome<\/a>, or as a side effect of certain medications. An unusually short QTc can be seen in severe hypercalcemia.\n<\/td>\n<td><440 ms\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/U_wave\" title=\"U wave\" rel=\"external_link\" target=\"_blank\">U wave<\/a>\n<\/td>\n<td>The U wave is hypothesized to be caused by the repolarization of the interventricular septum. It normally has a low amplitude, and even more often is completely absent.\n<\/td>\n<td>If the U wave is very prominent, suspect hypokalemia, hypercalcemia or hyperthyroidism.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/td>\n<td>\n<\/td><\/tr>\n<\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Ischemia_and_infarction\">Ischemia and infarction<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiography_in_myocardial_infarction\" title=\"Electrocardiography in myocardial infarction\" rel=\"external_link\" target=\"_blank\">Electrocardiography in myocardial infarction<\/a><\/div>\n<p>Ischemia or <a href=\"https:\/\/en.wikipedia.org\/wiki\/NSTEMI\" class=\"mw-redirect\" title=\"NSTEMI\" rel=\"external_link\" target=\"_blank\">non-ST elevation myocardial infarctions<\/a> (non-STEMIs) may manifest as <a href=\"https:\/\/en.wikipedia.org\/wiki\/ST_depression\" title=\"ST depression\" rel=\"external_link\" target=\"_blank\">ST depression<\/a> or inversion of <a href=\"https:\/\/en.wikipedia.org\/wiki\/T_wave\" title=\"T wave\" rel=\"external_link\" target=\"_blank\">T waves<\/a>. It may also affect the <a href=\"https:\/\/en.wikipedia.org\/wiki\/HFQRS\" class=\"mw-redirect\" title=\"HFQRS\" rel=\"external_link\" target=\"_blank\">high frequency band of the QRS<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/STEMI\" class=\"mw-redirect\" title=\"STEMI\" rel=\"external_link\" target=\"_blank\">ST elevation myocardial infarctions<\/a> (STEMIs) have different characteristic ECG findings based on the amount of time elapsed since the MI first occurred. The earliest sign is <i>hyperacute T waves,<\/i> peaked T waves due to local <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperkalemia\" title=\"Hyperkalemia\" rel=\"external_link\" target=\"_blank\">hyperkalemia<\/a> in ischemic myocardium. This then progresses over a period of minutes to elevations of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ST_segment\" title=\"ST segment\" rel=\"external_link\" target=\"_blank\">ST segment<\/a> by at least 1 mm. Over a period of hours, a pathologic <a href=\"https:\/\/en.wikipedia.org\/wiki\/QRS_complex#Q_wave\" title=\"QRS complex\" rel=\"external_link\" target=\"_blank\">Q wave<\/a> may appear and the T wave will invert. Over a period of days the ST elevation will resolve. Pathologic Q waves generally will remain permanently.<sup id=\"rdp-ebb-cite_ref-Alpert-2000_31-0\" class=\"reference\"><a href=\"#cite_note-Alpert-2000-31\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">coronary artery<\/a> that has been occluded can be identified in an STEMI based on the location of ST elevation. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_interventricular_branch_of_left_coronary_artery\" class=\"mw-redirect\" title=\"Anterior interventricular branch of left coronary artery\" rel=\"external_link\" target=\"_blank\">left anterior descending<\/a> (LAD) artery supplies the anterior wall of the heart, and therefore causes ST elevations in anterior leads (V<sub>1<\/sub> and V<sub>2<\/sub>). The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circumflex_branch_of_left_coronary_artery\" title=\"Circumflex branch of left coronary artery\" rel=\"external_link\" target=\"_blank\">LCx<\/a> supplies the lateral aspect of the heart and therefore causes ST elevations in lateral leads (I, aVL and V<sub>6<\/sub>). The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_coronary_artery\" title=\"Right coronary artery\" rel=\"external_link\" target=\"_blank\">right coronary artery<\/a> (RCA) usually supplies the inferior aspect of the heart, and therefore causes ST elevations in inferior leads (II, III and aVF).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Artifacts\">Artifacts<\/span><\/h3>\n<p>An ECG tracing is affected by patient motion. Some rhythmic motions (such as shivering or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tremor\" title=\"Tremor\" rel=\"external_link\" target=\"_blank\">tremors<\/a>) can create the illusion of cardiac arrhythmia.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[31]<\/a><\/sup> Artifacts are distorted signals caused by a secondary internal or external sources, such as muscle movement or interference from an electrical device.<sup id=\"rdp-ebb-cite_ref-Takla_33-0\" class=\"reference\"><a href=\"#cite_note-Takla-33\" rel=\"external_link\">[32]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p><p>Distortion poses significant challenges to healthcare providers,<sup id=\"rdp-ebb-cite_ref-Takla_33-1\" class=\"reference\"><a href=\"#cite_note-Takla-33\" rel=\"external_link\">[32]<\/a><\/sup> who employ various techniques<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[34]<\/a><\/sup> and strategies to safely recognize<sup id=\"rdp-ebb-cite_ref-Fahim_H_Jafary_36-0\" class=\"reference\"><a href=\"#cite_note-Fahim_H_Jafary-36\" rel=\"external_link\">[35]<\/a><\/sup> these false signals.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources_(medicine)\" title=\"Wikipedia:Identifying reliable sources (medicine)\" rel=\"external_link\" target=\"_blank\"><span title=\"Material near this tag needs references to reliable medical sources. (August 2015)\">medical citation needed<\/span><\/a><\/i>]<\/sup> Accurately separating the ECG artifact from the true ECG signal can have a significant impact on patient outcomes and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Legal_liability\" title=\"Legal liability\" rel=\"external_link\" target=\"_blank\">legal liabilities<\/a>.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[36]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources_(medicine)\" title=\"Wikipedia:Identifying reliable sources (medicine)\" rel=\"external_link\" target=\"_blank\"><span title=\"Material near this tag may rely on an unreliable or less reliable medical source. (August 2015)\">unreliable medical source?<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Improper lead placement (for example, reversing two of the limb leads) has been estimated to occur in 0.4% to 4% of all ECG recordings,<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[37]<\/a><\/sup> and has resulted in improper diagnosis and treatment including unnecessary use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombolytic\" class=\"mw-redirect\" title=\"Thrombolytic\" rel=\"external_link\" target=\"_blank\">thrombolytic<\/a> therapy.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[38]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Diagnosis\">Diagnosis<\/span><\/h2>\n<p>Numerous diagnoses and findings can be made based upon electrocardiography, and many are discussed above. Overall, the diagnoses are made based on the patterns. For example, an \"irregularly irregular\" QRS complex without P waves is the hallmark of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a>; however, other findings can be present as well, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bundle_branch_block\" title=\"Bundle branch block\" rel=\"external_link\" target=\"_blank\">bundle branch block<\/a> that alters the shape of the QRS complexes. ECGs can be interpreted in isolation but should be applied \u2013 like all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnostic_tests\" class=\"mw-redirect\" title=\"Diagnostic tests\" rel=\"external_link\" target=\"_blank\">diagnostic tests<\/a> \u2013 in the context of the patient. For example, an observation of peaked T waves is not sufficient to diagnose hyperkalemia; such a diagnosis should be verified by measuring the blood potassium level. Conversely, a discovery of hyperkalemia should be followed by an ECG for manifestations such as peaked T waves, widened QRS complexes, and loss of P waves. The following is an organized list of possible ECG-based diagnoses.\n<\/p><p>Rhythm disturbances or arrhythmias:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">Atrial fibrillation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_flutter\" title=\"Atrial flutter\" rel=\"external_link\" target=\"_blank\">atrial flutter<\/a> without rapid ventricular response<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Premature_atrial_contraction\" title=\"Premature atrial contraction\" rel=\"external_link\" target=\"_blank\">Premature atrial contraction<\/a> (PACs) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Premature_ventricular_contraction\" title=\"Premature ventricular contraction\" rel=\"external_link\" target=\"_blank\">premature ventricular contraction<\/a> (PVCs)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_arrhythmia\" class=\"mw-redirect\" title=\"Sinus arrhythmia\" rel=\"external_link\" target=\"_blank\">Sinus arrhythmia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_bradycardia\" title=\"Sinus bradycardia\" rel=\"external_link\" target=\"_blank\">Sinus bradycardia<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_tachycardia\" title=\"Sinus tachycardia\" rel=\"external_link\" target=\"_blank\">sinus tachycardia<\/a><\/li>\n<li> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinoatrial_arrest\" title=\"Sinoatrial arrest\" rel=\"external_link\" target=\"_blank\">sinoatrial arrest<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sick_sinus_syndrome\" title=\"Sick sinus syndrome\" rel=\"external_link\" target=\"_blank\">Sick sinus syndrome<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bradycardia-tachycardia_syndrome\" class=\"mw-redirect\" title=\"Bradycardia-tachycardia syndrome\" rel=\"external_link\" target=\"_blank\">bradycardia-tachycardia syndrome<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Supraventricular_tachycardia\" title=\"Supraventricular tachycardia\" rel=\"external_link\" target=\"_blank\">Supraventricular tachycardia<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">Atrial fibrillation<\/a> with rapid ventricular response<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_flutter\" title=\"Atrial flutter\" rel=\"external_link\" target=\"_blank\">Atrial flutter<\/a> with rapid ventricular response<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/AV_nodal_reentrant_tachycardia\" title=\"AV nodal reentrant tachycardia\" rel=\"external_link\" target=\"_blank\">AV nodal reentrant tachycardia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrioventricular_reentrant_tachycardia\" title=\"Atrioventricular reentrant tachycardia\" rel=\"external_link\" target=\"_blank\">Atrioventricular reentrant tachycardia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Junctional_ectopic_tachycardia\" title=\"Junctional ectopic tachycardia\" rel=\"external_link\" target=\"_blank\">Junctional ectopic tachycardia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_tachycardia\" title=\"Atrial tachycardia\" rel=\"external_link\" target=\"_blank\">Atrial tachycardia<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ectopic_atrial_tachycardia\" class=\"mw-redirect\" title=\"Ectopic atrial tachycardia\" rel=\"external_link\" target=\"_blank\">Ectopic atrial tachycardia<\/a> (unicentric)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Multifocal_atrial_tachycardia\" title=\"Multifocal atrial tachycardia\" rel=\"external_link\" target=\"_blank\">Multifocal atrial tachycardia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paroxysmal_atrial_tachycardia\" class=\"mw-redirect\" title=\"Paroxysmal atrial tachycardia\" rel=\"external_link\" target=\"_blank\">Paroxysmal atrial tachycardia<\/a><\/li><\/ul><\/li>\n<li><\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Torsades_de_pointes\" title=\"Torsades de pointes\" rel=\"external_link\" target=\"_blank\">Torsades de pointes<\/a> (polymorphic ventricular tachycardia)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wide_complex_tachycardia\" class=\"mw-redirect\" title=\"Wide complex tachycardia\" rel=\"external_link\" target=\"_blank\">Wide complex tachycardia<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_flutter\" title=\"Ventricular flutter\" rel=\"external_link\" target=\"_blank\">Ventricular flutter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_fibrillation\" title=\"Ventricular fibrillation\" rel=\"external_link\" target=\"_blank\">Ventricular fibrillation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_tachycardia\" title=\"Ventricular tachycardia\" rel=\"external_link\" target=\"_blank\">Ventricular tachycardia<\/a> (monomorphic ventricular tachycardia)<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pre-excitation_syndrome\" title=\"Pre-excitation syndrome\" rel=\"external_link\" target=\"_blank\">Pre-excitation syndrome<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lown%E2%80%93Ganong%E2%80%93Levine_syndrome\" title=\"Lown\u2013Ganong\u2013Levine syndrome\" rel=\"external_link\" target=\"_blank\">Lown\u2013Ganong\u2013Levine syndrome<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wolff%E2%80%93Parkinson%E2%80%93White_syndrome\" title=\"Wolff\u2013Parkinson\u2013White syndrome\" rel=\"external_link\" target=\"_blank\">Wolff\u2013Parkinson\u2013White syndrome<\/a><\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/J_wave\" title=\"J wave\" rel=\"external_link\" target=\"_blank\">J wave<\/a> (Osborn wave)<\/li><\/ul>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_block\" title=\"Heart block\" rel=\"external_link\" target=\"_blank\">Heart block<\/a> and conduction problems:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_aberrancy\" title=\"Cardiac aberrancy\" rel=\"external_link\" target=\"_blank\">Aberration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinoatrial_block\" title=\"Sinoatrial block\" rel=\"external_link\" target=\"_blank\">Sinoatrial block<\/a>: first, second, and third-degree<\/li>\n<li>AV node\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/First-degree_AV_block\" class=\"mw-redirect\" title=\"First-degree AV block\" rel=\"external_link\" target=\"_blank\">First-degree AV block<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Second-degree_AV_block\" class=\"mw-redirect\" title=\"Second-degree AV block\" rel=\"external_link\" target=\"_blank\">Second-degree AV block<\/a> (Mobitz [Wenckebach] I and II)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Third-degree_AV_block\" class=\"mw-redirect\" title=\"Third-degree AV block\" rel=\"external_link\" target=\"_blank\">Third-degree AV block<\/a> or complete AV block<\/li><\/ul><\/li>\n<li>Right bundle\n<ul><li><\/li>\n<li>Complete <a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_bundle_branch_block\" title=\"Right bundle branch block\" rel=\"external_link\" target=\"_blank\">right bundle branch block<\/a> (RBBB)<\/li><\/ul><\/li>\n<li>Left bundle\n<ul><li>Complete <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_bundle_branch_block\" title=\"Left bundle branch block\" rel=\"external_link\" target=\"_blank\">left bundle branch block<\/a> (LBBB)<\/li>\n<li><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_anterior_fascicular_block\" title=\"Left anterior fascicular block\" rel=\"external_link\" target=\"_blank\">Left anterior fascicular block<\/a> (LAFB)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_posterior_fascicular_block\" title=\"Left posterior fascicular block\" rel=\"external_link\" target=\"_blank\">Left posterior fascicular block<\/a> (LPFB)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bifascicular_block\" title=\"Bifascicular block\" rel=\"external_link\" target=\"_blank\">Bifascicular block<\/a> (LAFB plus LPFB)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trifascicular_block\" title=\"Trifascicular block\" rel=\"external_link\" target=\"_blank\">Trifascicular block<\/a> (LAFP plus FPFB plus RBBB)<\/li><\/ul><\/li>\n<li>QT syndromes\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brugada_syndrome\" title=\"Brugada syndrome\" rel=\"external_link\" target=\"_blank\">Brugada syndrome<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Short_QT_syndrome\" title=\"Short QT syndrome\" rel=\"external_link\" target=\"_blank\">Short QT syndrome<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Long_QT_syndrome\" title=\"Long QT syndrome\" rel=\"external_link\" target=\"_blank\">Long QT syndromes<\/a>, genetic and drug-induced<\/li><\/ul><\/li>\n<li> and <\/li><\/ul>\n<p>Electrolytes disturbances and intoxication:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Digoxin_poisoning\" class=\"mw-redirect\" title=\"Digoxin poisoning\" rel=\"external_link\" target=\"_blank\">Digitalis intoxication<\/a><\/li>\n<li>Calcium: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypocalcemia\" class=\"mw-redirect\" title=\"Hypocalcemia\" rel=\"external_link\" target=\"_blank\">hypocalcemia<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypercalcemia\" class=\"mw-redirect\" title=\"Hypercalcemia\" rel=\"external_link\" target=\"_blank\">hypercalcemia<\/a><\/li>\n<li>Potassium: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypokalemia\" title=\"Hypokalemia\" rel=\"external_link\" target=\"_blank\">hypokalemia<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperkalemia\" title=\"Hyperkalemia\" rel=\"external_link\" target=\"_blank\">hyperkalemia<\/a><\/li><\/ul>\n<p>Ischemia and infarction:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wellens%27_syndrome\" title=\"Wellens' syndrome\" rel=\"external_link\" target=\"_blank\">Wellens' syndrome<\/a> (LAD occlusion)<\/li>\n<li> (LAD occlusion) <sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ST_elevation\" title=\"ST elevation\" rel=\"external_link\" target=\"_blank\">ST elevation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/ST_depression\" title=\"ST depression\" rel=\"external_link\" target=\"_blank\">ST depression<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/High_Frequency_QRS\" class=\"mw-redirect\" title=\"High Frequency QRS\" rel=\"external_link\" target=\"_blank\">High Frequency QRS<\/a> changes<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">Myocardial infarction<\/a> (heart attack)\n<ul><li><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/NSTEMI\" class=\"mw-redirect\" title=\"NSTEMI\" rel=\"external_link\" target=\"_blank\">NSTEMI<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/STEMI\" class=\"mw-redirect\" title=\"STEMI\" rel=\"external_link\" target=\"_blank\">STEMI<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sgarbossa%27s_criteria\" title=\"Sgarbossa's criteria\" rel=\"external_link\" target=\"_blank\">Sgarbossa's criteria<\/a> for ischemia with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_bundle_branch_block\" title=\"Left bundle branch block\" rel=\"external_link\" target=\"_blank\">LBBB<\/a><\/li><\/ul><\/li><\/ul>\n<p>Structural:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_pericarditis\" title=\"Acute pericarditis\" rel=\"external_link\" target=\"_blank\">Acute pericarditis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_ventricular_hypertrophy\" title=\"Right ventricular hypertrophy\" rel=\"external_link\" target=\"_blank\">Right<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_ventricular_hypertrophy\" title=\"Left ventricular hypertrophy\" rel=\"external_link\" target=\"_blank\">left ventricular hypertrophy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_ventricular_strain\" class=\"mw-redirect\" title=\"Right ventricular strain\" rel=\"external_link\" target=\"_blank\">Right ventricular strain<\/a> or S1Q3T3 (can be seen in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_embolism\" title=\"Pulmonary embolism\" rel=\"external_link\" target=\"_blank\">pulmonary embolism<\/a>)<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Willem_Einthoven_ECG.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Willem_Einthoven_ECG.jpg\/220px-Willem_Einthoven_ECG.jpg\" width=\"220\" height=\"180\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Willem_Einthoven_ECG.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An early commercial ECG device (1911)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BASA-532K-1-2-15-Ran_Bosilek.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/BASA-532K-1-2-15-Ran_Bosilek.jpg\/220px-BASA-532K-1-2-15-Ran_Bosilek.jpg\" width=\"220\" height=\"36\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BASA-532K-1-2-15-Ran_Bosilek.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>ECG from 1957<\/div><\/div><\/div>\n<p>The etymology of the word is derived from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_language\" title=\"Greek language\" rel=\"external_link\" target=\"_blank\">Greek<\/a> <i>electro<\/i>, because it is related to electrical activity, <i>kardia<\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_language\" title=\"Greek language\" rel=\"external_link\" target=\"_blank\">Greek<\/a> for heart, and <i>graph<\/i>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_language\" title=\"Greek language\" rel=\"external_link\" target=\"_blank\">Greek<\/a> root meaning \"to write\".\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alexander_Muirhead\" title=\"Alexander Muirhead\" rel=\"external_link\" target=\"_blank\">Alexander Muirhead<\/a> is reported to have attached wires to a feverish patient's wrist to obtain a record of the patient's heartbeat in 1872 at <a href=\"https:\/\/en.wikipedia.org\/wiki\/St_Bartholomew%27s_Hospital\" title=\"St Bartholomew's Hospital\" rel=\"external_link\" target=\"_blank\">St Bartholomew's Hospital<\/a>.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[41]<\/a><\/sup> Another early pioneer was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Augustus_Desir%C3%A9_Waller\" title=\"Augustus Desir\u00e9 Waller\" rel=\"external_link\" target=\"_blank\">Augustus Waller<\/a>, of <a href=\"https:\/\/en.wikipedia.org\/wiki\/St_Mary%27s_Hospital_(London)\" class=\"mw-redirect\" title=\"St Mary's Hospital (London)\" rel=\"external_link\" target=\"_blank\">St Mary's Hospital<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/London\" title=\"London\" rel=\"external_link\" target=\"_blank\">London<\/a>.<sup id=\"rdp-ebb-cite_ref-Waller_1887_43-0\" class=\"reference\"><a href=\"#cite_note-Waller_1887-43\" rel=\"external_link\">[42]<\/a><\/sup> His electrocardiograph machine consisted of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lippmann_electrometer\" title=\"Lippmann electrometer\" rel=\"external_link\" target=\"_blank\">Lippmann capillary electrometer<\/a> fixed to a projector. The trace from the heartbeat was projected onto a photographic plate that was itself fixed to a toy train. This allowed a heartbeat to be recorded in real time.\n<\/p><p>An initial breakthrough came when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Willem_Einthoven\" title=\"Willem Einthoven\" rel=\"external_link\" target=\"_blank\">Willem Einthoven<\/a>, working in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Leiden\" title=\"Leiden\" rel=\"external_link\" target=\"_blank\">Leiden<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Netherlands\" title=\"Netherlands\" rel=\"external_link\" target=\"_blank\">Netherlands<\/a>, used the <a href=\"https:\/\/en.wikipedia.org\/wiki\/String_galvanometer\" title=\"String galvanometer\" rel=\"external_link\" target=\"_blank\">string galvanometer<\/a> (the first practical electrocardiograph) he invented in 1901.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[43]<\/a><\/sup> This device was much more sensitive than both the capillary electrometer Waller used and the string galvanometer that had been invented separately in 1897 by the French engineer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cl%C3%A9ment_Ader\" title=\"Cl\u00e9ment Ader\" rel=\"external_link\" target=\"_blank\">Cl\u00e9ment Ader<\/a>.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[44]<\/a><\/sup> Einthoven had previously, in 1895, assigned the letters P, Q, R, S, and T to the deflections in the theoretical waveform he created using equations which corrected the actual waveform obtained by the capillary electrometer to compensate for the imprecision of that instrument. Using letters different from A, B, C, and D (the letters used for the capillary electrometer's waveform) facilitated comparison when the uncorrected and corrected lines were drawn on the same graph.<sup id=\"rdp-ebb-cite_ref-naming_46-0\" class=\"reference\"><a href=\"#cite_note-naming-46\" rel=\"external_link\">[45]<\/a><\/sup> Einthoven probably chose the initial letter P to follow the example set by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Descartes\" class=\"mw-redirect\" title=\"Descartes\" rel=\"external_link\" target=\"_blank\">Descartes<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Geometry\" title=\"Geometry\" rel=\"external_link\" target=\"_blank\">geometry<\/a>.<sup id=\"rdp-ebb-cite_ref-naming_46-1\" class=\"reference\"><a href=\"#cite_note-naming-46\" rel=\"external_link\">[45]<\/a><\/sup> When a more precise waveform was obtained using the string galvanometer, which matched the corrected capillary electrometer waveform, he continued to use the letters P, Q, R, S, and T,<sup id=\"rdp-ebb-cite_ref-naming_46-2\" class=\"reference\"><a href=\"#cite_note-naming-46\" rel=\"external_link\">[45]<\/a><\/sup> and these letters are still in use today. Einthoven also described the electrocardiographic features of a number of cardiovascular disorders. In 1924, he was awarded the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nobel_Prize_in_Medicine\" class=\"mw-redirect\" title=\"Nobel Prize in Medicine\" rel=\"external_link\" target=\"_blank\">Nobel Prize in Medicine<\/a> for his discovery.<sup id=\"rdp-ebb-cite_ref-Cooper_1986_47-0\" class=\"reference\"><a href=\"#cite_note-Cooper_1986-47\" rel=\"external_link\">[46]<\/a><\/sup>\n<\/p><p>By 1927, General Electric had developed a portable apparatus that could produce electrocardiograms without the use of the string galvanometer. This device instead combined amplifier tubes similar to those used in a radio with an internal lamp and a moving mirror that directed the tracing of the electric pulses onto film.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p><p>In 1937, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Taro_Takemi\" title=\"Taro Takemi\" rel=\"external_link\" target=\"_blank\">Taro Takemi<\/a> invented a new portable electrocardiograph machine.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p><p>Though the basic principles of that era are still in use today, many advances in electrocardiography have been made over the years. Instrumentation has evolved from a cumbersome laboratory apparatus to compact electronic systems that often include computerized interpretation of the electrocardiogram.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p><p>In September 2018, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apple_Inc.\" title=\"Apple Inc.\" rel=\"external_link\" target=\"_blank\">Apple Inc.<\/a>, introduced the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apple_Watch_Series_4\" class=\"mw-redirect\" title=\"Apple Watch Series 4\" rel=\"external_link\" target=\"_blank\">Apple Watch Series 4<\/a>, with a built-in titanium electrode in the digital crown and the sapphire crystal electronic heart sensor, which allows the watch to give a single lead electrocardiogram using only the watch interface.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_conduction_system_of_the_heart\" title=\"Electrical conduction system of the heart\" rel=\"external_link\" target=\"_blank\">Electrical conduction system of the heart<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrogastrogram\" title=\"Electrogastrogram\" rel=\"external_link\" target=\"_blank\">Electrogastrogram<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electropalatography\" title=\"Electropalatography\" rel=\"external_link\" target=\"_blank\">Electropalatography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroretinography\" title=\"Electroretinography\" rel=\"external_link\" target=\"_blank\">Electroretinography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_rate\" title=\"Heart rate\" rel=\"external_link\" target=\"_blank\">Heart rate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_rate_monitor\" title=\"Heart rate monitor\" rel=\"external_link\" target=\"_blank\">Heart rate monitor<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Emergency_medicine\" title=\"Emergency medicine\" rel=\"external_link\" target=\"_blank\">Emergency medicine<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: lower-alpha;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The version with '-K-', more commonly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_English\" title=\"American English\" rel=\"external_link\" target=\"_blank\">American English<\/a> than in <a href=\"https:\/\/en.wikipedia.org\/wiki\/British_English\" title=\"British English\" rel=\"external_link\" target=\"_blank\">British English<\/a>, is an early-20th-century <a href=\"https:\/\/en.wikipedia.org\/wiki\/Loanword\" title=\"Loanword\" rel=\"external_link\" target=\"_blank\">loanword<\/a> from the German acronym EKG for <i lang=\"de\" title=\"German language text\">Elektrokardiogramm<\/i> (electrocardiogram),<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> which reflects that German physicians were pioneers in the field at the time. Today <a href=\"https:\/\/en.wikipedia.org\/wiki\/AMA_Manual_of_Style\" title=\"AMA Manual of Style\" rel=\"external_link\" target=\"_blank\">AMA style<\/a> and \u2013 under its stylistic influence \u2013 most American medical publications use ECG instead of EKG.<sup id=\"rdp-ebb-cite_ref-AMA_MOS_2-0\" class=\"reference\"><a href=\"#cite_note-AMA_MOS-2\" rel=\"external_link\">[2]<\/a><\/sup> The German term <i lang=\"de\" title=\"German language text\">Elektrokardiogramm<\/i> as well as the English equivalent, electrocardiogram, consist of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_Latin\" title=\"New Latin\" rel=\"external_link\" target=\"_blank\">New Latin<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/International_scientific_vocabulary\" title=\"International scientific vocabulary\" rel=\"external_link\" target=\"_blank\">international scientific vocabulary<\/a> elements <i lang=\"de\" title=\"German language text\"><a href=\"#German\" class=\"extiw\" title=\"wikt:elektro-\" rel=\"external_link\">elektro-<\/a><\/i> (cognate <i lang=\"de\" title=\"German language text\"><a href=\"#English\" class=\"extiw\" title=\"wikt:electro-\" rel=\"external_link\">electro-<\/a><\/i>) and <i lang=\"de\" title=\"German language text\">kardi-<\/i> (cognate 'cardi-'), the latter from Greek <i lang=\"el\" title=\"Greek language text\">kardia<\/i> (heart).<sup id=\"rdp-ebb-cite_ref-MW_Collegiate_3-0\" class=\"reference\"><a href=\"#cite_note-MW_Collegiate-3\" rel=\"external_link\">[3]<\/a><\/sup> The '-K-' version is more often retained under circumstances where there may be verbal confusion between ECG and EEG (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroencephalography\" title=\"Electroencephalography\" rel=\"external_link\" target=\"_blank\">electroencephalography<\/a>) due to similar pronunciation.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.oxforddictionaries.com\/us\/definition\/english\/EKG\" target=\"_blank\">EKG<\/a>. Oxford Online Dictionaries<\/span>\n<\/li>\n<li id=\"cite_note-AMA_MOS-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AMA_MOS_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\">\"15.3.1 Electrocardiographic Terms\", <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amamanualofstyle.com\/\" target=\"_blank\"><i>AMA Manual of Style<\/i><\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Medical_Association\" title=\"American Medical Association\" rel=\"external_link\" target=\"_blank\">American Medical Association<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=15.3.1+Electrocardiographic+Terms&rft.btitle=AMA+Manual+of+Style&rft.pub=American+Medical+Association&rft_id=http%3A%2F%2Fwww.amamanualofstyle.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-MW_Collegiate-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MW_Collegiate_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><span class=\"cs1-lock-subscription\" title=\"Paid subscription required\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/unabridged.merriam-webster.com\/collegiate\/\" target=\"_blank\">\"Merriam-Webster's Collegiate Dictionary\"<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Merriam-Webster\" title=\"Merriam-Webster\" rel=\"external_link\" target=\"_blank\">Merriam-Webster<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Merriam-Webster%27s+Collegiate+Dictionary&rft.pub=Merriam-Webster&rft_id=http%3A%2F%2Funabridged.merriam-webster.com%2Fcollegiate%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLilly2016\" class=\"citation book\">Lilly, Leonard S, ed. (2016). <i>Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty<\/i> (sixth ed.). Lippincott Williams & Wilkins. p. 74. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1451192759.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pathophysiology+of+Heart+Disease%3A+A+Collaborative+Project+of+Medical+Students+and+Faculty&rft.pages=74&rft.edition=sixth&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2016&rft.isbn=978-1451192759&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-LHC-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-LHC_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Aswini Kumar MD. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.lifehugger.com\/doc\/120\/ecg-100-steps\" target=\"_blank\">\"ECG- simplified\"<\/a>. LifeHugger<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 February<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ECG-+simplified&rft.pub=LifeHugger&rft.au=Aswini+Kumar+MD&rft_id=http%3A%2F%2Fwww.lifehugger.com%2Fdoc%2F120%2Fecg-100-steps&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FOOTNOTELilly201680-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FOOTNOTELilly201680_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FOOTNOTELilly201680_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFLilly2016\" rel=\"external_link\">Lilly 2016<\/a>, pp. 80.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Walraven, G. (2011). <i>Basic arrhythmias<\/i> (7th ed.), pp. 1\u201311<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Braunwald E. (ed) (1997), <i>Heart Disease: A Textbook of Cardiovascular Medicine, Fifth Edition<\/i>, p. 108, Philadelphia, W.B. Saunders Co.. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7216-5666-8.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ecgmedicaltraining.com\/what-is-a-stemi\/\" target=\"_blank\">\"What is a STEMI? - ECG Medical Training\"<\/a>. <i>ECG Medical Training<\/i>. 2015-06-24<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-06-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ECG+Medical+Training&rft.atitle=What+is+a+STEMI%3F+-+ECG+Medical+Training&rft.date=2015-06-24&rft_id=https%3A%2F%2Fwww.ecgmedicaltraining.com%2Fwhat-is-a-stemi%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/myheart.net\/articles\/nstemi\/\" target=\"_blank\">\"What is NSTEMI? What You NEED to Know \u2022 MyHeart\"<\/a>. <i>MyHeart<\/i>. 2015-04-30<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-06-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=MyHeart&rft.atitle=What+is+NSTEMI%3F+What+You+NEED+to+Know+%E2%80%A2+MyHeart&rft.date=2015-04-30&rft_id=https%3A%2F%2Fmyheart.net%2Farticles%2Fnstemi%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-masters-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-masters_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-masters_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-masters_12-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-masters_12-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Masters, Jo; Bowden, Carole; Martin, Carole (2003). <i>Textbook of veterinary medical nursing<\/i>. Oxford: Butterworth-Heinemann. p. 244. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7506-5171-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Textbook+of+veterinary+medical+nursing&rft.place=Oxford&rft.pages=244&rft.pub=Butterworth-Heinemann&rft.date=2003&rft.isbn=978-0-7506-5171-4&rft.au=Masters%2C+Jo&rft.au=Bowden%2C+Carole&rft.au=Martin%2C+Carole&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Annals2012-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Annals2012_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moyer VA (2 October 2012). \"Screening for coronary heart disease with electrocardiography: U.S. Preventive Services Task Force recommendation statement\". <i>Annals of Internal Medicine<\/i>. <b>157<\/b> (7): 512\u201318. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7326%2F0003-4819-157-7-201210020-00514\" target=\"_blank\">10.7326\/0003-4819-157-7-201210020-00514<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22847227\" target=\"_blank\">22847227<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Internal+Medicine&rft.atitle=Screening+for+coronary+heart+disease+with+electrocardiography%3A+U.S.+Preventive+Services+Task+Force+recommendation+statement&rft.volume=157&rft.issue=7&rft.pages=512-18&rft.date=2012-10-02&rft_id=info%3Adoi%2F10.7326%2F0003-4819-157-7-201210020-00514&rft_id=info%3Apmid%2F22847227&rft.au=Moyer+VA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-whenyouneedEKGs-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-whenyouneedEKGs_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFConsumer_ReportsAmerican_Academy_of_Family_PhysiciansABIM_Foundation2012\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Consumer_Reports\" title=\"Consumer Reports\" rel=\"external_link\" target=\"_blank\">Consumer Reports<\/a>; 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Blomstr\u00f6-Lundqvist, Carina; Ljungstr\u00f6, Erik; Blomstr\u00f6, Per (1994). \"Clinical value of transesophageal atrial stimulation and recording in patients with arrhythmia-related symptoms or documented supraventricular tachycardia-correlation to clinical history and invasive studies\". <i>Clinical Cardiology<\/i>. <b>17<\/b> (10): 528\u201334. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fclc.4960171004\" target=\"_blank\">10.1002\/clc.4960171004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8001299\" target=\"_blank\">8001299<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Cardiology&rft.atitle=Clinical+value+of+transesophageal+atrial+stimulation+and+recording+in+patients+with+arrhythmia-related+symptoms+or+documented+supraventricular+tachycardia-correlation+to+clinical+history+and+invasive+studies&rft.volume=17&rft.issue=10&rft.pages=528-34&rft.date=1994&rft_id=info%3Adoi%2F10.1002%2Fclc.4960171004&rft_id=info%3Apmid%2F8001299&rft.aulast=Pehrson&rft.aufirst=Steen+M.&rft.au=Blomstr%C3%B6-Lundqvist%2C+Carina&rft.au=Ljungstr%C3%B6%2C+Erik&rft.au=Blomstr%C3%B6%2C+Per&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Surawicz, Borys; 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Philadelphia, PA: Saunders\/Elsevier. p. 12. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1416037743.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chou%27s+electrocardiography+in+clinical+practice+%3A+adult+and+pediatric&rft.place=Philadelphia%2C+PA&rft.pages=12&rft.edition=6th&rft.pub=Saunders%2FElsevier&rft.date=2008&rft.isbn=978-1416037743&rft.aulast=Surawicz&rft.aufirst=Borys&rft.au=Knillans%2C+Timothy&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Otero J, Lenihan DJ (2000). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC101092\" target=\"_blank\">\"The \"normothermic\" Osborn wave induced by severe hypercalcemia\"<\/a>. <i>Tex Heart Inst J<\/i>. <b>27<\/b> (3): 316\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC101092\" target=\"_blank\">101092<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11093425\" target=\"_blank\">11093425<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tex+Heart+Inst+J&rft.atitle=The+%22normothermic%22+Osborn+wave+induced+by+severe+hypercalcemia&rft.volume=27&rft.issue=3&rft.pages=316-17&rft.date=2000&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC101092&rft_id=info%3Apmid%2F11093425&rft.au=Otero+J%2C+Lenihan+DJ&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC101092&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Houghton, Andrew R; Gray, David (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=8s4TQ6yYHRkC\" target=\"_blank\"><i>Making Sense of the ECG, Third Edition<\/i><\/a>. Hodder Education. p. 214. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4441-6654-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Making+Sense+of+the+ECG%2C+Third+Edition&rft.pages=214&rft.pub=Hodder+Education&rft.date=2012&rft.isbn=978-1-4441-6654-5&rft.au=Houghton%2C+Andrew+R&rft.au=Gray%2C+David&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D8s4TQ6yYHRkC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Alpert-2000-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Alpert-2000_31-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alpert JS, Thygesen K, Antman E, Bassand JP (2000). \"Myocardial infarction redefined \u2013 a consensus document of The Joint European Society of Cardiology\/American College of Cardiology Committee for the redefinition of myocardial infarction\". <i>J Am Coll Cardiol<\/i>. <b>36<\/b> (3): 959\u201369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0735-1097%2800%2900804-4\" target=\"_blank\">10.1016\/S0735-1097(00)00804-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10987628\" target=\"_blank\">10987628<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Am+Coll+Cardiol&rft.atitle=Myocardial+infarction+redefined+%E2%80%93+a+consensus+document+of+The+Joint+European+Society+of+Cardiology%2FAmerican+College+of+Cardiology+Committee+for+the+redefinition+of+myocardial+infarction&rft.volume=36&rft.issue=3&rft.pages=959-69&rft.date=2000&rft_id=info%3Adoi%2F10.1016%2FS0735-1097%2800%2900804-4&rft_id=info%3Apmid%2F10987628&rft.aulast=Alpert&rft.aufirst=JS&rft.au=Thygesen%2C+K&rft.au=Antman%2C+E&rft.au=Bassand%2C+JP&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Segura-Sampedro, Juan Jos\u00e9; 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Origins, pioneers, and contributors\". <i>N Engl J Med<\/i>. <b>315<\/b> (7): 461\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJM198608143150721\" target=\"_blank\">10.1056\/NEJM198608143150721<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3526152\" target=\"_blank\">3526152<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=N+Engl+J+Med&rft.atitle=Electrocardiography+100+years+ago.+Origins%2C+pioneers%2C+and+contributors&rft.volume=315&rft.issue=7&rft.pages=461-64&rft.date=1986&rft_id=info%3Adoi%2F10.1056%2FNEJM198608143150721&rft_id=info%3Apmid%2F3526152&rft.au=Cooper+JK&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blackford, John M., MD (1 May 1927). \"Electrocardiography: A Short Talk Before the Staff of the Hospital\". <i>Clinics of the Virginia Mason Hospital<\/i>. <b>6<\/b> (1): 28\u201334.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinics+of+the+Virginia+Mason+Hospital&rft.atitle=Electrocardiography%3A+A+Short+Talk+Before+the+Staff+of+the+Hospital&rft.volume=6&rft.issue=1&rft.pages=28-34&rft.date=1927-05-01&rft.au=Blackford%2C+John+M.%2C+MD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.hsph.harvard.edu\/takemi\/about-the-program\/dr-taro-takemi\/\" target=\"_blank\">\"Dr. Taro Takemi\"<\/a>. <i>Takemi Program in International Health<\/i>. 2012-08-27<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-10-21<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Takemi+Program+in+International+Health&rft.atitle=Dr.+Taro+Takemi&rft.date=2012-08-27&rft_id=https%3A%2F%2Fwww.hsph.harvard.edu%2Ftakemi%2Fabout-the-program%2Fdr-taro-takemi%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mark, Jonathan B. (1998). <i>Atlas of cardiovascular monitoring<\/i>. New York: Churchill Livingstone. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-443-08891-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Atlas+of+cardiovascular+monitoring&rft.place=New+York&rft.pub=Churchill+Livingstone&rft.date=1998&rft.isbn=978-0-443-08891-9&rft.aulast=Mark&rft.aufirst=Jonathan+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.apple.com\/apple-watch-series-4\/health\/\" target=\"_blank\">\"Apple Watch Series 4 - Health\"<\/a>. <i>Apple<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-09-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Apple&rft.atitle=Apple%C2%A0Watch+Series%C2%A04+-+Health&rft_id=https%3A%2F%2Fwww.apple.com%2Fapple-watch-series-4%2Fhealth%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElectrocardiography\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ecgpedia.org\/A4\/ECGpedia_on_1_A4En.pdf\" target=\"_blank\">The whole ECG course on 1 A4 paper<\/a> from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.ecgpedia.org\/wiki\/Main_Page\" target=\"_blank\">ECGpedia<\/a>, a wiki encyclopedia for <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.ecgpedia.org\/wiki\/ECG_course\" target=\"_blank\">a course on interpretation of ECG<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ecg.bidmc.harvard.edu\/maven\/mavenmain.asp\" target=\"_blank\">Wave Maven \u2013 a large database of practice ECG questions<\/a> provided by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beth_Israel_Deaconess_Medical_Center\" title=\"Beth Israel Deaconess Medical Center\" rel=\"external_link\" target=\"_blank\">Beth Israel Deaconess Medical Center<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.physionet.org\/physiobank\/database\/#ecg\" target=\"_blank\">PysioBank \u2013 a free scientific database with physiologic signals (here ecg) <\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ekg.academy\" target=\"_blank\">EKG Academy \u2013 free EKG lectures, drills and quizzes<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/ecg.utah.edu\/lesson\/1\" target=\"_blank\">ECG Learning Center<\/a> created by Eccles Health Sciences Library at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Utah\" title=\"University of Utah\" rel=\"external_link\" target=\"_blank\">University of Utah<\/a><\/li><\/ul>\n\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1245\nCached time: 20181217082930\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.240 seconds\nReal time usage: 1.574 seconds\nPreprocessor visited node count: 4326\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 193557\/2097152 bytes\nTemplate argument size: 5254\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 10\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 132208\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.675\/10.000 seconds\nLua memory usage: 19.89 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1160.963 1 -total\n<\/p>\n<pre>43.35% 503.309 2 Template:Reflist\n16.99% 197.257 1 Template:Efn\n16.23% 188.386 6 Template:Lang\n15.49% 179.845 20 Template:Cite_journal\n 8.60% 99.787 5 Template:Fix\n 7.53% 87.377 3 Template:Citation_needed\n 7.49% 86.933 2 Template:Citation\n 6.59% 76.489 1 Template:Infobox_medical_intervention\n 6.17% 71.626 1 Template:Infobox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:76988-1!canonical!math=5 and timestamp 20181217082929 and revision id 873489709\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiography\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214631\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.023 seconds\nReal time usage: 0.195 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 180.717 1 - wikipedia:Electrocardiography\n100.00% 180.717 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8525-0!*!*!*!*!*!* and timestamp 20181217214631 and revision id 24950\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Electrocardiography\">https:\/\/www.limswiki.org\/index.php\/Electrocardiography<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0e8d17422dd0e78773ae4216dd43a20b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9e\/SinusRhythmLabels.svg\/560px-SinusRhythmLabels.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/12leadECG.jpg\/650px-12leadECG.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/23\/De-Modern_ecg_%28CardioNetworks_ECGpedia%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/Limb_leads.svg\/440px-Limb_leads.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/41\/Precordial_leads_in_ECG.png\/440px-Precordial_leads_in_ECG.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/19\/Limb_leads_of_EKG.png\/1200px-Limb_leads_of_EKG.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/EKG_leads.png\/600px-EKG_leads.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/Contiguous_leads.svg\/600px-Contiguous_leads.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/94\/ECG_Vector.svg\/460px-ECG_Vector.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/EKG_Complex_en.svg\/560px-EKG_Complex_en.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/ECG_Paper_v2.svg\/1000px-ECG_Paper_v2.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e5\/ECG_principle_slow.gif\/440px-ECG_principle_slow.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Willem_Einthoven_ECG.jpg\/440px-Willem_Einthoven_ECG.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/BASA-532K-1-2-15-Ran_Bosilek.jpg\/440px-BASA-532K-1-2-15-Ran_Bosilek.jpg"],"0e8d17422dd0e78773ae4216dd43a20b_timestamp":1545083191,"791eff64fbe06fdbb80306a343fba2dd_type":"article","791eff64fbe06fdbb80306a343fba2dd_title":"Bandage","791eff64fbe06fdbb80306a343fba2dd_url":"https:\/\/www.limswiki.org\/index.php\/Bandage","791eff64fbe06fdbb80306a343fba2dd_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBandage\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the medical device. For the bandage used for minor cuts, see Adhesive bandage. For the Lands song, see Bandage (song). For the 2010 Japanese film, see Bandage (film).\n\"Bandages\" redirects here. For other uses, see Bandages (disambiguation).\nThis article does not cite any sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2011) (Learn how and when to remove this template message)\n Achilles bandaging Patroclus. Tondo of an Attic red-figure kylix, ca. 500 BC, from Vulci.\n Bandages are also used in martial arts to prevent dislocated joints.\n The double-spica bandage used on thigh injuries in ancient Greece.\nA bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to or to restrict the movement of a part of the body. When used with a dressing, the dressing is applied directly on a wound, and a bandage used to hold the dressing in place. Other bandages are used without dressings, such as elastic bandages that are used to reduce swelling or provide support to a sprained ankle. Tight bandages can be used to slow blood flow to an extremity, such as when a leg or arm is bleeding heavily.\nBandages are available in a wide range of types, from generic cloth strips to specialized shaped bandages designed for a specific limb or part of the body. Bandages can often be improvised as the situation demands, using clothing, blankets or other material. In American English, the word bandage is often used to indicate a small gauze dressing attached to an adhesive bandage.\n\nContents \n\n1 Types \n\n1.1 Adhesive bandage. \n1.2 Liquid bandage \n1.3 Gauze bandage (common gauze roller bandage) \n1.4 Compression bandage \n1.5 Triangular bandage \n1.6 Tube bandage \n\n\n2 See also \n3 References \n4 External links \n\n\nTypes \nAdhesive bandage. \nMain article: Adhesive bandage\nLiquid bandage \nMain article: Liquid bandage\n Gauze bandage (common gauze roller bandage) \nThe most common type of bandage is the gauze bandage, a simple woven strip of material, or a woven strip of material with a Telfa absorbent barrier to prevent adhering to wounds. A gauze bandage can come in any number of widths and lengths, and can be used for almost any bandage application, including holding a dressing in place.\nThe United States Pharmacopeia lists it as a form in which Absorbent Gauze may be provided. It is prepared from type 1 Absorbent gauze in various widths and lengths.\n\nCompression bandage \nMain article: Elastic bandage\nThe term 'compression bandage' describes a wide variety of bandages with many different applications.\n\n Short stretch compression bandages are good for protecting wounds on one's hands, especially on one's fingers.\nShort stretch compression bandages are applied to a limb (usually for treatment of lymphedema or venous ulcers). This type of bandage is capable of shortening around the limb after application and is therefore not exerting ever-increasing pressure during inactivity. This dynamic is called resting pressure and is considered safe and comfortable for long-term treatment. Conversely, the stability of the bandage creates a very high resistance to stretch when pressure is applied through internal muscle contraction and joint movement. This force is called working pressure.\nLong stretch compression bandages have long stretch properties, meaning their high compressive power can be easily adjusted. However, they also have a very high resting pressure and must be removed at night or if the patient is in a resting position.\n\nTriangular bandage \n Cavalier King Charles Spaniel with bandaged foot.\nMain article: Esmarch bandage\nAlso known as a cravat bandage, a triangular bandage is a piece of cloth put into a right-angled triangle, and often provided with safety pins to secure it in place. It can be used fully unrolled as a sling, folded as a normal bandage, or for specialized applications, as on the head. One advantage of this type of bandage is that it can be makeshift and made from a fabric scrap or a piece of clothing. The Boy Scouts popularized use of this bandage in many of their first aid lessons, as a part of the uniform is a \"neckerchief\" that can easily be folded to form a cravat.\n\nTube bandage \nA tube bandage is applied using an applicator, and is woven in a continuous circle. It is used to hold dressings or splints on to limbs, or to provide support to sprains and strains, so that it stops bleeding.\n\nSee also \nBandage scissors\nTulle gras\nCompression stockings\nField dressing (bandage)\nDressing (medical)\nReferences \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Bandages.\nHow to apply a bandage in a figure of 8 around an ankle. (YouTube)\nHow to apply a bandage in circular style around a wrist. (YouTube)\nUse of Paper Dressings for Wounds, Popular Science monthly, February 1919, page 68, Scanned by Google Books: https:\/\/books.google.com\/books?id=7igDAAAAMBAJ&pg=PA68\nA Mechanical Helper for the Red Cross, Popular Science monthly, February 1919, page 74, Scanned by Google Books: https:\/\/books.google.com\/books?id=7igDAAAAMBAJ&pg=PA74\nvteFirst aidTechniques\nAbdominal thrusts\nAirway management\nCardiopulmonary resuscitation\nEmergency bleeding control\nEquipment\nAutomated external defibrillator\nBag valve mask\nBandage\nDressing\nFirst aid kit\nNasopharyngeal airway\nOropharyngeal airway\nMnemonics\nABC\nDCAP-BTLS\nOPQRST\nRICE\nSAMPLE\nSOAP\nCertifications\nCertified first responder\nEmergency medical technician\nWilderness Emergency Medical Technician\nTopics\nBleeding\nGolden hour\nGood Samaritan law\nWilderness medicine\n\nAuthority control \nLCCN: sh85011479 \nNARA: 10663398 \nNDL: 00563547 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bandage\">https:\/\/www.limswiki.org\/index.php\/Bandage<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 22:16.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 448 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","791eff64fbe06fdbb80306a343fba2dd_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Bandage skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Bandage<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the medical device. For the bandage used for minor cuts, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesive_bandage\" title=\"Adhesive bandage\" rel=\"external_link\" target=\"_blank\">Adhesive bandage<\/a>. For the Lands song, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage_(song)\" title=\"Bandage (song)\" rel=\"external_link\" target=\"_blank\">Bandage (song)<\/a>. For the 2010 Japanese film, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage_(film)\" title=\"Bandage (film)\" rel=\"external_link\" target=\"_blank\">Bandage (film)<\/a>.<\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Bandages\" redirects here. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandages_(disambiguation)\" class=\"mw-disambig\" title=\"Bandages (disambiguation)\" rel=\"external_link\" target=\"_blank\">Bandages (disambiguation)<\/a>.<\/div>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Akhilleus_Patroklos_Antikensammlung_Berlin_F2278.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/ba\/Akhilleus_Patroklos_Antikensammlung_Berlin_F2278.jpg\/220px-Akhilleus_Patroklos_Antikensammlung_Berlin_F2278.jpg\" width=\"220\" height=\"217\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Akhilleus_Patroklos_Antikensammlung_Berlin_F2278.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Achilles\" title=\"Achilles\" rel=\"external_link\" target=\"_blank\">Achilles<\/a> bandaging <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patroclus\" title=\"Patroclus\" rel=\"external_link\" target=\"_blank\">Patroclus<\/a>. Tondo of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Attica\" title=\"Attica\" rel=\"external_link\" target=\"_blank\">Attic<\/a> red-figure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kylix_(drinking_cup)\" class=\"mw-redirect\" title=\"Kylix (drinking cup)\" rel=\"external_link\" target=\"_blank\">kylix<\/a>, ca. 500 BC, from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vulci\" title=\"Vulci\" rel=\"external_link\" target=\"_blank\">Vulci<\/a>.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KICKBOX008cropped.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/KICKBOX008cropped.jpg\/220px-KICKBOX008cropped.jpg\" width=\"220\" height=\"219\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KICKBOX008cropped.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Bandages are also used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Martial_arts\" title=\"Martial arts\" rel=\"external_link\" target=\"_blank\">martial arts<\/a> to prevent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dislocation_(medicine)\" class=\"mw-redirect\" title=\"Dislocation (medicine)\" rel=\"external_link\" target=\"_blank\">dislocated joints<\/a>.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Greek_kneewrapping.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/Greek_kneewrapping.jpg\/220px-Greek_kneewrapping.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Greek_kneewrapping.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The double-spica bandage used on thigh injuries in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greece\" title=\"Ancient Greece\" rel=\"external_link\" target=\"_blank\">ancient Greece<\/a>.<\/div><\/div><\/div>\n<p>A <b>bandage<\/b> is a piece of material used either to support a medical device such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dressing_(medical)\" title=\"Dressing (medical)\" rel=\"external_link\" target=\"_blank\">dressing<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Splint_(medicine)\" title=\"Splint (medicine)\" rel=\"external_link\" target=\"_blank\">splint<\/a>, or on its own to provide support to or to restrict the movement of a part of the body. When used with a dressing, the dressing is applied directly on a wound, and a bandage used to hold the dressing in place. Other bandages are used without dressings, such as elastic bandages that are used to reduce swelling or provide support to a sprained ankle. Tight bandages can be used to slow blood flow to an extremity, such as when a leg or arm is bleeding heavily.\n<\/p><p>Bandages are available in a wide range of types, from generic cloth strips to specialized shaped bandages designed for a specific limb or part of the body. Bandages can often be improvised as the situation demands, using clothing, blankets or other material. In <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_English\" title=\"American English\" rel=\"external_link\" target=\"_blank\">American English<\/a>, the word <i>bandage<\/i> is often used to indicate a small gauze dressing attached to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesive_bandage\" title=\"Adhesive bandage\" rel=\"external_link\" target=\"_blank\">adhesive bandage<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Adhesive_bandage.\">Adhesive bandage.<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesive_bandage\" title=\"Adhesive bandage\" rel=\"external_link\" target=\"_blank\">Adhesive bandage<\/a><\/div>\n<h3><span class=\"mw-headline\" id=\"Liquid_bandage\">Liquid bandage<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liquid_bandage\" title=\"Liquid bandage\" rel=\"external_link\" target=\"_blank\">Liquid bandage<\/a><\/div>\n<h3><span id=\"rdp-ebb-Gauze_bandage_.28common_gauze_roller_bandage.29\"><\/span><span class=\"mw-headline\" id=\"Gauze_bandage_(common_gauze_roller_bandage)\">Gauze bandage (common gauze roller bandage)<\/span><\/h3>\n<p>The most common type of bandage is the gauze bandage, a simple woven strip of material, or a woven strip of material with a Telfa absorbent barrier to prevent adhering to wounds. A gauze bandage can come in any number of widths and lengths, and can be used for almost any bandage application, including holding a dressing in place.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Pharmacopeia\" title=\"United States Pharmacopeia\" rel=\"external_link\" target=\"_blank\">United States Pharmacopeia<\/a> lists it as a form in which Absorbent Gauze may be provided. It is prepared from type 1 Absorbent gauze in various widths and lengths.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Compression_bandage\">Compression bandage<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_bandage\" title=\"Elastic bandage\" rel=\"external_link\" target=\"_blank\">Elastic bandage<\/a><\/div>\n<p>The term 'compression bandage' describes a wide variety of bandages with many different applications.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bandagedknuckles.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/65\/Bandagedknuckles.jpg\/220px-Bandagedknuckles.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bandagedknuckles.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Short stretch compression bandages are good for protecting wounds on one's hands, especially on one's fingers.<\/div><\/div><\/div>\n<p><b>Short stretch compression bandages<\/b> are applied to a limb (usually for treatment of lymphedema or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Venous_ulcer\" title=\"Venous ulcer\" rel=\"external_link\" target=\"_blank\">venous ulcers<\/a>). This type of bandage is capable of shortening around the limb after application and is therefore not exerting ever-increasing pressure during inactivity. This dynamic is called resting pressure and is considered safe and comfortable for long-term treatment. Conversely, the stability of the bandage creates a very high resistance to stretch when pressure is applied through internal muscle contraction and joint movement. This force is called working pressure.\n<\/p><p><b>Long stretch compression bandages<\/b> have long stretch properties, meaning their high compressive power can be easily adjusted. However, they also have a very high resting pressure and must be removed at night or if the patient is in a resting position.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Triangular_bandage\">Triangular bandage<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:20070114_dog_with_bandaged_foot.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/20070114_dog_with_bandaged_foot.jpg\/220px-20070114_dog_with_bandaged_foot.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:20070114_dog_with_bandaged_foot.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cavalier_King_Charles_Spaniel\" title=\"Cavalier King Charles Spaniel\" rel=\"external_link\" target=\"_blank\">Cavalier King Charles Spaniel<\/a> with bandaged foot.<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esmarch_bandage\" title=\"Esmarch bandage\" rel=\"external_link\" target=\"_blank\">Esmarch bandage<\/a><\/div>\n<p>Also known as a cravat bandage, a triangular bandage is a piece of cloth put into a right-angled triangle, and often provided with safety pins to secure it in place. It can be used fully unrolled as a sling, folded as a normal bandage, or for specialized applications, as on the head. One advantage of this type of bandage is that it can be makeshift and made from a fabric scrap or a piece of clothing. The Boy Scouts popularized use of this bandage in many of their first aid lessons, as a part of the uniform is a \"neckerchief\" that can easily be folded to form a cravat.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Tube_bandage\">Tube bandage<\/span><\/h3>\n<p>A tube bandage is applied using an applicator, and is woven in a continuous circle. It is used to hold dressings or splints on to limbs, or to provide support to sprains and strains, so that it stops bleeding.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage_scissors\" title=\"Bandage scissors\" rel=\"external_link\" target=\"_blank\">Bandage scissors<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tulle_gras\" title=\"Tulle gras\" rel=\"external_link\" target=\"_blank\">Tulle gras<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Compression_stockings\" title=\"Compression stockings\" rel=\"external_link\" target=\"_blank\">Compression stockings<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Field_dressing_(bandage)\" title=\"Field dressing (bandage)\" rel=\"external_link\" target=\"_blank\">Field dressing (bandage)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dressing_(medical)\" title=\"Dressing (medical)\" rel=\"external_link\" target=\"_blank\">Dressing (medical)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=HcfYYKglxrc\" target=\"_blank\">How to apply a bandage in a figure of 8 around an ankle. (YouTube)<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=w0KTMrSG_uo\" target=\"_blank\">How to apply a bandage in circular style around a wrist. (YouTube)<\/a><\/li>\n<li><i>Use of Paper Dressings for Wounds<\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Popular_Science\" title=\"Popular Science\" rel=\"external_link\" target=\"_blank\">Popular Science<\/a> monthly, February 1919, page 68, Scanned by Google Books: <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/books.google.com\/books?id=7igDAAAAMBAJ&pg=PA68\" target=\"_blank\">https:\/\/books.google.com\/books?id=7igDAAAAMBAJ&pg=PA68<\/a><\/li>\n<li><i>A Mechanical Helper for the Red Cross<\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Popular_Science\" title=\"Popular Science\" rel=\"external_link\" target=\"_blank\">Popular Science<\/a> monthly, February 1919, page 74, Scanned by Google Books: <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/books.google.com\/books?id=7igDAAAAMBAJ&pg=PA74\" target=\"_blank\">https:\/\/books.google.com\/books?id=7igDAAAAMBAJ&pg=PA74<\/a><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1272\nCached time: 20181212091109\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.188 seconds\nReal time usage: 0.301 seconds\nPreprocessor visited node count: 439\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 20695\/2097152 bytes\nTemplate argument size: 248\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.094\/10.000 seconds\nLua memory usage: 2.87 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 244.390 1 -total\n<\/p>\n<pre>25.17% 61.509 1 Template:Commons_category\n19.13% 46.742 1 Template:About\n16.01% 39.134 1 Template:Authority_control\n15.04% 36.756 1 Template:Unreferenced\n12.18% 29.775 1 Template:Ambox\n 8.94% 21.839 1 Template:Redirect\n 7.63% 18.642 1 Template:First_aid_topics\n 5.63% 13.759 1 Template:Navbox\n 5.02% 12.260 1 Template:Commons\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:273978-1!canonical and timestamp 20181212091109 and revision id 869373079\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214630\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.021 seconds\nReal time usage: 0.160 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 153.840 1 - wikipedia:Bandage\n100.00% 153.840 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8524-0!*!*!*!*!*!* and timestamp 20181217214630 and revision id 24949\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bandage\">https:\/\/www.limswiki.org\/index.php\/Bandage<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","791eff64fbe06fdbb80306a343fba2dd_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/ba\/Akhilleus_Patroklos_Antikensammlung_Berlin_F2278.jpg\/440px-Akhilleus_Patroklos_Antikensammlung_Berlin_F2278.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/KICKBOX008cropped.jpg\/440px-KICKBOX008cropped.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/Greek_kneewrapping.jpg\/440px-Greek_kneewrapping.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/65\/Bandagedknuckles.jpg\/440px-Bandagedknuckles.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/20070114_dog_with_bandaged_foot.jpg\/440px-20070114_dog_with_bandaged_foot.jpg"],"791eff64fbe06fdbb80306a343fba2dd_timestamp":1545083190,"debc8b82e26a585764d378a3253e03c0_type":"article","debc8b82e26a585764d378a3253e03c0_title":"Surgical instrument","debc8b82e26a585764d378a3253e03c0_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_instrument","debc8b82e26a585764d378a3253e03c0_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical instrument\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tTools designed for use during surgery\n Various scalpels\nA surgical instrument is a specially designed tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the Kocher forceps),[1] or a compound scientific name related to the kind of surgery (for example, a tracheotome is a tool used to perform a tracheotomy).\nThe expression surgical instrumentation is somewhat interchangeably used with surgical instruments,[2] but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a surgical technologist or sometimes a nurse or radiographer.\n\nClassification \nThere are several classes of surgical instruments:\n\nGraspers,[3] such as forceps\nClamps and occluders for blood vessels and other organs\nNeedle drivers,(also known as needle holders) used to hold suture needle while it is passed through tissue and to grasp suture while instrument knot tying.\nRetractors, used to spread open skin, ribs and other tissue\nDistractors, positioners and stereotactic devices\nMechanical cutters (scalpels, lancets, drill bits, rasps, trocars, Ligasure, Harmonic scalpel, surgical scissors, rongeurs etc.)\nDilators and specula, for access to narrow passages or incisions\nSuction tips and tubes, for removal of bodily fluids\nSealing devices, such as surgical staplers\nIrrigation and injection needles, tips and tubes, for introducing fluid\nPowered devices, such as drills, cranial drills and dermatomes\nScopes and probes, including fiber optic endoscopes and tactile probes\nCarriers and appliers for optical, electronic and mechanical devices\nUltrasound tissue disruptors, cryotomes and cutting laser guides\nMeasurement devices, such as rulers and calipers\nAn important relative distinction, regarding surgical instruments, is the amount of bodily disruption or tissue trauma that their use might cause the patient. Terms relating to this issue are 'atraumatic' and minimally invasive. Minimally invasive systems are an important recent development in surgery.\n\nReferences \n\n\n^ \"Kocher's Forceps Medical Definition | Merriam-Webster Medical Dictionary\". Merriam-webster.com. Retrieved 2016-02-15 . \n\n^ Renee Nimitz, Surgical Instrumentation: an Interactive Approach (Saunders, 2010) 1416037020, pxiii \n\n^ \"Laparoscopic graspers\", Laparoscopic.md. Accessed 16 August 2013 \n\n\nExternal links \nEdgar R. McGuire Historical Medical Instrument Collection from the University at Buffalo Libraries\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_instrument\">https:\/\/www.limswiki.org\/index.php\/Surgical_instrument<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 2 March 2016, at 19:36.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 319 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","debc8b82e26a585764d378a3253e03c0_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_instrument skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical instrument<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">Tools designed for use during surgery<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Various_scalpels.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Various_scalpels.png\/220px-Various_scalpels.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Various_scalpels.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpels<\/a><\/div><\/div><\/div>\n<p>A <b>surgical instrument<\/b> is a specially designed tool or device for performing specific actions or carrying out desired effects during a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> or operation, such as modifying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_tissue\" class=\"mw-redirect\" title=\"Biological tissue\" rel=\"external_link\" target=\"_blank\">biological tissue<\/a>, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">hemostat<\/a>), the name of its inventor(s) (for example, the ),<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> or a compound scientific name related to the kind of surgery (for example, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheotome\" title=\"Tracheotome\" rel=\"external_link\" target=\"_blank\">tracheotome<\/a> is a tool used to perform a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheotomy\" title=\"Tracheotomy\" rel=\"external_link\" target=\"_blank\">tracheotomy<\/a>).\n<\/p><p>The expression <b>surgical instrumentation<\/b> is somewhat interchangeably used with surgical instruments,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_technologist\" title=\"Surgical technologist\" rel=\"external_link\" target=\"_blank\">surgical technologist<\/a> or sometimes a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nurse\" class=\"mw-redirect\" title=\"Nurse\" rel=\"external_link\" target=\"_blank\">nurse<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiographer\" title=\"Radiographer\" rel=\"external_link\" target=\"_blank\">radiographer<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Classification\">Classification<\/span><\/h2>\n<p>There are several classes of surgical instruments:\n<\/p>\n<ul><li>Graspers,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps\" title=\"Forceps\" rel=\"external_link\" target=\"_blank\">forceps<\/a><\/li>\n<li>Clamps and occluders for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessel\" title=\"Blood vessel\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a> and other organs<\/li>\n<li>Needle drivers,(also known as needle holders) used to hold suture needle while it is passed through tissue and to grasp suture while instrument knot tying.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Retractor_(medical)\" title=\"Retractor (medical)\" rel=\"external_link\" target=\"_blank\">Retractors<\/a>, used to spread open <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rib\" title=\"Rib\" rel=\"external_link\" target=\"_blank\">ribs<\/a> and other tissue<\/li>\n<li>, positioners and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">stereotactic devices<\/a><\/li>\n<li>Mechanical cutters (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpels<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">lancets<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drill_bit\" title=\"Drill bit\" rel=\"external_link\" target=\"_blank\">drill bits<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rasp\" title=\"Rasp\" rel=\"external_link\" target=\"_blank\">rasps<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocars<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harmonic_scalpel\" title=\"Harmonic scalpel\" rel=\"external_link\" target=\"_blank\">Harmonic scalpel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_scissors\" title=\"Surgical scissors\" rel=\"external_link\" target=\"_blank\">surgical scissors<\/a>, rongeurs etc.)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dilator\" title=\"Dilator\" rel=\"external_link\" target=\"_blank\">Dilators<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speculum_(medical)\" title=\"Speculum (medical)\" rel=\"external_link\" target=\"_blank\">specula<\/a>, for access to narrow passages or incisions<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Suction\" title=\"Suction\" rel=\"external_link\" target=\"_blank\">Suction<\/a> tips and tubes, for removal of bodily fluids<\/li>\n<li>Sealing devices, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_staple\" title=\"Surgical staple\" rel=\"external_link\" target=\"_blank\">surgical staplers<\/a><\/li>\n<li>Irrigation and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle\" title=\"Hypodermic needle\" rel=\"external_link\" target=\"_blank\">injection needles<\/a>, tips and tubes, for introducing fluid<\/li>\n<li>Powered devices, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drill\" title=\"Drill\" rel=\"external_link\" target=\"_blank\">drills<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cranial_drill\" title=\"Cranial drill\" rel=\"external_link\" target=\"_blank\">cranial drills<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dermatome_(instrument)\" title=\"Dermatome (instrument)\" rel=\"external_link\" target=\"_blank\">dermatomes<\/a><\/li>\n<li>Scopes and probes, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber_optic\" class=\"mw-redirect\" title=\"Fiber optic\" rel=\"external_link\" target=\"_blank\">fiber optic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscopes<\/a> and tactile probes<\/li>\n<li>Carriers and appliers for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optics\" title=\"Optics\" rel=\"external_link\" target=\"_blank\">optical<\/a>, electronic and mechanical devices<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">Ultrasound<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_disruption\" title=\"Cell disruption\" rel=\"external_link\" target=\"_blank\">tissue disruptors<\/a>, and cutting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser\" title=\"Laser\" rel=\"external_link\" target=\"_blank\">laser<\/a> guides<\/li>\n<li>Measurement devices, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ruler\" title=\"Ruler\" rel=\"external_link\" target=\"_blank\">rulers<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caliper\" class=\"mw-redirect\" title=\"Caliper\" rel=\"external_link\" target=\"_blank\">calipers<\/a><\/li><\/ul>\n<p>An important relative distinction, regarding surgical instruments, is the amount of bodily disruption or tissue <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_trauma\" class=\"mw-redirect\" title=\"Physical trauma\" rel=\"external_link\" target=\"_blank\">trauma<\/a> that their use might cause the patient. Terms relating to this issue are 'atraumatic' and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive\" class=\"mw-redirect\" title=\"Minimally invasive\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a>. Minimally invasive systems are an important recent development in surgery.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.merriam-webster.com\/medical\/kocher%27s%20forceps\" target=\"_blank\">\"Kocher's Forceps Medical Definition | Merriam-Webster Medical Dictionary\"<\/a>. Merriam-webster.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-02-15<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Kocher%27s+Forceps+Medical+Definition+%26%23124%3B+Merriam-Webster+Medical+Dictionary&rft.pub=Merriam-webster.com&rft_id=http%3A%2F%2Fwww.merriam-webster.com%2Fmedical%2Fkocher%2527s%2520forceps&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+instrument\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Renee Nimitz, <i>Surgical Instrumentation: an Interactive Approach<\/i> (Saunders, 2010) 1416037020, pxiii<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.laparoscopic.md\/instruments\/grasper\" target=\"_blank\">\"Laparoscopic graspers\", Laparoscopic.md<\/a>. Accessed 16 August 2013<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/digital.lib.buffalo.edu\/collection\/LIB-HSL001\/\" target=\"_blank\">Edgar R. McGuire Historical Medical Instrument Collection<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_at_Buffalo_Libraries\" title=\"University at Buffalo Libraries\" rel=\"external_link\" target=\"_blank\">University at Buffalo Libraries<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1321\nCached time: 20181128165816\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.144 seconds\nReal time usage: 0.208 seconds\nPreprocessor visited node count: 329\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 26721\/2097152 bytes\nTemplate argument size: 194\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 3334\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.073\/10.000 seconds\nLua memory usage: 2.03 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 164.680 1 -total\n<\/p>\n<pre>52.41% 86.316 1 Template:Reflist\n44.12% 72.650 1 Template:Cite_web\n32.17% 52.978 1 Template:Short_description\n30.48% 50.190 1 Template:Pagetype\n13.69% 22.547 1 Template:Surgical_instruments\n13.13% 21.616 3 Template:Navbox\n 1.87% 3.079 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1455928-1!canonical and timestamp 20181128165815 and revision id 870998731\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214630\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.142 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 135.805 1 - wikipedia:Surgical_instrument\n100.00% 135.805 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8225-0!*!*!*!*!*!* and timestamp 20181217214630 and revision id 24387\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_instrument\">https:\/\/www.limswiki.org\/index.php\/Surgical_instrument<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","debc8b82e26a585764d378a3253e03c0_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Various_scalpels.png\/440px-Various_scalpels.png"],"debc8b82e26a585764d378a3253e03c0_timestamp":1545083190,"79dbc75d9223c22375492817dbae2161_type":"article","79dbc75d9223c22375492817dbae2161_title":"Medical software","79dbc75d9223c22375492817dbae2161_url":"https:\/\/www.limswiki.org\/index.php\/Medical_software","79dbc75d9223c22375492817dbae2161_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical software\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMedical software is any software item or system used within a medical context, such as:[1][2][3]\n\nstandalone software used for diagnostic or therapeutic purposes;\nsoftware embedded in a medical device (often referred to as \"medical device software\");\nsoftware that drives a medical device or determines how it is used;\nsoftware that acts as an accessory to a medical device;\nsoftware used in the design, production, and testing of a medical device; or\nsoftware that provides quality control management of a medical device.\nContents \n\n1 History \n2 Medical device software \n\n2.1 Software as a medical device \n\n\n3 International standards \n4 Further reading \n5 See also \n6 External links \n7 References \n\n\nHistory \nMedical software has been in use since at least since the 1960s,[4] a time when the first computerized information-handling system in the hospital sphere was being considered by Lockheed.[5][6] As computing became more widespread and useful in the late 1970s and into the 1980s, the concept of \"medical software\" as a data and operations management tool in the medical industry \u2014 including in the physician's office \u2014 became more prevalent.[7][8] Medical software became more prominent in medical devices in fields such as nuclear medicine, cardiology, and medical robotics by the early 1990s, prompting additional scrutiny of the \"safety-critical\" nature of medical software in the research and legislative communities, in part fueled by the Therac-25 radiation therapy device scandal.[9][10] The development of the ISO 9000-3 standard[9] as well as the European Medical Devices Directive in 1993[1] helped bring some harmonization of existing laws with medical devices and their associated software, and the addition of IEC 62304 in 2006 further cemented how medical device software should be developed and tested.[11] The U.S. Food and Drug Administration (FDA) has also offered guidance and driven regulation on medical software, particularly embedded in and used as medical devices.[2][12][13]\n\n A portable heart rate variability device is an example of a medical device that contains medical device software.\nMedical device software \nThe global IEC 62304 standard on the software life cycle processes of medical device software states it's a \"software system that has been developed for the purpose of being incorporated into the medical device being developed or that is intended for use as a medical device in its own right.\"[11] In the U.S., the FDA states that \"any software that meets the legal definition of a [medical] device\" is considered medical device software.[14] A similar \"software can be a medical device\" interpretation was also made by the European Union in 2007 with an update to its European Medical Devices Directive, when \"used specifically for diagnostic and\/or therapeutic purposes.\"[15]\nDue to the broad scope covered by these terms, manifold classifications can be proposed for various medical software, based for instance on their technical nature (embedded in a device or standalone), on their level of safety (from the most trivial to the most safety-critical ones), or on their primarily function (treatment, education, diagnostics, and\/or data management).\n\nSoftware as a medical device \nThe dramatic increase in smartphone usage in the twenty-first century triggered the emergence of thousands of stand-alone health- and medical-related software apps, many falling into a gray or borderline area in terms of regulation. While software embedded into a medical device was being addressed, medical software separate from medical hardware \u2014 referred to by the International Medical Device Regulators Forum (IMDRF) as \"software as a medical device\" or \"SaMD\"[16] \u2014 was falling through existing regulatory cracks. In the U.S., the FDA eventually released new draft guidance in July 2011 on \"mobile medical applications,\" with members of the legal community such as Keith Barritt speculating it should be read to imply \"as applicable to all software ... since the test for determining whether a mobile application is a regulated mobile 'medical' application is the same test one would use to determine if any software is regulated.\"[17] Examples of mobile apps potentially covered by the guidance included those that regulate an installed pacemaker or those that analyze images for cancerous lesions, X-rays and MRI, graphic data such as EEG waveforms as well as bedside monitors, urine analyzers, glucometer, stethoscopes, spirometers, BMI calculators, heart rate monitors and body fat calculators.[18] By the time its final guidance was released in late 2013, however, members of Congress began to be concerned about the how the guidance would be used in the future, in particular with what it would mean to the SOFTWARE Act legislation that had recently been introduced.[19] Around the same time, the IMDRF were working on a more global perspective of SaMD with the release of its Key Definitions in December 2013, focused on \"[establishing] a common framework for regulators to incorporate converged controls into their regulatory approaches for SaMD.\"[16] Aside from \"not [being] necessary for a hardware medical device to achieve its intended medical purpose,\" the IMDRF also found that SaMD also couldn't drive a medical device, though it could be used as a module of or interfaced with one.[16] The group further developed quality management system principles for SaMD in 2015.[20]\n\nInternational standards \nIEC 62304 has become the benchmark standard for the development of medical device software, whether standalone software or otherwise, in both the E.U. and the U.S.[3][21] Leading industry innovation in software technologies has led key industry leaders and government regulators to recognize the emergence of numerous standalone medical software products that operate as medical devices. This has been reflected in regulatory changes in the E.U. (European Medical Devices Directive[1]) and the U.S. (various FDA guidance documents[2][12][13][19]). Additionally, quality management system requirements for manufacturing a software medical device, as is the case with any medical device, are described in the U.S. Quality Systems Regulation[22] of the FDA and also in ISO 13485:2003. Software technology manufacturers that operate within the software medical device space conduct mandatory development of their products in accordance with those requirements. Furthermore, though not mandatory, they may elect to obtain certification from a notified body, having implemented such quality system requirements as described within international standards such as ISO 13485:2003.\n\nFurther reading \nBecchetti, C.; Neri, A. (2013). \"Chapter 6: Medical Software\". Medical Instrument Design and Development: From Requirements to Market Placements. Chichester, U.K.: John Wiley & Sons Ltd. pp. 359\u2013418. ISBN 9781119952404. \nDegoulet, P.; Fieschi, M. (2012). \"Chapter 2: Medical Software Development\". Introduction to Clinical Informatics. New York: Springer Science & Business Media. pp. 19\u201334. ISBN 9781461268659. \nSee also \nHealth informatics\nHealth information technology\nCategory:Medical software\nExternal links \n Media related to Medical Software at Wikimedia Commons\n\nReferences \n\n\n^ a b c Becchetti, C.; Neri, A. (2013). \"Chapter 6: Medical Software\". Medical Instrument Design and Development: From Requirements to Market Placements. Chichester, U.K.: John Wiley & Sons Ltd. pp. 359\u2013418. ISBN 9781119952404. \n\n^ a b c Vogel, D.A. (2011). \"Chapter 3: The FDA Software Validation Regulations and Why You Should Validate Software Anyway\". Medical Device Software Verification, Validation, and Compliance. Boston, MA: Artech House. pp. 27\u201336. ISBN 9781596934238. \n\n^ a b Jetley, R.; Sudarsan, S.; R., Sampath; Ramaswamy, S. (2013). \"Medical Software - Issues and Best Practices\". Distributed Computing and Internet Technology: 9th International Conference, ICDCIT 2013, Bhubaneswar, India, February 5-8, 2013, Proceedings. Hyderabad, India: Springer. pp. 69\u201391. ISBN 9783642360718. \n\n^ \"Radar and Electronics\". Radar and Electronics Association. March 1963. Retrieved 26 April 2016 . \n\n^ Lockheed Hospital Information System. Lockheed Aircraft Corporation. 1965. p. 82. \n\n^ Gall, John E.; Norwood, Donald D.; El Camino Hospital (1977). Demonstration and evaluation of a total hospital information system. NCHSR research summary series. U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, National Center for Health Services Research. p. 38. \n\n^ Zimmerman, J.; Rector, A. (1978). Computers for the Physician's Office. Forest Grove, OR: Research Studies Press. p. 305. ISBN 0893550078. \n\n^ Freedman, E.; Hecht, E.; Whiteside, D. (1985). \"Consultants Perspective on Medical Office Computerization\". Computers in Healthcare, Volume 6. Englewood: Cardiff Publishing Company. \n\n^ a b Cosgriff, P.S. (1994). \"Quality assurance of medical software\". Journal of Medical Engineering & Technology. 18 (1): 1\u201310. doi:10.3109\/03091909409030782. PMID 8006924. \n\n^ Jones, P.; Jetley, R.; Abraham, J. (9 February 2010). \"A Formal Methods-based verification approach to medical device software analysis\". Embedded. UBM. Retrieved 26 April 2016 . \n\n^ a b International Electrotechnical Commission (2006). \"Medical device software \u2013 Software life cycle processes\" (PDF) . International Standard IEC 62304, First Edition 2006-05. International Electrotechnical Commission. Retrieved 26 April 2016 . \n\n^ a b Office of Device Evaluation, Center for Devices and Radiological Health (9 September 1999). \"Guidance for Industry, FDA Reviewers and Compliance on Off-The-Shelf Software Use in Medical Devices\" (PDF) . U.S. Food and Drug Administration. Retrieved 26 April 2016 . \n\n^ a b Center for Devices; Radiological Health (11 May 2005). \"Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices\". U.S. Food and Drug Administration. Retrieved 26 April 2016 . \n\n^ Murray Jr., J.F. (March 2010). \"CDRH Regulated Software: An Introduction\" (PDF) . U.S. Food and Drug Administration. Retrieved 26 April 2016 . \n\n^ \"Directive 2007\/47\/ED of the European Parliament and of the Council\" (PDF) . Official Journal of the European Union. European Union. 5 September 2007. Retrieved 26 April 2016 . \n\n^ a b c Spanou, D. (9 December 2013). \"Software as a Medical Device (SaMD): Key Definitions\" (PDF) . International Medical Device Regulators Forum. p. 9. Retrieved 26 April 2016 . \n\n^ \"New FDA Draft Guidance Sheds Light On Regulation of 'Mobile Medical Apps' and Other Software\" (PDF) . Medical Devices Law & Industry Report. 5 (16): 1\u20133. August 2011. Retrieved 26 April 2016 . \n\n^ Yetisen, A.K.; Martinez-Hurtado, J.L.; Vasconcellos, F.C.; Simsekler, M.C.E.; Akram, M.S.; Lowe, C.R. (2014). \"The regulation of mobile medical applications\". Lab on a Chip. 14 (5): 833\u2013840. doi:10.1039\/C3LC51235E. \n\n^ a b Slabodkin, G. (20 November 2013). \"Congress, FDA at odds over software as a medical device\". Fierce Mobile Healthcare. Questex, LLC. \n\n^ Mezher, M. (8 April 2015). \"IMDRF Proposes QMS Principles for Software as a Medical Device\". Regulatory Focus. Regulatory Affairs Professionals Society. Retrieved 26 April 2016 . \n\n^ Rust, P.; Flood, D.; McCaffery, F. (2015). \"Software Process Improvement and Roadmapping \u2013 A Roadmap for Implementing IEC 62304 in Organizations Developing and Maintaining Medical Device Software\". In Rout, T.; C'Connor, R.V.; Dorling, A. Software Process Improvement and Capability Determination. Cham, Switzerland: Springer. pp. 19\u201332. doi:10.1007\/978-3-319-19860-6_3. ISBN 9783319198606. \n\n^ \"Quality System (QS) Regulation\/Medical Device Good Manufacturing Practices\". U.S. Food and Drug Administration. 30 June 2014. Retrieved 26 April 2016 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_software\">https:\/\/www.limswiki.org\/index.php\/Medical_software<\/a>\n\t\t\t\t\tCategories: Health informaticsMedical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 24 February 2016, at 19:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 942 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","79dbc75d9223c22375492817dbae2161_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_software skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical software<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Medical software<\/b> is any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Software\" title=\"Software\" rel=\"external_link\" target=\"_blank\">software<\/a> item or system used within a medical context, such as:<sup id=\"rdp-ebb-cite_ref-BecchettiMed13_1-0\" class=\"reference\"><a href=\"#cite_note-BecchettiMed13-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-VogelMed11_2-0\" class=\"reference\"><a href=\"#cite_note-VogelMed11-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-JetleyMed13_3-0\" class=\"reference\"><a href=\"#cite_note-JetleyMed13-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<ul><li>standalone software used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">diagnostic<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapy\" title=\"Therapy\" rel=\"external_link\" target=\"_blank\">therapeutic<\/a> purposes;<\/li>\n<li>software embedded in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> (often referred to as \"medical device software\");<\/li>\n<li>software that drives a medical device or determines how it is used;<\/li>\n<li>software that acts as an accessory to a medical device;<\/li>\n<li>software used in the design, production, and testing of a medical device; or<\/li>\n<li>software that provides quality control management of a medical device.<\/li><\/ul>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Medical software has been in use since at least since the 1960s,<sup id=\"rdp-ebb-cite_ref-REA63_4-0\" class=\"reference\"><a href=\"#cite_note-REA63-4\" rel=\"external_link\">[4]<\/a><\/sup> a time when the first computerized information-handling system in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospital<\/a> sphere was being considered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lockheed_Corporation\" title=\"Lockheed Corporation\" rel=\"external_link\" target=\"_blank\">Lockheed<\/a>.<sup id=\"rdp-ebb-cite_ref-LHHIS_5-0\" class=\"reference\"><a href=\"#cite_note-LHHIS-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DemEvalHos_6-0\" class=\"reference\"><a href=\"#cite_note-DemEvalHos-6\" rel=\"external_link\">[6]<\/a><\/sup> As computing became more widespread and useful in the late 1970s and into the 1980s, the concept of \"medical software\" as a data and operations management tool in the medical industry \u2014 including in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician%27s_office\" class=\"mw-redirect\" title=\"Physician's office\" rel=\"external_link\" target=\"_blank\">physician's office<\/a> \u2014 became more prevalent.<sup id=\"rdp-ebb-cite_ref-ZimmermanComp78_7-0\" class=\"reference\"><a href=\"#cite_note-ZimmermanComp78-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FreedmanCons85_8-0\" class=\"reference\"><a href=\"#cite_note-FreedmanCons85-8\" rel=\"external_link\">[8]<\/a><\/sup> Medical software became more prominent in medical devices in fields such as nuclear medicine, cardiology, and medical robotics by the early 1990s, prompting additional scrutiny of the \"safety-critical\" nature of medical software in the research and legislative communities, in part fueled by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therac-25\" title=\"Therac-25\" rel=\"external_link\" target=\"_blank\">Therac-25<\/a> radiation therapy device scandal.<sup id=\"rdp-ebb-cite_ref-CosgriffQual94_9-0\" class=\"reference\"><a href=\"#cite_note-CosgriffQual94-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-JonesAForm10_10-0\" class=\"reference\"><a href=\"#cite_note-JonesAForm10-10\" rel=\"external_link\">[10]<\/a><\/sup> The development of the ISO 9000-3 standard<sup id=\"rdp-ebb-cite_ref-CosgriffQual94_9-1\" class=\"reference\"><a href=\"#cite_note-CosgriffQual94-9\" rel=\"external_link\">[9]<\/a><\/sup> as well as the European <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_Devices_Directive\" title=\"Medical Devices Directive\" rel=\"external_link\" target=\"_blank\">Medical Devices Directive<\/a> in 1993<sup id=\"rdp-ebb-cite_ref-BecchettiMed13_1-1\" class=\"reference\"><a href=\"#cite_note-BecchettiMed13-1\" rel=\"external_link\">[1]<\/a><\/sup> helped bring some harmonization of existing laws with medical devices and their associated software, and the addition of <a href=\"https:\/\/en.wikipedia.org\/wiki\/IEC_62304\" title=\"IEC 62304\" rel=\"external_link\" target=\"_blank\">IEC 62304<\/a> in 2006 further cemented how medical device software should be developed and tested.<sup id=\"rdp-ebb-cite_ref-IEC62304_11-0\" class=\"reference\"><a href=\"#cite_note-IEC62304-11\" rel=\"external_link\">[11]<\/a><\/sup> The U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) has also offered guidance and driven regulation on medical software, particularly embedded in and used as medical devices.<sup id=\"rdp-ebb-cite_ref-VogelMed11_2-1\" class=\"reference\"><a href=\"#cite_note-VogelMed11-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAOff99_12-0\" class=\"reference\"><a href=\"#cite_note-FDAOff99-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAGuidance05_13-0\" class=\"reference\"><a href=\"#cite_note-FDAGuidance05-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portable_heart_rate_variability_device.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Portable_heart_rate_variability_device.JPG\/250px-Portable_heart_rate_variability_device.JPG\" width=\"250\" height=\"375\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portable_heart_rate_variability_device.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A portable heart rate variability device is an example of a medical device that contains medical device software.<\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Medical_device_software\">Medical device software<\/span><\/h2>\n<p>The global IEC 62304 standard on the software life cycle processes of medical device software states it's a \"software system that has been developed for the purpose of being incorporated into the medical device being developed or that is intended for use as a medical device in its own right.\"<sup id=\"rdp-ebb-cite_ref-IEC62304_11-1\" class=\"reference\"><a href=\"#cite_note-IEC62304-11\" rel=\"external_link\">[11]<\/a><\/sup> In the U.S., the FDA states that \"any software that meets the legal definition of a [medical] device\" is considered medical device software.<sup id=\"rdp-ebb-cite_ref-MurrayCDRH10_14-0\" class=\"reference\"><a href=\"#cite_note-MurrayCDRH10-14\" rel=\"external_link\">[14]<\/a><\/sup> A similar \"software can be a medical device\" interpretation was also made by the European Union in 2007 with an update to its European Medical Devices Directive, when \"used specifically for diagnostic and\/or therapeutic purposes.\"<sup id=\"rdp-ebb-cite_ref-2007\/47\/EC_15-0\" class=\"reference\"><a href=\"#cite_note-2007\/47\/EC-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>Due to the broad scope covered by these terms, manifold classifications can be proposed for various medical software, based for instance on their technical nature (embedded in a device or standalone), on their level of safety (from the most trivial to the most safety-critical ones), or on their primarily function (treatment, education, diagnostics, and\/or data management).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Software_as_a_medical_device\">Software as a medical device<\/span><\/h3>\n<p>The dramatic increase in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smartphone\" title=\"Smartphone\" rel=\"external_link\" target=\"_blank\">smartphone<\/a> usage in the twenty-first century triggered the emergence of thousands of stand-alone health- and medical-related software apps, many falling into a gray or borderline area in terms of regulation. While software embedded into a medical device was being addressed, medical software separate from medical hardware \u2014 referred to by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Global_Harmonization_Task_Force\" title=\"Global Harmonization Task Force\" rel=\"external_link\" target=\"_blank\">International Medical Device Regulators Forum<\/a> (IMDRF) as \"software as a medical device\" or \"SaMD\"<sup id=\"rdp-ebb-cite_ref-IMDRFSoft13_16-0\" class=\"reference\"><a href=\"#cite_note-IMDRFSoft13-16\" rel=\"external_link\">[16]<\/a><\/sup> \u2014 was falling through existing regulatory cracks. In the U.S., the FDA eventually released new draft guidance in July 2011 on \"mobile medical applications,\" with members of the legal community such as Keith Barritt speculating it should be read to imply \"as applicable to all software ... since the test for determining whether a mobile application is a regulated mobile 'medical' application is the same test one would use to determine if any software is regulated.\"<sup id=\"rdp-ebb-cite_ref-BarrittNew11_17-0\" class=\"reference\"><a href=\"#cite_note-BarrittNew11-17\" rel=\"external_link\">[17]<\/a><\/sup> Examples of mobile apps potentially covered by the guidance included those that regulate an installed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">pacemaker<\/a> or those that analyze images for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancerous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lesion\" title=\"Lesion\" rel=\"external_link\" target=\"_blank\">lesions<\/a>, X-rays and <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>, graphic data such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/EEG\" class=\"mw-redirect\" title=\"EEG\" rel=\"external_link\" target=\"_blank\">EEG<\/a> waveforms as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bedside_monitor\" class=\"mw-redirect\" title=\"Bedside monitor\" rel=\"external_link\" target=\"_blank\">bedside monitors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_urine_tests\" title=\"Clinical urine tests\" rel=\"external_link\" target=\"_blank\">urine analyzers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucometer\" class=\"mw-redirect\" title=\"Glucometer\" rel=\"external_link\" target=\"_blank\">glucometer<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stethoscope\" title=\"Stethoscope\" rel=\"external_link\" target=\"_blank\">stethoscopes<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spirometer\" title=\"Spirometer\" rel=\"external_link\" target=\"_blank\">spirometers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_mass_index\" title=\"Body mass index\" rel=\"external_link\" target=\"_blank\">BMI<\/a> calculators, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_rate_monitor\" title=\"Heart rate monitor\" rel=\"external_link\" target=\"_blank\">heart rate monitors<\/a> and body fat calculators.<sup id=\"rdp-ebb-cite_ref-YetisenTheReg14_18-0\" class=\"reference\"><a href=\"#cite_note-YetisenTheReg14-18\" rel=\"external_link\">[18]<\/a><\/sup> By the time its final guidance was released in late 2013, however, members of <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Congress\" title=\"United States Congress\" rel=\"external_link\" target=\"_blank\">Congress<\/a> began to be concerned about the how the guidance would be used in the future, in particular with what it would mean to the SOFTWARE Act legislation that had recently been introduced.<sup id=\"rdp-ebb-cite_ref-SlabodkinCongress13_19-0\" class=\"reference\"><a href=\"#cite_note-SlabodkinCongress13-19\" rel=\"external_link\">[19]<\/a><\/sup> Around the same time, the IMDRF were working on a more global perspective of SaMD with the release of its Key Definitions in December 2013, focused on \"[establishing] a common framework for regulators to incorporate converged controls into their regulatory approaches for SaMD.\"<sup id=\"rdp-ebb-cite_ref-IMDRFSoft13_16-1\" class=\"reference\"><a href=\"#cite_note-IMDRFSoft13-16\" rel=\"external_link\">[16]<\/a><\/sup> Aside from \"not [being] necessary for a hardware medical device to achieve its intended medical purpose,\" the IMDRF also found that SaMD also couldn't drive a medical device, though it could be used as a module of or interfaced with one.<sup id=\"rdp-ebb-cite_ref-IMDRFSoft13_16-2\" class=\"reference\"><a href=\"#cite_note-IMDRFSoft13-16\" rel=\"external_link\">[16]<\/a><\/sup> The group further developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_management_system\" title=\"Quality management system\" rel=\"external_link\" target=\"_blank\">quality management system<\/a> principles for SaMD in 2015.<sup id=\"rdp-ebb-cite_ref-MezherIMDRF15_20-0\" class=\"reference\"><a href=\"#cite_note-MezherIMDRF15-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"International_standards\">International standards<\/span><\/h2>\n<p>IEC 62304 has become the benchmark standard for the development of medical device software, whether standalone software or otherwise, in both the E.U. and the U.S.<sup id=\"rdp-ebb-cite_ref-JetleyMed13_3-1\" class=\"reference\"><a href=\"#cite_note-JetleyMed13-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-RustSoft15_21-0\" class=\"reference\"><a href=\"#cite_note-RustSoft15-21\" rel=\"external_link\">[21]<\/a><\/sup> Leading industry innovation in software technologies has led key industry leaders and government regulators to recognize the emergence of numerous standalone medical software products that operate as medical devices. This has been reflected in regulatory changes in the E.U. (European Medical Devices Directive<sup id=\"rdp-ebb-cite_ref-BecchettiMed13_1-2\" class=\"reference\"><a href=\"#cite_note-BecchettiMed13-1\" rel=\"external_link\">[1]<\/a><\/sup>) and the U.S. (various FDA guidance documents<sup id=\"rdp-ebb-cite_ref-VogelMed11_2-2\" class=\"reference\"><a href=\"#cite_note-VogelMed11-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAOff99_12-1\" class=\"reference\"><a href=\"#cite_note-FDAOff99-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAGuidance05_13-1\" class=\"reference\"><a href=\"#cite_note-FDAGuidance05-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SlabodkinCongress13_19-1\" class=\"reference\"><a href=\"#cite_note-SlabodkinCongress13-19\" rel=\"external_link\">[19]<\/a><\/sup>). Additionally, quality management system requirements for manufacturing a software medical device, as is the case with any medical device, are described in the U.S. Quality Systems Regulation<sup id=\"rdp-ebb-cite_ref-FDAQSR_22-0\" class=\"reference\"><a href=\"#cite_note-FDAQSR-22\" rel=\"external_link\">[22]<\/a><\/sup> of the FDA and also in <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_13485\" title=\"ISO 13485\" rel=\"external_link\" target=\"_blank\">ISO 13485<\/a>:2003. Software technology manufacturers that operate within the software medical device space conduct mandatory development of their products in accordance with those requirements. Furthermore, though not mandatory, they may elect to obtain certification from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Notified_Body\" title=\"Notified Body\" rel=\"external_link\" target=\"_blank\">notified body<\/a>, having implemented such quality system requirements as described within international standards such as ISO 13485:2003.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Becchetti, C.; Neri, A. (2013). \"Chapter 6: Medical Software\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=P3VeLRVMdQ8C&pg=PT275\" target=\"_blank\"><i>Medical Instrument Design and Development: From Requirements to Market Placements<\/i><\/a>. Chichester, U.K.: John Wiley & Sons Ltd. pp. 359\u2013418. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781119952404.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+6%3A+Medical+Software&rft.btitle=Medical+Instrument+Design+and+Development%3A+From+Requirements+to+Market+Placements&rft.place=Chichester%2C+U.K.&rft.pages=359-418&rft.pub=John+Wiley+%26+Sons+Ltd&rft.date=2013&rft.isbn=9781119952404&rft.au=Becchetti%2C+C.&rft.au=Neri%2C+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DP3VeLRVMdQ8C%26pg%3DPT275&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><\/li>\n<li><cite class=\"citation book\">Degoulet, P.; Fieschi, M. (2012). \"Chapter 2: Medical Software Development\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=obfDBAAAQBAJ&pg=PA26\" target=\"_blank\"><i>Introduction to Clinical Informatics<\/i><\/a>. New York: Springer Science & Business Media. pp. 19\u201334. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781461268659.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+2%3A+Medical+Software+Development&rft.btitle=Introduction+to+Clinical+Informatics&rft.place=New+York&rft.pages=19-34&rft.pub=Springer+Science+%26+Business+Media&rft.date=2012&rft.isbn=9781461268659&rft.au=Degoulet%2C+P.&rft.au=Fieschi%2C+M.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DobfDBAAAQBAJ%26pg%3DPA26&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_informatics\" title=\"Health informatics\" rel=\"external_link\" target=\"_blank\">Health informatics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_information_technology\" title=\"Health information technology\" rel=\"external_link\" target=\"_blank\">Health information technology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:Medical_software\" title=\"Category:Medical software\" rel=\"external_link\" target=\"_blank\">Category:Medical software<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Medical_Software\" class=\"extiw\" title=\"commons:Category:Medical Software\" rel=\"external_link\" target=\"_blank\">Medical Software <\/a> at Wikimedia Commons\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-BecchettiMed13-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BecchettiMed13_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BecchettiMed13_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BecchettiMed13_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Becchetti, C.; Neri, A. (2013). \"Chapter 6: Medical Software\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=P3VeLRVMdQ8C&pg=PT275\" target=\"_blank\"><i>Medical Instrument Design and Development: From Requirements to Market Placements<\/i><\/a>. Chichester, U.K.: John Wiley & Sons Ltd. pp. 359\u2013418. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781119952404.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+6%3A+Medical+Software&rft.btitle=Medical+Instrument+Design+and+Development%3A+From+Requirements+to+Market+Placements&rft.place=Chichester%2C+U.K.&rft.pages=359-418&rft.pub=John+Wiley+%26+Sons+Ltd&rft.date=2013&rft.isbn=9781119952404&rft.au=Becchetti%2C+C.&rft.au=Neri%2C+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DP3VeLRVMdQ8C%26pg%3DPT275&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-VogelMed11-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-VogelMed11_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-VogelMed11_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-VogelMed11_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Vogel, D.A. (2011). \"Chapter 3: The FDA Software Validation Regulations and Why You Should Validate Software Anyway\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=LYxH-zUSOTgC&pg=PA27\" target=\"_blank\"><i>Medical Device Software Verification, Validation, and Compliance<\/i><\/a>. Boston, MA: Artech House. pp. 27\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781596934238.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+3%3A+The+FDA+Software+Validation+Regulations+and+Why+You+Should+Validate+Software+Anyway&rft.btitle=Medical+Device+Software+Verification%2C+Validation%2C+and+Compliance&rft.place=Boston%2C+MA&rft.pages=27-36&rft.pub=Artech+House&rft.date=2011&rft.isbn=9781596934238&rft.au=Vogel%2C+D.A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DLYxH-zUSOTgC%26pg%3DPA27&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-JetleyMed13-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-JetleyMed13_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-JetleyMed13_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Jetley, R.; Sudarsan, S.; R., Sampath; Ramaswamy, S. (2013). \"Medical Software - Issues and Best Practices\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=5I25BQAAQBAJ&pg=PA69\" target=\"_blank\"><i>Distributed Computing and Internet Technology: 9th International Conference, ICDCIT 2013, Bhubaneswar, India, February 5-8, 2013, Proceedings<\/i><\/a>. Hyderabad, India: Springer. pp. 69\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783642360718.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Medical+Software+-+Issues+and+Best+Practices&rft.btitle=Distributed+Computing+and+Internet+Technology%3A+9th+International+Conference%2C+ICDCIT+2013%2C+Bhubaneswar%2C+India%2C+February+5-8%2C+2013%2C+Proceedings&rft.place=Hyderabad%2C+India&rft.pages=69-91&rft.pub=Springer&rft.date=2013&rft.isbn=9783642360718&rft.au=Jetley%2C+R.&rft.au=Sudarsan%2C+S.&rft.au=R.%2C+Sampath&rft.au=Ramaswamy%2C+S.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D5I25BQAAQBAJ%26pg%3DPA69&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-REA63-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-REA63_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=3WpVAAAAYAAJ&q=%22medical+software%22&dq=%22medical+software%22\" target=\"_blank\">\"Radar and Electronics\"<\/a>. Radar and Electronics Association. March 1963<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Radar+and+Electronics&rft.pub=Radar+and+Electronics+Association&rft.date=1963-03&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D3WpVAAAAYAAJ%26q%3D%2522medical%2Bsoftware%2522%26dq%3D%2522medical%2Bsoftware%2522&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-LHHIS-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-LHHIS_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=8vsFGwAACAAJ\" target=\"_blank\"><i>Lockheed Hospital Information System<\/i><\/a>. Lockheed Aircraft Corporation. 1965. p. 82.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Lockheed+Hospital+Information+System&rft.pages=82&rft.pub=Lockheed+Aircraft+Corporation&rft.date=1965&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D8vsFGwAACAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-DemEvalHos-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-DemEvalHos_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Gall, John E.; Norwood, Donald D.; El Camino Hospital (1977). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=6RA7YzUXYg8C\" target=\"_blank\"><i>Demonstration and evaluation of a total hospital information system<\/i><\/a>. NCHSR research summary series. U.S. Dept. of Health, Education, and Welfare, Public Health Service, Health Resources Administration, National Center for Health Services Research. p. 38.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Demonstration+and+evaluation+of+a+total+hospital+information+system&rft.series=NCHSR+research+summary+series&rft.pages=38&rft.pub=U.S.+Dept.+of+Health%2C+Education%2C+and+Welfare%2C+Public+Health+Service%2C+Health+Resources+Administration%2C+National+Center+for+Health+Services+Research&rft.date=1977&rft.au=Gall%2C+John+E.&rft.au=Norwood%2C+Donald+D.&rft.au=El+Camino+Hospital&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D6RA7YzUXYg8C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ZimmermanComp78-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ZimmermanComp78_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Zimmerman, J.; Rector, A. (1978). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=8FprAAAAMAAJ\" target=\"_blank\"><i>Computers for the Physician's Office<\/i><\/a>. Forest Grove, OR: Research Studies Press. p. 305. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0893550078.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Computers+for+the+Physician%27s+Office&rft.place=Forest+Grove%2C+OR&rft.pages=305&rft.pub=Research+Studies+Press&rft.date=1978&rft.isbn=0893550078&rft.au=Zimmerman%2C+J.&rft.au=Rector%2C+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D8FprAAAAMAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FreedmanCons85-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FreedmanCons85_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Freedman, E.; Hecht, E.; Whiteside, D. (1985). \"Consultants Perspective on Medical Office Computerization\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=xW1LAAAAYAAJ\" target=\"_blank\"><i>Computers in Healthcare, Volume 6<\/i><\/a>. Englewood: Cardiff Publishing Company.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Consultants+Perspective+on+Medical+Office+Computerization&rft.btitle=Computers+in+Healthcare%2C+Volume+6&rft.place=Englewood&rft.pub=Cardiff+Publishing+Company&rft.date=1985&rft.au=Freedman%2C+E.&rft.au=Hecht%2C+E.&rft.au=Whiteside%2C+D.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DxW1LAAAAYAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CosgriffQual94-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CosgriffQual94_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CosgriffQual94_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cosgriff, P.S. (1994). \"Quality assurance of medical software\". <i>Journal of Medical Engineering & Technology<\/i>. <b>18<\/b> (1): 1\u201310. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F03091909409030782\" target=\"_blank\">10.3109\/03091909409030782<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8006924\" target=\"_blank\">8006924<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Medical+Engineering+%26+Technology&rft.atitle=Quality+assurance+of+medical+software&rft.volume=18&rft.issue=1&rft.pages=1-10&rft.date=1994&rft_id=info%3Adoi%2F10.3109%2F03091909409030782&rft_id=info%3Apmid%2F8006924&rft.au=Cosgriff%2C+P.S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-JonesAForm10-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-JonesAForm10_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Jones, P.; Jetley, R.; Abraham, J. (9 February 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.embedded.com\/design\/prototyping-and-development\/4008888\/A-Formal-Methods-based-verification-approach-to-medical-device-software-analysis\" target=\"_blank\">\"A Formal Methods-based verification approach to medical device software analysis\"<\/a>. <i>Embedded<\/i>. UBM<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Embedded&rft.atitle=A+Formal+Methods-based+verification+approach+to+medical+device+software+analysis&rft.date=2010-02-09&rft.au=Jones%2C+P.&rft.au=Jetley%2C+R.&rft.au=Abraham%2C+J.&rft_id=http%3A%2F%2Fwww.embedded.com%2Fdesign%2Fprototyping-and-development%2F4008888%2FA-Formal-Methods-based-verification-approach-to-medical-device-software-analysis&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-IEC62304-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-IEC62304_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IEC62304_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">International Electrotechnical Commission (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/webstore.iec.ch\/preview\/info_iec62304%7Bed1.0%7Den_d.pdf\" target=\"_blank\">\"Medical device software \u2013 Software life cycle processes\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>International Standard IEC 62304, First Edition 2006-05<\/i>. 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Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=International+Standard+IEC+62304%2C+First+Edition+2006-05&rft.atitle=Medical+device+software+%E2%80%93++Software+life+cycle+processes&rft.date=2006&rft.au=International+Electrotechnical+Commission&rft_id=https%3A%2F%2Fwebstore.iec.ch%2Fpreview%2Finfo_iec62304%257Bed1.0%257Den_d.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDAOff99-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDAOff99_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAOff99_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Office of Device Evaluation, Center for Devices and Radiological Health (9 September 1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/downloads\/MedicalDevices\/...\/ucm073779.pdf\" target=\"_blank\">\"Guidance for Industry, FDA Reviewers and Compliance on Off-The-Shelf Software Use in Medical Devices\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. U.S. Food and Drug Administration<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guidance+for+Industry%2C+FDA+Reviewers+and+Compliance+on+Off-The-Shelf+Software+Use+in+Medical+Devices&rft.pub=U.S.+Food+and+Drug+Administration&rft.date=1999-09-09&rft.au=Office+of+Device+Evaluation%2C+Center+for+Devices+and+Radiological+Health&rft_id=http%3A%2F%2Fwww.fda.gov%2Fdownloads%2FMedicalDevices%2F...%2Fucm073779.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDAGuidance05-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDAGuidance05_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAGuidance05_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Center for Devices; Radiological Health (11 May 2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/RegulatoryInformation\/Guidances\/ucm089543.htm\" target=\"_blank\">\"Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices\"<\/a>. 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(March 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/downloads\/Training\/CDRHLearn\/UCM209129.pdf\" target=\"_blank\">\"CDRH Regulated Software: An Introduction\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. U.S. Food and Drug Administration<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=CDRH+Regulated+Software%3A+An+Introduction&rft.pub=U.S.+Food+and+Drug+Administration&rft.date=2010-03&rft.au=Murray+Jr.%2C+J.F.&rft_id=http%3A%2F%2Fwww.fda.gov%2Fdownloads%2FTraining%2FCDRHLearn%2FUCM209129.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-2007\/47\/EC-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2007\/47\/EC_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/eur-lex.europa.eu\/LexUriServ\/LexUriServ.do?uri=OJ:L:2007:247:0021:0055:en:PDF\" target=\"_blank\">\"Directive 2007\/47\/ED of the European Parliament and of the Council\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Official Journal of the European Union<\/i>. 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Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Official+Journal+of+the+European+Union&rft.atitle=Directive+2007%2F47%2FED+of+the+European+Parliament+and+of+the+Council&rft.date=2007-09-05&rft_id=http%3A%2F%2Feur-lex.europa.eu%2FLexUriServ%2FLexUriServ.do%3Furi%3DOJ%3AL%3A2007%3A247%3A0021%3A0055%3Aen%3APDF&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-IMDRFSoft13-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-IMDRFSoft13_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IMDRFSoft13_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IMDRFSoft13_16-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Spanou, D. (9 December 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.imdrf.org\/docs\/imdrf\/final\/technical\/imdrf-tech-131209-samd-key-definitions-140901.pdf\" target=\"_blank\">\"Software as a Medical Device (SaMD): Key Definitions\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. International Medical Device Regulators Forum. p. 9<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Software+as+a+Medical+Device+%28SaMD%29%3A+Key+Definitions&rft.pages=9&rft.pub=International+Medical+Device+Regulators+Forum&rft.date=2013-12-09&rft.au=Spanou%2C+D.&rft_id=http%3A%2F%2Fwww.imdrf.org%2Fdocs%2Fimdrf%2Ffinal%2Ftechnical%2Fimdrf-tech-131209-samd-key-definitions-140901.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BarrittNew11-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BarrittNew11_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fr.com\/files\/Uploads\/Documents\/Barritt,%20Keith.%20BNA%20Medical%20Devices%20Law%20&%20Industry%20Report.%20New%20FDA%20Draft%20Guidance.%2008-10-11.pdf\" target=\"_blank\">\"New FDA Draft Guidance Sheds Light On Regulation of 'Mobile Medical Apps' and Other Software\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Medical Devices Law & Industry Report<\/i>. <b>5<\/b> (16): 1\u20133. 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(2014). \"The regulation of mobile medical applications\". <i>Lab on a Chip<\/i>. <b>14<\/b> (5): 833\u2013840. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1039%2FC3LC51235E\" target=\"_blank\">10.1039\/C3LC51235E<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lab+on+a+Chip&rft.atitle=The+regulation+of+mobile+medical+applications&rft.volume=14&rft.issue=5&rft.pages=833-840&rft.date=2014&rft_id=info%3Adoi%2F10.1039%2FC3LC51235E&rft.au=Yetisen%2C+A.K.&rft.au=Martinez-Hurtado%2C+J.L.&rft.au=Vasconcellos%2C+F.C.&rft.au=Simsekler%2C+M.C.E.&rft.au=Akram%2C+M.S.&rft.au=Lowe%2C+C.R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SlabodkinCongress13-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-SlabodkinCongress13_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-SlabodkinCongress13_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Slabodkin, G. (20 November 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fiercemobilehealthcare.com\/story\/congress-fda-odds-over-software-medical-device\/2013-11-20\" target=\"_blank\">\"Congress, FDA at odds over software as a medical device\"<\/a>. <i>Fierce Mobile Healthcare<\/i>. Questex, LLC.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Fierce+Mobile+Healthcare&rft.atitle=Congress%2C+FDA+at+odds+over+software+as+a+medical+device&rft.date=2013-11-20&rft.au=Slabodkin%2C+G.&rft_id=http%3A%2F%2Fwww.fiercemobilehealthcare.com%2Fstory%2Fcongress-fda-odds-over-software-medical-device%2F2013-11-20&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MezherIMDRF15-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MezherIMDRF15_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Mezher, M. (8 April 2015). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.raps.org\/Regulatory-Focus\/News\/2015\/04\/08\/21936\/IMDRF-Proposes-QMS-Principles-for-Software-as-a-Medical-Device\/\" target=\"_blank\">\"IMDRF Proposes QMS Principles for Software as a Medical Device\"<\/a>. <i>Regulatory Focus<\/i>. Regulatory Affairs Professionals Society<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Regulatory+Focus&rft.atitle=IMDRF+Proposes+QMS+Principles+for+Software+as+a+Medical+Device&rft.date=2015-04-08&rft.au=Mezher%2C+M.&rft_id=http%3A%2F%2Fwww.raps.org%2FRegulatory-Focus%2FNews%2F2015%2F04%2F08%2F21936%2FIMDRF-Proposes-QMS-Principles-for-Software-as-a-Medical-Device%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-RustSoft15-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-RustSoft15_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rust, P.; Flood, D.; McCaffery, F. (2015). \"Software Process Improvement and Roadmapping \u2013 A Roadmap for Implementing IEC 62304 in Organizations Developing and Maintaining Medical Device Software\". In Rout, T.; C'Connor, R.V.; Dorling, A. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=u3zMCQAAQBAJ&pg=PA19\" target=\"_blank\"><i>Software Process Improvement and Capability Determination<\/i><\/a>. Cham, Switzerland: Springer. pp. 19\u201332. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2F978-3-319-19860-6_3\" target=\"_blank\">10.1007\/978-3-319-19860-6_3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783319198606.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Software+Process+Improvement+and+Roadmapping+%E2%80%93+A+Roadmap+for+Implementing+IEC+62304+in+Organizations+Developing+and+Maintaining+Medical+Device+Software&rft.btitle=Software+Process+Improvement+and+Capability+Determination&rft.place=Cham%2C+Switzerland&rft.pages=19-32&rft.pub=Springer&rft.date=2015&rft_id=info%3Adoi%2F10.1007%2F978-3-319-19860-6_3&rft.isbn=9783319198606&rft.au=Rust%2C+P.&rft.au=Flood%2C+D.&rft.au=McCaffery%2C+F.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Du3zMCQAAQBAJ%26pg%3DPA19&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDAQSR-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDAQSR_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/medicaldevices\/deviceregulationandguidance\/postmarketrequirements\/qualitysystemsregulations\/default.htm\" target=\"_blank\">\"Quality System (QS) Regulation\/Medical Device Good Manufacturing Practices\"<\/a>. U.S. Food and Drug Administration. 30 June 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Quality+System+%28QS%29+Regulation%2FMedical+Device+Good+Manufacturing+Practices&rft.pub=U.S.+Food+and+Drug+Administration&rft.date=2014-06-30&rft_id=http%3A%2F%2Fwww.fda.gov%2Fmedicaldevices%2Fdeviceregulationandguidance%2Fpostmarketrequirements%2Fqualitysystemsregulations%2Fdefault.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+software\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1256\nCached time: 20181212161918\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.340 seconds\nReal time usage: 0.406 seconds\nPreprocessor visited node count: 1214\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 46801\/2097152 bytes\nTemplate argument size: 299\/2097152 bytes\nHighest expansion depth: 8\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 68580\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.211\/10.000 seconds\nLua memory usage: 5.4 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 339.314 1 -total\n<\/p>\n<pre>55.21% 187.320 1 Template:Reflist\n36.02% 122.217 10 Template:Cite_book\n21.45% 72.785 1 Template:Commonscat-inline\n18.96% 64.333 11 Template:Cite_web\n11.65% 39.529 3 Template:Cite_journal\n 1.60% 5.435 1 Template:Sister-inline\n 0.81% 2.740 1 Template:Main_other\n 0.63% 2.124 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:467919-1!canonical and timestamp 20181212161918 and revision id 855776126\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_software\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214630\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.023 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.677 1 - wikipedia:Medical_software\n100.00% 144.677 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8113-0!*!*!*!*!*!* and timestamp 20181217214630 and revision id 24234\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_software\">https:\/\/www.limswiki.org\/index.php\/Medical_software<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","79dbc75d9223c22375492817dbae2161_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Portable_heart_rate_variability_device.JPG\/500px-Portable_heart_rate_variability_device.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png"],"79dbc75d9223c22375492817dbae2161_timestamp":1545083190,"dd984888304cc580154ea14150f550ab_type":"article","dd984888304cc580154ea14150f550ab_title":"Medical robot","dd984888304cc580154ea14150f550ab_url":"https:\/\/www.limswiki.org\/index.php\/Medical_robot","dd984888304cc580154ea14150f550ab_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical robot\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t A laparoscopic robotic surgery machine. Patient-side cart of the da Vinci surgical system.\nA medical robot is a robot used in the medical sciences. They include surgical robots. These are in most telemanipulators, which use the surgeon's actions on one side to control the \"effector\" on the other side.[1][2][3]\n\nContents \n\n1 Types \n2 See also \n3 References \n4 External links \n\n\nTypes \nSurgical robots: either allow surgical operations to be carried out with greater precision than an unaided human surgeon, or allow remote surgery where a human surgeon is not physically present with the patient.\nRehabilitation robots: facilitate and support the lives of infirm, elderly people, or those with dysfunction of body parts effecting movement. These robots are also used for rehabilitation and related procedures, such as training and therapy.\nBiorobots: a group of robots designed to imitate the cognition of humans and animals.\nTelepresence robots: allow off-site medical professionals to move, look around, communicate, and participate from remote locations.[4]\nPharmacy automation: robotic systems to dispense oral solids in a retail pharmacy setting or preparing sterile IV admixtures in a hospital pharmacy setting.\nCompanion robot: has the capability to engage emotionally with users keeping them company and alerting if there is a problem with their health.\nDisinfection robot: has the capability to disinfect a whole room in mere minutes, generally using pulsed ultraviolet light.[5][6] They are being used to fight Ebola virus disease.[7]\nSee also \n\n\n Robotics portal \n\n\n\nWikimedia Commons has media related to Medical robots.\nBiothreat\nRobots in healthcare\nHospi\nOpen-source robotics\nRobot & Frank\nReferences \n\n\n^ \"Technology & Clinical Applications: Report\". \n\n^ Beasley, Ryan A. (12 August 2012). \"Medical Robots: Current Systems and Research Directions\". 2012: 1\u201314. doi:10.1155\/2012\/401613. \n\n^ Schweikard, Achim & Ernst, Floris (October 2015). Medical Robotics. Springer Science+Business Media. ISBN 978-3-319-22890-7. \n\n^ Corley, Anne-Marie (September 2009). \"The Reality of Robot Surrogates\". spectrum.ieee.com. Retrieved 19 March 2013 . \n\n^ \"Pulsed (UV) Light\". Top Wiki. \n\n^ \"Tech on Seeker\". Seeker. \n\n^ Bayot, Asher (November 23, 2014). \"U.S. Military Robots To Join Fight Against Ebola\". Inquisitr. \n\n\nExternal links \nMedical Robotics Text Book\nMedical Robots Conference\nRobotic IV Automation - RIVA\nWhere Are the Elder Care Robots?\nNotable Chinese Firms Emerging in Medical Robots Sector (IEEE)\nvteMobile robots and uncrewed vehiclesAerial\nUnmanned aerial vehicle (UAV)\nUnmanned aircraft system\nAerobot\nHelicam\nList of unmanned aerial vehicle applications\nUnmanned combat air vehicle (UCAV)\nUnmanned Aircraft\nOrnithopter\nGroundWalking\nHumanoid (list)\nAndroid (list)\nHexapod (list)\nOther\nUnmanned ground vehicle (UGV)\nAutomated guided vehicle (AGV)\nUnmanned ground combat vehicle (UGCV)\nDriverless car\nAutomatic train operation (ATO) (list)\nUnderwater\nUnmanned underwater vehicle (UUV)\nAutonomous underwater vehicle (AUV)\nIntervention AUV (I-AUV)\nRemotely operated underwater vehicle (ROUV)\nUnderwater glider\nSurface\nUnmanned surface vehicle (USV)\nSpace\nUnmanned space vehicle (USV)\nRobotic spacecraft (list)\nRobotic telescope\nSpace probe\nUnmanned resupply spacecraft (list)\nOther\nDomestic\nMilitary\nRescue\nMedical\nDisability\nAgricultural\nBEAM robotics\nMicrobotics\nNanorobotics\n\nSee also\nUncrewed vehicle\nRobotics\nRobot locomotion\nAutonomous robot\nAutonomous logistics\nRadio-controlled model\nRemote control vehicle\nRemote control animal\nCategories\nRadio control\nUnmanned vehicles\n\nvteRoboticsMain articles\nOutline\nGlossary\nIndex\nHistory\nFuture\nGeography\nHall of Fame\nEthics\nLaws\nCompetitions\nAI competitions\nTypes\nAnthropomorphic\nHumanoid\nAndroid\nCyborg\nClaytronics\nCompanion\nAnimatronic\nIndustrial\nArticulated\narm\nDomestic\nEducational\nEntertainment\nJuggling\nMilitary\nMedical\nService\nDisability\nAgricultural\nFood service\nRetailing\nBEAM robotics\nSoft robotics\nUncrewed vehicle\nClassifications\nBiorobotics\nAerial vehicle\nGround vehicle\nMobile robot\nnavigation\nMicrobotics\nNanorobotics\nRobotic spacecraft\nSpace probe\nSwarm\nUnderwater\nLocomotion\nTracks\nWalking\nHexapod\nClimbing\nSelf-balancing unicycle\nResearch\nEvolutionary\nKits\nSimulator\nSuite\nOpen-source\nSoftware\nAdaptable\nDevelopmental\nParadigms\nUbiquitous\nRelated\nTechnological unemployment\nFictional robots\n\n Category\n Portal\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_robot\">https:\/\/www.limswiki.org\/index.php\/Medical_robot<\/a>\n\t\t\t\t\tCategories: Medical devicesMedical roboticsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView 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PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 26 February 2016, at 22:42.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 550 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","dd984888304cc580154ea14150f550ab_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_robot skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical robot<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/220px-Laproscopic_Surgery_Robot.jpg\" width=\"220\" height=\"320\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A laparoscopic robotic surgery machine. Patient-side cart of the da Vinci surgical system.<\/div><\/div><\/div>\n<p>A <b>medical robot<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot\" title=\"Robot\" rel=\"external_link\" target=\"_blank\">robot<\/a> used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_science\" class=\"mw-redirect\" title=\"Medical science\" rel=\"external_link\" target=\"_blank\">medical sciences<\/a>. They include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">surgical robots<\/a>. These are in most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telemanipulator\" class=\"mw-redirect\" title=\"Telemanipulator\" rel=\"external_link\" target=\"_blank\">telemanipulators<\/a>, which use the surgeon's actions on one side to control the \"effector\" on the other side.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Surgical robots<\/a>: either allow surgical operations to be carried out with greater precision than an unaided human surgeon, or allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">remote surgery<\/a> where a human surgeon is not physically present with the patient.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Rehabilitation_robotics\" title=\"Rehabilitation robotics\" rel=\"external_link\" target=\"_blank\">Rehabilitation robots<\/a>: facilitate and support the lives of infirm, elderly people, or those with dysfunction of body parts effecting movement. These robots are also used for rehabilitation and related procedures, such as training and therapy.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biorobotics\" title=\"Biorobotics\" rel=\"external_link\" target=\"_blank\">Biorobots<\/a>: a group of robots designed to imitate the cognition of humans and animals.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Telerobotics\" title=\"Telerobotics\" rel=\"external_link\" target=\"_blank\">Telepresence robots<\/a>: allow off-site medical professionals to move, look around, communicate, and participate from remote locations.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacy_automation\" title=\"Pharmacy automation\" rel=\"external_link\" target=\"_blank\">Pharmacy automation<\/a>: robotic systems to dispense oral solids in a retail pharmacy setting or preparing sterile IV admixtures in a hospital pharmacy setting.<\/li>\n<li>Companion robot: has the capability to engage emotionally with users keeping them company and alerting if there is a problem with their health.<\/li>\n<li>Disinfection robot: has the capability to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disinfection\" class=\"mw-redirect\" title=\"Disinfection\" rel=\"external_link\" target=\"_blank\">disinfect<\/a> a whole room in mere minutes, generally using pulsed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultraviolet_light\" class=\"mw-redirect\" title=\"Ultraviolet light\" rel=\"external_link\" target=\"_blank\">ultraviolet light<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> They are being used to fight <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ebola_virus_disease\" title=\"Ebola virus disease\" rel=\"external_link\" target=\"_blank\">Ebola virus disease<\/a>.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Animation2.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/17px-Animation2.gif\" width=\"17\" height=\"28\" class=\"noviewer\" \/><\/a><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Robotics\" title=\"Portal:Robotics\" rel=\"external_link\" target=\"_blank\">Robotics portal<\/a><\/span><\/li><\/ul><\/div>\n\n<ul><li><a href=\"https:\/\/en.wiktionary.org\/wiki\/biothreat\" class=\"extiw\" title=\"wikt:biothreat\" rel=\"external_link\" target=\"_blank\">Biothreat<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robots_in_healthcare\" class=\"mw-redirect\" title=\"Robots in healthcare\" rel=\"external_link\" target=\"_blank\">Robots in healthcare<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospi\" title=\"Hospi\" rel=\"external_link\" target=\"_blank\">Hospi<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Open-source_robotics\" title=\"Open-source robotics\" rel=\"external_link\" target=\"_blank\">Open-source robotics<\/a><\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot_%26_Frank\" title=\"Robot & Frank\" rel=\"external_link\" target=\"_blank\">Robot & Frank<\/a><\/i><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.doc.ic.ac.uk\/~nd\/surprise_96\/journal\/vol4\/ao2\/report.html\" target=\"_blank\">\"Technology & Clinical Applications: Report\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Technology+%26+Clinical+Applications%3A++Report&rft_id=http%3A%2F%2Fwww.doc.ic.ac.uk%2F~nd%2Fsurprise_96%2Fjournal%2Fvol4%2Fao2%2Freport.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+robot\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Beasley, Ryan A. (12 August 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hindawi.com\/journals\/jr\/2012\/401613\/\" target=\"_blank\">\"Medical Robots: Current Systems and Research Directions\"<\/a>. <b>2012<\/b>: 1\u201314. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1155%2F2012%2F401613\" target=\"_blank\">10.1155\/2012\/401613<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Medical+Robots%3A+Current+Systems+and+Research+Directions&rft.volume=2012&rft.pages=1-14&rft.date=2012-08-12&rft_id=info%3Adoi%2F10.1155%2F2012%2F401613&rft.aulast=Beasley&rft.aufirst=Ryan+A.&rft_id=http%3A%2F%2Fwww.hindawi.com%2Fjournals%2Fjr%2F2012%2F401613%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Schweikard, Achim & Ernst, Floris (October 2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/dx.doi.org\/10.1007\/978-3-319-22891-4\" target=\"_blank\"><i>Medical Robotics<\/i><\/a>. Springer Science+Business Media. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-319-22890-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Medical+Robotics&rft.pub=Springer+Science%2BBusiness+Media&rft.date=2015-10&rft.isbn=978-3-319-22890-7&rft.aulast=Schweikard&rft.aufirst=Achim&rft.au=Ernst%2C+Floris&rft_id=https%3A%2F%2Fdx.doi.org%2F10.1007%2F978-3-319-22891-4&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Corley, Anne-Marie (September 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spectrum.ieee.org\/robotics\/humanoids\/the-reality-of-robot-surrogates\/0\" target=\"_blank\">\"The Reality of Robot Surrogates\"<\/a>. spectrum.ieee.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 March<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Reality+of+Robot+Surrogates&rft.pub=spectrum.ieee.com&rft.date=2009-09&rft.aulast=Corley&rft.aufirst=Anne-Marie&rft_id=http%3A%2F%2Fspectrum.ieee.org%2Frobotics%2Fhumanoids%2Fthe-reality-of-robot-surrogates%2F0&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/en.topwiki.nl\/index.php?title=Pulsed_(UV)_Light&oldid=200\" target=\"_blank\">\"Pulsed (UV) Light\"<\/a>. Top Wiki.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pulsed+%28UV%29+Light&rft.pub=Top+Wiki&rft_id=http%3A%2F%2Fen.topwiki.nl%2Findex.php%3Ftitle%3DPulsed_%28UV%29_Light%26oldid%3D200&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.discovery.com\/tech\/robotics\" target=\"_blank\">\"Tech on Seeker\"<\/a>. Seeker.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Tech+on+Seeker&rft.pub=Seeker&rft_id=http%3A%2F%2Fnews.discovery.com%2Ftech%2Frobotics&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Bayot, Asher (November 23, 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.inquisitr.com\/1629714\/u-s-military-robots-to-join-fight-against-ebola\/\" target=\"_blank\">\"U.S. Military Robots To Join Fight Against Ebola\"<\/a>. Inquisitr.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=U.S.+Military+Robots+To+Join+Fight+Against+Ebola&rft.pub=Inquisitr&rft.date=2014-11-23&rft.aulast=Bayot&rft.aufirst=Asher&rft_id=http%3A%2F%2Fwww.inquisitr.com%2F1629714%2Fu-s-military-robots-to-join-fight-against-ebola%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+robot\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/dx.doi.org\/10.1007\/978-3-319-22891-4\" target=\"_blank\">Medical Robotics Text Book<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/conference.medicalrobots.eu\" target=\"_blank\">Medical Robots Conference<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130128071517\/http:\/\/www.intelligenthospitals.com\/product.html\" target=\"_blank\">Robotic IV Automation - RIVA<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spectrum.ieee.org\/automaton\/robotics\/home-robots\/where-are-the-eldercare-robots\" target=\"_blank\">Where Are the Elder Care Robots?<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/gcis.com.cn\/china-insights-en\/industry-articles-en\/188-notable-chinese-firms-emerging-in-medical-robots-sector\" target=\"_blank\">Notable Chinese Firms Emerging in Medical Robots Sector<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/IEEE\" class=\"mw-redirect\" title=\"IEEE\" rel=\"external_link\" target=\"_blank\">IEEE<\/a>)<\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181207074732\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.224 seconds\nReal time usage: 0.317 seconds\nPreprocessor visited node count: 624\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 47425\/2097152 bytes\nTemplate argument size: 305\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 17478\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.118\/10.000 seconds\nLua memory usage: 3.95 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 254.546 1 -total\n<\/p>\n<pre>44.72% 113.822 1 Template:Reflist\n30.40% 77.385 5 Template:Cite_web\n29.70% 75.598 1 Template:Commons_category\n13.18% 33.554 3 Template:Navbox\n10.91% 27.769 1 Template:Portal\n 7.91% 20.136 1 Template:Mobile_robots\n 6.69% 17.018 1 Template:Commons\n 6.63% 16.882 1 Template:Robotics\n 5.49% 13.974 1 Template:Sister_project\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2912360-1!canonical and timestamp 20181207074732 and revision id 867519335\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_robot\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214629\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.148 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 141.545 1 - wikipedia:Medical_robot\n100.00% 141.545 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8161-0!*!*!*!*!*!* and timestamp 20181217214629 and revision id 24298\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_robot\">https:\/\/www.limswiki.org\/index.php\/Medical_robot<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","dd984888304cc580154ea14150f550ab_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/440px-Laproscopic_Surgery_Robot.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/34px-Animation2.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c5\/Shadow_Hand_Bulb_large.jpg\/200px-Shadow_Hand_Bulb_large.jpg"],"dd984888304cc580154ea14150f550ab_timestamp":1545083189,"493da0ed539f193bbccf9b19a18c1d08_type":"article","493da0ed539f193bbccf9b19a18c1d08_title":"Medical implant","493da0ed539f193bbccf9b19a18c1d08_url":"https:\/\/www.limswiki.org\/index.php\/Implant_(medicine)","493da0ed539f193bbccf9b19a18c1d08_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tImplant (medicine)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\n Orthopedic implants to repair fractures to the radius and ulna. Note the visible break in the ulna. (right forearm)\n An coronary stent \u2014 in this case a drug-eluting stent \u2014 is another common item implanted in humans.\nAn implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure, or enhance an existing biological structure. Medical implants are man-made devices, in contrast to a transplant, which is a transplanted biomedical tissue. The surface of implants that contact the body might be made of a biomedical material such as titanium, silicone, or apatite depending on what is the most functional.[1] In some cases implants contain electronics e.g. artificial pacemaker and cochlear implants. Some implants are bioactive, such as subcutaneous drug delivery devices in the form of implantable pills or drug-eluting stents.[2]\n\nContents \n\n1 Applications \n\n1.1 Sensory and neurological \n1.2 Cardiovascular \n1.3 Orthopedic \n1.4 Contraception \n1.5 Cosmetic \n1.6 Other organs and systems \n\n\n2 Classification \n\n2.1 United States classification \n\n\n3 Complications \n4 Failures \n5 See also \n6 References \n7 External links \n\n\nApplications \nImplants can roughly be categorized into groups by application.\n\nSensory and neurological \nSensory and neurological implants are used for disorders affecting the major senses and the brain, as well as other neurological disorders. They are predominately used in the treatment of conditions such as cataract, glaucoma, keratoconus, and other visual impairments; otosclerosis and other hearing loss issues, as well as middle ear diseases such as otitis media; and neurological diseases such as epilepsy, Parkinson's disease, and treatment-resistant depression. Examples include the intraocular lens, intrastromal corneal ring segment, cochlear implant, tympanostomy tube, and neurostimulator.[1][2][3]\n\nCardiovascular \nCardiovascular medical devices are implanted in cases where the heart, its valves, and the rest of the circulatory system is in disorder. They are used to treat conditions such as heart failure, cardiac arrhythmia, ventricular tachycardia, valvular heart disease, angina pectoris, and atherosclerosis. Examples include the artificial heart, artificial heart valve, implantable cardioverter-defibrillator, cardiac pacemaker, and coronary stent.[1][2][3]\n\nOrthopedic \nOrthopaedic implants help alleviate issues with the bones and joints of the body. They're used to treat bone fractures, osteoarthritis, scoliosis, spinal stenosis, and chronic pain. Examples include a wide variety of pins, rods, screws, and plates used to anchor fractured bones while they heal.[1][2][3]\nMetallic glasses based on magnesium with zinc and calcium addition are tested as the potential metallic biomaterials for biodegradable medical implants.[4][5]\nPatient with orthopaedic implants sometimes need to be put under magnetic resonance imaging (MRI) machine for detailed musculoskeletal study. Therefore, concerns have been raised regarding the loosening and migration of implant, heating of the implant metal which could cause thermal damage to surrounding tissues, and distortion of the MRI scan that affects the imaging results. A study of orthopaedic implants in 2005 has shown that majority of the orthopaedic implants does not react with magnetic fields under the 1.0 Tesla MRI scanning machine with the exception of external fixator clamps.[6] However, at 7.0 Tesla, several orthopaedic implants would show significant interaction with the MRI magnetic fields, such as heel and fibular implant.[7]\n\nContraception \nContraceptive implants are primarily used to prevent unintended pregnancy and treat conditions such as non-pathological forms of menorrhagia. Examples include copper- and hormone-based intrauterine devices.[2][3][8]\n\nCosmetic \nCosmetic implants \u2014 often prosthetics \u2014 attempt to bring some portion of the body back to an acceptable aesthetic norm. They are used as a follow-up to mastectomy due to breast cancer, for correcting some forms of disfigurement, and modifying aspects of the body (as in buttock augmentation and chin augmentation). Examples include the breast implant, nose prosthesis, ocular prosthesis, and injectable filler.[1][2][3]\n\nOther organs and systems \nOther types of organ dysfunction can occur in the systems of the body, including the gastrointestinal, respiratory, and urological systems. Implants are used in those and other locations to treat conditions such as gastroesophageal reflux disease, gastroparesis, respiratory failure, sleep apnea, urinary and fecal incontinence, and erectile dysfunction. Examples include the LINX, implantable gastric stimulator, diaphragmatic\/phrenic nerve stimulator, neurostimulator, surgical mesh, and penile prosthesis.[2][3][9][10][11][12][13]\n\nClassification \nUnited States classification \nMedical devices are classified by the US Food and Drug Administration (FDA) under three different classes depending on the risks the medical device may impose on the user.According to 21CFR 860.3, Class I devices are considered to pose the least amount of risk to the user and require the least amount of control. Class I devices include simple devices such as arm slings and hand-held surgical instruments. Class II devices are considered to need more regulation than Class I devices and are required to undergo specific requirements before FDA approval. Class II devices include X-ray systems and physiological monitors. Class III devices require the most regulatory controls since the device supports or sustains human life or may not be well tested. Class III devices include replacement heart valves and implanted cerebellar stimulators. Many implants typically fall under Class II and Class III devices.[14][15]\n\nComplications \n Complications can arise from implant failure. Internal rupturing of a breast implant can lead to bacterial infection, for example.\nUnder ideal conditions, implants should initiate the desired host response. Ideally, the implant should not cause any undesired reaction from neighboring or distant tissues. However, the interaction between the implant and the tissue surrounding the implant can lead to complications.[1] The process of implantation of medical devices is subjected to the same complications that other invasive medical procedures can have during or after surgery. Common complications include infection, inflammation, and pain. Other complications that can occur include risk of rejection from implant-induced coagulation and allergic foreign body response. Depending on the type of implant, the complications may vary.[1]\nWhen the site of an implant becomes infected during or after surgery, the surrounding tissue becomes infected by microorganisms. Three main categories of infection can occur after operation. Superficial immediate infections are caused by organisms that commonly grow near or on skin. The infection usually occurs at the surgical opening. Deep immediate infection, the second type, occurs immediately after surgery at the site of the implant. Skin-dwelling and airborne bacteria cause deep immediate infection. These bacteria enter the body by attaching to the implant\u2019s surface prior to implantation. Though not common, deep immediate infections can also occur from dormant bacteria from previous infections of the tissue at the implantation site that have been activated from being disturbed during the surgery. The last type, late infection, occurs months to years after the implantation of the implant. Late infections are caused by dormant blood-borne bacteria attached to the implant prior to implantation. The blood-borne bacteria colonize on the implant and eventually get released from it. Depending on the type of material used to make the implant, it may be infused with antibiotics to lower the risk of infections during surgery. However, only certain types of materials can be infused with antibiotics, the use of antibiotic-infused implants runs the risk of rejection by the patient since the patient may develop a sensitivity to the antibiotic, and the antibiotic may not work on the bacteria.[16]\nInflammation, a common occurrence after any surgical procedure, is the body\u2019s response to tissue damage as a result of trauma, infection, intrusion of foreign materials, or local cell death, or as a part of an immune response. Inflammation starts with the rapid dilation of local capillaries to supply the local tissue with blood. The inflow of blood causes the tissue to become swollen and may cause cell death. The excess blood, or edema, can activate pain receptors at the tissue. The site of the inflammation becomes warm from local disturbances of fluid flow and the increased cellular activity to repair the tissue or remove debris from the site.[16]\nImplant-induced coagulation is similar to the coagulation process done within the body to prevent blood loss from damaged blood vessels. However, the coagulation process is triggered from proteins that become attached to the implant surface and lose their shapes. When this occurs, the protein changes conformation and different activation sites become exposed, which may trigger an immune system response where the body attempts to attack the implant to remove the foreign material. The trigger of the immune system response can be accompanied by inflammation. The immune system response may lead to chronic inflammation where the implant is rejected and has to be removed from the body. The immune system may encapsulate the implant as an attempt to remove the foreign material from the site of the tissue by encapsulating the implant in fibrinogen and platelets. The encapsulation of the implant can lead to further complications, since the thick layers of fibrous encapsulation may prevent the implant from performing the desired functions. Bacteria may attack the fibrous encapsulation and become embedded into the fibers. Since the layers of fibers are thick, antibiotics may not be able to reach the bacteria and the bacteria may grow and infect the surrounding tissue. In order to remove the bacteria, the implant would have to be removed. Lastly, the immune system may accept the presence of the implant and repair and remodel the surrounding tissue. Similar responses occur when the body initiates an allergic foreign body response. In the case of an allergic foreign body response, the implant would have to be removed.[17]\n\nFailures \nMain article: Implant failure\nThe many examples of implant failure include rupture of silicone breast implants, hip replacement joints, and artificial heart valves, such as the Bjork\u2013Shiley valve, all of which have caused FDA intervention. The consequences of implant failure depend on the nature of the implant and its position in the body. Thus, heart valve failure is likely to threaten the life of the individual, while breast implant or hip joint failure is less likely to be life-threatening.[1][17][18]\nDevices implanted directly in the grey matter of the brain produce the highest quality signals, but are prone to scar-tissue build-up, causing the signal to become weaker, or even non-existent, as the body reacts to a foreign object in the brain.[19]\nIn 2018, Implant files, an investigation made by ICIJ revealed that medical devices that are unsafe and have not been adequately tested were implanted in patients' bodies. In United Kingdom, Prof Derek Alderson, president of the Royal College of Surgeons, concludes: \"All implantable devices should be registered and tracked to monitor efficacy and patient safety in the long-term.\"[20]\n\nSee also \nBiofunctionalisation\nImplantable devices\nList of orthopedic implants\nMedical device\nProsthesis\n(in French) Implant Files scandal by ICIJ, November 2018.\nReferences \n\n\n^ a b c d e f g h Wong, J.Y.; Bronzino, J.D.; Peterson, D.R., eds. (2012). Biomaterials: Principles and Practices. Boca Raton, Florida: CRC Press. p. 281. ISBN 9781439872512. Retrieved 12 March 2016 . \n\n^ a b c d e f g \"Download Product Code Classification Files\". FDA.org\/medicaldevices. Food and Drug Administration. 4 November 2014. Retrieved 12 March 2016 . Relevant info in the foiclass.zip file. \n\n^ a b c d e f McLatchie, G.; Borley, N.; Chikwe, J., eds. (2013). Oxford Handbook of Clinical Surgery. Oxford, UK: OUP Oxford. p. 794. ISBN 9780199699476. Retrieved 12 March 2016 . \n\n^ Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). \"Resorbable bone fixation alloys, forming, and post-fabrication treatments\". Materials Science and Engineering: C. 70 (1): 870\u2013888. doi:10.1016\/j.msec.2016.09.069. PMID 27770965. \n\n^ Nowosielski R., Cesarz-Andraczke K., Sakiewicz P., Maciej A., Jak\u00f3bik-Kolon A., Babilas R., Corrosion of biocompatible Mg66+XZn30-XCa4 (X=0.2) bulk metallic glasses, Arch. Metall. Mater. 2016 vol. 61 iss. 2, s. 807-810 \n\n^ Ritabh, Kumar; Richard, A Lerski; Stephen, Gandy; Benedict, A Clift; Rami, J Abboud (12 July 2006). \"Safety of orthopedic implants in magnetic resonance imaging: An experimental verification\". Journal of Orthopaedic Research. 24 (9): 1799\u20131802. doi:10.1002\/jor.20213. PMID 16838376. \n\n^ David, X Feng; Joseph, P McCauley (9 November 2015). \"Evaluation of 39 medical implants at 7.0 T\". British Journal of Radiology. 88 (1056): 20150633. doi:10.1259\/bjr.20150633. PMC 4984944 . PMID 26481696. \n\n^ Duke, J.; Barhan, S. (2007). \"Chapter 27: Modern Concepts in Intrauterine Devices\". In Falcone, T.; Hurd, W. Clinical Reproductive Medicine and Surgery. Elsevier Health Sciences. pp. 405\u2013416. ISBN 9780323076593. Retrieved 12 March 2016 . \n\n^ \"Upper G.I. Surgery - Gastroesophageal Reflux Disease (GERD)\". Keck School of Medicine of USC. Retrieved 12 March 2016 . \n\n^ \"Gastric Electrical Stimulation\". The Regents of The University of California. Retrieved 12 March 2016 . \n\n^ \"Chapter 1, Part 2, Section 160.19: Phrenic Nerve Stimulator\". Medicare National Coverage Determinations Manual (PDF) . Centers for Medicare and Medicaid Services. 27 March 2015. Retrieved 19 February 2016 . \n\n^ Simmons M, Montague D (2008). \"Penile prosthesis implantation: past, present, and future\". International Journal of Impotence Research. 20 (5): 437\u2013444. doi:10.1038\/ijir.2008.11. PMID 18385678. \n\n^ Hjort, H; Mathisen, T; Alves, A; Clermont, G; Boutrand, JP (April 2012). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". Hernia. 16 (2): 191\u20137. doi:10.1007\/s10029-011-0885-y. PMC 3895198 . PMID 21972049. \n\n^ Syring, G. (6 May 2003). \"Overview: FDA Regulation of Medical Devices\". Quality and Regulatory Associates, LLC. Retrieved 12 March 2016 . \n\n^ \"Classify Your Medical Device\". FDA.gov\/MedicalDevices. Food and Drug Administration. 29 July 2014. Retrieved 12 March 2016 . \n\n^ a b Black, J. (2006). Biological Performance of Materials: Fundamentals of Biocompatibility. Boca Raton, Florida: CRC Press. p. 520. ISBN 9780849339592. Retrieved 12 March 2016 . \n\n^ a b Dee, K.C.; Puleo, D.A.; Bizios, R. (2002). An Introduction to Tissue-Biomaterial Interactions. Hoboken, NJ: Wiley-Liss. p. 248. ISBN 9780471461128. Retrieved 12 March 2016 . \n\n^ Wagenberg, B.; Froum, S.J. (2006). \"A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004\". The International Journal of Oral & Maxillofacial Implants. 21 (1): 71\u201380. PMID 16519184. \n\n^ Polikov, Vadim S.; Patrick A. Tresco & William M. Reichert (2005). \"Response of brain tissue to chronically implanted neural electrodes\". Journal of Neuroscience Methods. 148 (1): 1\u201318. doi:10.1016\/j.jneumeth.2005.08.015. PMID 16198003. \n\n^ BBC: Patients given unsafe medical implants \n\n\nExternal links \nAAOMS - Dental Implant Surgery\nACOG - IUDs and Birth Control Implants: Resource Overview\nFDA - Implants and Prosthetics\nInternational Medical Devices Database \u2013 Recalls, Safety Alerts and Field Safety Notices of medical devices \u2013 International Consortium of Investigative Journalists\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Implant_(medicine)\">https:\/\/www.limswiki.org\/index.php\/Implant_(medicine)<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:59.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,319 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","493da0ed539f193bbccf9b19a18c1d08_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Implant_medicine skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Implant (medicine)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray3.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/89\/X-ray3.jpg\/220px-X-ray3.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray3.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Orthopedic implants to repair fractures to the radius and ulna. Note the visible break in the ulna. (right forearm)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:352px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Taxus_stent_FDA.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Taxus_stent_FDA.jpg\/350px-Taxus_stent_FDA.jpg\" width=\"350\" height=\"256\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Taxus_stent_FDA.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_stent\" title=\"Coronary stent\" rel=\"external_link\" target=\"_blank\">coronary stent<\/a> \u2014 in this case a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug-eluting_stent\" title=\"Drug-eluting stent\" rel=\"external_link\" target=\"_blank\">drug-eluting stent<\/a> \u2014 is another common item implanted in humans.<\/div><\/div><\/div>\n<p>An <b>implant<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> manufactured to replace a missing biological structure, support a damaged biological structure, or enhance an existing biological structure. Medical implants are man-made devices, in contrast to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_transplant\" class=\"mw-redirect\" title=\"Organ transplant\" rel=\"external_link\" target=\"_blank\">transplant<\/a>, which is a transplanted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_tissue\" title=\"Biomedical tissue\" rel=\"external_link\" target=\"_blank\">biomedical tissue<\/a>. The surface of implants that contact the body might be made of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">biomedical material<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apatite\" title=\"Apatite\" rel=\"external_link\" target=\"_blank\">apatite<\/a> depending on what is the most functional.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-0\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup> In some cases implants contain electronics e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_pacemaker\" class=\"mw-redirect\" title=\"Artificial pacemaker\" rel=\"external_link\" target=\"_blank\">artificial pacemaker<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implants<\/a>. Some implants are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_activity\" title=\"Biological activity\" rel=\"external_link\" target=\"_blank\">bioactive<\/a>, such as subcutaneous drug delivery devices in the form of implantable pills or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug-eluting_stent\" title=\"Drug-eluting stent\" rel=\"external_link\" target=\"_blank\">drug-eluting stents<\/a>.<sup id=\"rdp-ebb-cite_ref-FDAClassDB_2-0\" class=\"reference\"><a href=\"#cite_note-FDAClassDB-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Implants can roughly be categorized into groups by application.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sensory_and_neurological\">Sensory and neurological<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Perception\" title=\"Perception\" rel=\"external_link\" target=\"_blank\">Sensory<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurotechnology#Implant_technologies\" title=\"Neurotechnology\" rel=\"external_link\" target=\"_blank\">neurological<\/a> implants are used for disorders affecting the major senses and the brain, as well as other neurological disorders. They are predominately used in the treatment of conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract\" title=\"Cataract\" rel=\"external_link\" target=\"_blank\">cataract<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keratoconus\" title=\"Keratoconus\" rel=\"external_link\" target=\"_blank\">keratoconus<\/a>, and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_impairment\" title=\"Visual impairment\" rel=\"external_link\" target=\"_blank\">visual impairments<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otosclerosis\" title=\"Otosclerosis\" rel=\"external_link\" target=\"_blank\">otosclerosis<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_loss\" title=\"Hearing loss\" rel=\"external_link\" target=\"_blank\">hearing loss<\/a> issues, as well as middle ear diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otitis media<\/a>; and neurological diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Treatment-resistant_depression\" title=\"Treatment-resistant depression\" rel=\"external_link\" target=\"_blank\">treatment-resistant depression<\/a>. Examples include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraocular_lens\" title=\"Intraocular lens\" rel=\"external_link\" target=\"_blank\">intraocular lens<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrastromal_corneal_ring_segment\" title=\"Intrastromal corneal ring segment\" rel=\"external_link\" target=\"_blank\">intrastromal corneal ring segment<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implant<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tympanostomy_tube\" title=\"Tympanostomy tube\" rel=\"external_link\" target=\"_blank\">tympanostomy tube<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurostimulation\" title=\"Neurostimulation\" rel=\"external_link\" target=\"_blank\">neurostimulator<\/a>.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-1\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAClassDB_2-1\" class=\"reference\"><a href=\"#cite_note-FDAClassDB-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-McLatchieOx13_3-0\" class=\"reference\"><a href=\"#cite_note-McLatchieOx13-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cardiovascular\">Cardiovascular<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">Cardiovascular<\/a> medical devices are implanted in cases where the heart, its valves, and the rest of the circulatory system is in disorder. They are used to treat conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_failure\" title=\"Heart failure\" rel=\"external_link\" target=\"_blank\">heart failure<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_arrhythmia\" class=\"mw-redirect\" title=\"Cardiac arrhythmia\" rel=\"external_link\" target=\"_blank\">cardiac arrhythmia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_tachycardia\" title=\"Ventricular tachycardia\" rel=\"external_link\" target=\"_blank\">ventricular tachycardia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Valvular_heart_disease\" title=\"Valvular heart disease\" rel=\"external_link\" target=\"_blank\">valvular heart disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angina_pectoris\" class=\"mw-redirect\" title=\"Angina pectoris\" rel=\"external_link\" target=\"_blank\">angina pectoris<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>. Examples include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart\" title=\"Artificial heart\" rel=\"external_link\" target=\"_blank\">artificial heart<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">artificial heart valve<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implantable_cardioverter-defibrillator\" title=\"Implantable cardioverter-defibrillator\" rel=\"external_link\" target=\"_blank\">implantable cardioverter-defibrillator<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">cardiac pacemaker<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_stent\" title=\"Coronary stent\" rel=\"external_link\" target=\"_blank\">coronary stent<\/a>.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-2\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAClassDB_2-2\" class=\"reference\"><a href=\"#cite_note-FDAClassDB-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-McLatchieOx13_3-1\" class=\"reference\"><a href=\"#cite_note-McLatchieOx13-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Orthopedic\">Orthopedic<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">Orthopaedic<\/a> implants help alleviate issues with the bones and joints of the body. They're used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_fracture\" title=\"Bone fracture\" rel=\"external_link\" target=\"_blank\">bone fractures<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scoliosis\" title=\"Scoliosis\" rel=\"external_link\" target=\"_blank\">scoliosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_stenosis\" title=\"Spinal stenosis\" rel=\"external_link\" target=\"_blank\">spinal stenosis<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\" title=\"Chronic pain\" rel=\"external_link\" target=\"_blank\">chronic pain<\/a>. Examples include a wide variety of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_fixator\" class=\"mw-redirect\" title=\"Internal fixator\" rel=\"external_link\" target=\"_blank\">pins, rods, screws, and plates<\/a> used to anchor fractured bones while they heal.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-3\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAClassDB_2-3\" class=\"reference\"><a href=\"#cite_note-FDAClassDB-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-McLatchieOx13_3-2\" class=\"reference\"><a href=\"#cite_note-McLatchieOx13-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Metallic glasses based on magnesium with zinc and calcium addition are tested as the potential metallic biomaterials for biodegradable medical implants.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Patient with orthopaedic implants sometimes need to be put under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">magnetic resonance imaging<\/a> (MRI) machine for detailed musculoskeletal study. Therefore, concerns have been raised regarding the loosening and migration of implant, heating of the implant metal which could cause thermal damage to surrounding tissues, and distortion of the MRI scan that affects the imaging results. A study of orthopaedic implants in 2005 has shown that majority of the orthopaedic implants does not react with magnetic fields under the 1.0 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">Tesla<\/a> MRI scanning machine with the exception of external fixator clamps.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> However, at 7.0 Tesla, several orthopaedic implants would show significant interaction with the MRI magnetic fields, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heel\" title=\"Heel\" rel=\"external_link\" target=\"_blank\">heel<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibula\" title=\"Fibula\" rel=\"external_link\" target=\"_blank\">fibular<\/a> implant.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Contraception\">Contraception<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Birth_control\" title=\"Birth control\" rel=\"external_link\" target=\"_blank\">Contraceptive<\/a> implants are primarily used to prevent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unintended_pregnancy\" title=\"Unintended pregnancy\" rel=\"external_link\" target=\"_blank\">unintended pregnancy<\/a> and treat conditions such as non-pathological forms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Menorrhagia\" class=\"mw-redirect\" title=\"Menorrhagia\" rel=\"external_link\" target=\"_blank\">menorrhagia<\/a>. Examples include <a href=\"https:\/\/en.wikipedia.org\/wiki\/IUD_with_copper\" class=\"mw-redirect\" title=\"IUD with copper\" rel=\"external_link\" target=\"_blank\">copper<\/a>- and <a href=\"https:\/\/en.wikipedia.org\/wiki\/IUD_with_progestogen\" class=\"mw-redirect\" title=\"IUD with progestogen\" rel=\"external_link\" target=\"_blank\">hormone<\/a>-based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrauterine_device\" title=\"Intrauterine device\" rel=\"external_link\" target=\"_blank\">intrauterine devices<\/a>.<sup id=\"rdp-ebb-cite_ref-FDAClassDB_2-4\" class=\"reference\"><a href=\"#cite_note-FDAClassDB-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-McLatchieOx13_3-3\" class=\"reference\"><a href=\"#cite_note-McLatchieOx13-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FalconeClin07_8-0\" class=\"reference\"><a href=\"#cite_note-FalconeClin07-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cosmetic\">Cosmetic<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">Cosmetic<\/a> implants \u2014 often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthetics\" class=\"mw-redirect\" title=\"Prosthetics\" rel=\"external_link\" target=\"_blank\">prosthetics<\/a> \u2014 attempt to bring some portion of the body back to an acceptable aesthetic norm. They are used as a follow-up to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastectomy\" title=\"Mastectomy\" rel=\"external_link\" target=\"_blank\">mastectomy<\/a> due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a>, for correcting some forms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disfigurement\" title=\"Disfigurement\" rel=\"external_link\" target=\"_blank\">disfigurement<\/a>, and modifying aspects of the body (as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buttock_augmentation\" title=\"Buttock augmentation\" rel=\"external_link\" target=\"_blank\">buttock augmentation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chin_augmentation\" title=\"Chin augmentation\" rel=\"external_link\" target=\"_blank\">chin augmentation<\/a>). Examples include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implant\" title=\"Breast implant\" rel=\"external_link\" target=\"_blank\">breast implant<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nose_prosthesis\" title=\"Nose prosthesis\" rel=\"external_link\" target=\"_blank\">nose prosthesis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ocular_prosthesis\" title=\"Ocular prosthesis\" rel=\"external_link\" target=\"_blank\">ocular prosthesis<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injectable_filler\" title=\"Injectable filler\" rel=\"external_link\" target=\"_blank\">injectable filler<\/a>.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-4\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAClassDB_2-5\" class=\"reference\"><a href=\"#cite_note-FDAClassDB-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-McLatchieOx13_3-4\" class=\"reference\"><a href=\"#cite_note-McLatchieOx13-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_organs_and_systems\">Other organs and systems<\/span><\/h3>\n<p>Other types of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_dysfunction\" title=\"Organ dysfunction\" rel=\"external_link\" target=\"_blank\">organ dysfunction<\/a> can occur in the systems of the body, including the gastrointestinal, respiratory, and urological systems. Implants are used in those and other locations to treat conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastroesophageal_reflux_disease\" title=\"Gastroesophageal reflux disease\" rel=\"external_link\" target=\"_blank\">gastroesophageal reflux disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastroparesis\" title=\"Gastroparesis\" rel=\"external_link\" target=\"_blank\">gastroparesis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_failure\" title=\"Respiratory failure\" rel=\"external_link\" target=\"_blank\">respiratory failure<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sleep_apnea\" title=\"Sleep apnea\" rel=\"external_link\" target=\"_blank\">sleep apnea<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_incontinence\" title=\"Urinary incontinence\" rel=\"external_link\" target=\"_blank\">urinary<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fecal_incontinence\" title=\"Fecal incontinence\" rel=\"external_link\" target=\"_blank\">fecal incontinence<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erectile_dysfunction\" title=\"Erectile dysfunction\" rel=\"external_link\" target=\"_blank\">erectile dysfunction<\/a>. Examples include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastroesophageal_reflux_disease#Surgery\" title=\"Gastroesophageal reflux disease\" rel=\"external_link\" target=\"_blank\">LINX<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implantable_gastric_stimulation\" class=\"mw-redirect\" title=\"Implantable gastric stimulation\" rel=\"external_link\" target=\"_blank\">implantable gastric stimulator<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diaphragm_pacing\" title=\"Diaphragm pacing\" rel=\"external_link\" target=\"_blank\">diaphragmatic\/phrenic nerve stimulator<\/a>, neurostimulator, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_mesh\" title=\"Surgical mesh\" rel=\"external_link\" target=\"_blank\">surgical mesh<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penile_prosthesis\" title=\"Penile prosthesis\" rel=\"external_link\" target=\"_blank\">penile prosthesis<\/a>.<sup id=\"rdp-ebb-cite_ref-FDAClassDB_2-6\" class=\"reference\"><a href=\"#cite_note-FDAClassDB-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-McLatchieOx13_3-5\" class=\"reference\"><a href=\"#cite_note-McLatchieOx13-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-USCLINX_9-0\" class=\"reference\"><a href=\"#cite_note-USCLINX-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-UCSFGastStim_10-0\" class=\"reference\"><a href=\"#cite_note-UCSFGastStim-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-CMSNatCovMan_11-0\" class=\"reference\"><a href=\"#cite_note-CMSNatCovMan-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SimmonsPenile08_12-0\" class=\"reference\"><a href=\"#cite_note-SimmonsPenile08-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HjortThree12_13-0\" class=\"reference\"><a href=\"#cite_note-HjortThree12-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Classification\">Classification<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"United_States_classification\">United States classification<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_devices\" class=\"mw-redirect\" title=\"Medical devices\" rel=\"external_link\" target=\"_blank\">Medical devices<\/a> are classified by the US <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) under three different classes depending on the risks the medical device may impose on the user.According to 21CFR 860.3, Class I devices are considered to pose the least amount of risk to the user and require the least amount of control. Class I devices include simple devices such as arm slings and hand-held <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instruments\" class=\"mw-redirect\" title=\"Surgical instruments\" rel=\"external_link\" target=\"_blank\">surgical instruments<\/a>. Class II devices are considered to need more regulation than Class I devices and are required to undergo specific requirements before FDA approval. Class II devices include X-ray systems and physiological monitors. Class III devices require the most regulatory controls since the device supports or sustains human life or may not be well tested. Class III devices include replacement <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valves\" class=\"mw-redirect\" title=\"Heart valves\" rel=\"external_link\" target=\"_blank\">heart valves<\/a> and implanted cerebellar stimulators. Many implants typically fall under Class II and Class III devices.<sup id=\"rdp-ebb-cite_ref-SyringOver03_14-0\" class=\"reference\"><a href=\"#cite_note-SyringOver03-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDAClassify_15-0\" class=\"reference\"><a href=\"#cite_note-FDAClassify-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ruptured_implant.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/52\/Ruptured_implant.JPG\/300px-Ruptured_implant.JPG\" width=\"300\" height=\"225\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ruptured_implant.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Complications can arise from implant failure. Internal rupturing of a breast implant can lead to bacterial infection, for example.<\/div><\/div><\/div>\n<p>Under ideal conditions, implants should initiate the desired <a href=\"https:\/\/en.wikipedia.org\/wiki\/Host_response\" class=\"mw-redirect\" title=\"Host response\" rel=\"external_link\" target=\"_blank\">host response<\/a>. Ideally, the implant should not cause any undesired reaction from neighboring or distant tissues. However, the interaction between the implant and the tissue surrounding the implant can lead to complications.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-5\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup> The process of implantation of medical devices is subjected to the same complications that other invasive medical procedures can have during or after surgery. Common complications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a>. Other complications that can occur include risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transplant_rejection\" title=\"Transplant rejection\" rel=\"external_link\" target=\"_blank\">rejection<\/a> from implant-induced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">coagulation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body_response\" class=\"mw-redirect\" title=\"Foreign body response\" rel=\"external_link\" target=\"_blank\">allergic foreign body response<\/a>. Depending on the type of implant, the complications may vary.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-6\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>When the site of an implant becomes infected during or after surgery, the surrounding tissue becomes infected by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microorganisms\" class=\"mw-redirect\" title=\"Microorganisms\" rel=\"external_link\" target=\"_blank\">microorganisms<\/a>. Three main categories of infection can occur after operation. Superficial immediate infections are caused by organisms that commonly grow near or on skin. The infection usually occurs at the surgical opening. Deep immediate infection, the second type, occurs immediately after surgery at the site of the implant. Skin-dwelling and airborne <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacteria\" title=\"Bacteria\" rel=\"external_link\" target=\"_blank\">bacteria<\/a> cause deep immediate infection. These bacteria enter the body by attaching to the implant\u2019s surface prior to implantation. Though not common, deep immediate infections can also occur from dormant bacteria from previous infections of the tissue at the implantation site that have been activated from being disturbed during the surgery. The last type, late infection, occurs months to years after the implantation of the implant. Late infections are caused by dormant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood-borne\" class=\"mw-redirect\" title=\"Blood-borne\" rel=\"external_link\" target=\"_blank\">blood-borne<\/a> bacteria attached to the implant prior to implantation. The blood-borne bacteria colonize on the implant and eventually get released from it. Depending on the type of material used to make the implant, it may be infused with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotic\" title=\"Antibiotic\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a> to lower the risk of infections during surgery. However, only certain types of materials can be infused with antibiotics, the use of antibiotic-infused implants runs the risk of rejection by the patient since the patient may develop a sensitivity to the antibiotic, and the antibiotic may not work on the bacteria.<sup id=\"rdp-ebb-cite_ref-BlackBio06_16-0\" class=\"reference\"><a href=\"#cite_note-BlackBio06-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Inflammation, a common occurrence after any surgical procedure, is the body\u2019s response to tissue damage as a result of trauma, infection, intrusion of foreign materials, or local <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_death\" title=\"Cell death\" rel=\"external_link\" target=\"_blank\">cell death<\/a>, or as a part of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_system\" title=\"Immune system\" rel=\"external_link\" target=\"_blank\">immune response<\/a>. Inflammation starts with the rapid dilation of local <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capillary\" title=\"Capillary\" rel=\"external_link\" target=\"_blank\">capillaries<\/a> to supply the local tissue with blood. The inflow of blood causes the tissue to become swollen and may cause cell death. The excess blood, or edema, can activate pain receptors at the tissue. The site of the inflammation becomes warm from local disturbances of fluid flow and the increased cellular activity to repair the tissue or remove debris from the site.<sup id=\"rdp-ebb-cite_ref-BlackBio06_16-1\" class=\"reference\"><a href=\"#cite_note-BlackBio06-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Implant-induced coagulation is similar to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation#Physiology\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">coagulation process<\/a> done within the body to prevent blood loss from damaged blood vessels. However, the coagulation process is triggered from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein\" title=\"Protein\" rel=\"external_link\" target=\"_blank\">proteins<\/a> that become attached to the implant surface and lose their shapes. When this occurs, the protein changes conformation and different activation sites become exposed, which may trigger an immune system response where the body attempts to attack the implant to remove the foreign material. The trigger of the immune system response can be accompanied by inflammation. The immune system response may lead to chronic inflammation where the implant is rejected and has to be removed from the body. The immune system may encapsulate the implant as an attempt to remove the foreign material from the site of the tissue by encapsulating the implant in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibrinogen\" title=\"Fibrinogen\" rel=\"external_link\" target=\"_blank\">fibrinogen<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platelet\" title=\"Platelet\" rel=\"external_link\" target=\"_blank\">platelets<\/a>. The encapsulation of the implant can lead to further complications, since the thick layers of fibrous encapsulation may prevent the implant from performing the desired functions. Bacteria may attack the fibrous encapsulation and become embedded into the fibers. Since the layers of fibers are thick, antibiotics may not be able to reach the bacteria and the bacteria may grow and infect the surrounding tissue. In order to remove the bacteria, the implant would have to be removed. Lastly, the immune system may accept the presence of the implant and repair and remodel the surrounding tissue. Similar responses occur when the body initiates an allergic foreign body response. In the case of an allergic foreign body response, the implant would have to be removed.<sup id=\"rdp-ebb-cite_ref-DeeAnIntro02_17-0\" class=\"reference\"><a href=\"#cite_note-DeeAnIntro02-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Failures\">Failures<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_failure\" title=\"Implant failure\" rel=\"external_link\" target=\"_blank\">Implant failure<\/a><\/div>\n<p>The many examples of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_failure\" title=\"Implant failure\" rel=\"external_link\" target=\"_blank\">implant failure<\/a> include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implant#Implant_rupture\" title=\"Breast implant\" rel=\"external_link\" target=\"_blank\">rupture<\/a> of silicone <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implant\" title=\"Breast implant\" rel=\"external_link\" target=\"_blank\">breast implants<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a> joints, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valves\" class=\"mw-redirect\" title=\"Artificial heart valves\" rel=\"external_link\" target=\"_blank\">artificial heart valves<\/a>, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bjork%E2%80%93Shiley_valve\" title=\"Bjork\u2013Shiley valve\" rel=\"external_link\" target=\"_blank\">Bjork\u2013Shiley valve<\/a>, all of which have caused FDA intervention. The consequences of implant failure depend on the nature of the implant and its position in the body. Thus, heart valve failure is likely to threaten the life of the individual, while breast implant or hip joint failure is less likely to be life-threatening.<sup id=\"rdp-ebb-cite_ref-WongBio12_1-7\" class=\"reference\"><a href=\"#cite_note-WongBio12-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DeeAnIntro02_17-1\" class=\"reference\"><a href=\"#cite_note-DeeAnIntro02-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-WagenbergARetro06_18-0\" class=\"reference\"><a href=\"#cite_note-WagenbergARetro06-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>Devices implanted directly in the grey matter of the brain produce the highest quality signals, but are prone to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar-tissue<\/a> build-up, causing the signal to become weaker, or even non-existent, as the body reacts to a foreign object in the brain.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>In 2018, <i>Implant files<\/i>, an investigation made by <a href=\"https:\/\/en.wikipedia.org\/wiki\/ICIJ\" class=\"mw-redirect\" title=\"ICIJ\" rel=\"external_link\" target=\"_blank\">ICIJ<\/a> revealed that medical devices that are unsafe and have not been adequately tested were implanted in patients' bodies. In United Kingdom, Prof Derek Alderson, president of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Royal_College_of_Surgeons\" title=\"Royal College of Surgeons\" rel=\"external_link\" target=\"_blank\">Royal College of Surgeons<\/a>, concludes: \"All implantable devices should be registered and tracked to monitor efficacy and patient safety in the long-term.\"<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofunctionalisation\" title=\"Biofunctionalisation\" rel=\"external_link\" target=\"_blank\">Biofunctionalisation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:Implants_(medicine)\" title=\"Category:Implants (medicine)\" rel=\"external_link\" target=\"_blank\">Implantable devices<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_orthopedic_implants\" title=\"List of orthopedic implants\" rel=\"external_link\" target=\"_blank\">List of orthopedic implants<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Medical device<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">Prosthesis<\/a><\/li>\n<li><span class=\"languageicon\">(in French)<\/span><a href=\"https:\/\/fr.wikipedia.org\/wiki\/Implant_Files\" class=\"extiw\" title=\"fr:Implant Files\" rel=\"external_link\" target=\"_blank\">Implant Files<\/a> scandal by <a href=\"https:\/\/en.wikipedia.org\/wiki\/ICIJ\" class=\"mw-redirect\" title=\"ICIJ\" rel=\"external_link\" target=\"_blank\">ICIJ<\/a>, November 2018.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-WongBio12-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-WongBio12_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WongBio12_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WongBio12_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WongBio12_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WongBio12_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WongBio12_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WongBio12_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WongBio12_1-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Wong, J.Y.; Bronzino, J.D.; Peterson, D.R., eds. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=mE9iK9UibNAC&printsec=frontcover\" target=\"_blank\"><i>Biomaterials: Principles and Practices<\/i><\/a>. Boca Raton, Florida: CRC Press. p. 281. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781439872512<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biomaterials%3A+Principles+and+Practices&rft.place=Boca+Raton%2C+Florida&rft.pages=281&rft.pub=CRC+Press&rft.date=2012&rft.isbn=9781439872512&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DmE9iK9UibNAC%26printsec%3Dfrontcover&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FDAClassDB-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDAClassDB_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAClassDB_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAClassDB_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAClassDB_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAClassDB_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAClassDB_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDAClassDB_2-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/Overview\/ClassifyYourDevice\/ucm051668.htm\" target=\"_blank\">\"Download Product Code Classification Files\"<\/a>. <i>FDA.org\/medicaldevices<\/i>. Food and Drug Administration. 4 November 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>. <q>Relevant info in the foiclass.zip file.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA.org%2Fmedicaldevices&rft.atitle=Download+Product+Code+Classification+Files&rft.date=2014-11-04&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FOverview%2FClassifyYourDevice%2Fucm051668.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-McLatchieOx13-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-McLatchieOx13_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-McLatchieOx13_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-McLatchieOx13_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-McLatchieOx13_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-McLatchieOx13_3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-McLatchieOx13_3-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">McLatchie, G.; Borley, N.; Chikwe, J., eds. (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=UaLIRStfy6IC&printsec=frontcover\" target=\"_blank\"><i>Oxford Handbook of Clinical Surgery<\/i><\/a>. Oxford, UK: OUP Oxford. p. 794. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780199699476<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Oxford+Handbook+of+Clinical+Surgery&rft.place=Oxford%2C+UK&rft.pages=794&rft.pub=OUP+Oxford&rft.date=2013&rft.isbn=9780199699476&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DUaLIRStfy6IC%26printsec%3Dfrontcover&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S092849311631534X\" target=\"_blank\">\"Resorbable bone fixation alloys, forming, and post-fabrication treatments\"<\/a>. <i>Materials Science and Engineering: C<\/i>. <b>70<\/b> (1): 870\u2013888. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.msec.2016.09.069\" target=\"_blank\">10.1016\/j.msec.2016.09.069<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27770965\" target=\"_blank\">27770965<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Science+and+Engineering%3A+C&rft.atitle=Resorbable+bone+fixation+alloys%2C+forming%2C+and+post-fabrication+treatments&rft.volume=70&rft.issue=1&rft.pages=870-888&rft.date=2017-01&rft_id=info%3Adoi%2F10.1016%2Fj.msec.2016.09.069&rft_id=info%3Apmid%2F27770965&rft.aulast=Ibrahim&rft.aufirst=H.&rft.au=Esfahani%2C+S.+N.&rft.au=Poorganji%2C+B.&rft.au=Dean%2C+D.&rft.au=Elahinia%2C+M.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS092849311631534X&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Nowosielski R., Cesarz-Andraczke K., Sakiewicz P., Maciej A., Jak\u00f3bik-Kolon A., Babilas R., <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.degruyter.com\/downloadpdf\/j\/amm.2016.61.issue-2\/amm-2016-0136\/amm-2016-0136.xml\" target=\"_blank\">Corrosion of biocompatible Mg66+XZn30-XCa4 (X=0.2) bulk metallic glasses<\/a>, Arch. 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Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Gastric+Electrical+Stimulation&rft.pub=The+Regents+of+The+University+of+California&rft_id=https%3A%2F%2Fwww.ucsfhealth.org%2Ftreatments%2Fgastric_electrical_stimulation%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CMSNatCovMan-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CMSNatCovMan_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">\"Chapter 1, Part 2, Section 160.19: Phrenic Nerve Stimulator\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cms.gov\/Regulations-and-Guidance\/Guidance\/Manuals\/Downloads\/ncd103c1_Part2.pdf\" target=\"_blank\"><i>Medicare National Coverage Determinations Manual<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. 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Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+1%2C+Part+2%2C+Section+160.19%3A+Phrenic+Nerve+Stimulator&rft.btitle=Medicare+National+Coverage+Determinations+Manual&rft.pub=Centers+for+Medicare+and+Medicaid+Services&rft.date=2015-03-27&rft_id=https%3A%2F%2Fwww.cms.gov%2FRegulations-and-Guidance%2FGuidance%2FManuals%2FDownloads%2Fncd103c1_Part2.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SimmonsPenile08-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SimmonsPenile08_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Simmons M, Montague D (2008). \"Penile prosthesis implantation: past, present, and future\". <i>International Journal of Impotence Research<\/i>. <b>20<\/b> (5): 437\u2013444. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fijir.2008.11\" target=\"_blank\">10.1038\/ijir.2008.11<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18385678\" target=\"_blank\">18385678<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Impotence+Research&rft.atitle=Penile+prosthesis+implantation%3A+past%2C+present%2C+and+future&rft.volume=20&rft.issue=5&rft.pages=437-444&rft.date=2008&rft_id=info%3Adoi%2F10.1038%2Fijir.2008.11&rft_id=info%3Apmid%2F18385678&rft.au=Simmons+M%2C+Montague+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HjortThree12-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HjortThree12_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hjort, H; Mathisen, T; Alves, A; Clermont, G; Boutrand, JP (April 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3895198\" target=\"_blank\">\"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\"<\/a>. <i>Hernia<\/i>. <b>16<\/b> (2): 191\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10029-011-0885-y\" target=\"_blank\">10.1007\/s10029-011-0885-y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3895198\" target=\"_blank\">3895198<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21972049\" target=\"_blank\">21972049<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hernia&rft.atitle=Three-year+results+from+a+preclinical+implantation+study+of+a+long-term+resorbable+surgical+mesh+with+time-dependent+mechanical+characteristics&rft.volume=16&rft.issue=2&rft.pages=191-7&rft.date=2012-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3895198&rft_id=info%3Apmid%2F21972049&rft_id=info%3Adoi%2F10.1007%2Fs10029-011-0885-y&rft.aulast=Hjort&rft.aufirst=H&rft.au=Mathisen%2C+T&rft.au=Alves%2C+A&rft.au=Clermont%2C+G&rft.au=Boutrand%2C+JP&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3895198&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SyringOver03-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SyringOver03_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Syring, G. (6 May 2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.qrasupport.com\/FDA_MED_DEVICE.html\" target=\"_blank\">\"Overview: FDA Regulation of Medical Devices\"<\/a>. Quality and Regulatory Associates, LLC<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Overview%3A+FDA+Regulation+of+Medical+Devices&rft.pub=Quality+and+Regulatory+Associates%2C+LLC&rft.date=2003-05-06&rft.au=Syring%2C+G.&rft_id=http%3A%2F%2Fwww.qrasupport.com%2FFDA_MED_DEVICE.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDAClassify-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDAClassify_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/Overview\/ClassifyYourDevice\/\" target=\"_blank\">\"Classify Your Medical Device\"<\/a>. <i>FDA.gov\/MedicalDevices<\/i>. Food and Drug Administration. 29 July 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA.gov%2FMedicalDevices&rft.atitle=Classify+Your+Medical+Device&rft.date=2014-07-29&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FOverview%2FClassifyYourDevice%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BlackBio06-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BlackBio06_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BlackBio06_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Black, J. (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=2kDLx3mKm1EC&printsec=frontcover\" target=\"_blank\"><i>Biological Performance of Materials: Fundamentals of Biocompatibility<\/i><\/a>. Boca Raton, Florida: CRC Press. p. 520. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780849339592<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biological+Performance+of+Materials%3A+Fundamentals+of+Biocompatibility&rft.place=Boca+Raton%2C+Florida&rft.pages=520&rft.pub=CRC+Press&rft.date=2006&rft.isbn=9780849339592&rft.au=Black%2C+J.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D2kDLx3mKm1EC%26printsec%3Dfrontcover&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-DeeAnIntro02-17\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-DeeAnIntro02_17-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DeeAnIntro02_17-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Dee, K.C.; Puleo, D.A.; Bizios, R. (2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=KEXVyjO8KQIC&printsec=frontcover\" target=\"_blank\"><i>An Introduction to Tissue-Biomaterial Interactions<\/i><\/a>. Hoboken, NJ: Wiley-Liss. p. 248. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780471461128<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=An+Introduction+to+Tissue-Biomaterial+Interactions&rft.place=Hoboken%2C+NJ&rft.pages=248&rft.pub=Wiley-Liss&rft.date=2002&rft.isbn=9780471461128&rft.au=Dee%2C+K.C.&rft.au=Puleo%2C+D.A.&rft.au=Bizios%2C+R.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DKEXVyjO8KQIC%26printsec%3Dfrontcover&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-WagenbergARetro06-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-WagenbergARetro06_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wagenberg, B.; Froum, S.J. (2006). \"A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004\". <i>The International Journal of Oral & Maxillofacial Implants<\/i>. <b>21<\/b> (1): 71\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16519184\" target=\"_blank\">16519184<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Oral+%26+Maxillofacial+Implants&rft.atitle=A+retrospective+study+of+1925+consecutively+placed+immediate+implants+from+1988+to+2004&rft.volume=21&rft.issue=1&rft.pages=71-80&rft.date=2006&rft_id=info%3Apmid%2F16519184&rft.aulast=Wagenberg&rft.aufirst=B.&rft.au=Froum%2C+S.J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Polikov, Vadim S.; Patrick A. Tresco & William M. Reichert (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0165027005002931\" target=\"_blank\">\"Response of brain tissue to chronically implanted neural electrodes\"<\/a>. <i>Journal of Neuroscience Methods<\/i>. <b>148<\/b> (1): 1\u201318. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jneumeth.2005.08.015\" target=\"_blank\">10.1016\/j.jneumeth.2005.08.015<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16198003\" target=\"_blank\">16198003<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neuroscience+Methods&rft.atitle=Response+of+brain+tissue+to+chronically+implanted+neural+electrodes&rft.volume=148&rft.issue=1&rft.pages=1-18&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fj.jneumeth.2005.08.015&rft_id=info%3Apmid%2F16198003&rft.au=Polikov%2C+Vadim+S.&rft.au=Patrick+A.+Tresco&rft.au=William+M.+Reichert&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0165027005002931&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bbc.com\/news\/health-46318445\" target=\"_blank\">BBC: Patients given unsafe medical implants<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.aaoms.org\/dental_implants.php\" target=\"_blank\">AAOMS - Dental Implant Surgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.acog.org\/Womens-Health\/IUDs-and-Birth-Control-Implants\" target=\"_blank\">ACOG - IUDs and Birth Control Implants: Resource Overview<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ImplantsandProsthetics\/default.htm\" target=\"_blank\">FDA - Implants and Prosthetics<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/medicaldevices.icij.org\/\" target=\"_blank\">International Medical Devices Database<\/a> \u2013 Recalls, Safety Alerts and Field Safety Notices of medical devices \u2013 <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Consortium_of_Investigative_Journalists\" title=\"International Consortium of Investigative Journalists\" rel=\"external_link\" target=\"_blank\">International Consortium of Investigative Journalists<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1267\nCached time: 20181215165011\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.492 seconds\nReal time usage: 0.608 seconds\nPreprocessor visited node count: 1274\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 36934\/2097152 bytes\nTemplate argument size: 222\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 57204\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.320\/10.000 seconds\nLua memory usage: 14.52 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 529.390 1 -total\n<\/p>\n<pre>46.79% 247.704 1 Template:Reflist\n37.26% 197.238 1 Template:Fr\n36.59% 193.695 1 Template:Link_language\n19.16% 101.453 6 Template:Cite_book\n15.16% 80.231 7 Template:Cite_journal\n 7.45% 39.431 1 Template:Use_dmy_dates\n 5.61% 29.692 5 Template:Cite_web\n 5.06% 26.785 1 Template:Category_handler\n 3.10% 16.414 1 Template:DMCA\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1910996-1!canonical and timestamp 20181215165011 and revision id 872205525\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_%28medicine%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214629\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.028 seconds\nReal time usage: 0.120 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 112.959 1 - wikipedia:Implant_(medicine)\n100.00% 112.959 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8026-0!*!*!*!*!*!* and timestamp 20181217214629 and revision id 24137\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Implant_(medicine)\">https:\/\/www.limswiki.org\/index.php\/Implant_(medicine)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","493da0ed539f193bbccf9b19a18c1d08_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/89\/X-ray3.jpg\/440px-X-ray3.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/5\/5c\/Taxus_stent_FDA.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/52\/Ruptured_implant.JPG\/600px-Ruptured_implant.JPG"],"493da0ed539f193bbccf9b19a18c1d08_timestamp":1545083189,"2f12bfa15b58b787083236d0a4603400_type":"article","2f12bfa15b58b787083236d0a4603400_title":"Home\/Durable medical equipment","2f12bfa15b58b787083236d0a4603400_url":"https:\/\/www.limswiki.org\/index.php\/Home_medical_equipment","2f12bfa15b58b787083236d0a4603400_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHome medical equipment\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. 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(April 2016) (Learn how and when to remove this template message)\nThis article discusses the definitions and types of home medical equipment (HME), also known as durable medical equipment (DME), and durable medical equipment prosthetics and orthotics (DMEPOS).\n\nContents \n\n1 HME \/ DMEPOS \n2 Types of home medical equipment \n3 Obtaining and using home medical equipment \n4 Insurance \n\n4.1 In the United States \n\n\n5 See also \n6 References \n\n\n HME \/ DMEPOS \nHome medical equipment is a category of devices used for patients whose care is being managed from a home or other private facility managed by a nonprofessional caregiver or family member. It is often referred to as \"durable\" medical equipment (DME) as it is intended to withstand repeated use by non-professionals or the patient, and is appropriate for use in the home.\nMedical supplies of an expendable nature, such as bandages, rubber gloves and irrigating kits are not considered by Medicare to be DME.\nWithin the US medical and insurance industries, the following acronyms are used to describe home medical equipment:\n\nDME: Durable Medical Equipment\nHME: Home Medical Equipment\nDMEPOS: Durable Medical Equipment, Prosthetics, Orthotics and Supplies\nTypes of home medical equipment \nThe following are representative examples of home medical equipment[1]\n\n\n \n\n\n\nAir ionizer\nAir purifier\nApnea monitor\nArtificial limb\nBedpan\nCannula\nCatheter\nColostomy bag\nCPAP machine\nCrutch\n \n\n\n\nDiabetic Shoes\nDrug test\nFeeding tube\nGlucose meter\nHeating pad\nHospital bed\nInfusion pump\nLift chair\nNasal cannula\nNebulizer\n \n\n\n\nOxygen concentrator\nOxygen cylinder\nPatient lift\nPill splitter\nProsthetic device\nPulse oximeter\nTraction splint\nWalker\nVentilator\nWheelchair\n \n\n\nObtaining and using home medical equipment \nFor most home medical equipment to be reimbursed by insurance, a patient must have a doctor's prescription for the equipment needed. Some equipment, such as oxygen, is FDA regulated and must be prescribed by a physician before purchase whether insurance reimbursed or otherwise.\nThe physician may recommend a supplier for the home medical equipment, or the patient will have to research this on their own. HME \/ DMEPOS suppliers are located throughout the country and some specialty shops can also be found on the internet.\nThere is no established typical size for HME \/ DMEPOS suppliers. Supply companies include very large organizations such as Walgreens, Lincare, and Apria to smaller local companies operated by sole proprietors or families. A new evolution in the home medical equipment arena is the advent of internet retailers who have lower operating costs so they often sell equipment for lower prices than local \"brick and mortar\", but lack the ability to offer in-home setup, equipment training and customer service.[citation needed ] In all cases, however, there are strict rules and laws governing HME \/ DMEPOS suppliers that participate in Medicare and Medicaid programs. In addition to rules outlined the National Supplier Clearinghouse, of division of CMS (centers for Medicare and Medicaid), all Medicare DME suppliers must obtain and maintain accreditation by one of many approved accrediting bodies.\nOnce a patient or caregiver selects an appropriate HME \/ DMEPOS supplier, he\/she presents the supplier with the prescription and patient's insurance information. HME \/ DMEPOS suppliers maintain an inventory of products and equipment, so fulfillment of the prescription is rapid, much like a Pharmacy.\nThe HME \/ DMEPOS supplier is obligated to perform certain functions when providing home medical equipment. These include:\n\nProper delivery and setup of the equipment\nEnsuring the home environment is suitable and safe for proper usage of the equipment\nTraining the patient, family and caregivers on the proper usage and maintenance of the equipment\nInforming the patient and\/or caregiver of their rights and responsibilities\nAll HME \/ DMEPOS suppliers are required to comply with Health Insurance Portability and Accountability Act (HIPAA) to protect patients' confidentiality and records.[citation needed ]\n\nInsurance \nIn the United States \nHome medical equipment is typically covered by patient's healthcare insurance, including Medicare (Part B). In order to properly code home medical equipment for billing, the Healthcare Common Procedure Coding System HCPCS is utilized.\nAs of 2014, under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, providers of HME\/DMEPOS will be required to become third-party accredited to standards regulated by the Centers for Medicare and Medicaid Services (CMS) in order to continue eligibility under Medicare Part B. This effort aims to standardize and improve the quality of service to patients provided by home medical equipment suppliers.\n\nSee also \nMedical device\nMedical technology\nMedical equipment\nLoan closet\nMedtrade- the largest international trade fair for HME in the US\nReferences \n\n^ Committee on the Role of Human Factors in Home Health Care, National Research Council (2010). \"Chapter 8: Medical Devices in Home Health Care\". The Role of Human Factors in Home Health Care. Washington, D.C.: National Academies Press. doi:10.17226\/12927. ISBN 9780309156295. Retrieved 6 April 2016 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Home_medical_equipment\">https:\/\/www.limswiki.org\/index.php\/Home_medical_equipment<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 486 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","2f12bfa15b58b787083236d0a4603400_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Home_medical_equipment skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Home medical equipment<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p>This article discusses the definitions and types of home <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment\" title=\"Medical equipment\" rel=\"external_link\" target=\"_blank\">medical equipment<\/a> (HME), also known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Durable_medical_equipment\" title=\"Durable medical equipment\" rel=\"external_link\" target=\"_blank\">durable medical equipment<\/a> (DME), and durable medical equipment prosthetics and orthotics (DMEPOS).\n<\/p>\n\n<h2><span id=\"rdp-ebb-HME_.2F_DMEPOS\"><\/span><span class=\"mw-headline\" id=\"HME_\/_DMEPOS\">HME \/ DMEPOS<\/span><\/h2>\n<p><b>Home medical equipment<\/b> is a category of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_devices\" class=\"mw-redirect\" title=\"Medical devices\" rel=\"external_link\" target=\"_blank\">devices<\/a> used for patients whose care is being managed from a home or other private facility managed by a nonprofessional caregiver or family member. It is often referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Durable_medical_equipment\" title=\"Durable medical equipment\" rel=\"external_link\" target=\"_blank\">\"durable\" medical equipment<\/a> (DME) as it is intended to withstand repeated use by non-professionals or the patient, and is appropriate for use in the home.\n<\/p><p>Medical supplies of an expendable nature, such as bandages, rubber gloves and irrigating kits are not considered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicare_(United_States)\" title=\"Medicare (United States)\" rel=\"external_link\" target=\"_blank\">Medicare<\/a> to be DME.\n<\/p><p>Within the US medical and insurance industries, the following acronyms are used to describe home medical equipment:\n<\/p>\n<ul><li><b>DME<\/b>: Durable Medical Equipment<\/li>\n<li><b>HME<\/b>: Home Medical Equipment<\/li>\n<li><b>DMEPOS<\/b>: Durable Medical Equipment, Prosthetics, Orthotics and Supplies<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Types_of_home_medical_equipment\">Types of home medical equipment<\/span><\/h2>\n<p>The following are representative examples of home medical equipment<sup id=\"rdp-ebb-cite_ref-NRCTheRole10_1-0\" class=\"reference\"><a href=\"#cite_note-NRCTheRole10-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<div>\n<p> \n<\/p>\n<table class=\"multicol\" role=\"presentation\" style=\"border-collapse: collapse; padding: 0; border: 0; background:transparent; width:100%;\"><tbody><tr>\n<td style=\"width: 33.33%;text-align: left; vertical-align: top;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Air_ionizer\" class=\"mw-redirect\" title=\"Air ionizer\" rel=\"external_link\" target=\"_blank\">Air ionizer<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Air_purifier\" title=\"Air purifier\" rel=\"external_link\" target=\"_blank\">Air purifier<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apnea_of_prematurity#Monitoring\" title=\"Apnea of prematurity\" rel=\"external_link\" target=\"_blank\">Apnea monitor<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_limb\" class=\"mw-redirect\" title=\"Artificial limb\" rel=\"external_link\" target=\"_blank\">Artificial limb<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bedpan\" title=\"Bedpan\" rel=\"external_link\" target=\"_blank\">Bedpan<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">Cannula<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">Catheter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ostomy_pouching_system\" title=\"Ostomy pouching system\" rel=\"external_link\" target=\"_blank\">Colostomy bag<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Continuous_positive_airway_pressure\" title=\"Continuous positive airway pressure\" rel=\"external_link\" target=\"_blank\">CPAP machine<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Crutch\" title=\"Crutch\" rel=\"external_link\" target=\"_blank\">Crutch<\/a><\/li><\/ul>\n<p> \n<\/p>\n<\/td>\n<td style=\"width: 33.33%;text-align: left; vertical-align: top;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_shoe\" title=\"Diabetic shoe\" rel=\"external_link\" target=\"_blank\">Diabetic Shoes<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_test\" title=\"Drug test\" rel=\"external_link\" target=\"_blank\">Drug test<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Feeding_tube\" title=\"Feeding tube\" rel=\"external_link\" target=\"_blank\">Feeding tube<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_meter\" title=\"Glucose meter\" rel=\"external_link\" target=\"_blank\">Glucose meter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heating_pad\" title=\"Heating pad\" rel=\"external_link\" target=\"_blank\">Heating pad<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_bed\" title=\"Hospital bed\" rel=\"external_link\" target=\"_blank\">Hospital bed<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Infusion_pump\" title=\"Infusion pump\" rel=\"external_link\" target=\"_blank\">Infusion pump<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lift_chair\" title=\"Lift chair\" rel=\"external_link\" target=\"_blank\">Lift chair<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasal_cannula\" title=\"Nasal cannula\" rel=\"external_link\" target=\"_blank\">Nasal cannula<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nebulizer\" title=\"Nebulizer\" rel=\"external_link\" target=\"_blank\">Nebulizer<\/a><\/li><\/ul>\n<p> \n<\/p>\n<\/td>\n<td style=\"width: 33.33%;text-align: left; vertical-align: top;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_concentrator\" title=\"Oxygen concentrator\" rel=\"external_link\" target=\"_blank\">Oxygen concentrator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_cylinder\" title=\"Gas cylinder\" rel=\"external_link\" target=\"_blank\">Oxygen cylinder<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_lift\" title=\"Patient lift\" rel=\"external_link\" target=\"_blank\">Patient lift<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pill_splitting\" title=\"Pill splitting\" rel=\"external_link\" target=\"_blank\">Pill splitter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthetic\" class=\"mw-redirect\" title=\"Prosthetic\" rel=\"external_link\" target=\"_blank\">Prosthetic device<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_oximetry\" title=\"Pulse oximetry\" rel=\"external_link\" target=\"_blank\">Pulse oximeter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Traction_splint\" title=\"Traction splint\" rel=\"external_link\" target=\"_blank\">Traction splint<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Walker_(mobility)\" title=\"Walker (mobility)\" rel=\"external_link\" target=\"_blank\">Walker<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventilator\" class=\"mw-redirect\" title=\"Ventilator\" rel=\"external_link\" target=\"_blank\">Ventilator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wheelchair\" title=\"Wheelchair\" rel=\"external_link\" target=\"_blank\">Wheelchair<\/a><\/li><\/ul>\n<p> \n<\/p>\n<\/td><\/tr><\/tbody><\/table><\/div>\n<h2><span class=\"mw-headline\" id=\"Obtaining_and_using_home_medical_equipment\">Obtaining and using home medical equipment<\/span><\/h2>\n<p>For most home medical equipment to be reimbursed by insurance, a patient must have a doctor's prescription for the equipment needed. Some equipment, such as oxygen, is FDA regulated and must be prescribed by a physician before purchase whether insurance reimbursed or otherwise.\n<\/p><p>The physician may recommend a supplier for the home medical equipment, or the patient will have to research this on their own. HME \/ DMEPOS suppliers are located throughout the country and some specialty shops can also be found on the internet.\n<\/p><p>There is no established typical size for HME \/ DMEPOS suppliers. Supply companies include very large organizations such as Walgreens, Lincare, and Apria to smaller local companies operated by sole proprietors or families. A new evolution in the home medical equipment arena is the advent of internet retailers who have lower operating costs so they often sell equipment for lower prices than local \"brick and mortar\", but lack the ability to offer in-home setup, equipment training and customer service.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2014)\">citation needed<\/span><\/a><\/i>]<\/sup> In all cases, however, there are strict rules and laws governing HME \/ DMEPOS suppliers that participate in Medicare and Medicaid programs. In addition to rules outlined the National Supplier Clearinghouse, of division of CMS (centers for Medicare and Medicaid), all Medicare DME suppliers must obtain and maintain accreditation by one of many approved accrediting bodies.\n<\/p><p>Once a patient or caregiver selects an appropriate HME \/ DMEPOS supplier, he\/she presents the supplier with the prescription and patient's insurance information. HME \/ DMEPOS suppliers maintain an inventory of products and equipment, so fulfillment of the prescription is rapid, much like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacy\" title=\"Pharmacy\" rel=\"external_link\" target=\"_blank\">Pharmacy<\/a>.\n<\/p><p>The HME \/ DMEPOS supplier is obligated to perform certain functions when providing home medical equipment. These include:\n<\/p>\n<ul><li>Proper delivery and setup of the equipment<\/li>\n<li>Ensuring the home environment is suitable and safe for proper usage of the equipment<\/li>\n<li>Training the patient, family and caregivers on the proper usage and maintenance of the equipment<\/li>\n<li>Informing the patient and\/or caregiver of their rights and responsibilities<\/li><\/ul>\n<p>All HME \/ DMEPOS suppliers are required to comply with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Insurance_Portability_and_Accountability_Act\" title=\"Health Insurance Portability and Accountability Act\" rel=\"external_link\" target=\"_blank\">Health Insurance Portability and Accountability Act<\/a> (HIPAA) to protect patients' confidentiality and records.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Insurance\">Insurance<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"In_the_United_States\">In the United States<\/span><\/h3>\n<p>Home medical equipment is typically covered by patient's healthcare insurance, including Medicare (Part B). In order to properly code home medical equipment for billing, the Healthcare Common Procedure Coding System <a href=\"https:\/\/en.wikipedia.org\/wiki\/HCPCS\" class=\"mw-redirect\" title=\"HCPCS\" rel=\"external_link\" target=\"_blank\">HCPCS<\/a> is utilized.\nAs of 2014, under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act\" title=\"Medicare Prescription Drug, Improvement, and Modernization Act\" rel=\"external_link\" target=\"_blank\">Medicare Prescription Drug, Improvement, and Modernization Act<\/a> of 2003, providers of HME\/DMEPOS will be required to become third-party accredited to standards regulated by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Medicare_and_Medicaid_Services\" title=\"Centers for Medicare and Medicaid Services\" rel=\"external_link\" target=\"_blank\">Centers for Medicare and Medicaid Services<\/a> (CMS) in order to continue eligibility under Medicare Part B. This effort aims to standardize and improve the quality of service to patients provided by home medical equipment suppliers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Medical device<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_technology\" class=\"mw-redirect\" title=\"Medical technology\" rel=\"external_link\" target=\"_blank\">Medical technology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment\" title=\"Medical equipment\" rel=\"external_link\" target=\"_blank\">Medical equipment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Loan_closet\" title=\"Loan closet\" rel=\"external_link\" target=\"_blank\">Loan closet<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medtrade\" title=\"Medtrade\" rel=\"external_link\" target=\"_blank\">Medtrade<\/a>- the largest international trade fair for HME in the US<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-NRCTheRole10-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NRCTheRole10_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Committee on the Role of Human Factors in Home Health Care, National Research Council (2010). \"Chapter 8: Medical Devices in Home Health Care\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK210056\/\" target=\"_blank\"><i>The Role of Human Factors in Home Health Care<\/i><\/a>. Washington, D.C.: National Academies Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.17226%2F12927\" target=\"_blank\">10.17226\/12927<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780309156295<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">6 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+8%3A+Medical+Devices+in+Home+Health+Care&rft.btitle=The+Role+of+Human+Factors+in+Home+Health+Care&rft.place=Washington%2C+D.C.&rft.pub=National+Academies+Press&rft.date=2010&rft_id=info%3Adoi%2F10.17226%2F12927&rft.isbn=9780309156295&rft.au=Committee+on+the+Role+of+Human+Factors+in+Home+Health+Care%2C+National+Research+Council&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK210056%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHome+medical+equipment\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181129181717\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.192 seconds\nReal time usage: 0.269 seconds\nPreprocessor visited node count: 582\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17080\/2097152 bytes\nTemplate argument size: 1059\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 3310\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.120\/10.000 seconds\nLua memory usage: 2.49 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 233.554 1 -total\n<\/p>\n<pre>46.07% 107.596 1 Template:Cite_book\n28.94% 67.591 1 Template:Globalize\/US\n21.79% 50.882 1 Template:Globalize\n21.16% 49.412 2 Template:Ambox\n15.62% 36.477 2 Template:Citation_needed\n13.84% 32.317 2 Template:Fix\n 7.01% 16.371 2 Template:Delink\n 4.99% 11.645 4 Template:Category_handler\n 3.70% 8.632 1 Template:Refimprove\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:8806323-1!canonical and timestamp 20181129181717 and revision id 861455306\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Home_medical_equipment\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214629\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.135 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 128.809 1 - wikipedia:Home_medical_equipment\n100.00% 128.809 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8021-0!*!*!*!*!*!* and timestamp 20181217214629 and revision id 24132\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Home_medical_equipment\">https:\/\/www.limswiki.org\/index.php\/Home_medical_equipment<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","2f12bfa15b58b787083236d0a4603400_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"2f12bfa15b58b787083236d0a4603400_timestamp":1545083189,"9b6dbbcd55fbd6abfd8dd2462f53a540_type":"article","9b6dbbcd55fbd6abfd8dd2462f53a540_title":"General medicine instrument","9b6dbbcd55fbd6abfd8dd2462f53a540_url":"https:\/\/www.limswiki.org\/index.php\/Instruments_used_in_general_medicine","9b6dbbcd55fbd6abfd8dd2462f53a540_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tInstruments used in general medicine\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis list is incomplete; you can help by expanding it.\n\n\nInstrument\n\nUses\n\n\nBedpan\nfor patients who are unconscious or too weak to sit up or walk to the toilet to defecate\n\n\nCannula\nto create a permanent pathway to a vein (or artery) for the purpose of repeated injections or infusion of intravenous fluids\n\n\nCardioverter \/ Defibrillator\nto correct arrhythmias of the heart or to start up a heart that is not beating\n\n\nCatheter\nto drain and collect urine directly from the bladder (primary use); also to act as a makeshift oxygen tube, etc.\n\n\nDialyser\nto remove toxic materials from the blood that are generally removed by the kidneys; used in case of renal failure\n\n\nElectrocardiograph machine\nto record the electrical activity of the heart over a period of time\n\n\nEnema equipment\nto passively evacuate the rectum of faeces\n\n\nEndoscope\nto look inside the gastrointestinal tract, used mainly in surgery or by surgical consultants\n\n\nGas cylinder\nas a supply of oxygen, nitrous oxide, carbon dioxide, etc.\n\n\nGauze sponge\nto absorb blood and other fluids as well as clean wounds\n\n\nSurgical scissors\nused for dissecting or cutting\n\n\nHypodermic needle \/ Syringe\nfor injections and aspiration of blood or fluid from the body\n\n\nInfection control equipment\nas in gloves, gowns, bonnets, shoe covers, face shields, goggles, and surgical masks for preventing nosocomial or healthcare-associated infection\n\n\nInstrument sterilizer\nto sterilize instruments in absence of an autoclave\n\n\nKidney dish\nas a tray for instruments, gauze, tissue, etc.\n\n\nMeasuring tape\nfor length, height, head circumference and girth measurements\n\n\nMedical halogen penlight\nto see into the eye, natural orifices, etc. and to test for pupillary light reflex, etc.\n\n\nNasogastric tube\nfor nasogastric suction or the introduction of food or drugs into the body\n\n\nNebulizer\nto produce aerosols of drugs to be administered by respiratory route\n\n\nOphthalmoscope\nto look at the retina\n\n\nOtoscope\nto look into the external ear cavity\n\n\nOxygen mask and tubes\nto deliver gases to the mouth\/nostrils to assist in oxygen intake or to administer aerosolized or gaseous drugs\n\n\nPipette or dropper\nto measure out doses of liquid, specially in children\n\n\nProctoscope\nto look inside the anal canal and lower part of the rectum\n\n\nReflex hammer\nto test motor reflexes of the body\n\n\nSphygmomanometer\nto measure the patient's blood pressure\n\n\nStethoscope\nto hear sounds from movements within the body like heart beats, intestinal movement, breath sounds, etc.\n\n\nSuction device\nto suck up blood or secretions\n\n\nThermometer\nto record body temperature\n\n\nTongue depressor\nfor use in oral examination\n\n\nTransfusion kit\nto transfuse blood and blood products\n\n\nTuning fork\nto test for deafness and to categorize it\n\n\nVentilator\nto assist or carry out the mechanical act of inspiration and expiration so the non-respiring patient can do so; a common component of \"life support\"\n\n\nWatch \/ Stopwatch\nfor recording rates like heart rate, respiratory rate, etc.; for certain hearing tests\n\n\nWeighing scale\nto measure weight\n\n\nCrocodile Forceps\n\nto remove foreign bodies from ear or nasal cavities\n\nImage gallery \n\n\t\t\n\t\t\t\n\t\t\t\nBandage\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBedpan\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBlood infusion set\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nCannula, intraveneous (separated)\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nCatheter, Foley\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nDefibrillator\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nDialyser, hemodialysis\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nEnema bulb\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nEnema set\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nEndoscope\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nFace shield\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nGas cylinder, oxygen\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nGauze sponges\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nInstrument sterilizer\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nKidney dish\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nMedical halogen penlight\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nNasogastric tube, Levin\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nNebulizer\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nOphthalmoscope\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nReflex hammer\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nReflex hammer, queen square\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nSphygmomanometer, electronic\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nStethoscope\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nSyringe and needle\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nThermometers, mercury\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nTongue depressors\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nTuning fork\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nVentilator, high-frequency\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nWeighing scale\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nWartenbergwheel\n\n\t\t\t\n\t\t\n\nReferences \n\n\nvteMedical instruments and implantsDiagnostics and research\nLaboratory diagnosis & research\nMicrobiology\nPathology\nRadiology\nToxicology\nSterilizationMicrobiological sterilization, disinfection, quarantine & biological waste managementFundamental clinical specializations\nDentistry\nGeneral medicine\nGeneral surgery\nSystem non-specific clinical specializations\nAnesthesiology\nOncology\nPhysical medicine & Rehabilitation\nPlastic surgery\nPreventive medicine\nSystem specific clinical specialties\nCardiology\nDermatology\nEndocrinology\nGastroenterology\nNephrology\nNeurology\nObstetrics & Gynecology\nOphthalmology\nOrthopedics\nOtorhinolaryngology (ENT)\nPulmonology\nPsychiatry\nUrology\nVascular surgery\nPost-mortem examinations\nAnatomy\nForensic sciences\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Instruments_used_in_general_medicine\">https:\/\/www.limswiki.org\/index.php\/Instruments_used_in_general_medicine<\/a>\n\t\t\t\t\tCategory: Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView 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PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 7 April 2016, at 21:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 452 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9b6dbbcd55fbd6abfd8dd2462f53a540_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Instruments_used_in_general_medicine skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Instruments used in general medicine<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>Instrument\n<\/th>\n<th>Uses\n<\/th><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bedpan\" title=\"Bedpan\" rel=\"external_link\" target=\"_blank\">Bedpan<\/a><\/td>\n<td>for patients who are unconscious or too weak to sit up or walk to the toilet to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defecate\" class=\"mw-redirect\" title=\"Defecate\" rel=\"external_link\" target=\"_blank\">defecate<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">Cannula<\/a><\/td>\n<td>to create a permanent pathway to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> (or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a>) for the purpose of repeated injections or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infusion\" title=\"Infusion\" rel=\"external_link\" target=\"_blank\">infusion<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_fluids\" class=\"mw-redirect\" title=\"Intravenous fluids\" rel=\"external_link\" target=\"_blank\">intravenous fluids<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardioversion\" title=\"Cardioversion\" rel=\"external_link\" target=\"_blank\">Cardioverter<\/a> \/ <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defibrillation\" title=\"Defibrillation\" rel=\"external_link\" target=\"_blank\">Defibrillator<\/a><\/td>\n<td>to correct <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arrhythmias\" class=\"mw-redirect\" title=\"Arrhythmias\" rel=\"external_link\" target=\"_blank\">arrhythmias<\/a> of the heart or to start up a heart that is not beating\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">Catheter<\/a><\/td>\n<td>to drain and collect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urine\" title=\"Urine\" rel=\"external_link\" target=\"_blank\">urine<\/a> directly from the bladder (primary use); also to act as a makeshift oxygen tube, etc.\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" title=\"Dialysis\" rel=\"external_link\" target=\"_blank\">Dialyser<\/a><\/td>\n<td>to remove toxic materials from the blood that are generally removed by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidneys\" class=\"mw-redirect\" title=\"Kidneys\" rel=\"external_link\" target=\"_blank\">kidneys<\/a>; used in case of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Renal_failure\" class=\"mw-redirect\" title=\"Renal failure\" rel=\"external_link\" target=\"_blank\">renal failure<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiography\" title=\"Electrocardiography\" rel=\"external_link\" target=\"_blank\">Electrocardiograph machine<\/a><\/td>\n<td>to record the electrical activity of the heart over a period of time\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Enema\" title=\"Enema\" rel=\"external_link\" target=\"_blank\">Enema equipment<\/a><\/td>\n<td>to passively evacuate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectum\" title=\"Rectum\" rel=\"external_link\" target=\"_blank\">rectum<\/a> of faeces\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">Endoscope<\/a><\/td>\n<td>to look inside the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_gastrointestinal_tract\" class=\"mw-redirect\" title=\"Human gastrointestinal tract\" rel=\"external_link\" target=\"_blank\">gastrointestinal tract<\/a>, used mainly in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> or by surgical consultants\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_cylinder\" title=\"Gas cylinder\" rel=\"external_link\" target=\"_blank\">Gas cylinder<\/a><\/td>\n<td>as a supply of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrous_oxide\" title=\"Nitrous oxide\" rel=\"external_link\" target=\"_blank\">nitrous oxide<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a>, etc.\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gauze_sponge\" title=\"Gauze sponge\" rel=\"external_link\" target=\"_blank\">Gauze sponge<\/a><\/td>\n<td>to absorb blood and other fluids as well as clean wounds\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_scissors\" title=\"Surgical scissors\" rel=\"external_link\" target=\"_blank\">Surgical scissors<\/a><\/td>\n<td>used for dissecting or cutting\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle\" title=\"Hypodermic needle\" rel=\"external_link\" target=\"_blank\">Hypodermic needle<\/a> \/ <a href=\"https:\/\/en.wikipedia.org\/wiki\/Syringe\" title=\"Syringe\" rel=\"external_link\" target=\"_blank\">Syringe<\/a><\/td>\n<td>for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_(medicine)\" title=\"Injection (medicine)\" rel=\"external_link\" target=\"_blank\">injections<\/a> and aspiration of blood or fluid from the body\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection_control\" title=\"Infection control\" rel=\"external_link\" target=\"_blank\">Infection control equipment<\/a><\/td>\n<td>as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_gloves\" class=\"mw-redirect\" title=\"Medical gloves\" rel=\"external_link\" target=\"_blank\">gloves<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_gown\" title=\"Hospital gown\" rel=\"external_link\" target=\"_blank\">gowns<\/a>, bonnets, shoe covers, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Face_shield\" title=\"Face shield\" rel=\"external_link\" target=\"_blank\">face shields<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Goggles\" title=\"Goggles\" rel=\"external_link\" target=\"_blank\">goggles<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_mask\" title=\"Surgical mask\" rel=\"external_link\" target=\"_blank\">surgical masks<\/a> for preventing nosocomial or healthcare-associated infection\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">Instrument sterilizer<\/a><\/td>\n<td>to sterilize instruments in absence of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclave<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_dish\" title=\"Kidney dish\" rel=\"external_link\" target=\"_blank\">Kidney dish<\/a><\/td>\n<td>as a tray for instruments, gauze, tissue, etc.\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tape_measure\" title=\"Tape measure\" rel=\"external_link\" target=\"_blank\">Measuring tape<\/a><\/td>\n<td>for length, height, head circumference and girth measurements\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Halogen_lamp\" title=\"Halogen lamp\" rel=\"external_link\" target=\"_blank\">Medical halogen penlight<\/a><\/td>\n<td>to see into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Natural_orifices\" class=\"mw-redirect\" title=\"Natural orifices\" rel=\"external_link\" target=\"_blank\">natural orifices<\/a>, etc. and to test for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pupillary_light_reflex\" title=\"Pupillary light reflex\" rel=\"external_link\" target=\"_blank\">pupillary light reflex<\/a>, etc.\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasogastric_tube\" class=\"mw-redirect\" title=\"Nasogastric tube\" rel=\"external_link\" target=\"_blank\">Nasogastric tube<\/a><\/td>\n<td>for nasogastric suction or the introduction of food or drugs into the body\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nebulizer\" title=\"Nebulizer\" rel=\"external_link\" target=\"_blank\">Nebulizer<\/a><\/td>\n<td>to produce aerosols of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drugs\" class=\"mw-redirect\" title=\"Drugs\" rel=\"external_link\" target=\"_blank\">drugs<\/a> to be administered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Route_of_administration#Other_locations\" title=\"Route of administration\" rel=\"external_link\" target=\"_blank\">respiratory route<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ophthalmoscope\" class=\"mw-redirect\" title=\"Ophthalmoscope\" rel=\"external_link\" target=\"_blank\">Ophthalmoscope<\/a><\/td>\n<td>to look at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Otoscope\" title=\"Otoscope\" rel=\"external_link\" target=\"_blank\">Otoscope<\/a><\/td>\n<td>to look into the external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">ear<\/a> cavity\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_mask\" title=\"Oxygen mask\" rel=\"external_link\" target=\"_blank\">Oxygen mask and tubes<\/a><\/td>\n<td>to deliver gases to the mouth\/nostrils to assist in oxygen intake or to administer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerosolization\" title=\"Aerosolization\" rel=\"external_link\" target=\"_blank\">aerosolized<\/a> or gaseous drugs\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pipette\" title=\"Pipette\" rel=\"external_link\" target=\"_blank\">Pipette or dropper<\/a><\/td>\n<td>to measure out doses of liquid, specially in children\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Proctoscope\" class=\"mw-redirect\" title=\"Proctoscope\" rel=\"external_link\" target=\"_blank\">Proctoscope<\/a><\/td>\n<td>to look inside the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anal_canal\" title=\"Anal canal\" rel=\"external_link\" target=\"_blank\">anal canal<\/a> and lower part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectum\" title=\"Rectum\" rel=\"external_link\" target=\"_blank\">rectum<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Reflex_hammer\" title=\"Reflex hammer\" rel=\"external_link\" target=\"_blank\">Reflex hammer<\/a><\/td>\n<td>to test <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motor_reflex\" class=\"mw-redirect\" title=\"Motor reflex\" rel=\"external_link\" target=\"_blank\">motor reflexes<\/a> of the body\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sphygmomanometer\" title=\"Sphygmomanometer\" rel=\"external_link\" target=\"_blank\">Sphygmomanometer<\/a><\/td>\n<td>to measure the patient's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stethoscope\" title=\"Stethoscope\" rel=\"external_link\" target=\"_blank\">Stethoscope<\/a><\/td>\n<td>to hear <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sound\" title=\"Sound\" rel=\"external_link\" target=\"_blank\">sounds<\/a> from movements within the body like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_cycle\" title=\"Cardiac cycle\" rel=\"external_link\" target=\"_blank\">heart beats<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intestine\" class=\"mw-redirect\" title=\"Intestine\" rel=\"external_link\" target=\"_blank\">intestinal movement<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breath_sound\" class=\"mw-redirect\" title=\"Breath sound\" rel=\"external_link\" target=\"_blank\">breath sounds<\/a>, etc.\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Suction_(medicine)\" title=\"Suction (medicine)\" rel=\"external_link\" target=\"_blank\">Suction device<\/a><\/td>\n<td>to suck up blood or secretions\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_thermometer\" title=\"Medical thermometer\" rel=\"external_link\" target=\"_blank\">Thermometer<\/a><\/td>\n<td>to record <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_temperature\" class=\"mw-redirect\" title=\"Body temperature\" rel=\"external_link\" target=\"_blank\">body temperature<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongue_depressor\" title=\"Tongue depressor\" rel=\"external_link\" target=\"_blank\">Tongue depressor<\/a><\/td>\n<td>for use in oral examination\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_transfusion\" title=\"Blood transfusion\" rel=\"external_link\" target=\"_blank\">Transfusion kit<\/a><\/td>\n<td>to transfuse blood and blood products\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuning_fork\" title=\"Tuning fork\" rel=\"external_link\" target=\"_blank\">Tuning fork<\/a><\/td>\n<td>to test for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deafness\" class=\"mw-redirect\" title=\"Deafness\" rel=\"external_link\" target=\"_blank\">deafness<\/a> and to categorize it\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventilator\" class=\"mw-redirect\" title=\"Ventilator\" rel=\"external_link\" target=\"_blank\">Ventilator<\/a><\/td>\n<td>to assist or carry out the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_ventilation\" title=\"Mechanical ventilation\" rel=\"external_link\" target=\"_blank\">mechanical<\/a> act of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inhalation\" title=\"Inhalation\" rel=\"external_link\" target=\"_blank\">inspiration<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exhalation\" title=\"Exhalation\" rel=\"external_link\" target=\"_blank\">expiration<\/a> so the non-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Breathing\" title=\"Breathing\" rel=\"external_link\" target=\"_blank\">respiring<\/a> patient can do so; a common component of \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Life_support\" title=\"Life support\" rel=\"external_link\" target=\"_blank\">life support<\/a>\"\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Watch\" title=\"Watch\" rel=\"external_link\" target=\"_blank\">Watch<\/a> \/ <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stopwatch\" title=\"Stopwatch\" rel=\"external_link\" target=\"_blank\">Stopwatch<\/a><\/td>\n<td>for recording rates like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_rate\" title=\"Heart rate\" rel=\"external_link\" target=\"_blank\">heart rate<\/a>, respiratory rate, etc.; for certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_(sense)\" class=\"mw-redirect\" title=\"Hearing (sense)\" rel=\"external_link\" target=\"_blank\">hearing<\/a> tests\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Weighing_scale\" title=\"Weighing scale\" rel=\"external_link\" target=\"_blank\">Weighing scale<\/a><\/td>\n<td>to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weight#Measuring_weight\" title=\"Weight\" rel=\"external_link\" target=\"_blank\">measure weight<\/a>\n<\/td><\/tr>\n<tr>\n<td>Crocodile Forceps\n<\/td>\n<td>to remove foreign bodies from ear or nasal cavities\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Image_gallery\">Image gallery<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:16.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bandage.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Bandage.jpg\/120px-Bandage.jpg\" width=\"120\" height=\"117\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Bandage\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Image-Oval-steel.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9c\/Image-Oval-steel.jpg\/120px-Image-Oval-steel.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Bedpan\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Infusionsbesteck.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/Infusionsbesteck.jpg\/89px-Infusionsbesteck.jpg\" width=\"89\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Blood infusion set\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Venflon_intravenous_cannula_3.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b9\/Venflon_intravenous_cannula_3.jpeg\/120px-Venflon_intravenous_cannula_3.jpeg\" width=\"120\" height=\"67\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Cannula, intraveneous (separated)\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:39px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Foley_catheter.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Foley_catheter.png\/120px-Foley_catheter.png\" width=\"120\" height=\"72\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Catheter, Foley\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Defibrillator_Monitor.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Defibrillator_Monitor.jpg\/120px-Defibrillator_Monitor.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Defibrillator\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemodialysismachine.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Hemodialysismachine.jpg\/84px-Hemodialysismachine.jpg\" width=\"84\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Dialyser, hemodialysis\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:29.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Rectal_bulb_syringe.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/af\/Rectal_bulb_syringe.jpg\/120px-Rectal_bulb_syringe.jpg\" width=\"120\" height=\"91\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Enema bulb\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pikto_Flasche.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Pikto_Flasche.svg\/102px-Pikto_Flasche.svg.png\" width=\"102\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Enema set\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Flexibles_Endoskop.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/Flexibles_Endoskop.jpg\/120px-Flexibles_Endoskop.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Endoscope\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:US_Army_53645_U.S._Army_uncovers_successful_results_for_AIDS_vaccine.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/US_Army_53645_U.S._Army_uncovers_successful_results_for_AIDS_vaccine.jpg\/120px-US_Army_53645_U.S._Army_uncovers_successful_results_for_AIDS_vaccine.jpg\" width=\"120\" height=\"89\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Face shield\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Diving_cylinder_oxygen_label.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ef\/Diving_cylinder_oxygen_label.JPG\/120px-Diving_cylinder_oxygen_label.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Gas cylinder, oxygen\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ThreeTypesOfGauze.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3e\/ThreeTypesOfGauze.JPG\/120px-ThreeTypesOfGauze.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Gauze sponges\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sterilizer_Getinge_HS11k3_IMG_0569.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Sterilizer_Getinge_HS11k3_IMG_0569.JPG\/120px-Sterilizer_Getinge_HS11k3_IMG_0569.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Instrument sterilizer\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:36px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2008-04_Nierenschalen.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/2008-04_Nierenschalen.jpg\/120px-2008-04_Nierenschalen.jpg\" width=\"120\" height=\"78\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Kidney dish\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:52.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Halogenlight.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/98\/Halogenlight.JPG\/120px-Halogenlight.JPG\" width=\"120\" height=\"45\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Medical halogen penlight\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kendall_stomach_tube_Fr18.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a2\/Kendall_stomach_tube_Fr18.jpg\/120px-Kendall_stomach_tube_Fr18.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Nasogastric tube, Levin\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:31.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CFnebulizer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/CFnebulizer.jpg\/120px-CFnebulizer.jpg\" width=\"120\" height=\"87\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Nebulizer\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:29.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ophthalmoscopy.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Ophthalmoscopy.JPG\/120px-Ophthalmoscopy.JPG\" width=\"120\" height=\"91\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Ophthalmoscope\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:48.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Reflex_hammer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Reflex_hammer.jpg\/120px-Reflex_hammer.jpg\" width=\"120\" height=\"53\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Reflex hammer\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Queen_square.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Queen_square.jpg\/57px-Queen_square.jpg\" width=\"57\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Reflex hammer, queen square\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:29.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2017_Sfigmomanometr_elektroniczny.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3f\/2017_Sfigmomanometr_elektroniczny.jpg\/120px-2017_Sfigmomanometr_elektroniczny.jpg\" width=\"120\" height=\"91\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Sphygmomanometer, electronic\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stethoscope_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/75\/Stethoscope_1.jpg\/90px-Stethoscope_1.jpg\" width=\"90\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Stethoscope\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Syringe2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1d\/Syringe2.jpg\/120px-Syringe2.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Syringe and needle\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kwikthermometers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Kwikthermometers.jpg\/120px-Kwikthermometers.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Thermometers, mercury\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:38.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mundspatel.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Mundspatel.jpg\/120px-Mundspatel.jpg\" width=\"120\" height=\"73\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Tongue depressors\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stimmgabel.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Stimmgabel.jpg\/27px-Stimmgabel.jpg\" width=\"27\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Tuning fork\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HFOV_3100A.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/HFOV_3100A.jpg\/93px-HFOV_3100A.jpg\" width=\"93\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Ventilator, high-frequency\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:35px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Feet_on_scale.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/Feet_on_scale.jpg\/120px-Feet_on_scale.jpg\" width=\"120\" height=\"80\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Weighing scale\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:35px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wartenbergwheel.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f1\/Wartenbergwheel.jpg\/120px-Wartenbergwheel.jpg\" width=\"120\" height=\"80\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Wartenbergwheel\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181211191649\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.140 seconds\nReal time usage: 0.242 seconds\nPreprocessor visited node count: 369\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 16507\/2097152 bytes\nTemplate argument size: 249\/2097152 bytes\nHighest expansion depth: 15\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 22129\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.012\/10.000 seconds\nLua memory usage: 857 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 192.205 1 -total\n<\/p>\n<pre>25.88% 49.741 1 Template:Expand_list\n17.76% 34.132 1 Template:Hatnote\n11.31% 21.732 1 Template:TDMCA\n 9.19% 17.669 1 Template:DMCA\n 9.06% 17.414 1 Template:MedInst\n 7.87% 15.135 1 Template:Dated_maintenance_category\n 6.18% 11.873 1 Template:Navbox\n 5.55% 10.672 1 Template:Reflist\n 5.09% 9.779 1 Template:FULLROOTPAGENAME\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:17545148-1!canonical and timestamp 20181211191649 and revision id 862181448\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_medicine\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214629\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.133 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 126.850 1 - wikipedia:Instruments_used_in_general_medicine\n100.00% 126.850 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8523-0!*!*!*!*!*!* and timestamp 20181217214628 and revision id 24946\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Instruments_used_in_general_medicine\">https:\/\/www.limswiki.org\/index.php\/Instruments_used_in_general_medicine<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9b6dbbcd55fbd6abfd8dd2462f53a540_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Bandage.jpg\/240px-Bandage.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9c\/Image-Oval-steel.jpg\/240px-Image-Oval-steel.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/Infusionsbesteck.jpg\/179px-Infusionsbesteck.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b9\/Venflon_intravenous_cannula_3.jpeg\/240px-Venflon_intravenous_cannula_3.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Foley_catheter.png\/240px-Foley_catheter.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Defibrillator_Monitor.jpg\/240px-Defibrillator_Monitor.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Hemodialysismachine.jpg\/168px-Hemodialysismachine.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/af\/Rectal_bulb_syringe.jpg\/240px-Rectal_bulb_syringe.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Pikto_Flasche.svg\/205px-Pikto_Flasche.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/Flexibles_Endoskop.jpg\/240px-Flexibles_Endoskop.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/US_Army_53645_U.S._Army_uncovers_successful_results_for_AIDS_vaccine.jpg\/240px-US_Army_53645_U.S._Army_uncovers_successful_results_for_AIDS_vaccine.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ef\/Diving_cylinder_oxygen_label.JPG\/240px-Diving_cylinder_oxygen_label.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3e\/ThreeTypesOfGauze.JPG\/240px-ThreeTypesOfGauze.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Sterilizer_Getinge_HS11k3_IMG_0569.JPG\/240px-Sterilizer_Getinge_HS11k3_IMG_0569.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/2008-04_Nierenschalen.jpg\/240px-2008-04_Nierenschalen.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/98\/Halogenlight.JPG\/240px-Halogenlight.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a2\/Kendall_stomach_tube_Fr18.jpg\/240px-Kendall_stomach_tube_Fr18.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/CFnebulizer.jpg\/240px-CFnebulizer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Ophthalmoscopy.JPG\/240px-Ophthalmoscopy.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Reflex_hammer.jpg\/240px-Reflex_hammer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Queen_square.jpg\/114px-Queen_square.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3f\/2017_Sfigmomanometr_elektroniczny.jpg\/240px-2017_Sfigmomanometr_elektroniczny.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/75\/Stethoscope_1.jpg\/180px-Stethoscope_1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1d\/Syringe2.jpg\/240px-Syringe2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Kwikthermometers.jpg\/240px-Kwikthermometers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Mundspatel.jpg\/240px-Mundspatel.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Stimmgabel.jpg\/54px-Stimmgabel.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/HFOV_3100A.jpg\/185px-HFOV_3100A.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/Feet_on_scale.jpg\/240px-Feet_on_scale.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f1\/Wartenbergwheel.jpg\/240px-Wartenbergwheel.jpg"],"9b6dbbcd55fbd6abfd8dd2462f53a540_timestamp":1545083188,"8e821122daa731f0fa8782fae57831fa_type":"article","8e821122daa731f0fa8782fae57831fa_title":"Medical device","8e821122daa731f0fa8782fae57831fa_url":"https:\/\/www.limswiki.org\/index.php\/Medical_device","8e821122daa731f0fa8782fae57831fa_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical device\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAny instrument, apparatus, implant, in vitro reagent, or similar or related article used for diagnostic and\/or therapeutic purposes\n A stethoscope, a popular medical device, ubiquitous in hospitals.\nA medical device is any apparatus, appliance, software, material, or other article\u2014whether used alone or in combination, including the software intended by its manufacturer to be used specifically for diagnostic and\/or therapeutic purposes and necessary for its proper application\u2014intended by the manufacturer to be used for human beings for the purpose of:\n\nDiagnosis, prevention, monitoring, treatment, or alleviation of disease;\nDiagnosis, monitoring, treatment, alleviation, or compensation for an injury or handicap;\nInvestigation, replacement, or modification of the anatomy or of a physiological process;\nControl of conception; and which does not achieve its principal intended action in or on the human body by pharmacological, immunological, or metabolic means, but which may be assisted in its function by such means\nMedical devices vary according to their intended use and indications. Examples range from simple devices such as tongue depressors, medical thermometers, and disposable gloves to advanced devices such as computers which assist in the conduct of medical testing, implants, and prostheses. Items as intricate as housings for cochlear implants are manufactured through the deep drawn and shallow drawn manufacturing processes. The design of medical devices constitutes a major segment of the field of biomedical engineering.\nThe global medical device market reached roughly $209 billion in 2006.[1]\n\nContents \n\n1 Design, prototyping, and product development \n2 Definitions \n\n2.1 European Union legal framework and definition \n2.2 Definition in United States by the Food and Drug Administration \n2.3 Definition in Canada by the Food and Drugs Act \n\n\n3 Classification \n\n3.1 Canada \n3.2 United States \n\n3.2.1 Class I: General controls \n3.2.2 Class II: General controls with special controls \n3.2.3 Class III: General controls, Special Controls and premarket approval \n\n\n3.3 European Union (EU) and European Free Trade Association (EFTA) \n3.4 Australia \n3.5 Iran \n\n\n4 Technological security issues \n5 Standardization and regulatory concerns \n\n5.1 Packaging standards \n5.2 Biocompatibility standards \n5.3 Cleanliness standards \n5.4 Mobile medical applications \n\n\n6 Academic resources \n\n6.1 University Based Research Packaging Institutes \n\n\n7 See also \n8 References \n9 External links \n\n\n Design, prototyping, and product development \nMain article: Medical device manufacturing\nMedical device manufacturing requires a level of process control according to the classification of the device. Higher risk; more controls. When in the initial R&D phase, manufacturers are now beginning to design for manufacturability. This means products can be more precision-engineered to for production to result in shorter lead times, tighter tolerances and more advanced specifications and prototypes. These days, with the aid of CAD or modelling platforms, the work is now much faster, and this can act also as a tool for strategic design generation as well as a marketing tool.[2]\nFailure to meet cost targets will lead to substantial losses for an organisation. In addition, with global competition, the R&D of new devices is not just a necessity, it is an imperative for medical device manufacturers. The realisation of a new design can be very costly, especially with the shorter product life cycle. As technology advances, there is typically a level of quality, safety and reliability that increases exponentially with time.[2]\nFor example, initial models of the artificial cardiac pacemaker were external support devices that transmits pulses of electricity to the heart muscles via electrode leads on the chest. The electrodes contact the heart directly through the chest, allowing stimulation pulses to pass through the body. Recipients of this typically suffered infection at the entrance of the electrodes, which led to the subsequent trial of the first internal pacemaker, with electrodes attached to the myocardium by thoracotomy. Future developments led to the isotope-power source that would last for the lifespan of the patient.\n\nDefinitions \nEuropean Union legal framework and definition \nBased on the New Approach, rules that relate to safety and performance of medical devices were harmonised in the EU in the 1990s. The New Approach, defined in a European Council Resolution of May 1985,[3] represents an innovative way of technical harmonisation. It aims to remove technical barriers to trade and dispel the consequent uncertainty for economic operators, to facilitate free movement of goods inside the EU.\nThe core legal framework consists of three directives: \n\nDirective 90\/385\/EEC regarding active implantable medical devices\nDirective 93\/42\/EEC regarding medical devices\nDirective 98\/79\/EC regarding in vitro diagnostic medical devices\nThey aim at ensuring a high level of protection of human health and safety and the good functioning of the Single Market. These three main directives have been supplemented over time by several modifying and implementing directives, including the last technical revision brought about by Directive 2007\/47 EC.[4]\nDirective 2007\/47\/EC defines a medical device as (paraphrasing): Any instrument, apparatus, appliance, software, material or other article, whether used alone or in combination, together with any accessories, including the software intended by its manufacturer to be used specifically for diagnostic and\/or therapeutic purposes and necessary for its proper application, intended by the manufacturer to be used for human beings for the purpose of:\n\nDiagnosis, prevention, monitoring, treatment, or alleviation of disease\nDiagnosis, monitoring, treatment, alleviation of, or compensation for an injury or handicap\nInvestigation, replacement, or modification of the anatomy or of a physiological process\nControl of conception\nThis includes devices that do not achieve their principal intended action in or on the human body by pharmacological, immunological, or metabolic means\u2014but may be assisted in their function by such means.[4]\nThe government of each Member State must appoint a competent authority responsible for medical devices. The competent authority (CA) is a body with authority to act on behalf of the member state to ensure that member state government transposes requirements of medical device directives into national law and applies them. The CA reports to the minister of health in the member state. The CA in one Member State has no jurisdiction in any other member state, but exchanges information and tries to reach common positions.\nIn the UK, for example, the Medicines and Healthcare products Regulatory Agency (MHRA) acts as a CA. In Italy it is the Ministero Salute (Ministry of Health) Medical devices must not be mistaken with medicinal products. In the EU, all medical devices must be identified with the CE mark.\nIn September 2012, the European Commission proposed new legislation aimed at enhancing safety, traceability, and transparency.[5]\n\nDefinition in United States by the Food and Drug Administration \nMedical machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory that is:\n\nRecognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them\nIntended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals\nIntended to affect the structure or any function of the body of man or other animals, and does not achieve any of its primary purpose through chemical action within or on the body of man or other animals and does not depend on metabolic action to achieve its primary purpose.[6]\nIn August 2013, the FDA released over 20 regulations aiming to improve the security of data in medical devices,[7] in response to the growing risks of limited cybersecurity.\nOn September 25, 2013 the FDA released a draft guidance document for regulation of mobile medical applications, to clarify what kind of mobile apps related to health would not be regulated, and which would be.[8][9]\n\nDefinition in Canada by the Food and Drugs Act \nThe term medical devices, as defined in the Food and Drugs Act, covers a wide range of health or medical instruments used in the treatment, mitigation, diagnosis or prevention of a disease or abnormal physical condition. Health Canada reviews medical devices to assess their safety, effectiveness, and quality before authorizing their sale in Canada.[10]\n\nClassification \nThe regulatory authorities recognize different classes of medical devices based on their design complexity, their use characteristics, and their potential for harm if misused. Each country or region defines these categories in different ways. The authorities also recognize that some devices are provided in combination with drugs, and regulation of these combination products takes this factor into consideration.\n\nCanada \nThe Medical Devices Bureau of Health Canada recognizes four classes of medical devices based on the level of control necessary to assure the safety and effectiveness of the device. Class I devices present the lowest potential risk and do not require a licence. Class II devices require the manufacturer's declaration of device safety and effectiveness, whereas Class III and IV devices present a greater potential risk and are subject to in-depth scrutiny.[10] A guidance document for device classification is published by Health Canada.[11]\nCanadian classes of medical devices correspond to the European Council Directive 93\/42\/EEC (MDD) devices:[11] \n\nClass IV (Canada) generally corresponds to Class III (ECD),\nClass III (Canada) generally corresponds to Class IIb (ECD),\nClass II (Canada) generally corresponds to Class IIa (ECD), and\nClass I (Canada) generally corresponds to Class I (ECD)\nExamples include surgical instruments (Class I), contact lenses and ultrasound scanners (Class II),\northopedic implants and hemodialysis machines (Class III), and cardiac pacemakers (Class IV).[12]\n\nUnited States \nFurther information: Federal_Food,_Drug,_and_Cosmetic_Act \u00a7 Medical_devices\nUnder the Food, Drug, and Cosmetic Act, the U.S. Food and Drug Administration recognizes three classes of medical devices, based on the level of control necessary to assure safety and effectiveness.[13] The classification procedures are described in the Code of Federal Regulations, Title 21, part 860 (usually known as 21 CFR 860).[14] The USFDA allows for two regulatory pathways that allow the marketing of medical devices. The first, and by far the most common is the so-called 510(k) process (named after the Food, Drug, and Cosmetic Act section that describes the process). A new medical device that can be demonstrated to be \"substantially equivalent\" to a previously legally marketed device can be \"cleared\" by the FDA for marketing as long as the general and special controls, as described below, are met. The vast majority of new medical devices (99%) enter the marketplace via this process. The 510(k) pathway rarely requires clinical trials. The second regulatory pathway for new medical devices is the Premarket Approval process, described below, which is similar to the pathway for a new drug approval. Typically, clinical trials are required for this premarket approval pathway.[15]\n\nClass I: General controls \nClass I devices are subject to the least regulatory control. Class I devices are subject to \"General Controls\" as are Class II and Class III devices.[13][16][17] General controls include provisions that relate to adulteration; misbranding; device registration and listing; premarket notification; banned devices; notification, including repair, replacement, or refund; records and reports; restricted devices; and good manufacturing practices.[17] Class I devices are not intended to help support or sustain life or be substantially important in preventing impairment to human health, and may not present an unreasonable risk of illness or injury.[17] Most Class I devices are exempt from the premarket notification and a few are also exempted from most good manufacturing practices regulation.[13][16][17] Examples of Class I devices include elastic bandages, examination gloves, and hand-held surgical instruments.[16]\n\nClass II: General controls with special controls \nClass II devices are those for which general controls alone cannot assure safety and effectiveness, and existing methods are available that provide such assurances.[13][16] In addition to complying with general controls, Class II devices are also subject to special controls.[16] A few Class II devices are exempt from the premarket notification.[16] Special controls may include special labeling requirements, mandatory performance standards and postmarket surveillance.[16] Devices in Class II are held to a higher level of assurance than Class I devices, and are designed to perform as indicated without causing injury or harm to patient or user. Examples of Class II devices include acupuncture needles, powered wheelchairs, infusion pumps, air purifiers, and surgical drapes.[13][16][18]\n\n Class III: General controls, Special Controls and premarket approval \nA Class III device is one for which insufficient information exists to assure safety and effectiveness solely through the general or special controls sufficient for Class I or Class II devices.[13][16] Such a device needs premarket approval, a scientific review to ensure the device's safety and effectiveness, in addition to the general controls of Class I.[13][16] Class III devices are usually those that support or sustain human life, are of substantial importance in preventing impairment of human health, or present a potential, unreasonable risk of illness or injury.[16] Examples of Class III devices that currently require a premarket notification include implantable pacemaker, pulse generators, HIV diagnostic tests, automated external defibrillators, and endosseous implants.[16]\n\n European Union (EU) and European Free Trade Association (EFTA) \nThe classification of medical devices in the European Union is outlined in Article IX of the Council Directive 93\/42\/EEC. There are basically four classes, ranging from low risk to high risk.\n\nClass I (including Is & Im)\nClass IIa\nClass IIb\nClass III\nThe authorization of medical devices is guaranteed by a Declaration of Conformity. This declaration is issued by the manufacturer itself, but for products in Class Is, Im, IIa, IIb or III, it must be verified by a Certificate of Conformity issued by a Notified Body. A Notified Body is a public or private organisation that has been accredited to validate the compliance of the device to the European Directive. Medical devices that pertain to class I (on condition they do not require sterilization or do not measure a function) can be marketed purely by self-certification.\nThe European classification depends on rules that involve the medical device's duration of body contact, invasive character, use of an energy source, effect on the central circulation or nervous system, diagnostic impact, or incorporation of a medicinal product. Certified medical devices should have the CE mark on the packaging, insert leaflets, etc.. These packagings should also show harmonised pictograms and EN standardised logos to indicate essential features such as instructions for use, expiry date, manufacturer, sterile, don't reuse, etc.\nIn November 2018 the Federal Administrative Court of Switzerland decided that the \"Sympto\" app, used to analyze a woman's menstrual cycle, was a medical device because it calculates a fertility window for each woman using personal data. The manufacturer, Sympto-Therm Foundation, argued that this was a didactic, not a medical process. the court laid down that an app is a medical device if it is to be used for any of the medical purposes provided by law, and creates or modifies health information by calculations or comparison,\nproviding information about an individual patient.[19]\n\n<\/p>\nAustralia \nThe classification of medical devices in Australia is outlined in section 41BD of the Therapeutic Goods Act 1989 and Regulation 3.2 of the Therapeutic Goods Regulations 2002, under control of the Therapeutic Goods Administration. Similarly to the EU classification, they rank in several categories, by order of increasing risk and associated required level of control. Various rules identify the device's category[20]\n\n\nMedical Devices Categories in Australia\n\n\nClassification\nLevel of Risk\n\n\nClass I\nLow\n\n\nClass I - measuring or Class I - supplied sterile or class IIa\nLow - medium\n\n\nClass IIb\nMedium - high\n\n\nClass III\nHigh\n\n\nActive implantable medical devices (AIMD)\nHigh\n\nIran \nWith the fourth world engineering rating of over a thousand medical Devices,Iran produces about 2,000 species of medical devices and medical supplies such as appliances and dental supplies and all sorts of disposable sterile medical stuff,laboratory machines and all kinds of Biomaterials and dental implants and 400 medical products are produced at the C and D risk class which all of them are licensed by the Iranian Health Ministry in terms of safety and performance based on EU standards.\nIranian medical Devices products are produced according to the European Union standards so the quality of products, skilled labour, access to the technologies of the world and the low price of products over the European countries are among the important features of these products and in these respects it is competitive with the products of European countries.\n\u200fOn cooperation with active commercial partners in the European Union, Iran exports medical devices and supplies which has Union\u2019s standards and CE Logo to the applicant countries including 40 Asian and European countries, some of which are in the rest of the world by transferring technology from Iran to other commercial partners.\nAmong the ways that Iranian producers do for exporting their products to foreign countries is exporting to foreign countries by placing products in the name of the country as that of manufacture (Made in Iran) or production of products in and packaging it in the name of the country's name and their exportation which is very welcomed by the European countries because of the contributions of other countries. It will also include the establishment of a joint production line between business partners and Iranian producing companies to manufacture and produce products to other applicants, from other production methods and export of Iranian devices and medical supplies.[21]\n\nTechnological security issues \nMedical devices such as pacemakers, insulin pumps, operating room monitors, defibrillators, and surgical instruments, including deep-brain stimulators, can incorporate the ability to transmit vital health information from a patient's body to medical professionals.[22] Some of these devices can be remotely controlled. This has engendered concern about privacy and security issues,[23] human error, and technical glitches with this technology. While only a few studies have looked at the susceptibility of medical devices to hacking, there is a risk.[24][25][26] In 2008, computer scientists proved that pacemakers and defibrillators can be hacked wirelessly via radio hardware, an antenna, and a personal computer.[27] These researchers showed they could shut down a combination heart defibrillator and pacemaker and reprogram it to deliver potentially lethal shocks or run out its battery. Jay Radcliff, a security researcher interested in the security of medical devices, raised fears about the safety of these devices. He shared his concerns at the Black Hat security conference.[28] Radcliff fears that the devices are vulnerable and has found that a lethal attack is possible against those with insulin pumps and glucose monitors. Some medical device makers downplay the threat from such attacks and argue that the demonstrated attacks have been performed by skilled security researchers and are unlikely to occur in the real world. At the same time, other makers have asked software security experts to investigate the safety of their devices.[29] As recently as June 2011, security experts showed that by using readily available hardware and a user manual, a scientist could both tap into the information on the system of a wireless insulin pump in combination with a glucose monitor. With the PIN of the device, the scientist could wirelessly control the dosage of the insulin.[30] Anand Raghunathan, a researcher in this study, explains that medical devices are getting smaller and lighter so that they can be easily worn. The downside is that additional security features would put an extra strain on the battery and size and drive up prices. Dr. William Maisel offered some thoughts on the motivation to engage in this activity. Motivation to do this hacking might include acquisition of private information for financial gain or competitive advantage; damage to a device manufacturer's reputation; sabotage; intent to inflict financial or personal injury or just satisfaction for the attacker.[31] Researchers suggest a few safeguards. One would be to use rolling codes. Another solution is to use a technology called \"body-coupled communication\" that uses the human skin as a wave guide for wireless communication. On 28 December 2016 the US Food and Drug Administration released its recommendations that are not legally enforceable for how medical device manufacturers should maintain the security of Internet-connected devices.[32][33]\n\nStandardization and regulatory concerns \nThe ISO standards for medical devices are covered by ICS 11.100.20 and 11.040.01.[34][35] The quality and risk management regarding the topic for regulatory purposes is convened by ISO 13485 and ISO 14971. ISO 13485:2003 is applicable to all providers and manufacturers of medical devices, components, contract services and distributors of medical devices. The standard is the basis for regulatory compliance in local markets, and most export markets.[36][37][38] Additionally, ISO 9001:2008 sets precedence because it signifies that a company engages in the creation of new products. It requires that the development of manufactured products have an approval process and a set of rigorous quality standards and development records before the product is distributed.[39] Further standards are IEC 60601-1 which is for electrical devices (mains-powered as well as battery powered), EN 45502-1 which is for Active implantable medical devices, and IEC 62304 for medical software. The US FDA also published a series of guidances for industry regarding this topic against 21 CFR 820 Subchapter H\u2014Medical Devices.[40] Subpart B includes quality system requirements, an important component of which are design controls (21 CFR 820.30). To meet the demands of these industry regulation standards, a growing number of medical device distributors are putting the complaint management process at the forefront of their quality management practices. This approach further mitigates risks and increases visibility of quality issues.[41]\nStarting in the late 1980s[42] the FDA increased its involvement in reviewing the development of medical device software. The precipitant for change was a radiation therapy device (Therac-25) that overdosed patients because of software coding errors.[43] FDA is now focused on regulatory oversight on medical device software development process and system-level testing.[44]\nA 2011 study by Dr. Diana Zuckerman and Paul Brown of the National Research Center for Women and Families, and Dr. Steven Nissen of the Cleveland Clinic, published in the Archives of Internal Medicine, showed that most medical devices recalled in the last five years for \"serious health problems or death\" had been previously approved by the FDA using the less stringent, and cheaper, 510(k) process. In a few cases the devices had been deemed so low-risk that they did not need FDA regulation. Of the 113 devices recalled, 35 were for cardiovascular issues.[15] This may lead to a reevaluation of FDA procedures and better oversight.\n \nIn 2014-2015 a new international agreement, the Medical Device Single Audit Program (MDSAP), was put in place with five participant countries: Australia, Brazil, Canada, Japan, and the United States. The aim of this program was to \"develop a process that allows a single audit, or inspection to ensure the medical device regulatory requirements for all five countries are satisfied\".[45]\n\n<\/p>In 2018, an investigation involving journalists across 36 countries coordinated by the International Consortium of Investigative Journalists (ICIJ) prompted calls for reform in the United States, particularly around the 510(k) substantial equivalence process;[46] the investigation prompted similar calls in the UK and Europe Union.[47]\n\nPackaging standards \nMedical device packaging is highly regulated. Often medical devices and products are sterilized in the package.[48]\nSterility must be maintained throughout distribution to allow immediate use by physicians. A series of special packaging tests measure the ability of the package to maintain sterility. Relevant standards include:\n\nASTM D1585 \u2013 Guide for Integrity Testing of Porous Medical Packages\nASTM F2097 \u2013 Standard Guide for Design and Evaluation of Primary Flexible Packaging for Medical Products\nASTM F3475-11 \u2013 Standard Guide for Biocompatibility Evaluation of Medical Device Packaging Materials[49]\nEN 868 Packaging materials and systems for medical devices to be sterilized, General requirements and test methods\nISO 11607 Packaging for terminally sterilized medical devices\nPackage testing documents and ensures that packages meet regulations and end-use requirements. Manufacturing processes must be controlled and validated to ensure consistent performance.[50][51]\n\nBiocompatibility standards \nISO 10993 - Biological Evaluation of Medical Devices\nCleanliness standards \nMedical device cleanliness has come under greater scrutiny since 2000, when Sulzer Orthopedics recalled several thousand metal hip implants that contained a manufacturing residue.[52] Based on this event, ASTM established a new task group (F04.15.17) for established test methods, guidance documents, and other standards to address cleanliness of medical devices. This task group has issued two standards for permanent implants to date: 1. ASTM F2459: Standard test method for extracting residue from metallic medical components and quantifying via gravimetric analysis[53] 2. ASTM F2847: Standard Practice for Reporting and Assessment of Residues on Single Use Implants[54] 3. ASTM F3172: Standard Guide for Validating Cleaning Processes Used During the Manufacture of Medical Devices [55]\nIn addition, the cleanliness of re-usable devices has led to a series of standards, including:\n\nASTM E2314: Standard Test Method for Determination of Effectiveness of Cleaning Processes for Reusable Medical Instruments Using a Microbiologic Method (Simulated Use Test)\"[56]\nASTM D7225: Standard Guide for Blood Cleaning Efficiency of Detergents and Washer-Disinfectors[57]\nASTM F3208: Standard Guide for Selecting Test Soils for Validation of Cleaning Methods for Reusable Medical Devices[55]\nThe ASTM F04.15.17 task group is working on several new standards that involve designing implants for cleaning, selection and testing of brushes for cleaning reusable devices, and cleaning assessment of medical devices made by additive manufacturing.[58] Additionally, the FDA is establishing new guidelines for reprocessing reusable medical devices, such as orthoscopic shavers, endoscopes, and suction tubes.[59]\n\nMobile medical applications \nWith the rise of smartphone usage in the medical space, in 2013, the FDA issued to regulate mobile medical applications and protect users from their unintended use, soon followed by European and other regulatory agencies. This guidance distinguishes the apps subjected to regulation based on the marketing claims of the apps.[60] Incorporation of the guidelines during the development phase of such apps can be considered as developing a medical device; the regulations have to adapt and propositions for expedite approval may be required due to the nature of 'versions' of mobile application development.[61][62]\n\nAcademic resources \nMedical & Biological Engineering & Computing\nExpert Review of Medical Devices\nJournal of Clinical Engineering[63]\nUniversity Based Research Packaging Institutes \nUniversity of Minnesota - Medical Devices Center (MDC)\nUniversity of Strathclyde - Strathclyde Institute of Medical Devices (SIMD)\nFlinders University - Medical Device Research Institute (MDRI)\nMichigan State University - School of Packaging (SoP)[64]\nSee also \n\n Biomedical engineering – Application of engineering principles and design concepts to medicine and biology for healthcare purposes\n Biomedical equipment technician\n Clinical engineering\n Design history file\n Durable medical equipment\n Electromagnetic compatibility\n Electronic health record\n Federal Institute for Drugs and Medical Devices\n In vitro diagnostics\n GHTF\n Health Level 7\n Home medical equipment\n Implant (medicine)\n ISO 13485\n List of common EMC test standards\n Medical Devices Directive\n Medical device hijack\n Medical equipment – Equipment designed to aid in the diagnosis, monitoring or treatment of medical conditions\n Medical logistics\n Medical software\n Safety engineering\nSection 201(h) of Federal Food, Drug, and Cosmetic Act\n Telemedicine – Medical care by telecommunication\n\nReferences \n\n\n^ \"Market Report: World Medical Devices Market\". Acmite Market Intelligence. 2014. Retrieved 15 June 2014 . \n\n^ a b Wong, K., Tu, J., Sun, Z., and Dissanayake, D. W. \"Methods in Research and Development of Biomedical Devices\". World Scientific Publishing. Retrieved 29 May 2013 . CS1 maint: Multiple names: authors list (link) \n\n^ \"Eur-lex Europa\". 2005. Retrieved 15 June 2014 . \n\n^ a b \"Directive 2007\/47\/ec of the European parliament and of the council\". Eur-lex Europa. 5 September 2007. Retrieved 15 June 2014 . \n\n^ \"Revision of the medical device directives\". European Commission. 2013. Retrieved 15 June 2014 . \n\n^ US Food and Drug Administration,\n\"Is The Product A Medical Device?\" \n\n^ \"Federal Register Vol 78, No 151, page 47712\" (PDF) . U.S. Government Publishing Office. 6 August 2013. Retrieved 17 February 2016 . \n\n^ FDA Mobile Medical Applications: Guidance for Industry and Food and Drug Administration Staff \n\n^ Piccardo, Carmelita (28 July 2014). \"FDA Eases the Way for New Product Development\". 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Retrieved 13 December 2018 . \n\n^ TGA, Australian regulatory guidelines for medical devices (ARGMD) Version 1.1, May 2011, http:\/\/www.tga.gov.au\/pdf\/devices-argmd-01.pdf \n\n^ \"Iran's Medical Devices at a glance\". IMED.ir. Retrieved 2018-11-10 . \n\n^ Jordan Robertson. Associated Press 8\/4\/2011 \n\n^ Altawy, R; Youssef, A. \"Security Trade-offs in Cyber Physical Systems: A Case Study Survey on Implantable Medical Devices\". IEEE Access. \n\n^ New Health Hazard:Hackable Medical Implants. MSNBC.com's Technology \n\n^ Camara, Carmen; Peris-Lopez, Pedro; Tapiador, Juan E. (2015-06-01). \"Security and privacy issues in implantable medical devices: A comprehensive survey\". Journal of Biomedical Informatics. 55: 272\u2013289. doi:10.1016\/j.jbi.2015.04.007. ISSN 1532-0480. PMID 25917056. \n\n^ Pycroft, Laurie; Boccard, Sandra G.; Owen, Sarah L. F.; Stein, John F.; Fitzgerald, James J.; Green, Alexander L.; Aziz, Tipu Z. (2016-05-13). \"Brainjacking: implant security issues in invasive neuromodulation\". World Neurosurgery. 92: 454\u2013462. doi:10.1016\/j.wneu.2016.05.010. ISSN 1878-8769. PMID 27184896. \n\n^ Takahashi, Dean (8 Aug 2008). \"Excuse Me While I turn off Your Pacemaker\". Venture Beat. \n\n^ Hacking Medical Devices for Fun and Insulin: Breaking the Human SCADA System \n\n^ Globe and Mail. Thursday Oct. 27, 2011 Jim Finkle. Insulin Pumps Vulnerable to Attacks by Hackers \n\n^ Daily Tech June 15, 2011 Nidhi Subbaraman \n\n^ Daily Tech June 15, 2011 Nidhi SubbaramanDaily Tech \n\n^ Becker, Rachel (27 December 2016). \"New cybersecurity guidelines for medical devices tackle evolving threats\". The Verge. Retrieved 29 December 2016 . \n\n^ \"Postmarket Management of Cybersecurity in Medical Devices\" (PDF) . 28 December 2016. Retrieved 29 December 2016 . \n\n^ International Organization for Standardization. \"11.100.20: Biological evaluation of medical devices\". Retrieved 10 April 2009 . \n\n^ International Organization for Standardization. \"11.040: Medical equipment\". Retrieved 26 April 2009 . \n\n^ \"ISO 13485:2003 - Medical devices -- Quality management systems -- Requirements for regulatory purposes\". www.iso.org. Retrieved 27 March 2018 . \n\n^ Canada, Health. \"Quality Systems ISO 13485 - Canada.ca\". www.hc-sc.gc.ca. Retrieved 27 March 2018 . \n\n^ \"ISO 13485 in USA\" (PDF) . fda.gov. Retrieved 27 March 2018 . \n\n^ \"ISO Standards Applied to Medical Device Manufacturing\" (PDF) . MK Precision. Retrieved 27 October 2014 . \n\n^ Food and Drug Administration Standards (Medical Devices) Page Last Updated: 11 March 2014. Accessed 18 May 2014 \n\n^ \"Preparing a Complaints\/eMDR System for Upcoming FDA Mandate\". Sparta Systems. 18 May 2015. \n\n^ \"Therac-25 Timeline\". Computingcases.org. Retrieved 2011-01-04 . \n\n^ Jones, Paul; Jetley, Raoul; Abraham, Jay (2010-02-09). \"A Formal Methods-based verification approach to medical device software analysis\". Embedded Systems Design. Retrieved 2016-04-21 . \n\n^ FDA (2010-09-08). \"Infusion Pump Software Safety Research at FDA\". FDA. Retrieved 2010-09-09 . \n\n^ Trautman, Kim (16 January 2015). \"Australia, Brazil, Canada, Japan, and the US: Safeguarding Medical Devices\". FDA Voice. Food and Drug Administration. \n\n^ Lenzer, Jeanne (2018-11-27). \"FDA recommends \"modernizing\" review of devices in wake of global investigation\". BMJ. 363: k5026. doi:10.1136\/bmj.k5026. ISSN 1756-1833. PMID 30482750. \n\n^ Coombes, Rebecca (2018-11-26). \"Surgeons call for compulsory registers of all new medical devices\". BMJ. 363: k5010. doi:10.1136\/bmj.k5010. ISSN 1756-1833. PMID 30478186. \n\n^ Dacy, D (2010), \"Optimizing Package Design for EtO Sterilization\", Medical Device and Diagnostic Industry, 33 (1) \n\n^ \"ASTM International - Standards Worldwide\". www.astm.org. Retrieved 2017-08-23 . \n\n^ \nBix, L.; Fuente, J. (2009), \"Medical Device Packaging\", in Yam, K. L, Wiley Encyclopedia of Packaging Technology, Wiley, ISBN 978-0-470-08704-6 \n\n^ \nFotis, N.; Bix, L. (2006), \"Sample Size Selection Using Margin of Error Approach\", Medical Device and Diagnostic Industry, 28 (10): 80\u201389 \n\n^ \"Spiegelberg, S.H., Deluzio, K.J., Muratoglu, O.K., \"Extractable residue from recalled Inter-Op acetabular shells,\" 49th Annual Meeting of the Orthopaedic Research Society, 2003\" (PDF) . ors.org. Retrieved 27 March 2018 . \n\n^ \"Standard Test Method for Extracting Residue from Metallic Medical Components and Quantifying via Gravimetric Analysis\". ASTM International Products and Services. Retrieved 15 June 2014 . \n\n^ \"Standard Practice for Reporting and Assessment of Residues on Single Use Implants\". ASTM Products and Services. Retrieved 15 June 2014 . \n\n^ a b \"ASTM F3208 - 17 Standard Guide for Selecting Test Soils for Validation of Cleaning Methods for Reusable Medical Devices\". www.astm.org. Retrieved 27 March 2018 . \n\n^ \"Standard Test Method for Determination of Effectiveness of Cleaning Processes for Reusable Medical Instruments Using a Microbiologic Method (Simulated Use Test)\". ASTM International - Products and Services. Retrieved 15 June 2014 . \n\n^ \"Standard Guide for Blood Cleaning Efficiency of Detergents and Washer-Disinfectors\". 2014. Retrieved 15 June 2014 . \n\n^ \"Committee F04 on Medical and Surgical Materials and Devices\". 2014. Retrieved 15 June 2014 . \n\n^ \"Reprocessing of Reusable Medical Devices\". U.S. Department of Health and Human Services - Food and Drug Administration - Medical Devices. 2014. Retrieved 15 June 2014 . \n\n^ http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ConnectedHealth\/MobileMedicalApplications\/ucm255978.htm \n\n^ Yetisen A. K.; Martinez-Hurtado J. L.; et al. (2014). \"The regulation of mobile medical applications\". Lab on a Chip. 14 (5): 833\u2013840. doi:10.1039\/C3LC51235E. \n\n^ Vincent, Christopher James; Niezen, Gerrit; O'Kane, Aisling Ann; Stawarz, Katarzyna (3 June 2015). \"Can Standards and Regulations Keep Up With Health Technology?\". JMIR mHealth and uHealth. 3 (2): e64. doi:10.2196\/mhealth.3918. \n\n^ Lippincott Williams & Wilkins. \"Journal Information\". Retrieved 10 April 2009 . \n\n^ \"School of Packaging\". School of Packaging. Retrieved 2017-08-23 . \n\n\nExternal links \nUS Food and Drug Administration \u2013 Center for Devices and Radiological Health\nPremarket Notification (510k)\nPremarket Approval (PMA)\nFDA \u2013 Is the Product a Medical Device?\nMHRA - Medical devices regulation and safety\nEC - Medical devices\nHealth Canada - List of Recognized Standards for Medical Devices (International)\nISO - Standards catalogue: 11.040.01: Medical equipment in general\nRadio Frequency Wireless Technology in Medical Devices - Guidance for Industry and Food and Drug Administration Staff. FDA (2013)\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_device\">https:\/\/www.limswiki.org\/index.php\/Medical_device<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 21:21.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 2,335 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8e821122daa731f0fa8782fae57831fa_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_device skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical device<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">Any instrument, apparatus, implant, in vitro reagent, or similar or related article used for diagnostic and\/or therapeutic purposes<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stetoskop.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Stetoskop.jpg\/220px-Stetoskop.jpg\" width=\"220\" height=\"235\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stetoskop.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stethoscope\" title=\"Stethoscope\" rel=\"external_link\" target=\"_blank\">stethoscope<\/a>, a popular medical device, ubiquitous in hospitals.<\/div><\/div><\/div>\n<p>A <b>medical device<\/b> is any apparatus, appliance, software, material, or other article\u2014whether used alone or in combination, including the software intended by its manufacturer to be used specifically for diagnostic and\/or therapeutic purposes and necessary for its proper application\u2014intended by the manufacturer to be used for human beings for the purpose of:\n<\/p>\n<ul><li>Diagnosis, prevention, monitoring, treatment, or alleviation of disease;<\/li>\n<li>Diagnosis, monitoring, treatment, alleviation, or compensation for an injury or handicap;<\/li>\n<li>Investigation, replacement, or modification of the anatomy or of a physiological process;<\/li>\n<li>Control of conception; and which does not achieve its principal intended action in or on the human body by pharmacological, immunological, or metabolic means, but which may be assisted in its function by such means<\/li><\/ul>\n<p>Medical devices vary according to their intended use and indications. Examples range from simple devices such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongue_depressor\" title=\"Tongue depressor\" rel=\"external_link\" target=\"_blank\">tongue depressors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_thermometer\" title=\"Medical thermometer\" rel=\"external_link\" target=\"_blank\">medical thermometers<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_glove\" title=\"Medical glove\" rel=\"external_link\" target=\"_blank\">disposable gloves<\/a> to advanced devices such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer\" title=\"Computer\" rel=\"external_link\" target=\"_blank\">computers<\/a> which assist in the conduct of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_test\" title=\"Medical test\" rel=\"external_link\" target=\"_blank\">medical testing<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implants<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prostheses<\/a>. Items as intricate as housings for cochlear implants are manufactured through the deep drawn and shallow drawn manufacturing processes. The design of medical devices constitutes a major segment of the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_engineering\" title=\"Biomedical engineering\" rel=\"external_link\" target=\"_blank\">biomedical engineering<\/a>.\n<\/p><p>The global medical device market reached roughly $209 billion in 2006.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span id=\"rdp-ebb-Design.2C_prototyping.2C_and_product_development\"><\/span><span class=\"mw-headline\" id=\"Design,_prototyping,_and_product_development\">Design, prototyping, and product development<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device_manufacturing\" title=\"Medical device manufacturing\" rel=\"external_link\" target=\"_blank\">Medical device manufacturing<\/a><\/div>\n<p>Medical device manufacturing requires a level of process control according to the classification of the device. Higher risk; more controls. When in the initial R&D phase, manufacturers are now beginning to design for manufacturability. This means products can be more precision-engineered to for production to result in shorter lead times, tighter tolerances and more advanced specifications and prototypes. These days, with the aid of CAD or modelling platforms, the work is now much faster, and this can act also as a tool for strategic design generation as well as a marketing tool.<sup id=\"rdp-ebb-cite_ref-bemd_2-0\" class=\"reference\"><a href=\"#cite_note-bemd-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Failure to meet cost targets will lead to substantial losses for an organisation. In addition, with global competition, the R&D of new devices is not just a necessity, it is an imperative for medical device manufacturers. The realisation of a new design can be very costly, especially with the shorter product life cycle. As technology advances, there is typically a level of quality, safety and reliability that increases exponentially with time.<sup id=\"rdp-ebb-cite_ref-bemd_2-1\" class=\"reference\"><a href=\"#cite_note-bemd-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>For example, initial models of the artificial cardiac pacemaker were external support devices that transmits pulses of electricity to the heart muscles via electrode leads on the chest. The electrodes contact the heart directly through the chest, allowing stimulation pulses to pass through the body. Recipients of this typically suffered infection at the entrance of the electrodes, which led to the subsequent trial of the first internal pacemaker, with electrodes attached to the myocardium by thoracotomy. Future developments led to the isotope-power source that would last for the lifespan of the patient.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Definitions\">Definitions<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"European_Union_legal_framework_and_definition\">European Union legal framework and definition<\/span><\/h3>\n<p>Based on the <i>New Approach<\/i>, rules that relate to safety and performance of medical devices were harmonised in the EU in the 1990s. The <i>New Approach<\/i>, defined in a European Council Resolution of May 1985,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> represents an innovative way of technical harmonisation. It aims to remove technical barriers to trade and dispel the consequent uncertainty for economic operators, to facilitate free movement of goods inside the EU.\n<\/p><p>The core legal framework consists of three directives: \n<\/p>\n<ul><li>Directive 90\/385\/EEC regarding active implantable medical devices<\/li>\n<li>Directive 93\/42\/EEC regarding medical devices<\/li>\n<li>Directive 98\/79\/EC regarding <i>in vitro<\/i> diagnostic medical devices<\/li><\/ul>\n<p>They aim at ensuring a high level of protection of human health and safety and the good functioning of the Single Market. These three main directives have been supplemented over time by several modifying and implementing directives, including the last technical revision brought about by Directive 2007\/47 EC.<sup id=\"rdp-ebb-cite_ref-:0_4-0\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Directive 2007\/47\/EC defines a medical device as (paraphrasing): Any instrument, apparatus, appliance, software, material or other article, whether used alone or in combination, together with any accessories, including the software intended by its manufacturer to be used specifically for diagnostic and\/or therapeutic purposes and necessary for its proper application, intended by the manufacturer to be used for human beings for the purpose of:\n<\/p>\n<ul><li>Diagnosis, prevention, monitoring, treatment, or alleviation of disease<\/li>\n<li>Diagnosis, monitoring, treatment, alleviation of, or compensation for an injury or handicap<\/li>\n<li>Investigation, replacement, or modification of the anatomy or of a physiological process<\/li>\n<li>Control of conception<\/li><\/ul>\n<p>This includes devices that do not achieve their principal intended action in or on the human body by pharmacological, immunological, or metabolic means\u2014but may be assisted in their function by such means.<sup id=\"rdp-ebb-cite_ref-:0_4-1\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>The government of each Member State must appoint a <i>competent authority<\/i> responsible for medical devices. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Competent_authority\" title=\"Competent authority\" rel=\"external_link\" target=\"_blank\">competent authority<\/a> (CA) is a body with authority to act on behalf of the member state to ensure that member state government transposes requirements of medical device directives into national law and applies them. The CA reports to the minister of health in the member state. The CA in one Member State has no jurisdiction in any other member state, but exchanges information and tries to reach common positions.\n<\/p><p>In the UK, for example, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicines_and_Healthcare_products_Regulatory_Agency\" title=\"Medicines and Healthcare products Regulatory Agency\" rel=\"external_link\" target=\"_blank\">Medicines and Healthcare products Regulatory Agency<\/a> (MHRA) acts as a CA. In Italy it is the Ministero Salute (Ministry of Health) Medical devices must not be mistaken with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicinal_product\" class=\"mw-redirect\" title=\"Medicinal product\" rel=\"external_link\" target=\"_blank\">medicinal products<\/a>. In the EU, all medical devices must be identified with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/CE_mark\" class=\"mw-redirect\" title=\"CE mark\" rel=\"external_link\" target=\"_blank\">CE mark<\/a>.\n<\/p><p>In September 2012, the European Commission proposed new legislation aimed at enhancing safety, traceability, and transparency.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Definition_in_United_States_by_the_Food_and_Drug_Administration\">Definition in United States by the Food and Drug Administration<\/span><\/h3>\n<p>Medical machine, contrivance, implant, <i>in vitro<\/i> reagent, or other similar or related article, including a component part, or accessory that is:\n<\/p>\n<ul><li>Recognized in the official <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Formulary\" class=\"mw-redirect\" title=\"National Formulary\" rel=\"external_link\" target=\"_blank\">National Formulary<\/a>, or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Pharmacopoeia\" class=\"mw-redirect\" title=\"United States Pharmacopoeia\" rel=\"external_link\" target=\"_blank\">United States Pharmacopoeia<\/a>, or any supplement to them<\/li>\n<li>Intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals<\/li>\n<li>Intended to affect the structure or any function of the body of man or other animals, and does not achieve any of its primary purpose through chemical action within or on the body of man or other animals and does not depend on metabolic action to achieve its primary purpose.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><\/li><\/ul>\n<p>In August 2013, the FDA released over 20 regulations aiming to improve the security of data in medical devices,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> in response to the growing risks of limited <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cybersecurity\" class=\"mw-redirect\" title=\"Cybersecurity\" rel=\"external_link\" target=\"_blank\">cybersecurity<\/a>.\n<\/p><p>On September 25, 2013 the FDA released a draft guidance document for regulation of mobile medical applications, to clarify what kind of mobile apps related to health would not be regulated, and which would be.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Definition_in_Canada_by_the_Food_and_Drugs_Act\">Definition in Canada by the Food and Drugs Act<\/span><\/h3>\n<p>The term medical devices, as defined in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drugs_Act\" title=\"Food and Drugs Act\" rel=\"external_link\" target=\"_blank\">Food and Drugs Act<\/a>, covers a wide range of health or medical instruments used in the treatment, mitigation, diagnosis or prevention of a disease or abnormal physical condition. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Canada\" title=\"Health Canada\" rel=\"external_link\" target=\"_blank\">Health Canada<\/a> reviews medical devices to assess their safety, effectiveness, and quality before authorizing their sale in Canada.<sup id=\"rdp-ebb-cite_ref-Canada_regulations_10-0\" class=\"reference\"><a href=\"#cite_note-Canada_regulations-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Classification\">Classification<\/span><\/h2>\n<p>The regulatory authorities recognize different classes of medical devices based on their design complexity, their use characteristics, and their potential for harm if misused. Each country or region defines these categories in different ways. The authorities also recognize that some devices are provided in combination with drugs, and regulation of these combination products takes this factor into consideration.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Canada\">Canada<\/span><\/h3>\n<p>The Medical Devices Bureau of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Canada\" title=\"Health Canada\" rel=\"external_link\" target=\"_blank\">Health Canada<\/a> recognizes four classes of medical devices based on the level of control necessary to assure the safety and effectiveness of the device. Class I devices present the lowest potential risk and do not require a licence. Class II devices require the manufacturer's declaration of device safety and effectiveness, whereas Class III and IV devices present a greater potential risk and are subject to in-depth scrutiny.<sup id=\"rdp-ebb-cite_ref-Canada_regulations_10-1\" class=\"reference\"><a href=\"#cite_note-Canada_regulations-10\" rel=\"external_link\">[10]<\/a><\/sup> A guidance document for device classification is published by Health Canada.<sup id=\"rdp-ebb-cite_ref-HealthCanada_11-0\" class=\"reference\"><a href=\"#cite_note-HealthCanada-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Canadian classes of medical devices correspond to the European Council Directive 93\/42\/EEC (MDD) devices:<sup id=\"rdp-ebb-cite_ref-HealthCanada_11-1\" class=\"reference\"><a href=\"#cite_note-HealthCanada-11\" rel=\"external_link\">[11]<\/a><\/sup> \n<\/p>\n<ul><li>Class IV (Canada) generally corresponds to Class III (ECD),<\/li>\n<li>Class III (Canada) generally corresponds to Class IIb (ECD),<\/li>\n<li>Class II (Canada) generally corresponds to Class IIa (ECD), and<\/li>\n<li>Class I (Canada) generally corresponds to Class I (ECD)<\/li><\/ul>\n<p>Examples include surgical instruments (Class I), contact lenses and ultrasound scanners (Class II),\northopedic implants and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> machines (Class III), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_pacemaker\" title=\"Cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">cardiac pacemakers<\/a> (Class IV).<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"United_States\">United States<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Food,_Drug,_and_Cosmetic_Act#Medical_devices\" title=\"Federal Food, Drug, and Cosmetic Act\" rel=\"external_link\" target=\"_blank\">Federal_Food,_Drug,_and_Cosmetic_Act \u00a7 Medical_devices<\/a><\/div>\n<p>Under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Food,_Drug,_and_Cosmetic_Act#Medical_devices\" title=\"Federal Food, Drug, and Cosmetic Act\" rel=\"external_link\" target=\"_blank\">Food, Drug, and Cosmetic Act<\/a>, the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> recognizes three classes of medical devices, based on the level of control necessary to assure safety and effectiveness.<sup id=\"rdp-ebb-cite_ref-classification_13-0\" class=\"reference\"><a href=\"#cite_note-classification-13\" rel=\"external_link\">[13]<\/a><\/sup> The classification procedures are described in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Code_of_Federal_Regulations\" title=\"Code of Federal Regulations\" rel=\"external_link\" target=\"_blank\">Code of Federal Regulations<\/a>, Title 21, part 860 (usually known as 21 CFR 860).<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> The USFDA allows for two regulatory pathways that allow the marketing of medical devices. The first, and by far the most common is the so-called 510(k) process (named after the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Food,_Drug,_and_Cosmetic_Act#Medical_devices\" title=\"Federal Food, Drug, and Cosmetic Act\" rel=\"external_link\" target=\"_blank\">Food, Drug, and Cosmetic Act<\/a> section that describes the process). A new medical device that can be demonstrated to be \"substantially equivalent\" to a previously legally marketed device can be \"cleared\" by the FDA for marketing as long as the general and special controls, as described below, are met. The vast majority of new medical devices (99%) enter the marketplace via this process. The 510(k) pathway rarely requires clinical trials. The second regulatory pathway for new medical devices is the Premarket Approval process, described below, which is similar to the pathway for a new drug approval. Typically, clinical trials are required for this premarket approval pathway.<sup id=\"rdp-ebb-cite_ref-Zuckerman_2011_15-0\" class=\"reference\"><a href=\"#cite_note-Zuckerman_2011-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Class_I:_General_controls\">Class I: General controls<\/span><\/h4>\n<p>Class I devices are subject to the least regulatory control. Class I devices are subject to \"General Controls\" as are Class II and Class III devices.<sup id=\"rdp-ebb-cite_ref-classification_13-1\" class=\"reference\"><a href=\"#cite_note-classification-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-controls_16-0\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-general_controls_17-0\" class=\"reference\"><a href=\"#cite_note-general_controls-17\" rel=\"external_link\">[17]<\/a><\/sup> General controls include provisions that relate to adulteration; misbranding; device registration and listing; premarket notification; banned devices; notification, including repair, replacement, or refund; records and reports; restricted devices; and good manufacturing practices.<sup id=\"rdp-ebb-cite_ref-general_controls_17-1\" class=\"reference\"><a href=\"#cite_note-general_controls-17\" rel=\"external_link\">[17]<\/a><\/sup> Class I devices are not intended to help support or sustain life or be substantially important in preventing impairment to human health, and may not present an unreasonable risk of illness or injury.<sup id=\"rdp-ebb-cite_ref-general_controls_17-2\" class=\"reference\"><a href=\"#cite_note-general_controls-17\" rel=\"external_link\">[17]<\/a><\/sup> Most Class I devices are exempt from the premarket notification and a few are also exempted from most good manufacturing practices regulation.<sup id=\"rdp-ebb-cite_ref-classification_13-2\" class=\"reference\"><a href=\"#cite_note-classification-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-controls_16-1\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-general_controls_17-3\" class=\"reference\"><a href=\"#cite_note-general_controls-17\" rel=\"external_link\">[17]<\/a><\/sup> Examples of Class I devices include elastic bandages, examination gloves, and hand-held surgical instruments.<sup id=\"rdp-ebb-cite_ref-controls_16-2\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Class_II:_General_controls_with_special_controls\">Class II: General controls with special controls<\/span><\/h4>\n<p>Class II devices are those for which general controls alone cannot assure safety and effectiveness, and existing methods are available that provide such assurances.<sup id=\"rdp-ebb-cite_ref-classification_13-3\" class=\"reference\"><a href=\"#cite_note-classification-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-controls_16-3\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup> In addition to complying with general controls, Class II devices are also subject to special controls.<sup id=\"rdp-ebb-cite_ref-controls_16-4\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup> A few Class II devices are exempt from the premarket notification.<sup id=\"rdp-ebb-cite_ref-controls_16-5\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup> Special controls may include special labeling requirements, mandatory performance standards and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Postmarketing_surveillance\" title=\"Postmarketing surveillance\" rel=\"external_link\" target=\"_blank\">postmarket surveillance<\/a>.<sup id=\"rdp-ebb-cite_ref-controls_16-6\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup> Devices in Class II are held to a higher level of assurance than Class I devices, and are designed to perform as indicated without causing injury or harm to patient or user. Examples of Class II devices include acupuncture needles, powered wheelchairs, infusion pumps, air purifiers, and surgical drapes.<sup id=\"rdp-ebb-cite_ref-classification_13-4\" class=\"reference\"><a href=\"#cite_note-classification-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-controls_16-7\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h4><span id=\"rdp-ebb-Class_III:_General_controls.2C_Special_Controls_and_premarket_approval\"><\/span><span class=\"mw-headline\" id=\"Class_III:_General_controls,_Special_Controls_and_premarket_approval\">Class III: General controls, Special Controls and premarket approval<\/span><\/h4>\n<p>A Class III device is one for which insufficient information exists to assure safety and effectiveness solely through the general or special controls sufficient for Class I or Class II devices.<sup id=\"rdp-ebb-cite_ref-classification_13-5\" class=\"reference\"><a href=\"#cite_note-classification-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-controls_16-8\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup> Such a device needs <a href=\"https:\/\/en.wikipedia.org\/wiki\/Premarket_approval#Premarket_approval_(PMA)\" class=\"mw-redirect\" title=\"Premarket approval\" rel=\"external_link\" target=\"_blank\">premarket approval<\/a>, a scientific review to ensure the device's safety and effectiveness, in addition to the general controls of Class I.<sup id=\"rdp-ebb-cite_ref-classification_13-6\" class=\"reference\"><a href=\"#cite_note-classification-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-controls_16-9\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup> Class III devices are usually those that support or sustain human life, are of substantial importance in preventing impairment of human health, or present a potential, unreasonable risk of illness or injury.<sup id=\"rdp-ebb-cite_ref-controls_16-10\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup> Examples of Class III devices that currently require a premarket notification include implantable pacemaker, pulse generators, HIV diagnostic tests, automated external defibrillators, and endosseous implants.<sup id=\"rdp-ebb-cite_ref-controls_16-11\" class=\"reference\"><a href=\"#cite_note-controls-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-European_Union_.28EU.29_and_European_Free_Trade_Association_.28EFTA.29\"><\/span><span class=\"mw-headline\" id=\"European_Union_(EU)_and_European_Free_Trade_Association_(EFTA)\">European Union (EU) and European Free Trade Association (EFTA)<\/span><\/h3>\n<p>The classification of medical devices in the European Union is outlined in Article IX of the Council Directive 93\/42\/EEC. There are basically four classes, ranging from low risk to high risk.\n<\/p>\n<ul><li>Class I (including Is & Im)<\/li>\n<li>Class IIa<\/li>\n<li>Class IIb<\/li>\n<li>Class III<\/li><\/ul>\n<p>The authorization of medical devices is guaranteed by a Declaration of Conformity. This declaration is issued by the manufacturer itself, but for products in Class Is, Im, IIa, IIb or III, it must be verified by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Certificate_of_Conformity\" class=\"mw-redirect\" title=\"Certificate of Conformity\" rel=\"external_link\" target=\"_blank\">Certificate of Conformity<\/a> issued by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Notified_Body\" title=\"Notified Body\" rel=\"external_link\" target=\"_blank\">Notified Body<\/a>. A Notified Body is a public or private organisation that has been accredited to validate the compliance of the device to the European Directive. Medical devices that pertain to class I (on condition they do not require sterilization or do not measure a function) can be marketed purely by self-certification.\n<\/p><p>The European classification depends on rules that involve the medical device's duration of body contact, invasive character, use of an energy source, effect on the central circulation or nervous system, diagnostic impact, or incorporation of a medicinal product. Certified medical devices should have the <a href=\"https:\/\/en.wikipedia.org\/wiki\/CE_mark\" class=\"mw-redirect\" title=\"CE mark\" rel=\"external_link\" target=\"_blank\">CE mark<\/a> on the packaging, insert leaflets, etc.. These packagings should also show harmonised pictograms and <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_EN_standards\" title=\"List of EN standards\" rel=\"external_link\" target=\"_blank\">EN<\/a> standardised logos to indicate essential features such as instructions for use, expiry date, manufacturer, sterile, don't reuse, etc.\n<\/p><p>In November 2018 the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Administrative_Court_(Switzerland)\" title=\"Federal Administrative Court (Switzerland)\" rel=\"external_link\" target=\"_blank\">Federal Administrative Court of Switzerland<\/a> decided that the \"Sympto\" app, used to analyze a woman's menstrual cycle, was a medical device because it calculates a fertility window for each woman using personal data. The manufacturer, Sympto-Therm Foundation, argued that this was a didactic, not a medical process. the court laid down that an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Application_software\" title=\"Application software\" rel=\"external_link\" target=\"_blank\">app<\/a> is a medical device if it is to be used for any of the medical purposes provided by law, and creates or modifies health information by calculations or comparison,\n<p>providing information about an individual patient.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Australia\">Australia<\/span><\/h3>\n<p>The classification of medical devices in Australia is outlined in section 41BD of the Therapeutic Goods Act 1989 and Regulation 3.2 of the Therapeutic Goods Regulations 2002, under control of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration\" title=\"Therapeutic Goods Administration\" rel=\"external_link\" target=\"_blank\">Therapeutic Goods Administration<\/a>. Similarly to the EU classification, they rank in several categories, by order of increasing risk and associated required level of control. Various rules identify the device's category<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" border=\"1\" style=\"\">\n<caption>Medical Devices Categories in Australia\n<\/caption>\n<tbody><tr>\n<th>Classification<\/th>\n<th>Level of Risk\n<\/th><\/tr>\n<tr>\n<td>Class I<\/td>\n<td>Low\n<\/td><\/tr>\n<tr>\n<td>Class I - measuring or Class I - supplied sterile or class IIa<\/td>\n<td>Low - medium\n<\/td><\/tr>\n<tr>\n<td>Class IIb<\/td>\n<td>Medium - high\n<\/td><\/tr>\n<tr>\n<td>Class III<\/td>\n<td>High\n<\/td><\/tr>\n<tr>\n<td>Active implantable medical devices (AIMD)<\/td>\n<td>High\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Iran\">Iran<\/span><\/h3>\n<p>With the fourth world engineering rating of over a thousand medical Devices,<a href=\"https:\/\/en.wikipedia.org\/wiki\/Iran\" title=\"Iran\" rel=\"external_link\" target=\"_blank\">Iran<\/a> produces about 2,000 species of medical devices and medical supplies such as appliances and dental supplies and all sorts of disposable sterile medical stuff,laboratory machines and all kinds of Biomaterials and dental implants and 400 medical products are produced at the C and D risk class which all of them are licensed by the Iranian Health Ministry in terms of safety and performance based on EU standards.\n<\/p><p>Iranian medical Devices products are produced according to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Union\" title=\"European Union\" rel=\"external_link\" target=\"_blank\">European<\/a> Union standards so the quality of products, skilled labour, access to the technologies of the world and the low price of products over the European countries are among the important features of these products and in these respects it is competitive with the products of European countries.\n<\/p><p>\u200fOn cooperation with active commercial partners in the European Union, Iran exports medical devices and supplies which has Union\u2019s standards and <a href=\"https:\/\/en.wikipedia.org\/wiki\/CE_marking\" title=\"CE marking\" rel=\"external_link\" target=\"_blank\">CE Logo<\/a> to the applicant countries including 40 Asian and European countries, some of which are in the rest of the world by transferring technology from Iran to other commercial partners.\n<\/p><p>Among the ways that Iranian producers do for exporting their products to foreign countries is exporting to foreign countries by placing products in the name of the country as that of manufacture (Made in Iran) or production of products in and packaging it in the name of the country's name and their exportation which is very welcomed by the European countries because of the contributions of other countries. It will also include the establishment of a joint production line between business partners and Iranian producing companies to manufacture and produce products to other applicants, from other production methods and export of Iranian devices and medical supplies.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technological_security_issues\">Technological security issues<\/span><\/h2>\n<p>Medical devices such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">pacemakers<\/a>, insulin pumps, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_room\" class=\"mw-redirect\" title=\"Operating room\" rel=\"external_link\" target=\"_blank\">operating room<\/a> monitors, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defibrillators\" class=\"mw-redirect\" title=\"Defibrillators\" rel=\"external_link\" target=\"_blank\">defibrillators<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instruments\" class=\"mw-redirect\" title=\"Surgical instruments\" rel=\"external_link\" target=\"_blank\">surgical instruments<\/a>, including deep-brain stimulators, can incorporate the ability to transmit vital <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_information\" class=\"mw-redirect\" title=\"Health information\" rel=\"external_link\" target=\"_blank\">health information<\/a> from a patient's body to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_professionals\" class=\"mw-redirect\" title=\"Medical professionals\" rel=\"external_link\" target=\"_blank\">medical professionals<\/a>.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> Some of these devices can be remotely controlled. This has engendered concern about privacy and security issues,<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_error\" title=\"Human error\" rel=\"external_link\" target=\"_blank\">human error<\/a>, and technical glitches with this technology. While only a few studies have looked at the susceptibility of medical devices to hacking, there is a risk.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> In 2008, computer scientists proved that pacemakers and defibrillators can be hacked wirelessly via radio hardware, an antenna, and a personal computer.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> These researchers showed they could shut down a combination heart defibrillator and pacemaker and reprogram it to deliver potentially lethal shocks or run out its battery. Jay Radcliff, a security researcher interested in the security of medical devices, raised fears about the safety of these devices. He shared his concerns at the Black Hat security conference.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> Radcliff fears that the devices are vulnerable and has found that a lethal attack is possible against those with insulin pumps and glucose monitors. Some medical device makers downplay the threat from such attacks and argue that the demonstrated attacks have been performed by skilled security researchers and are unlikely to occur in the real world. At the same time, other makers have asked software security experts to investigate the safety of their devices.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> As recently as June 2011, security experts showed that by using readily available hardware and a user manual, a scientist could both tap into the information on the system of a wireless insulin pump in combination with a glucose monitor. With the PIN of the device, the scientist could wirelessly control the dosage of the insulin.<sup id=\"rdp-ebb-cite_ref-ReferenceA_30-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-30\" rel=\"external_link\">[30]<\/a><\/sup> Anand Raghunathan, a researcher in this study, explains that medical devices are getting smaller and lighter so that they can be easily worn. The downside is that additional security features would put an extra strain on the battery and size and drive up prices. Dr. William Maisel offered some thoughts on the motivation to engage in this activity. Motivation to do this hacking might include acquisition of private information for financial gain or competitive advantage; damage to a device manufacturer's reputation; sabotage; intent to inflict financial or personal injury or just satisfaction for the attacker.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> Researchers suggest a few safeguards. One would be to use rolling codes. Another solution is to use a technology called \"body-coupled communication\" that uses the human skin as a wave guide for wireless communication. On 28 December 2016 the US <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> released its recommendations that are not legally enforceable for how medical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device_manufacturing\" title=\"Medical device manufacturing\" rel=\"external_link\" target=\"_blank\">device manufacturers<\/a> should maintain the security of Internet-connected devices.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Standardization_and_regulatory_concerns\">Standardization and regulatory concerns<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Organization_for_Standardization\" title=\"International Organization for Standardization\" rel=\"external_link\" target=\"_blank\">ISO<\/a> standards for medical devices are covered by ICS 11.100.20 and 11.040.01.<sup id=\"rdp-ebb-cite_ref-ISO11.100_34-0\" class=\"reference\"><a href=\"#cite_note-ISO11.100-34\" rel=\"external_link\">[34]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-meg_35-0\" class=\"reference\"><a href=\"#cite_note-meg-35\" rel=\"external_link\">[35]<\/a><\/sup> The quality and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Risk_management\" title=\"Risk management\" rel=\"external_link\" target=\"_blank\">risk management<\/a> regarding the topic for regulatory purposes is convened by <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_13485\" title=\"ISO 13485\" rel=\"external_link\" target=\"_blank\">ISO 13485<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_14971\" title=\"ISO 14971\" rel=\"external_link\" target=\"_blank\">ISO 14971<\/a>. ISO 13485:2003 is applicable to all providers and manufacturers of medical devices, components, contract services and distributors of medical devices. The standard is the basis for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Regulatory_compliance\" title=\"Regulatory compliance\" rel=\"external_link\" target=\"_blank\">regulatory compliance<\/a> in local markets, and most export markets.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup> Additionally, <a href=\"https:\/\/en.wikipedia.org:2008\/wiki\/ISO_9001:2008\" class=\"mw-redirect\" title=\"ISO 9001:2008\" rel=\"external_link\" target=\"_blank\">ISO 9001:2008<\/a> sets precedence because it signifies that a company engages in the creation of new products. It requires that the development of manufactured products have an approval process and a set of rigorous quality standards and development records before the product is distributed.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> Further standards are <a href=\"https:\/\/en.wikipedia.org\/wiki\/IEC_60601-1\" class=\"mw-redirect\" title=\"IEC 60601-1\" rel=\"external_link\" target=\"_blank\">IEC 60601-1<\/a> which is for electrical devices (mains-powered as well as battery powered), <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_EN_standards\" title=\"List of EN standards\" rel=\"external_link\" target=\"_blank\">EN 45502-1<\/a> which is for Active implantable medical devices, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/IEC_62304\" title=\"IEC 62304\" rel=\"external_link\" target=\"_blank\">IEC 62304<\/a> for medical software. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration_(United_States)\" class=\"mw-redirect\" title=\"Food and Drug Administration (United States)\" rel=\"external_link\" target=\"_blank\">US FDA<\/a> also published a series of guidances for industry regarding this topic against <a href=\"https:\/\/en.wikipedia.org\/wiki\/21_CFR_820\" class=\"mw-redirect\" title=\"21 CFR 820\" rel=\"external_link\" target=\"_blank\">21 CFR 820<\/a> Subchapter H\u2014Medical Devices.<sup id=\"rdp-ebb-cite_ref-dp_40-0\" class=\"reference\"><a href=\"#cite_note-dp-40\" rel=\"external_link\">[40]<\/a><\/sup> Subpart B includes quality system requirements, an important component of which are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Design_controls\" title=\"Design controls\" rel=\"external_link\" target=\"_blank\">design controls<\/a> (21 CFR 820.30). To meet the demands of these industry regulation standards, a growing number of medical device distributors are putting the complaint management process at the forefront of their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_management\" title=\"Quality management\" rel=\"external_link\" target=\"_blank\">quality management<\/a> practices. This approach further mitigates risks and increases visibility of quality issues.<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p><p>Starting in the late 1980s<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> the FDA increased its involvement in reviewing the development of medical device software. The precipitant for change was a radiation therapy device (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Therac-25\" title=\"Therac-25\" rel=\"external_link\" target=\"_blank\">Therac-25<\/a>) that overdosed patients because of software coding errors.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> FDA is now focused on regulatory oversight on medical device software development process and system-level testing.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup>\n<\/p><p>A 2011 study by Dr. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diana_Zuckerman\" title=\"Diana Zuckerman\" rel=\"external_link\" target=\"_blank\">Diana Zuckerman<\/a> and Paul Brown of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Research_Center_for_Women_and_Families\" class=\"mw-redirect\" title=\"National Research Center for Women and Families\" rel=\"external_link\" target=\"_blank\">National Research Center for Women and Families<\/a>, and Dr. Steven Nissen of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleveland_Clinic\" title=\"Cleveland Clinic\" rel=\"external_link\" target=\"_blank\">Cleveland Clinic<\/a>, published in the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Archives_of_Internal_Medicine\" class=\"mw-redirect\" title=\"Archives of Internal Medicine\" rel=\"external_link\" target=\"_blank\">Archives of Internal Medicine<\/a><\/i>, showed that most medical devices recalled in the last five years for \"serious health problems or death\" had been previously approved by the FDA using the less stringent, and cheaper, 510(k) process. In a few cases the devices had been deemed so low-risk that they did not need FDA regulation. Of the 113 devices recalled, 35 were for cardiovascular issues.<sup id=\"rdp-ebb-cite_ref-Zuckerman_2011_15-1\" class=\"reference\"><a href=\"#cite_note-Zuckerman_2011-15\" rel=\"external_link\">[15]<\/a><\/sup> This may lead to a reevaluation of FDA procedures and better oversight.\n<\/p><p><span id=\"rdp-ebb-Medical_Device_Single_Audit_Program\"><\/span><span id=\"rdp-ebb-MDSAP\"><\/span>\n<p>In 2014-2015 a new international agreement, the Medical Device Single Audit Program (MDSAP), was put in place with five participant countries: Australia, Brazil, Canada, Japan, and the United States. The aim of this program was to \"develop a process that allows a single audit, or inspection to ensure the medical device regulatory requirements for all five countries are satisfied\".<sup id=\"rdp-ebb-cite_ref-trautman2015_45-0\" class=\"reference\"><a href=\"#cite_note-trautman2015-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p>\n<\/p><p>In 2018, an investigation involving journalists across 36 countries coordinated by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Consortium_of_Investigative_Journalists\" title=\"International Consortium of Investigative Journalists\" rel=\"external_link\" target=\"_blank\">International Consortium of Investigative Journalists<\/a> (ICIJ) prompted calls for reform in the United States, particularly around the 510(k) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Substantial_equivalence\" title=\"Substantial equivalence\" rel=\"external_link\" target=\"_blank\">substantial equivalence<\/a> process;<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> the investigation prompted similar calls in the UK and Europe Union.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Packaging_standards\">Packaging standards<\/span><\/h3>\n<p>Medical device <a href=\"https:\/\/en.wikipedia.org\/wiki\/Packaging\" class=\"mw-redirect\" title=\"Packaging\" rel=\"external_link\" target=\"_blank\">packaging<\/a> is highly regulated. Often medical devices and products are sterilized in the package.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\nSterility must be maintained throughout distribution to allow immediate use by physicians. A series of special packaging tests measure the ability of the package to maintain sterility. Relevant standards include:\n<\/p>\n<ul><li>ASTM D1585 \u2013 <i>Guide for Integrity Testing of Porous Medical Packages<\/i><\/li>\n<li>ASTM F2097 \u2013 <i>Standard Guide for Design and Evaluation of Primary Flexible Packaging for Medical Products<\/i><\/li>\n<li>ASTM F3475-11 \u2013 Standard Guide for Biocompatibility Evaluation of Medical Device Packaging Materials<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup><\/li>\n<li>EN 868 <i>Packaging materials and systems for medical devices to be sterilized, General requirements and test methods<\/i><\/li>\n<li>ISO 11607 <i>Packaging for terminally sterilized medical devices<\/i><\/li><\/ul>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Package_testing\" title=\"Package testing\" rel=\"external_link\" target=\"_blank\">Package testing<\/a> documents and ensures that packages meet regulations and end-use requirements. Manufacturing processes must be controlled and validated to ensure consistent performance.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Biocompatibility_standards\">Biocompatibility standards<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_10993\" title=\"ISO 10993\" rel=\"external_link\" target=\"_blank\">ISO 10993<\/a> - Biological Evaluation of Medical Devices<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Cleanliness_standards\">Cleanliness standards<\/span><\/h3>\n<p>Medical device cleanliness has come under greater scrutiny since 2000, when Sulzer Orthopedics recalled several thousand metal hip implants that contained a manufacturing residue.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup> Based on this event, ASTM established a new task group (F04.15.17) for established test methods, guidance documents, and other standards to address cleanliness of medical devices. This task group has issued two standards for permanent implants to date: 1. ASTM F2459: Standard test method for extracting residue from metallic medical components and quantifying via gravimetric analysis<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> 2. ASTM F2847: Standard Practice for Reporting and Assessment of Residues on Single Use Implants<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup> 3. ASTM F3172: Standard Guide for Validating Cleaning Processes Used During the Manufacture of Medical Devices <sup id=\"rdp-ebb-cite_ref-astm.org_55-0\" class=\"reference\"><a href=\"#cite_note-astm.org-55\" rel=\"external_link\">[55]<\/a><\/sup>\n<\/p><p>In addition, the cleanliness of re-usable devices has led to a series of standards, including:\n<\/p>\n<ul><li>ASTM E2314: <i>Standard Test Method for Determination of Effectiveness of Cleaning Processes for Reusable Medical Instruments Using a Microbiologic Method (Simulated Use Test)\"<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup><\/i><\/li>\n<li>ASTM D7225: <i>Standard Guide for Blood Cleaning Efficiency of Detergents and Washer-Disinfectors<\/i><sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup><\/li>\n<li>ASTM F3208: <i>Standard Guide for Selecting Test Soils for Validation of Cleaning Methods for Reusable Medical Devices<\/i><sup id=\"rdp-ebb-cite_ref-astm.org_55-1\" class=\"reference\"><a href=\"#cite_note-astm.org-55\" rel=\"external_link\">[55]<\/a><\/sup><\/li><\/ul>\n<p>The ASTM F04.15.17 task group is working on several new standards that involve designing implants for cleaning, selection and testing of brushes for cleaning reusable devices, and cleaning assessment of medical devices made by additive manufacturing.<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup> Additionally, the FDA is establishing new guidelines for reprocessing reusable medical devices, such as orthoscopic shavers, endoscopes, and suction tubes.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Mobile_medical_applications\">Mobile medical applications<\/span><\/h3>\n<p>With the rise of smartphone usage in the medical space, in 2013, the FDA issued to regulate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mobile_medical_apps\" class=\"mw-redirect\" title=\"Mobile medical apps\" rel=\"external_link\" target=\"_blank\">mobile medical applications<\/a> and protect users from their unintended use, soon followed by European and other regulatory agencies. This guidance distinguishes the apps subjected to regulation based on the marketing claims of the apps.<sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup> Incorporation of the guidelines during the development phase of such apps can be considered as developing a medical device; the regulations have to adapt and propositions for expedite approval may be required due to the nature of 'versions' of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mobile_medical_apps\" class=\"mw-redirect\" title=\"Mobile medical apps\" rel=\"external_link\" target=\"_blank\">mobile application<\/a> development.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Academic_resources\">Academic resources<\/span><\/h2>\n<ul><li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_%26_Biological_Engineering_%26_Computing\" title=\"Medical & Biological Engineering & Computing\" rel=\"external_link\" target=\"_blank\">Medical & Biological Engineering & Computing<\/a><\/i><\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Expert_Review_of_Medical_Devices\" title=\"Expert Review of Medical Devices\" rel=\"external_link\" target=\"_blank\">Expert Review of Medical Devices<\/a><\/i><\/li>\n<li><i><\/i><sup id=\"rdp-ebb-cite_ref-jce_63-0\" class=\"reference\"><a href=\"#cite_note-jce-63\" rel=\"external_link\">[63]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"University_Based_Research_Packaging_Institutes\">University Based Research Packaging Institutes<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Minnesota\" title=\"University of Minnesota\" rel=\"external_link\" target=\"_blank\">University of Minnesota<\/a> - Medical Devices Center (MDC)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Strathclyde\" title=\"University of Strathclyde\" rel=\"external_link\" target=\"_blank\">University of Strathclyde<\/a> - Strathclyde Institute of Medical Devices (SIMD)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Flinders_University\" title=\"Flinders University\" rel=\"external_link\" target=\"_blank\">Flinders University<\/a> - Medical Device Research Institute (MDRI)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Michigan_State_University\" title=\"Michigan State University\" rel=\"external_link\" target=\"_blank\">Michigan State University<\/a> - School of Packaging (SoP)<sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_engineering\" title=\"Biomedical engineering\" rel=\"external_link\" target=\"_blank\"> Biomedical engineering<\/a> – Application of engineering principles and design concepts to medicine and biology for healthcare purposes<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_equipment_technician\" title=\"Biomedical equipment technician\" rel=\"external_link\" target=\"_blank\"> Biomedical equipment technician<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_engineering\" title=\"Clinical engineering\" rel=\"external_link\" target=\"_blank\"> Clinical engineering<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Design_history_file\" title=\"Design history file\" rel=\"external_link\" target=\"_blank\"> Design history file<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Durable_medical_equipment\" title=\"Durable medical equipment\" rel=\"external_link\" target=\"_blank\"> Durable medical equipment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetic_compatibility\" title=\"Electromagnetic compatibility\" rel=\"external_link\" target=\"_blank\"> Electromagnetic compatibility<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronic_health_record\" title=\"Electronic health record\" rel=\"external_link\" target=\"_blank\"> Electronic health record<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Institute_for_Drugs_and_Medical_Devices\" title=\"Federal Institute for Drugs and Medical Devices\" rel=\"external_link\" target=\"_blank\"> Federal Institute for Drugs and Medical Devices<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vitro_diagnostics\" class=\"mw-redirect\" title=\"In vitro diagnostics\" rel=\"external_link\" target=\"_blank\"> In vitro diagnostics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/GHTF\" class=\"mw-redirect\" title=\"GHTF\" rel=\"external_link\" target=\"_blank\"> GHTF<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Level_7\" title=\"Health Level 7\" rel=\"external_link\" target=\"_blank\"> Health Level 7<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Home_medical_equipment\" title=\"Home medical equipment\" rel=\"external_link\" target=\"_blank\"> Home medical equipment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\"> Implant (medicine)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_13485\" title=\"ISO 13485\" rel=\"external_link\" target=\"_blank\"> ISO 13485<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_common_EMC_test_standards\" title=\"List of common EMC test standards\" rel=\"external_link\" target=\"_blank\"> List of common EMC test standards<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_Devices_Directive\" title=\"Medical Devices Directive\" rel=\"external_link\" target=\"_blank\"> Medical Devices Directive<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device_hijack\" title=\"Medical device hijack\" rel=\"external_link\" target=\"_blank\"> Medical device hijack<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment\" title=\"Medical equipment\" rel=\"external_link\" target=\"_blank\"> Medical equipment<\/a> – Equipment designed to aid in the diagnosis, monitoring or treatment of medical conditions<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_logistics\" title=\"Medical logistics\" rel=\"external_link\" target=\"_blank\"> Medical logistics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_software\" title=\"Medical software\" rel=\"external_link\" target=\"_blank\"> Medical software<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Safety_engineering\" title=\"Safety engineering\" rel=\"external_link\" target=\"_blank\"> Safety engineering<\/a><\/li>\n<li><i>Section 201(h)<\/i> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Food,_Drug,_and_Cosmetic_Act\" title=\"Federal Food, Drug, and Cosmetic Act\" rel=\"external_link\" target=\"_blank\"> Federal Food, Drug, and Cosmetic Act<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Telemedicine\" title=\"Telemedicine\" rel=\"external_link\" target=\"_blank\"> Telemedicine<\/a> – Medical care by telecommunication<\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.acmite.com\/market-reports\/medicals\/world-medical-devices-market.html\" target=\"_blank\">\"Market Report: World Medical Devices Market\"<\/a>. Acmite Market Intelligence. 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 June<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Market+Report%3A+World+Medical+Devices+Market&rft.pub=Acmite+Market+Intelligence&rft.date=2014&rft_id=http%3A%2F%2Fwww.acmite.com%2Fmarket-reports%2Fmedicals%2Fworld-medical-devices-market.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+device\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-bemd-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-bemd_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-bemd_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Wong, K., Tu, J., Sun, Z., and Dissanayake, D. W. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.worldscientific.com\/worldscibooks\/10.1142\/8621\" target=\"_blank\">\"Methods in Research and Development of Biomedical Devices\"<\/a>. World Scientific Publishing<span class=\"reference-accessdate\">. 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MSNBC.com's Technology<\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Camara, Carmen; Peris-Lopez, Pedro; Tapiador, Juan E. 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Retrieved <span class=\"nowrap\">10 April<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Journal+Information&rft.au=Lippincott+Williams+%26+Wilkins&rft_id=http%3A%2F%2Fpt.wkhealth.com%2Fpt%2Fre%2Fjce%2Fhome.htm%3Bjsessionid%3DJpYXfLlnQ8TLpH1QhcM0T2HSpsQLFJLTSBcHHmC0QjzGgpPJ9V9Q%21-707522149%21181195629%218091%21-1&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-64\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.canr.msu.edu\/packaging\/\" target=\"_blank\">\"School of Packaging\"<\/a>. <i>School of Packaging<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-08-23<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=School+of+Packaging&rft.atitle=School+of+Packaging&rft_id=http%3A%2F%2Fwww.canr.msu.edu%2Fpackaging%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/Training\/CDRHLearn\/\" target=\"_blank\">US Food and Drug Administration \u2013 Center for Devices and Radiological Health<\/a>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/HowtoMarketYourDevice\/PremarketSubmissions\/PremarketNotification510k\/default.htm\" target=\"_blank\">Premarket Notification (510k)<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/HowtoMarketYourDevice\/PremarketSubmissions\/PremarketApprovalPMA\/ucm2007514.htm\" target=\"_blank\">Premarket Approval (PMA)<\/a><\/li><\/ul><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/medicaldevices\/deviceregulationandguidance\/overview\/classifyyourdevice\/ucm051512.htm\" target=\"_blank\">FDA \u2013 Is the Product a Medical Device?<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.gov.uk\/topic\/medicines-medical-devices-blood\/medical-devices-regulation-safety\" target=\"_blank\">MHRA - Medical devices regulation and safety<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ec.europa.eu\/growth\/single-market\/european-standards\/harmonised-standards\/medical-devices\/index_en.htm\" target=\"_blank\">EC - Medical devices<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hc-sc.gc.ca\/dhp-mps\/md-im\/standards-normes\/md_rec_stand_im_norm_lst-eng.php\" target=\"_blank\">Health Canada - List of Recognized Standards for Medical Devices<\/a> (International)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iso.org\/iso\/products\/standards\/catalogue_ics_browse.htm?ICS1=11&ICS2=040&ICS3=01&\" target=\"_blank\">ISO - Standards catalogue: 11.040.01: Medical equipment in general<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fda.gov\/RegulatoryInformation\/Guidances\/ucm077210.htm\" target=\"_blank\">Radio Frequency Wireless Technology in Medical Devices - Guidance for Industry and Food and Drug Administration Staff<\/a>. FDA (2013)<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1333\nCached time: 20181215030807\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.768 seconds\nReal time usage: 0.883 seconds\nPreprocessor visited node count: 3838\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 94069\/2097152 bytes\nTemplate argument size: 2640\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 151036\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.467\/10.000 seconds\nLua memory usage: 5.12 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 764.382 1 -total\n<\/p>\n<pre>54.87% 419.395 1 Template:Reflist\n31.66% 241.987 40 Template:Cite_web\n28.06% 214.509 23 Template:Annotated_link\n25.89% 197.874 49 Template:Template_parameter_value\n 7.81% 59.664 7 Template:Cite_journal\n 6.02% 45.985 4 Template:Citation\n 4.88% 37.296 1 Template:Short_description\n 4.56% 34.859 1 Template:Pagetype\n 1.77% 13.493 1 Template:Main_article\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1363291-1!canonical and timestamp 20181215030806 and revision id 873460939\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214628\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.180 seconds\nReal time usage: 0.297 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 285.623 1 - wikipedia:Medical_device\n100.00% 285.623 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7959-0!*!*!*!*!*!* and timestamp 20181217214628 and revision id 24076\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_device\">https:\/\/www.limswiki.org\/index.php\/Medical_device<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8e821122daa731f0fa8782fae57831fa_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/b\/bf\/Stetoskop.jpg"],"8e821122daa731f0fa8782fae57831fa_timestamp":1545083188,"ee77e4a7522cc3f6cfb0aaffebcae6ba":{"type":"chapter","title":"1. What Is a Medical Device?","key":"ee77e4a7522cc3f6cfb0aaffebcae6ba"}},"link":"https:\/\/www.limswiki.org\/index.php\/Book:Introduction_to_Medical_Devices,_Volume_1","price_currency":"","price_amount":"","book_size":"","download_url":"https:\/\/www.limsforum.com?ebb_action=book_download&book_id=78184","language":"","cta_button_content":"","toc":[{"type":"chapter","name":"1. What Is a Medical Device?","id":"ee77e4a7522cc3f6cfb0aaffebcae6ba","children":[{"type":"article","name":"Medical device","id":"8e821122daa731f0fa8782fae57831fa","pageUrl":"https:\/\/www.limswiki.org\/index.php\/Medical_device"}]},{"type":"chapter","name":"2. Categories of Medical Devices","id":"c4f188707353127c76c22e964a8d7b40","children":[{"type":"article","name":"General medicine instrument","id":"9b6dbbcd55fbd6abfd8dd2462f53a540","pageUrl":"https:\/\/www.limswiki.org\/index.php\/Instruments_used_in_general_medicine"},{"type":"article","name":"Home\/Durable medical equipment","id":"2f12bfa15b58b787083236d0a4603400","pageUrl":"https:\/\/www.limswiki.org\/index.php\/Home_medical_equipment"},{"type":"article","name":"Medical implant","id":"493da0ed539f193bbccf9b19a18c1d08","pageUrl":"https:\/\/www.limswiki.org\/index.php\/Implant_(medicine)"},{"type":"article","name":"Medical robot","id":"dd984888304cc580154ea14150f550ab","pageUrl":"https:\/\/www.limswiki.org\/index.php\/Medical_robot"},{"type":"article","name":"Medical software","id":"79dbc75d9223c22375492817dbae2161","pageUrl":"https:\/\/www.limswiki.org\/index.php\/Medical_software"},{"type":"article","name":"Surgical instrument","id":"debc8b82e26a585764d378a3253e03c0","pageUrl":"https:\/\/www.limswiki.org\/index.php\/Surgical_instrument"}]},{"type":"chapter","name":"3. 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Introduction to Medical Devices: Volume 1
Editor: Shawn Douglas
Publisher: LabLynx Press
Copyright LabLynx Inc. All rights reserved.